Rejecting care for 'conscience'

January 23, 2009|By Diana Carvajal and Eva Moore

Before this week, when an uninsured Baltimore woman needed contraception, she had an open door to affordable, confidential services. She could go to her local family planning clinic to receive comprehensive reproductive health care services.

But thanks to a last-minute rule change ordered by the departing Bush administration, this is no longer the case. Now, care can be denied if a doctor, a nurse - even a receptionist - has a moral objection to a woman's legal right to contraception or other sexual health services.

On Monday, the door closed on 17 million women in Maryland and across the nation who rely on public funds for health care. The "conscience clause" allows any employee of a federally funded clinic to abstain from participating in care for "moral" reasons. They can refuse to schedule appointments, clean exam rooms or dispense safe and effective medications. In fact, an employee is not even obligated to refer a woman to a facility that will provide care.

This extreme measure goes against everything that we, as physicians, have been trained to do.

A woman seeking reproductive health care should be entitled to information about all safe and effective options. Federal Title X funding was made available to provide affordable reproductive care such as pap smears, sexually transmitted infection testing and treatment, contraception and pregnancy options counseling. These funds provide reproductive care for women who otherwise cannot afford it.

As health care providers, we are, at the very least, obligated to provide all patients with appropriate referrals - even if we do not participate in or agree with the care. Our personal morality does not enter into it. For example, we cannot refuse to treat a drug user for his drug-induced heart attack just because we are morally opposed to drug use. Nor can a doctor deny a blood transfusion to a woman who lost blood in a fight, even though he or she is opposed to violence. How, then, can we allow a receptionist, doctor, nurse or janitor to turn away a women seeking birth control at a clinic that provides such services just because the employee thinks premarital sex is wrong?

Where else will these women go? Many uninsured women have limited options for reproductive health care services. Even worse, the very clinics that need federal funding the most could lose that funding if an employee were made to participate in the care of a woman by providing her with options or proper referral.

A health care facility works as a team to take care of patients - to provide every patient with the best medical care available. But under this rule, we are no longer working together. Instead, the team may be torn apart by one person's moral objections. As a result, women will be denied needed care.

The "conscience clause" was our former president's last effort to impose moral restrictions on a woman's right to reproductive freedom. The new administration must overturn this extreme and dangerous regulation as soon as possible. It's a simple fix. And it would protect the rights and health of millions of women nationwide.

When a worried and scared woman calls her local family planning clinic with no other place to go, she must not be told that health care will be withheld from her on moral grounds. What she needs to hear is, "You called the right place. We'll be glad to help you."

Dr. Diana Carvajal is a family medicine physician at the Johns Hopkins School of Medicine and the University of Maryland Department of Family Medicine. Her e-mail is Dr. Eva Moore is a pediatrician specializing in adolescent medicine at Hopkins. Her e-mail is

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