NEW YORK STATE — Abortion rights groups throughout New York are worried that a proposed federal health regulation protecting other health care providers who refuse to participate in the delivery of medical services, such as abortion and sterilization, that violate their religious beliefs will make it more difficult for women to receive the services they need.

“The challenge for us is to figure out how to alert people and get them to communicate with Congress that it’s important to halt the implementation of these rules,” said Blue Carreker, vice president of public affairs and marketing at Upper Hudson Planned Parenthood in Albany.

Meanwhile, abortion opponents believe the regulation is not only necessary, but long overdue. “We strongly support this,” said Kathleen Gallagher, director of pro-life activities for the New York State Catholic Conference.

The regulation proposed by the U.S. Department of Health and Human Services contains a provision that prohibits the federal governments and state and local governments from discriminating against individual and institutional providers who refuse to receive training in abortions, require or provide such training, perform abortions or refer or make arrangements for abortions or training in abortions. It would allow federal health officials to deny funding to more than 584,000 hospitals, clinics and doctors’ offices if they do not accommodate employees with religious or moral objections to certain procedures.

Bob Baker, director of the Bioethics Program at Union College/Union Graduate College and Mount Sinai School of Medicine in New York City, said he consider the regulation extreme for two reasons: It allows physicians to forgo learning how to perform an abortion, and it permits medical professionals and pharmacists who object to certain services not to tell patients and customers where else they can receive those services. Sometimes, Baker said, abortions are medically necessary to save a woman’s life; if a doctor doesn’t know how to perform one, he or she won’t be able to provide necessary, life-saving care in an emergency situation. “This legislation is saying that you’ve got a right to impose your beliefs on a woman in need,” he said.

Similarly, a pharmacist who refuses for personal reasons to prescribe Plan B, known as the morning-after pill, would be going too far by refusing to give a referral, Baker said. “It’s not up to the pharmacist to judge your lifestyle. … The regulation seems to be pushing a set of beliefs on professionals and the public, instead of just allowing people not to do things they don’t want to do.”

“In a reasonable health care system, you want to find a way to accommodate differences and still deliver quality health care to people in need,” said Baker, who debated the issue at the United Nations with a Jesuit priest and a feminist bioethicist. “Forget about scare scenarios. Is this reasonable?” He added, “If you’re a Quaker, you probably shouldn’t go into the armed services. If you’re a Catholic or a Calvinist and you have such a deep aversion to the possibility of performing an abortion even to save a woman’s life, or to refer a woman to a pharmacist who will prescribe Plan B, maybe this is not the profession for you.”

Paul Drisgula, co-president and CEO of Planned Parenthood Mohawk Hudson, questioned why the new regulation is needed. He said there are already several federal rules that protect the rights of health care workers who object to abortion and sterilization on religious or moral grounds. “We believe this is a gratuitous attempt to clarify legislation that didn’t need to be clarified,” he said. “We don’t believe the Department of Health and Human Services needs to do anything.”

Drisgula questioned whether discrimination against health care providers who object to abortion for religious reasons is as widespread as the federal government claims. “There isn’t a single example [the Department of Health and Human Services] can provide that identifies this attitude they’re describing,” he said.

Gallagher disputed this. She said that the regulation is needed because the laws on the books haven’t been enforced, and suggested that discrimination against health care providers with religious or moral objections to certain procedures is fairly common. In 1998, she noted, a court allowed two former nurses to sue Albany Medical Center for firing them, allegedly because they refused to help perform an abortion. The case was eventually settled.

Gallagher said doctors, nurses and health care professionals throughout the country are facing increased pressure to carry out procedures that violate their religious beliefs. The problem has worsened, she said, as hospitals have merged. She noted that some pharmacists have refused to prescribe emergency contraception such as the Plan B pill, which some people consider a form of abortion. The Plan B pill works in several ways: by preventing release of an egg from a woman’s ovary, by blocking fertilization of an egg by sperm and by preventing a fertilized egg from attaching to the uterus.

personal beliefs

In an op-ed earlier this year, Gallagher wrote, “No one should ever be fired, demoted, transferred, fined or punished in any way for sticking to their sincerely held beliefs.” She said the proposed HHS regulations should go even further, and require hospitals, health clinics and research labs to post notices informing workers of their rights.

Carreker said that a small number of women experience complications during an abortion and are taken to the emergency room; she said that if the proposed regulation is implemented, it’s possible that doctors, nurses, technicians and other health care professionals could refuse to treat these women in the ER. “People shouldn’t worry when they go to receive medical care, whether it’s an emergency or non-emergency situation,” she said.

Abortion rights advocates also objected to what they described as the vagueness of the proposed regulation, which doesn’t provide a definition of abortion. Their concern stems from a draft version of the proposed regulation that leaked over the summer; this earlier version of the proposed rule would have defined abortion as anything that interfered with the fertilized egg after conception.

Although the latest version of the regulation drops that language, opponents say the wording is still so vague that the term is abortion is open to interpretation, and that it could apply to certain contraceptives.

Gallagher said those fears are overblown, and that the proposed regulations would not deny anyone anything. “Do they really expect us to believe that a woman won’t be able to find an abortionist unless the government compels every practitioner to perform the procedure?” she wrote, in her op-ed.

Baker said the new regulation could open a debate over what constitutes abortion; pharmacists, he said, could be in the front lines of that debate.

Selig Corman, director of professional affairs for the Pharmacists Society of the State of New York, said that in the past two years Plan B has emerged as an issue for pharmacists, but that so far the Pharmacists Society hadn’t received any complaints from pharmacists who felt they had been coerced into providing services to which they objected.

Corman said that pharmacists should “be allowed to practice according to their own personal code,” but that pharmacists who object to providing certain services should guide patients to a pharmacist who doesn’t share those objections.

“You don’t want to leave the patient hanging,” he said.

reason for regulation

In a section titled “The Problem,” the Department of Health and Human Services outlines the reasons for the new regulation.

“There appears to be an attitude toward the health care professions that health care professionals and institutions should be required to provide or assist in the provision of medicine or procedures to which they object, or else risk being subjected to discrimination,” the document says. “Reflecting this attitude, in some instances the standards of professional organizations have been used to define the exercise of conscience to be unprofessional, forcing health care professionals to choose between their capacity to practice in good standing and their right of conscience. … In general, the Department is concerned that the development of an environment in the health care field that is intolerant of individual conscience, certain religious beliefs, ethnic and cultural traditions and moral convictions may discourage individuals from diverse backgrounds from entering health care professions.”

The proposed regulation was offered by the U.S. Department of Health and Human Services on Aug. 21. There is a 30-day comment period, followed by up to 60 days for the Bush administration to review the comments and release the final rule.