Conservative groups welcomed what they call “conscience protections” for health care workers and others, while LGBTQ and women’s groups warned the rule would reduce services and potentially harm patients if providers refuse to deliver certain care, or treat gay and transgender people.

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“Religious liberty is a fundamental right, but it doesn’t include the right to discriminate or harm others,” said Louise Melling, deputy legal director at the American Civil Liberties Union. “This rule threatens to prevent people from accessing critical medical care and may endanger people’s lives. … Medical standards, not religious belief, should guide medical care.”

Religious conservatives counter that such protections are necessary because of increasing mandates to provide care and ineffectual enforcement of existing statutes protecting workers.

“No health-care worker should ever be forced to choose between their practice or their faith,” said Ashley McGuire, a senior fellow at the Catholic Association. “That principle is enshrined in countless laws and regulations but has been violated for far too long.”

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Trump’s remarks on the National Day of Prayer were the third time he has used the 67-year-old annual multifaith observance to make announcements addressing the concerns of Christian conservatives, who are a large part of his base. During his first year in office, he promised to make it easier for religious leaders to speak openly about politics. On Thursday, he said the Johnson Amendment, which prevents churches from endorsing political candidates, has been effectively eliminated, though it would take an act of Congress to officially strike it.

At the White House Rose Garden ceremony, Trump also noted the three black churches set aflame in Louisiana, along with the bombings of churches in Sri Lanka, the attack on a mosque in New Zealand and the attack on a synagogue in Pittsburgh last year.

“We will fight with all our strength and everything that we have in our bodies to defeat anti-Semitism, to end the attacks on the Jewish people and to conquer all forms of persecution, intolerance and hate,” he said. Rabbi Yisroel Goldstein, who lost his finger during a shooting at his synagogue last week in Poway, Calif., thanked Trump for “being, as they say in Yiddish, ‘a mensch par excellence.’ ”

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The final rule regarding health care — issued by the Department of Health and Human Services — explicitly mentions abortion, sterilization, assisted suicide and advance directives as issues, and says that individuals and entities — from medical students to people who prep patients before operations to charitable groups — could object on religious or moral grounds.

It also includes language that supporters and opponents alike said would ratchet up parents’ right to dictate whether their children receive several types of care, diminishing the role of the government in guaranteeing youngsters’ well-being.

Saying that these parental rights flow from existing federal laws, the rule says that children cannot be made to undergo suicide assessment or early treatment if their parents or legal guardian hold religious or moral objections to such services. And in any state that allows parents to exercise religious objections to childhood vaccines or to testing newborns for hearing loss, doctors must heed those parents’ wishes.

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“We think it’s important to protect parental rights against. . the government,” said Travis Weber, vice president for policy for the Family Research Council, a conservative Christian think tank and advocacy group. “We are looking broadly at family integrity. Families can govern themselves.”

Some groups on the left, however, were outraged.

The rule “gives a very broad exemption to people to not provide care for kids,” said Mary Alice Carter, executive director of Equity Forward, a reproductive rights group. “If you are a six-year-old or a four-year-old, you can’t say, ‘I want to have immunity to measles.’ If your health-care provider can no longer protect the patient, and the patient is a child, we’ve created a dangerous precedent.”

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The rule broadly defines, or in some cases redefines, key terms in the law such as discrimination, referrals and what it means to assist in a procedure. It also meticulously lays out religious exemptions in detail, both in terms of the types of workers that are covered and specific situations that might arise.

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Such “conscience protections,” as conservatives describe them, have become a flash point in recent culture war debates. In a high-profile battle with the Obama administration, for instance, several religious institutions objected to HHS’s mandate that employers must cover employees’ contraception.

Speaking to reporters, HHS Office of Civil Rights Director Roger Severino said conscience-related complaints have increased from an average of 1.25 a year under the Obama administration to 343 in the last fiscal year.

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The rule expands the powers of the civil rights office — requiring health-care entities to maintain records and report and cooperate with OCR requests. These new mechanisms, Severino said, will ensure “Congress’ protections are not just empty words on paper.”

Health-care providers and civil rights groups, however, expressed worry the rule could compromise patients’ well-being in ways large and small. On page 80, for instance, HHS appears to allow for the possibility that ambulance drivers, or EMT personnel, could refuse care in certain situations.

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“It appears that a paramedic could refuse to drive a woman having an emergency – such as an ectopic pregnancy – because they object to the treatment she will receive at the hospital,” Heather Shumaker, senior counsel at the National Women’s Law Center.

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Others feared the rule would be used as cover for discrimination.

“The administration’s decision puts LGBTQ people at greater risk of being denied necessary and appropriate health care solely based on their sexual orientation or gender identity,” said David Stacy, government affairs director for Human Rights Campaign, the nation’s largest LGBTQ advocacy group.

Social conservatives said that the rule was needed at a time when many health care workers feel intimidated about standing up for what they believe is right.

“There are over 20 federal laws protecting against this, and many more at the state level,” tweeted Montse Alvarado, executive director of the Becket Fund for Religious Liberty. “But these laws often go unenforced. So today’s regulation makes clear that HHS can enforce them—mainly by showing violators how to improve, but also by cutting off federal funds for those who refuse to follow the law.”

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“Though these laws were passed on a bipartisan basis and have been policy for years, the previous administration did not fully enforce them, and now they are increasingly being violated,” said Archbishops Joseph F. Naumann of Kansas City, Kans. and Joseph E. Kurtz of Louisville, both chairmen of the U.S. Conference of Catholic Bishops. “Health care providers like New York nurse Cathy DeCarlo and medical trainees have been coerced into participating in the brutal act of abortion against their core beliefs, while churches and others who oppose abortion are being compelled by states like California to cover elective abortion—including late-term abortion—in their health plans.”

Under President Barack Obama, HHS replaced a rule passed during the administration of George W. Bush that was interpreted as allowing medical workers to opt out of a broad range of medical services. Obama’s narrower version left in place long-standing federal protections for workers who object to performing abortions or sterilizations, and it kept the ability for workers to file complaints.