PROTECTING THE RIGHTS OF CONSCIENCE OF HEALTH CARE PROVIDERS AND A PARENT'S RIGHT TO KNOW THURSDAY, JULY 11, 2002 HOUSE OF REPRESENTATIVES, COMMITTEE ON ENERGY AND COMMERCE, SUBCOMMITTEE ON HEALTH, Washington, DC. The subcommittee met, pursuant to notice, at 3 p.m., in room 2322, Rayburn House Office Building, Hon. Michael Bilirakis (chairman) presiding. Members present: Representatives Bilirakis, Burr, Norwood, Pitts, Tauzin (ex officio), Brown, Strickland, Capps, Towns, Deutsch, and Wynn. Staff present: Patrick Morrisey, deputy staff director; Cheryl Jaeger, majority professional staff; Steven Tilton, health policy coordinator; Eugenia Edwards, legislative clerk; John Ford, minority counsel; and Jessica McNiece, minority staff assistant. Mr. BILIRAKIS. I call this hearing to order and first would like to thank our witnesses for appearing before the subcommittee today. This subcommittee certainly values your expertise, and we are very grateful for your cooperation and attendance. And as you good people fall in, please, let us try to be orderly. Today's hearing will touch on two subjects that I know many members of the subcommittee, myself included, feel very strongly about. Because of the vastly divergent views and strong feelings invoked by the issues we will be discussing today, I believe it is important to have a hearing which will afford us the opportunity to listen to different viewpoints. And I think this open dialog and expert testimony will aid all members in making an informed decision about how best to legislate in this area. Our first panel will discuss an issue that we commonly refer to as the conscience clause. In 1996, the Congress passed, and President Clinton signed into law, provisions that provide protections to health care professionals and a, "health care entity" from being forced to perform abortions if they have moral or religious objections to the procedure. However, court interpretations have called into question whether these sections of law apply to hospitals that object to offering elective abortions. In 1998, a number of senators attempted to clarify the record by stating that a health care entity was defined to include physicians and other which does not mean that it excludes hospitals. However, this clarification has not been sufficient and it has come to my at (1) tention that we need to amend the current statute to ensure that hospitals are covered by the conscience clause. Consequently, I have introduced H.R. 4691, the Abortion Non-Discrimination Act, to guarantee that all health care entities are afforded the important protections provided by the original law, as I believe was intended. Our second panel will discuss the issue of whether parents have the right to know if their children receive contraceptive devices or drugs from title X family planning clinics. And, again, this is an issue where most of us have had some experience in the raising of our children. And I think it is safe to say that most parents have strong feelings about wanting to know what is going on with their children's health, and as a parent, I certainly can identify with this notion. Title X regulations specifically prohibit health care providers from informing parents of their child's actions to seek contraceptives. I am interested to hear from our witnesses today whether title X rules allow for appropriate flexibility and deference to the health care professionals that provide care in these clinics. Can a doctor use his or her best judgment about notifying a child's parents about health concerns when providing care to a minor? Question. Again, I know these are difficult issues, and I look forward to hearing from our witnesses so we can make informed decisions about how best to proceed, and I now recognize my good friend from Ohio, Mr. Brown, for his opening statement. Mr. Brown. Mr. BROWN. Thank you, Mr. Chairman. This afternoon we will discuss the merits of a proposal to permit health care entities to refuse to comply with Federal, State and local laws pertaining to abortion services. We will discuss parental consent requirement for access to reproductive health services. I want to thank Ms. Weiss for joining us, Dr. Jenkins and the other distinguished panelists. The majority has labeled the first issue for debate a clarification of existing law. They will argue the legislation clarifies a provision of law known as the Coats Amendment, adopted, as the chairman said, in 1996 omnibus appropriations bill. The Coats Amendment allowed post-graduate physician training programs that chose not to provide or refer for training and abortion procedures to still qualify for Federal funding. This so-called clarification bill would dramatically, dramatically expand this narrow law. Let me be clear, this is not simply a technical amendment. It is a sweeping expansion to the law that would override Federal and State and local laws. This bill expands this scope of the law beyond graduate medical programs and permits any health care entity, including insurance companies and hospitals and HMOs to refuse to perform, to refuse to provide coverage of, to pay for or refer for abortions. In the interest of time, I want to mention just one example of how this bill is egregious and irresponsible, putting a political agenda, in my mind, above access to critical and human health care. The Federal Hyde Amendment ensures Medicaid patients access to abortion services in cases of rape, incest or where the pregnancy endangers the woman's life. The chairman's bill would override these standards of care. The bill would give the HMOs the legal standing to refuse to adhere to the Hyde Amendment. That is a major policy change with tremendous ethical implications. The chairman's bill also blurs the line between medicine and personal preference. How does this differ from a health care facility or an insurance company denying a critical procedure based on an ethnic bias or a racial bias? And I want to point out that once again the same Members of Congress who claim to be staunch champions of State and local sovereignty, who want to block grant Medicaid to gives States more flexibility, who want to privatize Medicare because it is a "one-size-fits-all," program, who constantly demonize the one-size-fits-all mentality of the Federal Government are now trying to impose a one-size-fits-all refusal clause at the State and the local level. Once you get into the realm of religion and ethics and morals, my conservative colleagues have no problem using the heavy hand of the Federal Government to stifle different perspectives at the State and local level. Second issue we will discuss this afternoon is parental consent. title X, the only Federal program dedicated exclusively to funding family planning and reproductive health care services has helped to prevent unintended pregnancies, reduce abortions, lower the rate of STDs, including HIV, and improve women's health overall. A study 4 years ago reported that teen pregnancy rates fell 17 percent sine the rate peaked in 1990, and 75 percent of this decline reflects improved contraceptive use among sexually active teens, 25 percent due to reduced sexual activity. That is a very impressive track record that an overwhelming majority of Americans support. What we are considering today would undermine the inherent value of a title X clinic, confidential access to family planning services, and require teens to get the consent of their parents before receiving contraceptives. While family planning clinics encourage minors to involve their parents in health care decisions, an admiral thing, as Chairman Bilirakis said, Congress cannot and should not write laws that will achieve communication between and adolescent and her or his parents where it simply doesn't exist. The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Nurses Association, the American Public Health Association, the American Academy of Family Physicians, among many other respected members of the medical community, all oppose, all those groups that are so involved in this kind of medical care oppose mandatory parental consent or notification requirements for teens receiving services at a title X family planning clinic for obvious reasons, that children and parents, young teens and parents don't always communicate as well as we would like. This committee should respect the medical community's opinion as well as the success, the success that family planning clinics have achieved in reducing unintended teen pregnancies. Reducing unintended pregnancies is, after all, the key goal, it is a bipartisan goal, it should remain a bipartisan goal. I thank the chairman. Mr. BILIRAKIS. The Chair thanks the gentleman. The Chair recognizes the chairman of the full committee, Mr. Tauzin, for an opening statement. Chairman TAUZIN. Thank you, Mr. Chairman. I want to thank you for holding this hearing today. I am pleased the committee is addressing two important ethical questions that impact health care The first question we ask is should the Federal Government re- On the first question, it is important to note that for over 30 years State and Federal Governments have passed conscience clause statutes intended to protect health care providers from being coerced into performing procedures that violate their moral and religiously held beliefs. I supported these laws in the past, and I hope we can all continue to do so in the future. A health care provider should never be forced to abandoned his or her moral values and religious beliefs and be required to perform a particular procedure. I would like to express my appreciation for the work of Chairman Bilirakis in raising awareness on this important issue. The chairman has offered the Abortion Non-Discrimination Act of this year, H.R. 4691, to clarify the intent of existing law so that it clearly prohibits the discrimination of health care entities who refuse to perform abortions. I strongly support this bill and encourage my colleagues to co-sponsor the bill if they have not already done so. On the second question we are addressing today, I am frankly very pleased we are beginning to take a closer look at whether or not parents should be denied information about whether a minor that they are legally responsible for is permitted access to contraceptives. And while there are substantial differences of opinion regarding the value and effectiveness of title X programs, current title X regulations do not permit health care providers to use their best judgment or even discuss sensitive health care issues with parents without the express consent of the minor. I think this turns things on its head. We learned, for example, at our welfare reform hearings last April, that when we were growing up, in the sixties, there were really two sexually transmitted diseases of great concern to be worried about. We were told today there are 25, and they include such diseases affecting young men and women in our society, very often ။ women, as HPV, herpes and chlamydia. These are viral diseases; they cannot be cured, only managed. And when a title X clinic provides contraceptives and condoms to teens without the parent's consent or notification and there is no evidence that condoms reduce the sexual transmission of many of these infections, the health of these children, in many cases young women of our country, is put at risk without the parents even knowing that is occurring. That doesn't make sense to me. And when title X clinics allow a child to begin taking a prescription drug or to have access to contraceptives, that encourage a child to make a choice to engage in sexual activities, that put them at risk for diseases that can't be cured, in some cases are non-detectable, they don't even know they have them until they find out they have lost their ability to have children because the disease has destroyed the reproductive capacities. Or they have now incurred a disease that maybe a precursor to cancer because their parents didn't have the chance to tell them maybe this isn't such a good idea for you, maybe you ought to try abstinence, because the parents didn't know because the title X clinic couldn't talk to the parent about these kind of important decisions that parents and children should be making in their lives. Something has gone terribly wrong. If we only had these two diseases in the 1960's to worry about today, that would be one thing. Think about what young people are facing today, and think about the role that parents are being denied in caring for their own children and worrying about them, helping them make the right decisions. And I think you get a sense of why this is an important hearing today. So Mr. Bilirakis, I want to thank you for conducting it, and I want to thank the witnesses who are going to come share their thoughts with us today. I hope we learn a little bit today, and maybe we will quell politics with the issue and begin thinking about what really is best for the children of our country. Thank you, Mr. Chairman. Mr. BILIRAKIS. Thank you, Mr. Chairman, for your statement. The gentlelady from California, Ms. Capps. Ms. CAPPS. Thank you, Mr. Chairman. And I appreciate your holding this hearing, and I appreciate our expert witnesses for being with us today. Today, I am speaking and listening, not just as an elected representative but as a mother and a grandmother, a public health nurse and the former director of the Santa Barbara School District Teenage Pregnancy and Parenting Program, a program which provided, and does still provide, child care and development, child development services for school-age parents. I have first-hand real world experience with young men and women struggling with the difficult subject of sex. I have dealt with teenagers trying to cope with the ramifications of bad decisions, and I have worked with young women as they strive to make life-altering decisions. And I have seen the terrible results when we turn our back and deny them help. So today's subjects are of great personal interest to me, and I have significant concerns about them. First of all, I can tell you from my experience that parental consent requirements for title X services will result in higher teenage |