Monday, November 22, 2004

Federal Refusal Clause

The Federal Refusal [to Treat Women] Clause (FRC) has passed both the House and Senate and is now the law of the land (emphasis added):

Congress made it a little easier for hospitals, insurers and others to refuse to provide or cover abortions. A provision in a $388 billion spending bill passed by the House and Senate on Saturday would block any of the measure's money from going to federal, state or local agencies that act against health care providers and insurers because they don't provide abortions, make abortion referrals or cover them.

Moreover, it appears the legal right to refuse women medical treatment is here to stay:

[Sen. Barbara] Boxer [D-Calif] said she has been promised a vote in next year's Senate to repeal the provision. But House Democrats conceded earlier this year that they lacked the votes to stop Republicans from approving the measure, and likely would not have votes to strip the measure next year either.

To refresh your memory, the timeline for this piece of legislation is here.

Specifically, the FRC (pdf, page 99) states that:

d)(1) None of the funds made available in this Act may be made available to a Federal agency or program, or to a State or local government, if such agency, program, or government subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortion. In this subsection, the term "health care entity" includes any individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.

So, under FRC, any federal, state or local law or regulation that preserves access to abortion services and information could be deemed discriminatory and thus not enforceable, unless the government body enforcing the law would be willing to sacrifice all federal assistance made available through the Labor-HHS-Education Appropriations bill (H.R. 5006). Any health care entity, including individual physicians or other health care professionals, hospitals, provider-sponsored organizations, HMOs, health insurance plans, or any other kind of health care facility, organization, or plan, could be allowed to refuse to perform, pay for, provide coverage of, or refer for abortion.

According to Rep. David Weldon (R-Fla) who sponsored the amendment [t]his provision is meant to protect health care entities from discrimination because they choose not to provide abortion services....

An abortion is not a consumer service. Providing an abortion, or a referral for one is medical care. And, in a civilized society, rendering appropriate medical care isn't optional, even when the patient is just a female.

At the risk of stating the obvious, the need for an abortion does not discriminate based on politics, morals, religion, geography, etc. Any woman of reproductive age who is sexually active is at risk of a spontaneous abortion. The treatment for a spontaneous abortion is providing an abortion. And in the case of elective abortions, refusing to provide medical care ups a woman's risk of death from 1:263,000, to 1:10,000.

Of course, as long as health care entities are protected from discrimination, a few dead women here and there are irrelevant.

I think an explanation of my tone is in order. In real life I am more the surgeon type (you know ... cut first, ask questions later) than the IM or psych one. When confronted with a problem my first impulse is to do something about it, rather than to ponder its philosophical aspects. As a rule, on this blog I like to offer you practical solutions, along with any criticism. Unfortunately, in this instance I'm unable to come up with anything useful.

I am totally stuck at the "I-can't-believe-this" stage. I know the FRC is now the law, but I can't understand how normal people [politicians, physicians, laypersons] think it acceptable to deny health care to women in the name of some abstract constructs.

Discussing, debating, and contemplating morality, philosophy, religion, politics, etc., are good for all of us. These activities enrich our mind and expand our horizon. And, since we're all human, it's quite possible, and understandable, for us to think that our beliefs are better than anyone else's. Of course, people can disagree and still learn something from each other; people can also adjust their beliefs. But in the end, when it comes to refusal to treat laws, surely everybody realizes we are talking about real women, and real morbidity and mortality.

Abstract concepts are irrelevant when an 18 year old is undergoing a slow, painful death from a septic abortion, while two agents of the state stand guard by her bed to prevent physicians from rendering care because abortion is not sanctioned by the politicians du jour. [This is not my imagination run wild, this is an actual case report.]

Bottom line: I don't understand how belief can trump reality. Also, not that it matters so much apparently, but as a result of the FRC many women will die, and many more will suffer long-term sequelae. And for what?


At 11:57 PM, Blogger Linkmeister said...

For what? For votes in a re-election campaign down the road, of course. There may be some in Congress who actually worry about the morality of providing legal abortions, but others treat their votes against it like merit badges when they go back on the campaign trail.

At 1:18 PM, Blogger archcrone said...

Linkmeister, if voting to harm women is considered moral (badge of honor), then it is our duty to show the country that it is really IMMORAL.

Ema, this was a very clearly written post, thank you. I too have been stuck in the unbelievable stage, moving towards extreme anger, and it's really hard to be clear when angry.

At 3:04 PM, Anonymous Anonymous said...


I don't mean to doubt you but the horrible story about the 18 year old slowly dying while doctors were prevented from helping her is hard to believe. Are you sure that your source is reliable? When and where did this happen?

At 6:43 PM, Blogger ema said...


E Europe, early 1980s, and I was an accidental [your basic career day at the local hospital situation] eyewitness.

The girl induced an abortion at home, and upon arrival to the hospital (she was already septic at that time), as mandated by law, the secret police had been notified. They were also the ones that decided if the patient may receive medical care or not. In this instance they decided against allowing any care, as a punishment for disobeying the law (abortions were illegal at that time). The MD's (the attending, and even the head of the department) were ready to assist, and were literally pained by their inability to intervene. Had I been a physician at that time, or even old enough to do something about it, I'd probably be dead by now. All this for what? The regime changed, the laws changed [I assume abortion is now legal over there, but I'm not sure], yet real people suffered and died.


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