Recently, the U.S. Department of Veterans Affairs (VA) issued new regulations. These unconscionable rules, which permit doctors to deny patients vital treatment based on the doctor’s personal beliefs, caused an uproar among the medical community and veterans alike. These changes have a direct effect on how millions of veterans are treated. They do leave us with several important questions regarding the ethics of these policies and the possibility for discrimination in the VA healthcare system.
Under the new regulations, VA doctors can deny care based on a patient’s marital status, political party affiliation, or union activity. This radical shift has drawn sharp rebuke from most historians. They caution that it may lead to harmful, discriminatory enforcement practices toward at-risk communities. Dr. Kenneth Kizer, who served as the VA’s top healthcare official during the Clinton administration, stated that these changes “seem to open the door to discrimination on the basis of anything that is not legally protected.”
Dr. Arthur Caplan is the founding head of the division of medical ethics at New York University’s Grossman School of Medicine. He called the proposed new rules “deeply troubling and unprincipled.” He spoke of the need, more than ever, to bring the patient back into focus. He argued for the separation of personal belief from the practice of medicine.
“You keep your politics at home and take care of your patients,” – Dr. Arthur Caplan
The implications of these revised regulations would be significant. For most of our veterans, traveling in excess of one hundred miles to receive critical medical attention is not a hardship, it’s impossible. As a result, some VA hospitals are implementing new policies without adequately informing or consulting their employees. This Catch-22 creates a real barrier to care for veterans who, for numerous reasons, are often already limited in their access to care.
Documents from several VA hospitals suggest that this change in policy was implemented without consultation with VA physicians. This should send shockwaves through the organization about transparency and how decisions are made. Peter Kasperowicz, the VA’s press secretary at the time, vigorously defended the changes. He argued that these changes were needed to bring VA policy in line with federal law.
“All eligible veterans will always be welcome at VA and will always receive the benefits and services they’ve earned under the law,” – Peter Kasperowicz
The new rules across the nation are indicative of a larger trend. Most people interpret them as a blatant attack on medical independence and scientific integrity by the Trump administration. Critics lament that such policies point to a politicization of healthcare that erodes the basic tenets of medical ethics.
Under the guise of protecting personal beliefs, the VA has opened the door to discrimination. It has further ceased to provide any gender-affirming care and prohibited the use of certain language about gender identity in clinical spaces. This effort is seen as part of a larger initiative titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” which some view as an attempt to restrict access to essential healthcare services for marginalized communities.
The American Medical Association (AMA) went on record by passing a resolution opposing physician-assisted suicide. They are putting front and center their continuing commitment to taking on discrimination in healthcare. The AMA’s position represents a deep concern within the physician community. More importantly, they are concerned about how these macro policy shifts would impact patient care and health equity.
To that end, nearly 26,000 doctors are employed by the VA, serving about nine million patients annually. These new rules will ultimately have a huge effect on thousands of veterans looking to access much-needed treatment. Navy veteran Tia Christopher fearlessly came forward to say she was raped while in the military’s service in 2000. She shared her frustration with the new rules that have reduced her healthcare choices to only three clinics.
These rules are currently being rolled out at several pilot VA medical centers. Providers and leaders across the country are understandably asking how this will affect patient care going forward. Critics argue that the potential for discrimination could create an environment where veterans feel unsafe or unwelcome when seeking necessary medical attention.
“It seems on its face an effort to exert political control over the VA medical staff,” – Dr. Arthur Caplan