You are a physician being asked to provide a treatment or a procedure for a patient which you believe violates your conscience. Where does a physician’s or healthcare worker’s religious freedoms under the First Amendment and a patient/citizen’s rights to equal protection and access to the law begin and end?
Feds Create Healthcare “Conscience and Religious Freedom” Office

On January 18, 2018 the Department of Health and Human Services (HHS) formally tackled that issue by forming a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR).
OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information.
OCR Director Roger Severino said, “Laws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. 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. 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.”
Then Acting HHS Secretary Eric Hargan said, “President Trump promised the American people that his administration would vigorously uphold the rights of conscience and religious freedom. That promise is being kept today.”
The agency is reportedly drafting rules to define the circumstances in which healthcare workers could refuse to provide services to which they had moral or religious objections.
The American College of Physicians (ACP) immediately cautioned that the creation of the new division “must not lead to discrimination against any category of class of patients, as guided by the medical profession’s ethical obligations.” ACP President Jack Ende, M.D., MACP, said, “By history, tradition, and professional oath, physicians have a moral obligation to provide care for ill persons. Although this obligation is collective, each individual physician is obliged to do his or her fair share to ensure that all ill persons receive appropriate treatment. A physician may not discriminate against a class or category of patients.”
U.S. Senator Patty Murray, a Democrat, said in the New York Times that the Trump Administration was using the civil rights office as “a tool to restrict access to health care for people who are transgender and women.”
Physicians have had to make hard moral judgements about care since Hippocrates. Now the federal government has given them a bureaucracy to help them. What could go wrong?
To learn more about the new Conscience and Religious Freedom Division, click here.
To file a complaint with OCR based on a violation of civil rights, conscience or religious freedom, or health information privacy, click here.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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