U.S. Federal Policy Change: “Toppling the Ethical Balance”

A recent commentary (E Sepper. NEJM 2019; 381: 896-8) explains how the current administration’s “Protecting Statutory Conscience Rights in Health Care” policy will create additional problems for patients.


  • “For nearly 50 years, U.S. federal law has permitted medical professional and religious institutions to refuse, for religious and moral reasons, to provide abortions and sterilizations.”  In addition, there are similar safeguards with regards to professionals who do not want to comply with advance directives.  And, recipients of federal funding like hospitals and clinics are obligated to “not discriminate against individuals that refuse to provide such care.
  • However, “health care providers bear legal and ethical duties to patients. They must provide information about treatment options.”

What is changing?

  • The “Protecting Statutory Conscience Rights in Health Care” policy from the Department of Health and Human Services (HHS) “creates a wide-ranging right to refuse to provide health care services.”  Any entity receiving HHS funding “is barred from requiring anyone to ‘assist in the performance’ of ‘any health service or research activity’ that is contrary to that person’s religious beliefs or moral convictions.”
  • This could include contraception, gender dysphoria treatment, nondiscriminatory care of lesbian, gay, bisexual and transgender patients.  This could affect care for individuals with HIV.
  • “Providers may refuse to refer patients or counsel them about the contested service.”  This is an HHS mandate that affirms an individual provider’s right to not meet the standard of care.
  • This could result in an ICU nurse who will not follow advance directives or a pediatric provider (MD, PA, RN) who will not administer vaccines.
  • In addition, the rule includes no emergency exception.  An ambulance driver could refuse to transport a woman with a miscarriage or ectopic pregnancy to the hospital.

My take: In an effort to pander to religious communities, the administration is giving the green light to medical providers/staff to discriminate and deny services; this denial extends to even providing adequate information.  The results of this policy could result in increased morbidity and even death in those denied services.

Pittock Mansion Hike, Portland, OR