The New York Times provides a disturbing look at the state of legalized abortion in Mexico City.
When Mexico City’s government made abortion legal last year, it also set out to make it available to any woman who asked for one. That includes the city’s poorest, who for years resorted to illegal clinics and midwives as wealthy women visited private doctors willing to quietly end unwanted pregnancies…
Since the city’s legislature voted for the law in April 2007, some 85 percent of the gynecologists in the city’s public hospitals have declared themselves conscientious objectors. And women complain that even at those hospitals that perform abortions, staff members are often hostile, demeaning them and throwing up bureaucratic hurdles.
In other words, abortion was made legal, but actually having access to abortion, especially for poor women, could not be guaranteed in the face of so many health providers refusing to perform the procedure or refusing to treat patients with respect and dignity.
Women in the United States struggle with lack of access to abortion as well, even though the legality of the procedure is protected by the Roe v. Wade Supreme Court ruling. And new regulations (in PDF) released by the Department of Health and Human Services (and previously discussed on this blog here) may make the situation worse. While the exact implications (particularly whether or not they will apply to pharmacists) are not yet entirely clear, the broad language of the regulations could lead to some unfortunate results, especially in areas of the United States where access to abortion and other family planning services is already limited. The regulations state, in essence, that a medical institution could lose federal funding if it discriminates against medical personnel that refuse to perform certain procedures due to religious or moral objections. While it certainly is true, as HHS states, that medical providers do not have an obligation to leave their personal beliefs aside in their work, on the other hand, I can see some disturbing possibilities in these regulations, including but not limited to:
- Would a family planning clinic be forced to tolerate the presence of a doctor that refused to perform essential services of the clinic, including abortion? Would a family planning clinic be forced to reckon with lawsuits from anti-choice doctors who were not hired for open positions because refusing to hire an anti-choice doctor would constitute discrimination?
-Would a family planning clinic be forced to tolerate the presence of other staff that refused to perform essential tasks of their job? What if the appointment scheduler refused to serve patients that called to make appointments for abortions?
-Do these new regulations protect pharmacists that refuse to fill prescriptions for birth control or the morning after pill? Does it protect their ability to discriminate against some patients (for example, refusing to prescribe birth control to unmarried women) because of a supposed religious objection?
-Just how broad will the enshrined right to refuse to provide medical services be? While the California Supreme Court recently held that medical providers in California cannot discriminate against LGBT patients on religious grounds, it appears to me that these HHS regulations might open the door to discrimination of this nature. Does this mean that medical providers in California complying with state law would run afoul of federal HHS regulation?
There are many more unanswered questions with these new rules (which, by the way, have entered their 30 day public comment period; see the above link to the regulations for instructions on how to submit comments). While freedom of conscience for medical providers is important, access for patients to medical care and constitutionally guaranteed medical procedures is essential to maintain the health of society. It is already so difficult for women in many parts of the United States to access their right to safe and legal abortion; any additional obstacle will only hinder this access further. We must be careful as we proceed, or we risk ending up with a morass like that of Mexico City — a guaranteed right without protection of access, worth no more than the paper it is printed on.