Memorandum #1
Support for policy protecting practitioner freedom of conscience
15 July, 2008
The Honorable Michael O. Leavitt
Secretary of Health & Human Services,
U.S. Department of Health & Human Services
Hubert Humphrey Building
200 Independence Ave., S.W.
Washington, DC 20201
Dear Secretary Leavitt,
The New York Times has indicated that you intend to soon publish
regulations in accord with federal laws protecting patients and healthcare
professionals in decisions relating to controversial procedures and
prescriptions. These regulations reportedly will help "to ensure that
federal money does not 'support morally coercive or discriminatory practices
or policies in violation of federal law.'" On behalf of our 13,000 members,
we applaud your leadership in taking this long overdue action.
It is entirely appropriate, given the past 35 years of laws passed by
Congress, that these principles finally be translated into practical
healthcare regulations. From the 1973 Church Amendment to the more recent
Hyde-Weldon Amendment, Congress has recognized the importance of protecting
patients and their healthcare professionals from political pressures on
these vital issues.
Americans on all sides of controversial issues such as abortion,
reproductive technologies and assisted suicide can appreciate the need to
protect everyone's First Amendment rights of free speech and religious
exercise. That means that healthcare professionals must be free to follow
their individual conscientious convictions on these life-and-death matters.
An informal survey of Christian Medical Association members found that
over 41 percent of respondents had been "pressured to compromise Biblical or
ethical convictions." Anecdotal accounts suggest that few persecuted
healthcare professionals actually know their conscience rights and that they
typically simply submit to pressure by resigning. Students who experience
discrimination and pressure to violate conscience simply give in and attempt
to find a more tolerant institution or a less controversial field of
medicine than obstetrics and gynecology. Unless pro-life professionals are
equipped to know and apply their conscience rights, they actually stand at
risk of being weeded out from the profession altogether.
Patients are protected when physicians follow objective ethical codes,
such as those expressed in the Hippocratic Oath and the Judeo-Christian
Scriptures. These life-honoring principles have protected patients for
millennia. We recognize that some individuals choose to refuse to follow
these principles, and under current law, that is their choice.
The regulations reportedly under consideration at Health and Human
Services apparently would simply protect the right for all healthcare
professionals to make professional judgements based on moral convictions and
ethical standards. Protecting this right also protects patients who choose
their physicians based on life-affirming values.
We applaud your leadership in this area and look forward to commenting on
the proposed regulations.
Sincerely,
David Stevens, MD
Chief Executive Officer
Memorandum # 2
Methods of Communication
DATE: September 19, 2008
FROM: Jonathan Imbody
Vice President for Government Relations
Christian Medical Association - Washington Bureau
Ashburn, Va.
TO: Secretary Mike Leavitt
RE: Provider Conscience Regulation - methods of communication
I write in strong support of the regulation and in specific reference to
the request for comment on
"…what constitutes the most effective methods of educating recipients
of Department funds, their employees, and participants of the
protections against discrimination found in the Church Amendments, PHS
Act § 245, and the Weldon Amendment. What is the best method for
communicating to the public the protections afforded by these statutes,
and any regulation implementing them?"
Methods of communicating legal protections and requirements
1. Physically posting notices in buildings is probably a necessary but a
less than effective communication method due to (a) competition with many
other similar-looking notices and (b) the fact that many individuals expect
federal notices to be arcane and will not likely read them.
a. Instead of replicating the typical format that telegraphs "boring
technical information" to the reader, notices should enhance their
readability with the use of pictures and engaging headlines such as
those found in advertisements.
b. Clear criteria should be communicated along with the notices
specifying to the institutions how and where they are to be posted,
including the requirement that they be prominent, not obscured, and
checked regularly and replaced as needed.
2. Notices on websites and in handbooks are a bit more likely to be read,
although arguably busy individuals will not plod through handbooks and
similar information vehicles.
a. The HHS web site could feature on its home page a graphic with a
link to a distinct HHS web section that provides summary and in-depth
information on conscience rights.
b. To increase readership, web notices should imitate the format found
in web advertisements.
c. Information in handbooks should be set apart graphically to increase
visibility.
3. Including notices in applications for training, residency, and
educational programs is a great approach and crucial, since individuals in
training are typically in the information gathering mode, and more
importantly, because the beginning of medical careers is where education
concerning conscience protections must begin.
a. Besides requiring written notices in applications, official
handbooks and student manuals should also contain the notices.
b. Consider also requiring that institutions verbally relay a summary
statement prepared by HHS during orientation sessions. Alternately,
separate notices could be required to be distributed during orientation
sessions.
c. Educational institutions can also be encouraged to include this
information inappropriate classes and other venues.
4. A series of 30-second radio public service announcements would help
educate the public without incurring advertising costs.
5. Medical specialty groups could be contacted and urged to alert their
constituents withinformation prepared by HHS, including links to the HHS web
site.
6. All of these information strategies can be enhanced by:
a. Keeping the message simple. Headlines, slogans and introductory
sentences should convey the basic principles, while more detailed or
legal information can be included following these simple points.
Example: "Healthcare Professionals Have First Amendment Rights, Too."
b. Employing the unexpected. A headline such as, "How to Lose Your
Federal Funding," for example, is sure to gain attention.
c. Providing concrete examples, similar to the hypothetical examples
used to explain IRS guidelines, that illustrate legal protections and
boundaries.
d. Using stories that illustrate conscience protection principles.
Ample stories are available from those submitted on the Secretary's blog
and elsewhere.
7. Hiring a consulting firm with expertise in public relations and
communications would be worthwhile, similar to the approach used by HHS in
expanding public awareness regarding trafficking in persons.
Thank you very much for your consideration of these suggestions, and for
your efforts to implement civil rights protections for healthcare
professionals.
Memorandum # 3
Results of nationwide survey
DATE: September 18, 2008
FROM: Jonathan Imbody
Vice President for Government Relations
Christian Medical Association - Washington Bureau
Ashburn, Va.
TO: Secretary Mike Leavitt
RE: Provider Conscience Regulation
I write in strong support of the regulation and in specific reference to
the request for "information with regard to general knowledge or lack
thereof of the protections established by these nondiscrimination
provisions, including any facts, surveys, audits, reports, or any other
evidence of knowledge or lack of knowledge on these matters in the general
public…"
To answer this question, the polling company, inc. on September 11-14,
2008 conducted a nationwide survey, commissioned by the Christian Medical
Association. Full results of this survey are included in this memorandum,
below.
This scientific, objective poll found that only 38 percent of Americans
realize that physicians may not legally be coerced into violating standards
of medical ethics and their own conscientiously held moral convictions by
requiring them to perform abortions or refer patients for abortions.
This widespread ignorance of civil rights protections helps explain why
over 40 percent of our members report being pressured to violate their moral
and ethical convictions in healthcare. It also underscores the urgent need
for the HHS regulation and to educate the public and medical community
concerning civil rights in healthcare.
Protecting the civil rights of healthcare professionals allows their
adherence to time-tested ethical standards that protect patients, including
the Hippocratic Oath. It's ironic and alarming that many today would
actually disregard civil rights and forbid physicians from following the
Hippocratic Oath and other ethical standards that respect early human life.
If physicians lose the freedom to follow conscience and ethical
standards, patients lose the protections of those standards. Patients also
will ultimately lose access to those physicians, who will be forced to
choose other careers rather than violate ethical standards.
Thank you very much for your consideration of these views and the
poll data, which follows.
the polling company TM, inc./WomanTrend for Christian Medical
Association
To: Jonathan Imbody, Vice President for Government Relations
From: Kellyanne Conway, President and CEO
Date: September 16, 2008
Re: Analysis of Findings: Nationwide Survey of American Adults
Introduction and Methodology
The Polling Company TM, Inc. is pleased to present to Christian Medical
Association (CMA) the results of a recent nationwide telephone survey of
1,000 adults (aged 18+).
The survey was fielded September 11-14, 2008 at a
Computer Assisted Telephone Interviewing (CATI) phone facility using live
callers. The sample was drawn utilizing a Random Digit Dial (RDD), where
phone numbers were generated by a computer to ensure that every household in
the nation with a landline telephone had an equal chance to be surveyed.
Sampling controls were used to ensure that a proportional and
representative number of adults were interviewed from such demographic
groups as age, gender, race and ethnicity, and geographic region1
according to the latest figures available from the United States Census.
One close-ended question that probed Americans' knowledge about federal
law and the obligations of doctors when patients request abortions was added
to a national omnibus survey.
The addition of this question was prompted by a request from the U.S.
Department of Health and Human Services for information regarding the
public's knowledge (or lack thereof) about this topic.
The final question wording was approved by an authorized representative
of CMA prior to fielding.
The margin of error is calculated at +/- 3.1%at the 95% confidence level,
meaning that in 19 out of 20 cases, the results obtained would differ by no
more than three point one percentage points in either direction if other
groups of 1,000 adults were surveyed using the same random sampling plan.
Margins of error for subgroups are higher.
Most Americans Don't Know the Law Regarding Doctors and Abortion.
"I am now going to ask you a question about healthcare and the law.
"If a patient in the United States wants a doctor to perform an abortion
or to refer her to another doctor who will perform an abortion, which of the
following BEST describes what the doctor is required to do by federal law?"
[Read entire list before recording one answer]
| 4% |
"The doctor must perform the abortion." |
| 38% |
"The doctor does not have to perform the abortion, but must
refer the patient to another doctor who will." |
| 38% |
"The doctor does not have to perform the abortion, nor does
he or she have to refer the patient to another doctor who will." |
| 5% |
"It depends" (volunteered). |
| 11% |
Don't know (volunteered). |
| 4% |
Refused (volunteered). |
When read three possible descriptions regarding the legal obligations of
a doctor when a patient requests an abortion, the clear majority of
Americans surveyed revealed they did not have a firm grasp on the law.
As the results box demonstrates, just 38%of those surveyed selected the
description that is actually in line with current federal law: that a doctor
has the right to refuse to provide both the procedure and the referral.
By comparison, 42%of these adults believed the doctor did have some
obligation under federal law: either to perform the abortion (a paltry 4%)
or at least refer the patient to someone who would(38%). Another 11%
admitted they weren't sure and 5% allowed for situational variances,
saying"it depends."
An examination of the crosstabular data revealed the following:
- The lack of knowledge of federal law on this topic was widespread as
no more than 47%of any demographic subgroup selected the correct
description of the doctor's obligations. Those more likely than most to
know the doctors was not required to perform an abortion or provide a
referral included 45-64 year olds, residents of the North Central
region, and those earning between $25,000 and $50,000 per year.
- Young adults (those aged 18-24) stood out as especially likely
to believe the doctor was legally required to perform an abortion
(10% vs. 4% overall).
- Groups more likely than most to believe a physician in this
situation was legally bound togive a referral to an abortion provider
included 18-24 year olds, residents of the NorthEast, and Hispanics.
- Americans more apt than average to admit they simply did not know
included 25- 34year olds, seniors (65+), and those earning less than
$25,000 per year.
- There was no appreciable difference between the answers of men and
women, nor wasthere a statistically significant pattern based on
education.
In Conclusion...
These data make clear that most Americans aren't sure what the rights and
obligations of doctors are regarding abortion. While very few believe
doctors are compelled by federal law to perform the procedure, a substantial
number think they are required to provide a referral. To fully comprehend
their rights and options as patients, it is important for Americans to
understand the laws governing the practice of medicine by doctors.
Overall, it seems apparent that additional information is required to ensure
both doctors and patients know both their rights and their obligations.
TOPLINE DATA
Nationwide Telephone Survey of 1,000 Adults
Field Dates: September 11-14,2008
Margin of Error: +/- 4.4%
1. I am now going to ask you a question about healthcare and the law.
If a patient in the United States wants a doctor to perform an abortion or
to refer her to another doctor who will perform an abortion, which of the
following BEST describes what the doctor is required to do by federal law?
[Read entire list before recording one answer]
| 4% |
"The doctor must perform the abortion." |
| 38% |
"The doctor does not have to perform the abortion, but must
refer the patient to another doctor who will." |
| 38% |
"The doctor does not have to perform the abortion, nor does
he or she have to refer the patient to another doctor who will." |
| 5% |
"It depends" (volunteered). |
| 11% |
Don't know (volunteered). |
| 4% |
Refused (volunteered). |
DEMOGRAPHICS
2. What is your age?
| 13% |
18-24 |
| 17% |
25-34 |
| 19% |
35-44 |
| 19% |
45-54 |
| 14% |
55-64 |
| 16% |
65+ |
| 2% |
REFUSED (VOLUNTEERED) |
3. Are you Spanish, Hispanic, or Latino?
| 13% |
YES |
| 86% |
NO |
| 1% |
REFUSED (VOLUNTEERED) |
4. Which of the following describe your race? You can select as many
as apply.
| 75% |
WHITE/CAUCASIAN |
| 11% |
BLACK/AFRICAN-AMERICAN |
| 2% |
ASIAN/ASIAN-AMERICAN |
| 12% |
SOME OTHER RACE |
| 2% |
REFUSED (VOLUNTEERED) |
5. What is your household's total income before taxes?
| 14% |
UNDER $25,000 |
| 9% |
$25,000- $34,999 |
| 17% |
$35,000- $49,999 |
| 17% |
$50,000- $74,999 |
| 26% |
$75,000 OR MORE |
| 17% |
DON'T KNOW/REFUSED (VOLUNTEERED) |
6. Are there any children under the age of 18 living in your
household?
| 40% |
YES |
| 59% |
NO |
| 1% |
REFUSED (VOLUNTEERED) |
7. What was the last grade in school you completed?
| 7% |
LESS THAN HIGH SCHOOL |
| 32% |
HIGH SCHOOL GRADUATE |
| 28% |
SOME COLLEGE/ ASSOCIATES DEGREE |
| 19% |
COLLEGE GRADUATE |
| 13% |
POST GRADUATE |
| 1% |
REFUSED (VOLUNTEERED) |
7. Gender
8. Region1
| 19% |
NORTHEAST |
| 22% |
NORTH CENTRAL |
| 37% |
SOUTH |
| 23% |
WEST |
Notes
1. Northeast includes CT, ME, MA, NH, RI, VT, NJ, NY,
PA; North Central includes IL, IN, MI, OH, WI, IA, KS, MN, MO, NE, ND, SD;
South includes DC, DE, FL, GA, MD, NC, SC, VA, WV, AL, KY, MS, TN, AR,
LA,OK, TX; West includes AZ, CO, ID, MT, NV, NM, UT,WY, AK, CA, HI, OR,WA.