HHS Sec. Leavitt Tries to Define Contraception as Abortion, Then Pretends He Didn't


Health and Human Services Secretary Michael Leavitt acknowledges in his second blog post on the issue, that traffic has increased on his blog as people respond with concerns to the HHS proposal that redefines contraception as abortion.

Readers will recall that when the draft regulation was first leaked, RH Reality Check experienced our highest traffic weeks, Speaker Nancy Pelosi's web site actually crashed, and many sites saw increased readership. In his first post on the topic last week, Leavitt attempted to redirect the conversation away from contraception, claiming a redefinition of contraception as abortion was not his or the draft regulations' intent.

In his second blog on the issue, posted yesterday, the word contraception doesn't even appear. As is often the case with anti-choice politicians, Leavitt only wants to talk about abortion to stir people's emotions. Leavitt quotes Mary Jane Gallagher, President of the National Family Planning and Reproductive Health Association, writing:

So, according to Ms. Gallagher's ideology, if a person goes to medical school they lose their right of conscience. Freedom of expression and action is surrendered with the issuance of a medical degree.

No Secretary Leavitt, what Ms. Gallagher was talking about was medical ethics, not ideology. In my post last week, I quoted Jon O'Brien, President of Catholics for Choice:

While some have pointed to Catholic teaching to support the imposition of ever-more restrictive refusal clauses, they do not reflect the Catholic position. Catholic teaching requires due deference to the conscience of others in making decisions--meaning that health-care providers must not dismiss the conscience of the person seeking care. If conscience truly is one's "most secret core and his sanctuary [where] he is alone with God, whose voice echoes in his depths," as the Catechism states, how can anyone, or any institution for that matter, justify coercing someone into acting contrary to her or his conscience?

The goal of any reasonable conscience clause must be to strike the right balance between the right of health-care professionals to provide care that is in line with their moral and religious beliefs and the right of patients to have access to the medical care they need. Within the field of medical ethics, the accepted resolution to a conflict of values is to allow the individual to act on their own conscience and for the institution (the hospital, clinic or pharmacy) to serve as the facilitator of all consciences.

The question, Sec. Leavitt, is not about people checking their beliefs at the door. Medical ethics and morality dictate that it is the patient, the person in need of help, sometimes in crisis, whose conscience and beliefs matter in the moment they are seeking health care services. Medical professionals who have a problem dispensing contraception should not choose professions where they will be asked for contraception, or as a commenter on another blog wrote, "if this is about people living their religious convictions, then they should have enough faith not to choose work that conflicts with their convictions." There is plenty demand for medical professionals in fields in which practitioners will never come in contact with people seeking contraception.

But this isn't about any individual's right to refuse service, as the Secretary suggests. As Leavitt demonstrates in his second blog, the politics of abortion are not new to him, he knows how to play the game. Congress won't be taking up any more legislation of significance, and the clock is ticking on the Bush Administration. The only thing left for the Bush Administration to do on abortion will be done from HHS through rules and regulations. Leavitt knows it, knows how to play it, and is spinning wildly without addressing the very serious threats to preventing abortion through access to contraception that these regulations pose.

One would think that recent reports of the high rate of abortion in New York, linked to that fact that too many women do not have the information about how to obtain access to contraception, would underscore the importance of contraception as a means of reducing unintended pregnancy. But by genuflecting to ideology over prevention in order to allow a medical professional who believes contraception terminates, rather than prevents, a pregnancy, to refuse services to a couple who want to use contraception to plan their family -- Leavitt demonstrates clearly that the anti-choice movement is not about preventing abortion.

The only thing a refusal clause does is elevate one set of beliefs over another, and allow that judgment to be delivered in a medical setting where one person is seeking help from another who has received special training in science. The patient did not come to the pharmacist seeking spiritual counseling, and likely has her own place of worship. The patient/customer did not come for a scolding from a stranger, or to be stigmatized. She came for a prescription, and unless the pharmacy is operated and advertised as "Preacher Bill's Pharmacy, where we pick and choose which medical science we believe in," then there is a reasonable expectation that any physician's prescription should be honored.

In parts of the country in which Catholic hospitals have taken over small rural hospitals and there aren't any others around for hundreds of miles, concerns about the availability of emergency contraception for rape victims and others in crisis has already been raised. From Princeton's web site on emergency contraception:

It can be difficult, if not impossible, to get emergency contraceptive pills (sometimes called "morning after pills" or "day after pills") at a Catholic hospital in the United States. That's because the medical care in these facilities is governed by the Ethical and Religious Directives for Catholic Health Care Services, guidelines developed by the United States Conference of Catholic Bishops based on Church teachings that prohibit using artificial contraception. As a result, the Directives essentially ban Catholic hospitals from providing emergency contraception to a woman whose birth control failed or who didn't use contraception during consensual sex.

If you have been raped, however, a Catholic hospital might be able to provide emergency contraceptive pills to help you prevent pregnancy. Directive 36 seems to allow providing emergency contraception to "a female who has been raped to defend herself against a potential conception from the sexual assault . . . if, after appropriate testing there is no indication she is pregnant." It does not say how to determine if conception has occurred and, since emergency contraception might sometimes prevent implantation of a fertilized egg (which happens after conception), Catholic hospitals still have to interpret the Directives and decide if they can provide emergency contraceptive pills to a woman who has been raped. In one recent survey, roughly one-third of the Catholic hospitals in three states were not complying with state laws that require making emergency contraception available to women who have been raped. (You can get more information about Catholic hospitals and contraception from Catholics for a Free Choice, which commissioned the survey.)

After a woman has been raped Catholic hospitals "might" help.

If there is that much doubt about how to help a person in crisis, even at a Catholic hospital where beliefs are supposedly rock solid (and should default to helping the woman in crisis), how in the world do we expect HHS bureaucrats to write a clear regulation for Americans of all beliefs?

In situational medical ethics, it is the person in crisis or need of specialized service whose conscience takes precedence. Pacifists do not volunteer to serve in the military, they live their convictions by living a peaceful life. War rages on. Vegans do not eat or wear anything that has ever been alive, they live their convictions with the choices they make every day; beef and leather goods are still chosen by others and only a radical few will make a fuss about that. Monks and other religious seekers take vows that require them to constantly come up against the parts of the material world that others have chosen for themselves, not to condemn others, but as a spiritual test for the path the monk chose, the life s/he is pledged to, the journey her/his soul is on.

That is conviction. That is conscience. No one refusing or renouncing anything other than for themselves and the choices they are making for their lives. Most people of faith believe they should use their lives as an example for others to follow, not as a bludgeon to beat people down with.

People must recognize the world as it is and that each person here gets to make their own choices. What Sec. Leavitt is doing has nothing to do with operating in the real world -- it is about using what time he has left in office to elevate one person's ideology over another's choice, and to further divide the nation by using the issue of abortion and ideology, as opposed to working together on education, prevention and accepted medical science.

Question Two

Now that Sec. Leavitt has engaged his blog on substantive issues of the day, I'm hoping he will take time to answer part two of the question I asked him in person at the Kaiser Family Foundation forum on health care blogging. Because the two were bound together, I'll restate the entire question here, hoping he will soon blog about the end run his department is attempting on Title V abstinence-only grants.

Mr. Secretary, thank you for being here and sharing your thoughts about blogging. I'm hoping you'll engage a policy question to give us something to blog about. Within the past two weeks, two highly charged issues have surfaced from HHS: a leaked memo redefining some contraceptive devices as abortion; and a waiver of the annual application for Title V abstinence-only programs.

The former will substitute an ideological and political definition of when pregnancy begins for the medical judgment of the American Medical Association and the American College of Obstetricians and Gynecologists. The latter will, for the first time, ignore Congress' reluctance to make abstinence-only programs permanent -- they have had 19 short-term extensions, and Speaker Pelosi said last week that with a stronger majority in Congress it will end. This effort potentially ties the hands of the next administration and promises states money that has not been authorized.

1) Will it be HHS policy that the 98 percent of Americans who use contraception at some point in their lives are terminating rather than preventing pregnancy?

2) Can you explain why this grant period should be treated differently than the previous 19 short-term extensions for abstinence-only programs?

Looking forward to your reply, Mr. Secretary.

Originally published on RH Reality Check

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