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]
Lawsuit claims Catholic health care organization is breaking law by denying coverage for all transgender services
The ACLU of Washington has filed a civil rights lawsuit against a Catholic health care organization for refusing to cover the medically necessary surgery required by a transgender son of one of their employees.
The ACLU is suing on behalf of Cheryl Enstad, a medical social worker at PeaceHealth St. Joseph Medical Center in Bellingham, Wash. Enstad decided to file a lawsuit after PeaceHealth refused to cover the medical expenses of her transgender son, Pax, even though the treatments that were denied were recommended to treat his gender dysphoria.
Because PeaceHealth is a Catholic health care organization, it tries to abide by the teachings of the Catholic Church when it comes to issues surrounding sexual orientation or gender identity. It used that as justification for refusing to provide coverage for a recommended chest reconstruction surgery and other treatments for gender dysphoria under its medical benefits plan. . . [Full text]
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.
Available statistics indicate that Quebec is on track to reach euthanasia rates after two years that correspond to Belgian rates after seven to eight years (i.e., per 100,000 population and as a percentage of deaths from all causes).
Not all Quebec euthanasia statistics have been made public. However, the following points appear to be of interest:
Almost 20 requests for euthanasia were made weekly in the province in the first half of 2017, slightly higher than the last half of 2016.
The percentage of requests that did not result in euthanasia increased slightly from about 37% to 40%
Increases in this category, when reported, were attributed mainly to patients becoming incompetent, dying or withdrawing their requests.
Vatican officials want to hear in person why Brothers of Charity board members insist on allowing the euthanasia
The Vatican is planning to summon members of a Belgian nursing order to Rome to explain why they are refusing to ditch a policy which allows doctors to kill psychiatric patients in Church-run homes.
Senior Vatican officials want to hear in person why board members of the Organisation of the Brothers of Charity insist on allowing the euthanasia of non-terminally ill patients in the face of a top-level order to reverse the policy. . . [Full text]
Physicians for Human Rights is sponsoring a Health Professionals’ Pledge Against Torture that includes statements that signatories will never “participate or condone” torture and support colleagues who “resist orders to torture or inflict harm.” It also commits signatories to insist that their professional associations support those facing pressure “to participate or condone torture and ill-treatment.”
What is noteworthy is that the pledge is not limited to simply refusing to torture someone, but is a pledge against participation (which would include forms of facilitation like referral) and against condoning the practice.
Replace “torture” with commonly morally contested procedures and it becomes obvious that the ethical position taken by Physicians for Human Rights vis-à-vis torture is identical to the position of many health care professionals who object to practices like euthanasia or abortion for reasons of conscience.
A new abortion law has been enacted in Bolivia as part of the revision of the country’s Penal Code. Section 153 of the Penal Code now permits abortion of any girl under the age of 20 for any reason and at any point in gestation, when pregnancy results from rape, incest or involuntary artificial reproduction. Abortion is also allowed at any point in gestation in the case of present or future risk to the life or “overall health” of a woman, and (when pregnancy is under 8 weeks gestation) the woman is a student or has the care of a disabled relative.
The protection of conscience provision prohibits “the national health system” from asserting conscientious objection and insists that conscientious objection is limited to individual medical personnel “directly involved in the accomplishment” of the procedure, and must be stated in advance. “The national health system” is not defined in the law. It would appear from this that private or denominational health facilities (if they exist) cannot establish policies prohibiting abortion.
The fact that abortion is permitted as an exception to a general prohibition should mean that medical personnel or institutions of the opinion that a women does not qualify for an abortion under one of the legal criterion (such as risk to “overall health”) cannot be compelled to participate. This would not constitute conscientious objection and could not be stated in advance.
Canada recently legalized medical assistance in dying (MAiD), which allows patients to receive a lethal drug that they can self-administer, or be administered a lethal drug by an authorized clinician with consent of the patient. As provinces and territories work to create and clarify legal guidelines for providing MAiD, many Catholic hospitals have refused to offer it, citing opposition to physician-assisted suicide and euthanasia in Catholic moral teaching.
This controversy surrounding institutional conscience-based refusals raises an important question: Should a health care institution have the right to refuse to provide a particular treatment for conscience-based reasons? . . . [Full text]
Lethal medication provisions are in a precarious state. Over the past decade, pharmaceutical companies have attempted to stamp out the use of their drugs in executions, creating several economic and regulatory hurdles for access to these medications. As a result, patients seeking physician-assisted suicide (PAS) as well as death penalty states aiming to execute their capital offenders have been forced to turn to unregulated and dangerous alternatives for these drugs. This note attempts to unpack the quality, safety, and access issues emerging from these recent changes and to explore the implications for the future of these practices.
In order to fully grasp the exact mechanisms at work, this note will first offer a brief pharmacological description of the lethal medications and detail many technical aspects of their use. The next section provides a historical account of the past decade, illustrating the emergent quality, safety, and access issues. This note then evaluates the competing notions of ‘botched’ executions and ‘complications’ in PAS while analysing the standards set forward to measure safety and efficacy for each. Finally, this note closes by exploring the future of each practice in light of our discussion.
Riley S. Navigating the new era of assisted suicide and execution drugs. Journal of Law and the Biosciences. Volume 4, Issue 2, 1 August 2017, Pages 424–434, https://doi.org/10.1093/jlb/lsx028
1. The practice of medicine is a service to human dignity and doctors must adhere to the highest standards of professional competence in treating, protecting and advocating for patients.
2. In the course of their work on behalf of patients, doctors have the right not to participate in procedures which, in conscience, they believe to be wrong.
3. Doctors should not, by action or omission, deliberately shorten a patient’s life. Doctors must respect a patient’s fully-informed decision to refuse life-sustaining treatment or to request withdrawal of medical treatment.
4. Doctors have the right to refuse applications for referral for treatments to which they object in conscience.
5. Doctors have an obligation to provide care in emergencies, even if the condition results from a procedure to which the doctor has a conscientious objection.
6. Doctors have an obligation to explain the reasons for their conscientious objection with clarity and courtesy to patients and colleagues. Patients have a right to see another doctor and to be given impartial information as to how they can exercise that right. [Full text]