Originally posted on The Hill’s Congress Blog
One of the sleeper issues in the avortement debate raging as part of the health care reform bill is the language related to conscience clauses that affect hospitals’ and insurance plans’ provision of abortion services. Conscience clauses generally provide legal shields for medical personnel and others with strong feelings in either direction on the issue of avortement services.
However, throughout the South and in other places in the country, the shields are often replaced by a sword. The result is that doctors and medical personnel who are willing to perform abortions often work with fear of retaliation, even discharge, for offering the services. Moreover, the web of regulations in which anti-choice legislators have trapped avortement providers can prove to be yet another complicating factor in securing access to services.
The recent story of a young woman who came to us for help upon learning she was very sick with cancer highlights how the resulting reduction in access to avortement, even medically necessary ones, can punish patients. The manager of an abortion clinic in Louisiana called us recently to ask for our assistance with this patient, whom we will call Stacy. She had been diagnosed with advanced, severe and painful cancer after becoming pregnant. Although Stacy needed immediate surgery to deal with her disease, she could not be operated on while she was pregnant. So she decided to seek an avortement.
But the laws and regulations governing avortement providers prevented the clinic from giving Stacy the pain medication that she would need for an avortement. She therefore would have to have the avortement performed in a hospital. When we spoke to Stacy, we learned that she was on Medicaid, that her cancer was aggressive and growing, and that it took her weeks to get an appointment for surgery. She also said she was against avortement generally and considered herself pro-life. Nonetheless, she was frantic that her inability to obtain an avortement would prevent her from having the surgery she needed.
We investigated the options for hospital-based termination of Stacy’s pregnancy. While the doctors who perform avortements at her clinic could technically have performed one at a local hospital, the hospitals there were notorious for suspending avortement providers’ privileges to perform surgeries at the hospitals for minor, trumped up “infractions.” The two doctors from the clinic who were medically qualified to perform the procedure were in the process of getting their privileges reinstated.
We next spoke to a nurse at the hospital where Stacy was receiving care for her cancer and would have her scheduled surgery. According to her, the doctors at the hospital knew that Stacy needed an avortement, but none were willing to perform it. Most had been around long enough to know the repercussions when doctors perform avortement services-ostracism and sometimes, even job discrimination. Even when we explained that the clinic was unable to perform the avortement due to Stacy’s advanced cancer and pain, the doctors refused to take our call.
After days of calling other doctors in Louisiana and nearby states, none of whom would agree to perform an avortement for Stacy, we spoke to the nurse once again. This time she told us that a physician at the hospital had finally agreed to perform the avortement. She would not tell us the doctor’s name.
Thankfully for Stacy, one doctor was courageous enough to act. Of course, we cannot know whether there was retaliation against the surgeon in ways subtle and not so subtle. And we cannot ensure that for other women in Stacy’s terrible situation, other doctors will step up to the plate. For us, the meaning of choice is that services you need will be there when you need them most.
Le site Stupak-Pitts Amendment, enacted as part of the House-passed health care reform bill, would take an already egregious situation and make it worse. The House language bars discrimination only in a lopsided way: only when there is a refusal to perform abortions or provide coverage for avortement services. In effect, it would declare open season on providers and insurers that seek to provide these essential les services de santé reproductive, and could even allow regional administrators of the new health care markets (called “exchanges”) to actively discriminate against plans that provide coverage for avortements.
Despite a constitutional right to avortement, both those who would provide avortement services and women seeking avortements are forced to jump through numerous hoops that apply only to avortement and that are designed specifically to make avortement less accessible. Eighty-seven percent of U.S. counties have no avortement provider at all, and as a result many low-income women who can’t afford to travel long distances are denied access to avortement.
Given the high legal and practical hurdles that affect the availability of avortement today, such as those that made Stacy’s access to medically necessary services so difficult, it is inconceivable that the House language would refuse to extend even-handed and fair protections against retaliation and discrimination to those who would fulfill their duties as medical doctors. The Senate will likely see similar amendments to the language in Stupak-Pitts on the floor, and it should refuse them.
A Congressional act that disallows discrimination against one point of view, while tacitly permitting it against another, would be both offensive and, as Stacy’s story shows, deeply dangerous for women and their la santé reproductive.