Proposed Rule Lets Conscience Guide Health Care; MORALS Doctors Could Refuse Procedures They Deem Morally Objectionable. MEDICINE Some Contend the Rule Would Prevent Patients from Getting Full Care

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Some say it would violate patients' rights and quality of care. Others say it would protect the moral integrity of health-care professionals.

Either way, the 11th-hour Bush administration "right of conscience" proposal is stirring up controversy.

The Los Angeles Times reported the White House is planning to announce the rule that would permit medical facilities, doctors, nurses, pharmacists and other health-care workers to refuse to participate in any procedure they find morally objectionable, including abortion and possibly even artificial insemination and birth control.

For more than 30 years, federal law has dictated that doctors and nurses may refuse to perform abortions. The new rule -- covering providers that receive federal funds -- would go further by making it clear that health-care workers may also refuse to provide information or advice to patients who might want an abortion, according to the Times.

Reaction to the proposal comes down to differences about who needs the most protection, patients or providers.

The key is finding a balance between the medical needs of patients and moral concerns of providers, said Alissa Swota, an assistant professor of philosophy at the University of North Florida and a medical ethicist at Wolfson Children's Hospital.

"But trying to find the middle ground, that's where the difficulty is," she said.

The proposal seems to give the "weight of authority" to the providers, which could be a real problem for some people turned away by a pharmacist or doctor.

"When you're talking about Jacksonville, Florida, with a Walgreens on every corner, that's not an undue burden," she said. "But if you're talking rural South Dakota, then it might be you have no other option."

Jacksonville pharmacist Anita Thompson said the rule would be a relief because it would protect pharmacists and other health-care professionals from growing efforts in other states to require them to provide any service a patient requests.

"I would like to see it be 'let your conscience be your guide,'" said Thompson, a board member with the Duval County Pharmacy Association and a part-time pharmacist with St. …


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