WASHINGTON - A Bush administration proposal aimed at protecting healthcare workers who object to abortion and birth control methods they consider tantamount to abortion has escalated a bitter debate over the balance between religious freedom and patients' rights.
The Health and Human Services Department is reviewing a draft regulation that would deny federal funding to any hospital, clinic, health plan, or other entity that does not accommodate employees who want to opt out of participating in care that runs counter to their personal convictions, including providing birth control pills, IUDs, and the Plan B emergency contraceptive.
Conservative groups, abortion opponents, and some members of Congress are welcoming the initiative as necessary to safeguard doctors, nurses, and other health workers who, they say, are increasingly facing discrimination because of their beliefs or are being coerced into delivering services they find repugnant.
But the draft proposal has sparked intense criticism by family planning advocates, women's health activists, and members of Congress who say the regulation would create overwhelming obstacles for women seeking abortions and birth control.
There is also deep concern that the rule could have far-reaching, but less obvious, implications. Because of its wide scope and because it would - apparently for the first time - define abortion in a federal regulation as anything that affects a fertilized egg, the regulation could raise questions about a broad spectrum of scientific research and care, critics say.
"The breadth of this is potentially immense," said Robyn S. Shapiro, a bioethicist and lawyer at the Medical College of Wisconsin. "Is this going to result in a kind of blessed censorship of a whole host of areas of medical care and research?"
Critics charge that the proposal is the latest example of the administration politicizing science to advance ideological goals.
"They are manipulating the system by manipulating the definition of the word 'abortion,' " said Susan F. Wood, a professor at George Washington University who resigned from the Food and Drug Administration over the delays in approving the nonprescription sale of Plan B. "It's another example of this administration's disregard for science and medicine in how agencies make decisions."
The proposal is outlined in a 39-page draft regulation that has been circulated among several HHS agencies.
The FDA has not objected, but several officials at the National Institutes of Health said that the agency had expressed serious concerns.
Since a copy of the document leaked earlier this month, outside advocates and scientists have voiced growing alarm that the regulation could inhibit research in areas including stem cells, infertility, and even such unrelated fields as cancer.
Dozens of members of Congress have sent letters of protest to Health and Human Services Secretary Mike Leavitt, as have scores of major medical and health groups that say their supporters have sent Congress, the White House and HHS thousands of letters protesting the proposal.
HHS officials declined to discuss the draft, saying it is in the very early stages of review. But HHS issued a statement that reads in part: "Over the past three decades, Congress has passed several antidiscrimination laws to protect institutional and individual health care providers participating in federal programs. HHS has an obligation to enforce these laws, and is exploring a number of options."