Federal agency may redefine abortion rules

A proposed federal rule change to redefine pregnancy and abortion would override a recent Minnesota law requiring all hospitals to offer rape victims emergency contraception.

If approved by the Department of Health and Human Services, the rule would broaden the definition of abortion to include the most widely used forms of birth control, which can prevent implantation of a fertilized egg.

The existing abortion definition used by the federal government and medical groups is the removal of a fertilized egg that has successfully implanted in the uterine wall, where it would continue to grow.

The proposal would cut off federal funds to hospitals and clinics that discriminate against people objecting to abortion because of "religious beliefs or moral convictions."

There is no timetable for when a final version of the rule would be made public and open for comment, said an HHS spokesperson. But since news of it leaked two weeks ago, it has inflamed debate around one of the most controversial issues in medicine: Do the beliefs of an individual or organization trump a patient's right to receive legal medical care?

The rule is still being debated within Health and Human Services, and medical organizations, family planning groups and women's advocates across the country have been up in arms about it.

On Tuesday, Minnesota women's health advocates and legislators held a news conference at the State Capitol urging lawmakers to resist attempts to make the proposed rule a reality.

The federal proposal "is really out of the mainstream from how Minnesota women think about birth control and how Minnesotans think of emergency contraception," said House Speaker Margaret Anderson Kelliher, DFL-Minneapolis.

Some conservative political and religious organizations, however, applauded the proposal. "We don't think medical people should be punished for acting on their deep moral convictions on that issue," said Tom Prichard, executive director of the Minnesota Family Council.

The draft proposal states that, despite numerous statutes protecting health care providers from discrimination, "recent events suggest the public and people in the health care industry are largely uninformed of protections" they are afforded. Both federal and state laws forbid discrimination against providers who refuse to perform abortions.

The draft proposal cites a survey of physicians published in 2007 by the New England Journal of Medicine that found that 86 percent of doctors felt they were obligated to present all options to patients "regardless of their own objections." The majority also said they felt obligated to refer patients to other physicians for services they did not want to provide.

That mirrors the standards of the American Medical Association, the American College of Obstetricians and Gynecologists and the Minnesota Hospital Association.

The hospitals initially resisted the law mandating emergency contraception for rape victims because they don't like mandates requiring them to buy and store rarely used medications, Feinwachs said. Even Catholic hospitals generally do not object to providing emergency contraception to rape victims as long as it does not risk an established pregnancy, he said.

Emergency contraception, called Plan B, is a large dose of hormones, the same contained in most birth control pills. If taken within 72 hours of intercourse, it delays ovulation until the chance of pregnancy has passed, but it does not harm an established pregnancy.

However, groups opposed to abortion object to it because it may sometimes interfere with a fertilized egg implanting in the wall of the uterus. IUDs and occasionally birth control pills do the same thing.

The HHS proposal says that "the conscience of the individual or institution should be paramount in determining what constitutes abortion, within the bounds of reason." That includes the belief that life begins at conception, the proposal says. It elaborates that the rule change would mean doctors and nurses would not have to provide information on birth control, prescriptions or give referrals to get it elsewhere. Operating room technicians would not have to clean instruments used in a surgical procedure, the proposal said.