From HHS: The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced on May 2 the issuance of the final conscience rule that protects individuals and health care entities from discrimination on the basis of their exercise of conscience in HHS-funded programs. Just as OCR enforces other civil rights, the rule implements full and robust enforcement of approximately 25 provisions passed by Congress protecting longstanding conscience rights in healthcare.
A final rule issued this week by the Department of Health and Human Services (HHS) expands "conscience protections" for providers who refuse to administer certain types of care based on religious belief or moral conviction. This rule is worrisome and dangerous for patients, according to Vidor Friedman, MD, FACEP, president of the American College of Emergency Physicians (ACEP), and Omar Maniya, MD, MBA, president of the Emergency Medicine Residents' Association (EMRA).
ACEP and EMRA released the following joint statement:
"Emergency physicians will care for any patient that needs emergency medical treatment. Denying emergency care or delaying emergency services based on race, religion, sexual orientation, gender identity, ethnic background, social status, type of illness, or ability to pay, is unethical and dangerous.
Refusing to care for patients who require emergency medical attention could violate federal law and stands in stark contrast to the sworn oath and fundamental principle of emergency care: we must treat or stabilize anyone who visits the emergency department, anytime.
ACEP and EMRA are concerned that these types of exemptions may run afoul of the Emergency Medical Treatment and Labor Act (EMTALA), fail to recognize the unique and vital nature of emergency medicine, and open the door to discrimination by institutions or individuals that are expected to prioritize patient care and safety ahead of personal beliefs."
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
EMRA is the voice of emergency medicine physicians-in-training and the future of our specialty. EMRA is the largest and oldest independent resident organization in the world. EMRA was founded in 1974 and today has a membership over 16,000 residents, medical students, and alumni.
The final rule fulfills President Trump's promise to promote and protect the fundamental and unalienable rights of conscience and religious liberty, a promise he made when he signed an executive order in May 2017 protecting religious liberty. In October 2017, the Department of Justice issued guidance encouraging other Departments, including HHS, to implement and enforce all relevant religious freedom laws.
As a result, in January 2018, following the launch of its new Conscience and Religious Freedom Division, HHS announced the proposed conscience rule. OCR received over 242,000 public comments, and analyzed and carefully considered all comments submitted from the public on the proposed conscience regulation before finalizing it.
This final rule replaces a 2011 rule that has proven inadequate, and ensures that HHS implements the full set of tools appropriate for enforcing the conscience protections passed by Congress. These federal laws protect providers, individuals, and other health care entities from having to provide, participate in, pay for, provide coverage of, or refer for, services such as abortion, sterilization, or assisted suicide. It also includes conscience protections with respect to advance directives.
The final rule clarifies what covered entities need to do to comply with applicable conscience provisions and requires applicants for HHS federal financial assistance to provide assurances and certifications of compliance. The rule also specifies compliance obligations for covered entities, including cooperation with OCR, maintenance of records, reporting, and non-retaliation requirements.
"Finally, laws prohibiting government funded discrimination against conscience and religious freedom will be enforced like every other civil rights law." said OCR Director Roger Severino. "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. Protecting conscience and religious freedom not only fosters greater diversity in healthcare, it's the law," Severino concluded.
AMA & AHA
In April, the American Medical Association called upon Health and Human Services Secretary Alex Azar to ask the rule be withdrawn and express the organization's opposition. In March the American Hospital Association sent a letter to Roger Severino, director of the Office for Civil Rights for HHS, noting the importance of respecting the conscience objectives of hospital employees and medical staff but also the equally critical need to ensure patients have access to the care needed. Recognizing both needs are equally important, the organization outlined their thoughts on the proposed rule in late March:
Currently, the AHA is reviewing the 440-page rule before issuing a statement.
HIV Medicine Association
The final rule released by the U.S. Department of Health and Human Services Thursday affirming support for health care providers who deny care and treatment based on their religious beliefs reinforces stigma and discrimination, with clear negative impacts to the administration's initiative to End the HIV Epidemic within the next decade.
Disregarding the imperatives of science and evidence-based medical practices to health care, and giving credence to misconceptions regarding populations disproportionately affected by public health threats that include the HIV epidemic, the opioid crisis, and rising rates of viral hepatitis and sexually transmitted infections, the new rule perpetuates social and structural barriers that keep individuals affected by, or at risk for HIV and other stigmatized conditions from accessing prevention, care and treatment services.
HHS states that it will review concerns on the rule's impact on access to HIV prevention, care and treatment, as well as on treatment for gender dysphoria, on a case-by-case basis. This response disregards the basic rights of people at risk for HIV, living with HIV or who are transgender to have access to the medical care and treatment recognized by our country's medical establishment as the standard of care. As a society of medical providers, HIVMA will continue to emphasize that all health care providers have an ethical and professional obligation to provide all patients with humane and competent medical treatment and care.
NCLR
The following is a statement by Julianna S. Gonen, Policy Director at the National Center for Lesbian Rights (NCLR):
"This rule does not just implement existing federal conscience protections for healthcare providers, it dramatically expands them in ways that will lead to dangerous denials of reproductive health care, and put vulnerable populations, including LGBTQ people, at risk of increased discrimination. We've seen firsthand, through our Legal Help Line and our Rural Pride campaign, that health care discrimination against LGBTQ people is already pervasive and causes serious harm to individuals and families. In many communities in this country, LGBTQ people routinely face open hostility and outright denials of care from doctors, hospitals, therapists, and other health care providers. Rather than addressing this serious problem, HHS issued a rule that will make it worse."
