In 2008, the Obama administration moved quickly to suspend the new HHS regulations, and in 2011 HHS Secretary Kathleen Sebelius officially reversed them, leaving only the complaint system in the HHS Office of Civil Rights — the system that has yet to respond to DeCarlo.
Vanderbilt pushes the limits
In the absence of HHS support, pushback on conscience defenses continues. In 2011 Vanderbilt University's nursing program began requiring program applicants to pledge that they would participate in abortions. "If you are chosen for the Nurse Residency Program in the Women's Health track," the application stated, "you will be expected to care for women undergoing termination of pregnancy. … If you feel you cannot provide care to women during this type of event, we encourage you to apply to a different track."
The Alliance Defense Fund filed a complaint with HHS, and Vanderbilt quickly backed down. "Christians and other pro-life members of the medical community shouldn't be forced to participate in abortions to pursue their profession. That's what federal law says, and that's why Vanderbilt is doing the right thing in changing its policy and application," said ADF Legal Counsel Matt Bowman.
Other medical school entrance practices are harder to monitor. A 1996 study by two doctors at the University of Texas-Houston Medical School, for example, contains piles of interview notes characterizing candidates' religiosity, rigidity and presumed psychological disorders based on religious perspectives and attitudes toward abortion.
Sample comments from interviewer notes included: "He has found God but does not hear voices;" "Negative view of candidate who said she was Catholic and this influenced her view on abortion;" "Thoughts on euthanasia and abortion were downright naive;" "Applicant would dissuade and would not refer patient for abortion;" and "Do not recommend acceptance due to indecisiveness on abortion and pulling the plug."
Contraception blurs lines
Even as medical schools and nursing programs began filtering applicants, the professional norms conflict expanded beyond surgical abortion into pharmaceuticals, blurring the line between them. In the early 1980s, a drug called RU-486 emerged that induces abortion well into the first trimester.
Newer drugs pushed the line back to the first hours or days after intercourse. Two widely used emergency contraceptives (ECPs) are Plan B and Ella, though the term "contraception" itself is disputed by pro-life OB/GYNs. Much hinges on whether one defines life as beginning at conception or implantation.
In 1998 Susan Cohen, now the director of governmental affairs at the pro-choice Guttmacher Institute, defended ECPs by distinguishing them from RU-486, which she called "clearly a method of abortion." Unlike RU-486, she wrote, "ECPs cannot disrupt an established pregnancy, and, therefore, cannot under any circumstances cause an abortion."
The newest ECP is Ella, approved by the FDA in 2010. "Ella is really just a second-generation RU-486," Dr. Harrison said, adding that it is more controversial than Plan B because while Ella can be used to prevent ovulation and implantation, it can also destroy an embryo after it implants — even months into a pregnancy when used in high doses.
Seattle pharmacy under fire
When the state of Washington began requiring pharmacies to carry ECPs in 2007, the owner of two local grocery stores objected. His alternative was a "facilitated referral," meaning he would "refer the customer to a nearby provider and, upon the patient's request, call the provider to make sure the product is in stock."
In February 2012 the U.S. District Court struck down the state regulation, noting that none of the "customers have ever been denied timely access to emergency contraception" and pointing to various secular reasons a pharmacy may not stock certain drugs. The court concluded that "literally all of the evidence demonstrates that the 2007 rulemaking was undertaken primarily (if not solely) to ensure that religious objectors would be required to stock and dispense Plan B." In short, the court held that the policy was crafted to sideline religious objectors.
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