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HIVMA chair argues new HHS division ‘defies fundamental medical ethic’
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HHS recently announced that a new “Conscience and Religious Freedom Division” in HHS’ Office for Civil Rights has been established to enforce federal laws that protect health care professionals from being forced to provide medical care services that violate their conscience and religious freedom.
“No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice,” Office for Civil Rights (OCR) Director Roger Severino said in a press release. “For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.”
During a press conference, Severino said the number of “conscience complaints” submitted to the OCR has increased in recent years. Ten complaints of “conscience violations” were filed between 2008 and the 2016 election, he said. To date, there are 34.
“With the rise in complaints of religious freedom and conscience, we need to have an institutional force to address them, to deal with them, and to vindicate people’s rights when the law has been violated,” he said.
Examples Severino had given of medical practice that may go against health care providers’ beliefs included abortion services and assisted suicides. However, HIV Medicine Association Chair Melanie Thompson, MD, argued that the impact of the new division “will go well beyond those examples, shifting the foundation for medical decisions ranging from basic preventive services to life-saving care and treatment — from sound, scientific practice to health care providers’ personal beliefs.”
“The [HSS’] establishment of a ‘Conscience and Religious Freedom’ Division is deeply concerning and will roll back critical protections that ensured women, LGBTQ individuals and other minority and vulnerable populations could not be denied medical care,” she said in a statement. “The new division, designed to ‘protect’ health care providers who discriminate in the care and services they provide, defies the fundamental medical ethic to first do no harm.”
Thompson told Infectious Disease News that instead of creating more barriers to medical care, OCR funding should be used to enhance access to care and treatment. For example, she said funds should address pending civil rights complaints filed under Section 1557 of the Affordable Care Act — which prohibits discrimination based on race, national origin, gender, age or disability in certain health programs and activities — that have not been acted upon since 2016. Two of these complaints were filed by the AIDS Research Consortium of Atlanta — a nonprofit, community-based HIV/AIDS research center of which Thompson is principal investigator and executive director — in collaboration with the Harvard Center for Health Law and Policy Innovation. They claim that the health insurance companies Cigna and Humana had placed all recommended HIV treatments at the top of a tiered costing system, resulting in unaffordable out-of-pocket costs for patients with HIV in Georgia. Thompson said the actions violate the civil rights of patients who need the life-saving medications.
“We were told that OCR has a backlog due to inadequate staff to process the complaints,” she continued. “Rather than spending money on legal proceedings about denial of care, we should be ensuring that all Americans get the care to which they are equally entitled under the law.”
The establishment of the Conscience and Religious Freedom Division follows a series of other efforts that rescind protections for vulnerable populations in health care, education, housing and employment, according to Thompson.
“The new HHS division, like other ‘religious freedom’ efforts across the country, is a thinly disguised invitation to stigmatize and discriminate against LGBTQ individuals in the name of religion,” she said.
Among these “harmful actions” include the dismissal of the Presidential Advisory Council on HIV/AIDS, the release of federal style guidelines that advise against the use of the term “transgender,” and the Justice Department’s recent filing of a brief that argues the 1964 Civil Rights Act does not prohibit discrimination based on sexual orientation or gender identity, Thompson said.
“These actions strengthen stigma and discrimination and drive vulnerable populations into the shadows where they are less likely to seek and receive preventive medical care, or to receive timely medical treatment,” she said. “In the setting of HIV, this means not getting tested and not getting access to pre-exposure prophylaxis to prevent acquisition of HIV, and for those who already are living with HIV, not getting into care, not getting life-saving HIV medication, and not controlling the virus to benefit both the individual and to stop transmission to others.”
Referring to a man in Colorado who refused to bake a wedding cake for a gay couple because of religious reasons, Thompson said that “stigma is not just about baking cakes. It’s about life and death.”
“As medical providers, we emphasize that all health care providers have an ethical and professional obligation to provide all patients with humane and competent medical treatment and care,” Thompson said in the statement. “The legislative, judicial and executive branches have an ethical and legal responsibility to ensure that this occurs, and we must hold them accountable when they fall short.”
HHS did not immediately respond to a request for comment. – by Stephanie Viguers
Disclosures: Thompson reports no relevant financial disclosures. Infectious Disease News was unable to confirm relevant financial disclosures for Severino at the time of publication.