In early November 2019, a federal district judge voided the ‘Protecting Statutory Conscience in Healthcare’, declaring it was unconstitutional, in a defeat for the Trump Administration. The former rule had allowed healthcare workers to refuse to perform lifesaving medical procedures on patients based on their personal moral and religious beliefs.
The CEO of the National Women’s Law Center, Fatima Goss Graves, released a statement shortly after the ruling was announced, stating: “We are thrilled that the court saw the Trump-Pence refusal of care rule for what it is- unlawful, discriminatory, and an unconscionable attack on our health care.” (News@Jama)
The U.S. Department of Health & Human Services ("HHS") promulgated the regulation, which delved into hot topic issues including abortion and assisted suicide.
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"This rule ensures that healthcare entities and professionals won't be bullied out of the health care field because they decline to participate in actions that violate their conscience, including the taking of human life," said HHS Office of Civil Rights Director Robert Severino after the initial law was brought up. (NPR)
Had the law been ruled constitutional, it would have applied to both state and local governments and public and private healthcare. Those under Medicare of Medicaid would have been affected as well, impacting nearly 74 million people in the United States. (Statistica)
The final ruling would have allowed health care professionals to deny services constitutionally protected, such as abortion, treatment to the LGBTQ+ community, and others. The ruling would have allowed parents to object care on religious or moral grounds for their children- including suicide prevention, child abuse prevention, and vaccines.
For the many people, this is not the first time their access to healthcare has been threatened. Since the HIVAIDs epidemic first took place in the 80s, doctors and communities alike have alienated patients from treatment for fear of transmission. Since then, medical practices have improved care for HIV-infectio drastically, but the HHS law threatened to endanger more lives.
Currently a federal court case in Wisconsin is claiming violation of federal and state anti-discrimination laws. When an HIV positive woman sought treatment for a necessary gallbladder surgery, the surgeon denied the surgery because he was worried about HIV exposure to his medical team. Another hospital then removed her gallbladder in a “routine surgical procedure, which includes universal precautions taken to prevent the transmission of bloodborne pathogens such as HIV,” said the AMA Journal of Ethics. (AMA)
According to a study conducted by the National Women’s Law Center, approximately 8% of LGB individuals, nearly 27% of transgender and nonconforming individuals, and almost 20% of HIV-positive individuals report being denied needed healthcare outright. In another case, a 53-year old man was denied a kidney transplant by his insurance company because of his HIV-positive status, putting his life at risk. (NWLC)
“A patient with HIV who was admitted to a hospital reported that after he disclosed that he had sex with men, the hospital staff ignored him, refused to allow his family to visit, and did not honor his requests for his HIV medication.16 The doctor at the hospital told the patient’s personal doctor, “This is what he gets for going against God’s will” and “You must be gay, too, if you’re his doctor.”17 Despite explaining to the nurses the importance of taking his HIV medication, the patient missed five doses.18 Because some HIV medications are highly time-sensitive, a missed or delayed dose can make the medicine less effective or even completely ineffective,” said NWLC.
“Two judges in two days have recognized the Denial of Care Rule for what it is, an egregious and unconstitutional attack on women, LGBT people and other vulnerable populations. The Denial of Care Rule targets some of our most marginalized and vulnerable communities and deserves to be relegated to the dustbin of history,” said Jamie Gliksberg, a senior attorney at Lamda Legal, after the law was ruled unconstitutional.
References:
- Anderson JD, Bebe J. (December 2019). HIV Stigma and Discrimination Persist, Even in Health Care. AMA Journal of Ethics. Retrieved online at https://journalofethics.ama-assn.org/article/hiv-stigma-and-discrimination-persist-even-health-care/2009-12.
- Gever, John (2018, November 6). Federal Judge Voids 'Conscience Rule' - Policy would have allowed providers to refuse care because of "moral objections". MedPage Today. Retrieved online at https://www.medpagetoday.com/publichealthpolicy/healthpolicy/83166?xid=NL_breakingnewsalert_2019-11-06&eun=g1295317d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=ConscienceAlert_110619&utm_term=NL_Daily_Breaking_News_Active.
- Gostin, Lawrence O. (2019, May 15). JAMA Forum: The “Conscience” Rule: How Will It Affect Patients’ Access to Health Services? JAMA. Retrieved online at https://newsatjama.jama.com/2019/05/15/jama-forum-the-conscience-rule-how-will-it-affect-patients-access-to-health-services/.
- Kodjak, Alison (2019, May 2). New Trump Rule Protects Health Care Workers Who Refuse Care For Religious Reasons. NPR. Retrieved online at https://www.npr.org/sections/health-shots/2019/05/02/688260025/new-trump-rule-protects-health-care-workers-who-refuse-care-for-religious-reason.
- Mikulic, Matej (2018, October 26). Medicaid - Statistics & Facts. Statista. Retrieved online at https://www.statista.com/topics/1091/medicaid/.
- National Women's Law Center (May 2014). Health Care Refusals Harm Patients: The Threat to LGBT People and Individuals Living with HIV/AIDS. Retrieved online at https://nwlc.org/wp-content/uploads/2015/08/lgbt_refusals_factsheet_05-09-14.pdf.
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