Trump Admin Will Protect Health Workers Who Refuse Services On Religious Grounds

[herring_RN, ASN, BSN]

January 18, 2018

Health care workers who want to refuse to treat patients because of religious or moral beliefs will have a new defender in the Trump administration.

The top civil rights official at the Department of Health and Human Services is creating the Division of Conscience and Religious Freedom to protect doctors, nurses and other health care workers who refuse to take part in procedures like abortion or treat certain people because of moral or religious objections...

... Louise Melling, deputy legal director at the American Civil Liberties Union, said those conscience objections could expand to allow health workers to refuse some services to gay, lesbian and transgender people...

Trump Administration Will Shield Health Workers Citing Religion To Refuse Care : Shots - Health News : NPR

[herring_RN, ASN, BSN]

Since 1964 it has been illegal for an employer to require performance or assistance in an abortion or sterilization procedure.

I don't think there is a need for new statutes or regulations regarding abortion or sterilization. Education on existing protection is needed for employers, healthcare workers, and the public.

Regarding treatment of transgender individuals, I think the administration needs to clarify what the conscience protections are.

I think no one should be forced to participate in surgery or medical treatment for gender change.

I also believe in my soul that no nurse or other employee should be allowed to refuse to care for a transgendered person needing care for an illness or injury.

I don't know any nurse who would refuse to care for any patient.

This was clarified by the United States Senate in 2011:

https://www.dpc.senate.gov/healthreformbill/healthbill18.pdf

Quote

U. S. Code TITLE 42 > CHAPTER 6A > SUBCHAPTER VIII > 300a-7 states:

Prohibition of public officials and public authorities from imposition of certain requirements contrary to religious beliefs or moral convictions

The receipt of any grant, contract, loan, or loan guarantee under the Public Health Service Act [42 U.S.C. 201 et seq.], the Community Mental Health Centers Act [42 U.S.C. 2689 et seq.], or the Developmental Disabilities Services and Facilities Construction Act [42 U.S.C. 6000 et seq.] by any individual or entity does not authorize any court or any public official or other public authority to require--

(1) such individual to perform or assist in the performance of any sterilization procedure or abortion if his performance or assistance in the performance of such procedure or abortion would be contrary to his religious beliefs or moral convictions;

42 U.S. Code SS 3a7 - Sterilization or abortion | US Law | LII / Legal Information Institute

Hospitals have repeatedly lost lawsuits regarding this

Hospital Apologizes to Nurses Who Refused to Assist in Abortion | Mary Ellen Kelly | First Things

[brownbook]

As you noted since 1964 employers can't demand staff perform or assist with abortions.

I don't understand where religion comes into assisting with gender change surgery?

If I can cite religious reasons for refusing to care for a patient.....why can't I say my religion won't allow me to care for Jews or Muslims, etc.?

[Mini2544, ASN, RN]

I am not sure exactly what circumstances these "new" protections will provide exemption for but as usual, the ACLU is putting words and actions in people's mouth. I don't think this applies to life saving procedures for a patient. However, if someone does have a serious religious objection to something, than they shouldn't have to do it. Abortion is really the only thing that comes to mind though.

[catsmeow1972, BSN, RN]

I think (fair warning: my opinion here) that as with many other things the Trump administration is spouting off with new "regulations and directives" without actually spelling out what they mean. Basically a sentence that pleases his so called base but without any details as to what it actually means, who it pertains to, how to implement it, etc. I would say that this, along with other things that have come out of this train wreck of an administration, has no real chance of ever actually going into effect, because the lawsuits blocking it will tie up the courts for years....

[offlabel]

Well conscience rights and religious rights can be distinct entities and it's why these clauses, at least on some statutory levels, are written to accommodate the more vague "conscience" opt out. They recognize that opposition to, for example, abortion is commonly associated with religious belief but not always and the non-religious have as much a right to objection as religious.

For example if a non-religious gyn NP were presented with a transgendered woman that insisted on a pap smear despite there not being a cervix in the interests of advancing the transgendered woman's sexual identity, would that NP be forced to perform a sham exam despite his or her objection on ethical and conscience grounds?

[Neats, BSN]

The only thing stopping me from assisting would be abortion. Other than this it is my duty as a healthcare professional to assist those in need. Now if the patient does not want my help because I am female, Jewish, an Army Veteran, white, green eyes, too tall, too short, too skinny, too fat, too what ever... these situations belong to the patient not me. I have no problem getting someone else to switch patients with me even if I end up with a higher acuity patient. Its called freedom and I am not going to masticate on it... I would just move on.

The example of Sham exam for transgender pelvic exam when there is none....I would not buy into that and refer to MH where they are subject matter experts (SME) in assisting those who need to "advance their sexual identity" that is clearly beyond my scope of practice.

[offlabel]

brownbook said:

As you noted since 1964 employers can't demand staff perform or assist with abortions.

I don't understand where religion comes into assisting with gender change surgery?

If I can cite religious reasons for refusing to care for a patient.....why can't I say my religion won't allow me to care for Jews or Muslims, etc.?

When anyone cites a religious objection to anything, the burden is on that individual to actually demonstrate that their religion actually holds that particular position, and has held it as a commonly understood tenet for as long as the religion has been in existence. Someone can't say that the way they understand their faith prohibits participation. The faith must have a demonstrable historical doctrine specifically applicable to the situation.

A Catholic can't say that they won't care for a transgendered individual having heart surgery, because their faith teaches against gender reassignment because it's heart surgery. They can, however, opt out of gender reassignment surgical procedures, not because of the enabling of the discrimination against the individual patient, but because of the procedure itself.

[Wannabenurseneko]

What scares me about this is some folks will use this to discriminate against folks, just based on their race as well.

[Jedrnurse, BSN, RN]

offlabel said:

Well conscience rights and religious rights can be distinct entities and it's why these clauses, at least on some statutory levels, are written to accommodate the more vague "conscience" opt out. They recognize that opposition to, for example, abortion is commonly associated with religious belief but not always and the non-religious have as much a right to objection as religious.

For example if a non-religious gyn NP were presented with a transgendered woman that insisted on a pap smear despite there not being a cervix in the interests of advancing the transgendered woman's sexual identity, would that NP be forced to perform a sham exam despite his or her objection on ethical and conscience grounds?

Poor example, as it wouldn't be clinically indicated. No practitioner is forced by a patient to do something that isn't standard of care. (Maybe they would be pestered, but that's different...)

[Been there,done that, ASN, RN]

Why would I trust a guy with a gold elevator? I am here to take care of people, not judge them.

[offlabel]

Jedrnurse said:

Poor example, as it wouldn't be clinically indicated. No practitioner is forced by a patient to do something that isn't standard of care. (Maybe they would be pestered, but that's different...)

I suppose it depends on who is doing the "pestering". But you're right, forcing that person to perform that procedure would be illegal and unethical.