Toppling the Ethical Balance — Health Care Refusal and the Trump Administration


Elizabeth W Sepper


For nearly 50 years, U.S. federal law has permitted medical professionals and religious institutions to refuse, for religious and moral reasons, to provide abortions and sterilizations. But health care providers still bear legal and ethical duties to patients. As reflected in professional ethical guidelines, they must provide information about treatment options, may not abandon patients, and must comply with antidiscrimination laws.

A new rule from the Department of Health and Human Services (HHS) topples this delicate balance. It creates a wide-ranging right to refuse to provide health care services that encompasses referrals and counseling and extends to ancillary personnel. If the rule goes into effect, hospitals, physician groups, and health insurers will face both hardship and uncertainty in attempting to comply with the rule. Under existing federal law, health care facilities already accommodate employees with religious objections. The new rule instead introduces a near-absolute duty of accommodation. This new rigidity threatens other legal and ethical mandates and accreditation rules, especially in emergencies. Vulnerable patients will bear the costs as services denied will result in morbidity and mortality. 

Full Citation

Elizabeth W Sepper, Toppling the Ethical Balance — Health Care Refusal and the Trump Administration, 381 NEW ENG. J. OF MED. 896 (2019).