NH House Roundup: House kills ‘medical conscience’ bill, restores rail study

New Hampshire Union Leader

Dave Solomon

CONCORD — A bill that would allow medical professionals to exercise their “rights of conscience” failed in a 218-109 vote in the House of Representatives on Thursday.

The bill, HB 1787, would allow medical professionals to refuse any procedure that goes against their personal beliefs, including abortion, providing contraceptives or contraceptive counseling.

“In our state right now, there are no rights of conscience protections for medical people,” said Rep. Kurt Wuelper, R-Strafford. “Doctors are required in many areas to participate in and perform procedures that violate their consciences. That’s not right.” . . .[Full Text]

Medical professionals divided on bill allowing them to refuse to perform abortions, other procedures

New Hampshire Union Leader

Dave Solomon

CONCORD  –  The national debate over the rights of health care workers to refuse to perform procedures like abortion or assisted suicide is working its way through the New Hampshire State House as lawmakers consider “an act relative to the rights of conscience for medical professionals.”

The medical community is divided over the bill, which would allow medical professionals to refuse any procedure that goes against their personal beliefs, including abortion, providing contraceptives or contraceptive counseling.

Doctors at a public hearing last week testified for and against the bill (HB 1787), which would also cover physician’s assistants, nurses, pharmacists, medical students … basically anyone and everyone who works in the health care profession. The lengthy definition of “health care provider” in the bill includes “hospital or clinic employees.” . . . [Full Text]

The ‘Uber for birth control’ expands in conservative states, opening a new front in war over contraception

Stat

Max Blau

It’s a telemedicine app that seems rather innocuous — enter your info, have it reviewed by a physician, and get a prescription. The California-based company behind it has raised millions to support its mission of expanding access to the pill, ring, or morning-after pill with minimal hurdles.

But that last option is now starting to attract pushback from anti-abortion activists, who consider the morning-after pill equivalent to abortion — and who say lax telemedicine laws are enabling access to this drug with insufficient oversight.

Nurx, an app that’s been called the “Uber for birth control,” lets patients obtain a variety of contraceptives from the touch of a smartphone; it also gives women access to Plan B and Ella, two forms of the morning-after pill, which is effective in preventing a pregnancy after sex. Women can order these drugs in a few easy steps: answer a series of health questions; provide basic demographic information; and choose a preferred drug. A doctor then reviews the patient’s information, writes a prescription, and the drug is delivered to either the patient’s home or her local pharmacy. . .  [Full text]

 

Contraceptive Coverage and the Balance Between Conscience and Access

Ronit Y. Stahl,PhD; Holly Fernandez Lynch, JD, MBE

When the Obama administration included contraception in the essential benefits package to be covered by employer-sponsored health insurance plans under the Affordable Care Act, it sought to preserve access for women while addressing the concerns of employers with religious objections. Although the accommodations and exemptions were not enough for some employers, balance was the ultimate goal. This also was reflected in Zubik v Burwell, the Supreme Court’s most recent decision on the matter; on May 16, 2016, the justices remanded the litigants to the lower court so they could be afforded the opportunity to reach a compromise between religious exercise and seamless contraceptive coverage. No further compromise was forthcoming.

Now the Trump administration has rejected balance as a worthwhile goal.1 Its new contraceptive coverage rules, released on October 6, 2017, prioritize conscientious objection over access.2,3 The rules take effect immediately, and new legal challenges, this time on behalf of patients rather than objecting employers, have already begun.4 The new rules preserve the default requirement that employers must include free access to contraceptives as part of their insurance plans. However, the rules now exempt employers with religious or moral objections to contraceptives, without requiring any alternative approaches to ensure that beneficiaries can obtain contraceptives at no cost.2,3
[Full Text]


Stahl RY, Lynch HF. Contraceptive Coverage and the Balance Between Conscience and Access. JAMA. Published online October 19, 2017. doi:10.1001/jama.2017.17086

Trump gives relief to religious Obamacare objectors

Deseret News

Hannah C. Smith

Last Friday, the Trump administration revised rules implementing the Affordable Care Act in a way that expands protections for religious and moral objectors to the contraception mandate — achieving the common-sense balance that religious organizations have sought for the past six years. These revisions allow religious nonprofits — like the Little Sisters of the Poor — to avoid millions of dollars in fines because their employee health insurance plans exclude coverage for contraception, a practice contrary to Catholic doctrine on respecting human life.

Judging by some media hyperbole, however, you would think that the federal government had just abolished the ACA’s birth control mandate altogether. Headlines that claim the federal government’s move “reverses” or “scraps” or “ends” the mandate are all wrong.. . .The vast majority of women in America will continue to receive free birth control, and religious objectors will not be forced into providing services that violate their conscience. . . [Full text]

 

Donald Trump’s new guidelines for protecting religious faith restore justice

Washington Times

Editorial

Not so long ago, President Trump’s new guidelines for the Department of Health and Human Services for protecting freedom of religious faith would have been superfluous and unnecessary. A casual observer might have read them in puzzlement, as if the government had reaffirmed its opposition to robbery or murder.

But all that was before the Obama administration sought to bring those of religious faith to heel, ordering employers to pay for contraception devices and abortion-inducing drugs, even if it violated the conscience of employers. Under pressure, the Obama administration grudgingly exempted churches from its mandate, but employers affiliated with religious groups still were required to pay through third-party administrators.

The new guidelines, drawn up by the U.S. Justice Department, change that. The order does not prohibit employers paying such benefits, and many employers will continue to do so. Nor will anyone be deprived by the government of their condoms, diaphragms and other birth-control devices. But “going forward,” as the cliche goes, an employer will not be required by the U.S. Government to violate his conscience for the convenience of those hostile to religious faith. . .[Full text]

Christian Medical Association and Freedom2Care Applaud Administration’s Actions to Protect Conscience in Healthcare

News Release

Christian Medical Association

WASHINGTON, Oct. 6, 2017 — Today the nation’s largest association of Christian health professionals, the 18,000-member Christian Medical Association (CMA, Christian Medical Association www.cmda.org) applauded the administration’s actions to restore conscience freedoms in healthcare. The administration took action concerning the Obamacare contraceptives mandate, insurance premiums used to pay for abortions, and regarding government respect for religious freedom.

“We are thankful to see these vital conscience freedoms restored in healthcare,” noted CMA Senior Vice President Gene Rudd, MD, and Ob-Gyn physician. “For millennia, medical ethics have provided for conscientious opposition to abortion by physicians who took up the practice of medicine as a healing art never to be used for the destruction of human life. And until recently, our government reinforced those ethical principles with conscience protections. We are heartened to see our government heading back in the direction of these vital freedoms that protect patients, medicine and freedom in our country.”

Jonathan Imbody, director of Freedom2Care (www.Freedom2Care.org), which is affiliated with CMA said, “As Americans who have inherited a nation founded upon freedom of faith, conscience and speech, we can agree that the government must never force individuals to violate their deepest held beliefs on vital and extremely controversial issues such as abortion. When our leaders forget these principles, and take to forcing nuns to participate in matters they consider wholly immoral, the American people realize that our fundamental freedoms are in jeopardy. If the government can take away the rights of one group, then no one is safe from government coercion.

“These actions today by the administration are an important step back in the direction of freedom and respect for one another, and we look forward to more actions in the future, including restoration of the conscience rule for health professionals that President Obama gutted.”

Contact: Margie Shealy, Christian Medical Association, 423-341-4254

Trump Administration Rolls Back ACA Contraceptive Coverage Rule

Several organizations plan to sue over the change

Medpage Today

Joyce Frieden

WASHINGTON — Medical groups expressed disappointment in rules issued Friday by the Trump administration that rollback contraceptive coverage requirements put in place by the Obama administration.

The new rules were issued as “interim final” regulations, meaning that they will be implemented immediately. The rules allow employers to refuse to cover contraceptives for any moral or religious reason. It also no longer requires employers to allow their insurers or third-party administrators to provide separate coverage, instead calling that arrangement an “optional” accommodation.

Under the Affordable Care Act, employers were required to cover all forms of contraception with no co-pay. Certain religiously affiliated employers, such as churches or religious affiliated hospitals or universities, were exempted from this rule; however, once they signed paperwork stating that they did not want to provide coverage, the employer’s insurer or third-party administrator then had to provide that same coverage, with no co-pay, to employees who needed it. . .[Full text]

 

Trump Administration Issues Rules Protecting the Conscience Rights of All Americans

News Release

For immediate release

United States Department of Health and Human Services

The Departments of Health and Human Services, Treasury, and Labor are announcing two companion interim final rules that provide conscience protections to Americans who have a religious or moral objection to paying for health insurance that covers contraceptive/abortifacient services. Obamacare-compliant health insurance plans are required to cover “preventive services,” a term defined through regulation. Under the existing regulatory requirements created by the previous administration, employers, unless they qualify for an exemption, must offer health insurance that covers all FDA-approved contraception, which includes medications and devices that may act as abortifacients as well sterilization procedures.

Under the first of two companion rules released today, entities that have sincerely held religious beliefs against providing such services would no longer be required to do so. The second rule applies the same protections to organizations and small businesses that have objections on the basis of moral conviction which is not based in any particular religious belief.

In May, President Trump issued an “Executive Order Promoting Free Speech and Religious Liberty” in which the President directed the Secretaries of Health and Human Services, Labor and the Treasury to consider amending existing regulations relative to Obamacare’s preventive-care mandate in order to address conscience-based objections.

Key Facts about today’s interim final rules:

  • The regulations exempt entities only from providing an otherwise mandated item to which they object on the basis of their religious beliefs or moral conviction.
  • The regulation leaves in place preventive services coverage guidelines where no religious or moral objection exists – meaning that out of millions of employers in the U.S., these exemptions may impact only about 200 entities, the number that that filed lawsuits based on religious or moral objections.
    • These rules will not affect over 99.9% of the 165 million women in the United States.
  • Current law itself already exempts over 25 million people from the preventive-care mandate because they are insured through an entity that has a health insurance plan that existed prior to the Obamacare statute.
  • The regulations leave in place government programs that provide free or subsidized contraceptive coverage to low income women, such as through community health centers.
  • These regulations do not ban any drugs or devices.
  • The mandate as defined by the previous administration suffered defeats in court after court, including the Supreme Court, which ruled that the government cannot punish business owners for their faith.

The IFR can be found here:

https://www.federalregister.gov/d/2017-21852

https://www.federalregister.gov/d/2017-21851

To find a fact sheet on the IFRs, visit:  Religious and Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act

Contact: HHS Press Office
202-690-6343
media@hhs.gov

 

There is no defence for ‘Conscientious objection’ in reproductive health care

Abstract

A widespread assumption has taken hold in the field of medicine that we must allow health care professionals the right to refuse treatment under the guise of ‘conscientious objection’ (CO), in particular for women seeking abortions. At the same time, it is widely recognized that the refusal to treat creates harm and barriers for patients receiving reproductive health care. In response, many recommendations have been put forward as solutions to limit those harms. Further, some researchers make a distinction between true CO and ‘obstructionist CO’, based on the motivations or actions of various objectors. This paper argues that ‘CO’ in reproductive health care should not be considered a right, but an unethical refusal to treat. Supporters of CO have no real defence of their stance, other than the mistaken assumption that CO in reproductive health care is the same as CO in the military, when the two have nothing in common (for example, objecting doctors are rarely disciplined, while the patient pays the price). Refusals to treat are based on non-verifiable personal beliefs, usually religious beliefs, but introducing religion into medicine undermines best practices that depend on scientific evidence and medical ethics. CO therefore represents an abandonment of professional obligations to patients. Countries should strive to reduce the number of objectors in reproductive health care as much as possible until CO can feasibly be prohibited. Several Scandinavian countries already have a successful ban on CO.

Fiala C, Arthur JH. Eur J Obstet Gynecol Reprod Biol. 2017 Jul 23. pii: S0301-2115(17)30357-3. doi: 10.1016/j.ejogrb.2017.07.023. [Epub ahead of print]