Federal conscience protection laws for health care providers have developed over the past 45 years, generally focusing on the right to refuse to perform, accommodate or assist with certain services — most typically abortion — on religious or moral grounds. But the 1973 Church Amendment, the first of these conscience clauses, is broader. Rather than sheltering medical personnel from workplace discrimination only when they refuse to provide abortions and sterilizations, this law also protects those who are willing to do so.

The Department of Health and Human Services seems to have forgotten these inclusive roots.

In their zeal to underscore the need for strong conscience protections, none of the speakers unveiling the Conscience and Religious Freedom Division mentioned physicians like Willie Parker, an obstetrician/gynecologist who views providing abortion as religious ministry. But Dr. Parker and his colleagues face enormous obstacles to acting upon their moral convictions. Despite Church Amendment protections, abortion providers are often denied admitting privileges and threatened with adverse employment actions, and they face difficulty getting training. That these obstacles were not highlighted by the department is telling, suggesting that its new enforcement efforts are unlikely to safeguard these exercises of conscience.

Health care workers seeking to provide services to the transgender community — care that can be lifesaving — can also face substantial roadblocks despite their belief in an ethical and professional obligation to act in their patients’ best interest. For example, when Lindsey Dawson set out to provide a hysterectomy to a transgender patient seeking to transition, her efforts were impeded by the Catholic hospital where she practiced. Being forced to refrain from care — like being forced to provide it — can conflict with a person’s sense of moral duty. As Dr. Daphna Stroumsa, another physician serving transgender patients, explained to us, “As a matter of conscience, I am called to do this work.”

If the new division is as serious about protecting conscience as it claims to be, it should commit to enforcing the Church Amendment’s existing protections for both refusers and providers of abortion and sterilization services, as Congress intended. More generally, it should recognize that conscientious providers encounter legal and institutional barriers to acting on their convictions. The department should encourage Congress to emulate the Church Amendment’s bidirectional protection in all federal conscience clauses and should use its own policymaking authority to protect providers seeking to promote patient access.