WASHINGTON The Bush administration on Thursday proposed stronger job protections for doctors and other health-care workers who refuse to participate in abortions because of religious or moral objections.
Health and Human Services Secretary Mike Leavitt said that health-care professionals should not face retaliation from employers or from medical societies because they object to abortion.
"Freedom of conscience is not to be surrendered upon issuance of a medical degree," said Leavitt, former governor of Utah. "This nation was built on a foundation of free speech. The first principle of free speech is protected conscience."
The proposed rule, which applies to institutions receiving government money, would require as many as 584,000 employers ranging from major hospitals to doctors' offices and nursing homes to certify in writing that they are complying with several federal laws that protect the conscience rights of health-care workers. Violations could lead to a loss of government funding and legal action to recoup federal money already paid.
Abortion foes called it a victory for the First Amendment, but abortion-rights supporters said they feared the rule could stretch the definition of abortion to include birth control, and served notice that they intend to challenge the administration.
"Women's ability to manage their own health care is at risk of being compromised by politics and ideology," said Cecile Richards, president of the Planned Parenthood Federation of America.
Abortion-rights groups had complained that earlier drafts contained vague language that might block access to birth control, and they said the latest version has not addressed all of their concerns.
The rule "fails to give assurances that current laws about abortion will not be stretched to cover birth control," said Nancy Keenan, president of NARAL Pro-Choice America.
But Tony Perkins, president of the conservative Family Research Council, said it upholds basic constitutional freedoms.
"This proposal ensures that doctors and other medical personnel will retain the constitutional right to listen to their own conscience when it comes to performing or participating in an abortion," Perkins said. "These regulations will ensure that pro-life medical personnel will not be forced to engage in the unconscionable killing of innocent human life."
Leavitt said the regulation was intended to protect practitioners who have moral objections to abortion and sterilization, and would not interfere with patients' ability to get birth control or any legal medical procedure.
"Nothing in the new regulation in any way changes a patient's right to any legal procedure," he said, noting that a patient could go to another provider.
"This regulation is not about contraception," Leavitt added. "It's about abortion and conscience. It is very closely focused on abortion and physician's conscience."
The 42-page rule seeks to set up a system for enforcing conscience protections in three separate federal laws, the earliest of which dates to the 1970s. In some cases, the laws aim to protect both providers who refuse to take part in abortions and those who do.
The regulation is written to apply to a broad swath of the health care work force, not doctors alone. Accordingly, an employee whose task it is to clean the instruments used in a particular procedure would be covered. Also covered would be volunteers and trainees.
The underlying laws deal mainly with abortion and sterilization, but both the laws and the language of the rule seem to recognize that objections on conscience grounds could involve other types of services.
"This regulation does not limit patient access to health care, but rather protects any individual health-care provider or institution from being compelled to participate in, or from being punished for refusal to participate in, a service that, for example, violates their conscience," the rule said.
Planned Parenthood attorney Roger Evans said that a key legal problem with the rule is that it fails to define what constitutes an abortion, and thereby could be stretched to cover other types of services. But Leavitt said existing laws adequately define abortion.
The regulation now faces a 30-day public comment period.