Tamesha Means had been pregnant for just 18 weeks when her water broke in 2010. In pain, she rushed to a hospital near her house in Michigan. But because it was a Catholic health center, doctors there did not tell her that continuing her pregnancy could threaten her health and that abortion was her safest option. Instead they sent her home. They did so again when she returned the next day, bleeding, with painful contractions. They were preparing to send her home for a third time when she miscarried at the hospital.
Cases like this, in which a provider’s religious beliefs take precedence over a patient’s needs, could become more common because of a series of recent White House decisions that please the anti-abortion movement. The decisions may make it more difficult for teenagers wanting to get tested for sexually transmitted diseases, for gay men looking to prevent HIV and even for women seeking breast exams or pap smears.
Earlier this month, the Department of Health and Human Services announced the creation of a “Conscience and Religious Freedom Division” to enforce laws protecting health care providers’ right to opt out of certain procedures, including post-abortion care or gender-affirming surgery, because of religious objections. (The website displays what appears to be a female Muslim doctor in a hijab smiling enthusiastically — a twist on the administration’s usual attitude toward Muslims.)
The unveiling of the new office may simply be a signal to the conservative base, an elaborate way of saying, “We haven’t been able to ban abortions after the 20th week of pregnancy, but we still care.”
Continue reading the main storyBut the administration also released a 216-page proposed rule detailing how the new division will double down on religious protections. Right now, state and federal laws already protect a nurse, for instance, who doesn’t want to assist with an abortion for religious reasons. But in a list of definitions, the administration would expand the meaning of “assisting” to include making referrals to a different provider, or even simply counseling a patient on her options. In the same list, the department broadly redefines “work force” so religious protections can apply not just to the nurse in the room, but also to the scheduler, the janitor and the security guard outside.
“The definition of ‘to assist’ is unparalleled,” said Louise Melling, the deputy legal director of the American Civil Liberties Union. “It goes so far as to include someone objecting to checking you in, someone objecting to doing your insurance paperwork, someone objecting to even taking your temperature.”
The regulations don’t recommend that doctors balance a patient’s needs with religious objections; religious objections are given top priority.
The rule suggests that the office can investigate a health care entity not just based on actual complaints, but also based on “threatened” or “potential” ones.
There could also be grim consequences from a one-page letter the administration sent to state Medicaid directors, suggesting that they may now block Medicaid funding for Planned Parenthood or other health centers that provide abortions. (Planned Parenthood says that more than half of its patients are covered by Medicaid.) The letter overturned a 2016 Obama-era directive that required states to distribute federal funds for family planning services, like contraception, prenatal care and testing for sexually transmitted diseases, to qualified health providers, regardless of whether those providers also perform abortions.
Freedom of religion is essential — and so is access to health care. Current law tries to accommodate both, but the far right has stirred unfounded fears that religion (and Christianity in particular) is under assault, and that people of faith are in danger of being forced to do things they find morally objectionable. “Patient-centered care” is an important goal in clinical training today, but the administration is instead proposing provider-centered care.
In recent conflicts between patient needs and religious freedom, patients have too often lost. The Trump administration wants to keep it that way.
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