[Congressional Record Volume 142, Number 38 (Tuesday, March 19, 1996)]
[Senate]
[Pages S2268-S2277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
BALANCED BUDGET DOWNPAYMENT ACT, II
The Senate continued with the consideration of the bill.
Mr. KENNEDY. Mr. President, I understand the time is controlled. I
yield myself 12 minutes from Senator Boxer.
The PRESIDING OFFICER. The Senator from California has 5 minutes
remaining. Senator Murray has 7\1/2\, and Senator Feinstein has 7\1/2\.
Mr. KENNEDY. I yield myself 3 minutes, Mr. President.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 3508
Mr. KENNEDY. Mr. President, very briefly, there are two major
proposals before the Senate this afternoon. One proposal prohibits the
District of Columbia from using locally raised funds to provide
abortions for its residents. It allows the Congress of the United
States to undermine the constitutional rights of poor women and thus,
their ability to receive an abortion.
We do not interfere with the disbursement of local funds in any of
the States because it is inappropriate to dictate State and local
policy in this area. It is equally inappropriate to impose the will of
the Federal Government on the District of Columbia. This is the long
arm of the Federal Government reaching in and dictating the health
conditions for needy women in the District. Many of these women have
determined that they must have an abortion but, because they are poor,
they need assistance from the District of Columbia. District of
Columbia elected officials should have the ability to allocate funds to
women in these circumstances.
Second, I reject the belief that the Senate should determine medical
residency training criteria as it pertains to issues regarding women.
This is the first real attempt to superimpose Congress' view on
obstetric and gynecological medical training. Today, we are saying we
will not require that medical training institutions provide abortion
training for ob/gyn residents. Tomorrow, we may be making policy and
setting standards in another area of medical training. Congress should
leave the practice of medicine to the doctors. In this case, a highly
respected board is attempting to insure that we have the best-trained
physicians in the world. We have already acceded to a conscience clause
that protects religious and moral beliefs of institutions and
residents. Those individuals and institutions will not be required to
participate in certain medical procedures that violate their conscience
or their religious training. But to go beyond that by passing a law
that substitutes congressional and political opinion for medical
decisionmaking is wrong. Congress should not interfere with current
ACGME policy. It is an inappropriate use of our authority. It is bad
policy and it is bad medicine. We should reject this proposal.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. KENNEDY. Mr. President, I yield whatever time remains.
Mrs. BOXER addressed the Chair.
The PRESIDING OFFICER. The Senator from California.
Mrs. BOXER. I yield myself 1 minute just to say to the Senator from
Massachusetts how grateful I am that he expressed his views on the
floor. This has been a very difficult morning because there was a
modified amendment which, unfortunately, I could not get to analyze
until this morning. And the Senator is right. We already have a
conscience clause. Any institution who has a moral or religious
objection to teaching abortion is covered under current law, and what
this would say is that any institution, even if they did not have a
moral or religious objection, would not have to teach residents how to
perform safe, competent abortions so that our women are safe.
On the matter of Washington, DC, I wish to tell the Senator that
there are 3,049 counties, 19,100 cities, and every one of them has the
right to spend their locally raised funds as they wish. To pick out one
entity and reach the long arm of the Federal Government into it is
really unfair and goes against the supposed spirit of this Republican
Congress. So I thank my friend very much.
The PRESIDING OFFICER. The Senator has used her 1 minute.
Who yields time?
Ms. SNOWE addressed the Chair.
The PRESIDING OFFICER. The Senator from Maine.
Ms. SNOWE. I thank the Chair.
The PRESIDING OFFICER. The Senator from Maine has 30 minutes
allocated to her under the previous order.
Amendment No. 3513, as Modified
Ms. SNOWE. I will consume as much time as I require. I thank the
Chair.
I rise today to join the distinguished Senator from Indiana in
offering an amendment that I think will address many concerns. In fact,
I am pleased to have the opportunity to clarify some of the
misinformation that has been expressed regarding this compromise
amendment.
No one can question whether or not it is appropriate to ensure
quality care for women in America. No one can question that we need to
maintain accreditation standards for medical institutions across this
country. The fact remains that this amendment on which I worked in
conjunction with the Senator from Indiana does not allow Federal funds
to go to an unaccredited institution because they fail to provide for
abortion training.
Nothing could be further from the truth. This amendment accomplishes
two things. One, it does protect those institutions and those
individuals who do not want to get involved in the performance or
training of abortion when it is contrary to their beliefs. Second, and
just as important, it preserves the quality of health care that will be
provided to women because it protects the universally accepted
standards--there is only one set of standards--of the Accreditation
Council for Graduate Medical Education that provides for quality
standards for ob-gyn programs. So this amendment would not only make
sure that women have access to quality health care with the strictest
of standards when it comes to quality and safety but it also will
ensure that they have access to physicians who specialize in women's
health care.
I do not think anybody would disagree with the fact--and I am pro-
choice on this matter, but I do not think anybody would disagree with
the fact that an institution or an individual who does not want to
perform an abortion should do so contrary to their beliefs. But at the
same time we have to make sure we preserve the accreditation standards
that are established by the Accreditation Council for Graduate Medical
Education, that provides for the standards for more than 7,400 medical
institutions in America.
[[Page S2269]]
We want to make sure we do not undo 50 State licensure boards with
respect to overturning or overriding this one set of accreditation
standards. That is what we were dealing with, and hence this compromise
here today, because whether we like it or not--and certainly I do not
like it--in the House of Representatives they have already passed
legislation that would allow Federal funds to go to an unaccredited
institution. That is a fact, and that is unacceptable. That is why I
worked with the Senator from Indiana to ensure that would not happen.
Contrary to what has been said here today, 88 percent of medical
institutions in this country do not provide abortion training even
though it is implicitly required in the accreditation standards. So we
are not broadening this issue to provide for an exodus from performing
or participating in abortion training. Eighty-eight percent of the
institutions currently do not provide it, even though there is a
conscience clause.
So this legislation is saying we do not want what is going to happen
in the House of Representatives with the accreditation standards being
dismissed and abandoned. That is an issue and that is a reality. That
is why I worked with the Senator from Indiana to ensure that we
preserve the one set of standards in America that the Federal
Government relies on for the purposes of Federal funding, that medical
students rely on for the purposes of Federal funding, that physicians
rely on in terms of judging standards, that patients and consumers and
States rely on in terms of determining their licensing procedures.
So the choice was not to address the reality of what is taking place
in the House or making sure, more importantly, that the Senate was on
record in opposition to that kind of language and developing a
compromise with the Senator from Indiana to ensure that we maintained
the accreditation standards for all medical institutions to advance the
quality health care for women and at the same time to allow training
for abortion for those who want to participate in that training or for
the institutions who want to provide it. Because that is the way it is
done now. That is the status quo, and that is not changing.
I know consensus and compromise is not the norm anymore. I think it
is important on this issue because abortion is a very divisive issue.
No one can challenge me on where I stand on this issue. But I think it
is also important to make sure that we preserve quality health care for
women in America. I do not want to see these accreditation standards
undone, and that is what the legislation that was originally pending
would have done. The House language went much further than that. This
is a compromise to preserve those standards. This is a compromise to
ensure that it does not jeopardize the 273 ob-gyn programs that
otherwise would have been affected if this compromise was not before
us. That is the risk, and that is why I worked with the Senator from
Indiana to ensure that would not happen.
It is inappropriate for this institution to be involved in the
accreditation standards or curriculum, but that is not what we are
dealing with here. It has already happened. I want to be able to go to
conference to ensure that the House language is not adopted, and the
best way to do that is to ensure we can pass language that everybody
could agree on, that represents a consensus and does not jeopardize the
kind of care that women in America deserve. That is what this
compromise amendment is all about.
I urge adoption of this compromise amendment. To do otherwise is to
risk getting the House language in the final analysis. That, indeed,
would set a very dangerous precedent.
Mr. President, I yield 5 minutes to the Senator from Indiana.
The PRESIDING OFFICER. The Senator from Indiana is recognized for 5
minutes.
Mr. COATS. Mr. President, I thank the Senator from Maine for her
diligent work with us in clarifying language here and for her
articulate statement of support and the reasons why she supports this
particular amendment. I will not repeat those, but I think they clearly
make the case.
I would like to respond, also, to the Senator from California, who
indicated that one of the reasons why she opposes the Coats amendment
is that we will not have medical personnel adequately trained to
perform abortions if necessary.
I would like to state for the record that an ACGME member--the
certifying body--ACGME member submitted testimony to the Senate Labor
and Human Resources Committee that the D&C procedures that are taught
to every ob-gyn and procedures used in cases of miscarriages and those
of induced abortion require similar experience. Numerous ob-gyn's have
indicated to us--and I have a pile of letters here from them,
indicating so, and I will be happy to submit those for the Record--that
an OB-GYN who is trained, as they must be trained, to perform D&C
procedures in the case of spontaneous abortions, are more than
adequately prepared, should the need arise, to perform an induced
abortion. Again, I have an extensive set of letters from those who are
trained in those procedures, indicating that is the case.
In short, a resident needs not to have performed an abortion on a
live, unborn child, to have mastered the procedure to protect the
health of the mother if necessary. Maternal health will not be improved
by forcing ob-gyn's to perform abortions on live fetuses if an ob-gyn
will not do an abortion in actual practice. But it is clear from the
record that they will have sufficient training to do so if necessary.
Second, I would like to just once again, for my colleagues' benefit,
indicate the support of Dr. Bill Frist, the Senator from Tennessee, for
this amendment, who has stated, ``The Coats amendment will protect
medical residents, individual physicians, and medical training programs
from abortion-related discrimination in the training and licensing of
physicians.'' ``However,'' he goes on to say, ``in our efforts to
safeguard freedom of conscience, there are limits to what Congress can
impose on private medical accrediting bodies. I believe this amendment
stays within the confines of the governmental role and addresses the
matter of discrimination in a way that is acceptable to all parties.
The Congress is responsible,'' he goes on to say, ``for the Federal
funding that is tied to accreditation by the ACGME, and as public
servants we must ensure that there is no hint of discrimination
associated with the use of public funds, and that is exactly what this
amendment does.''
Amendment No. 3508
I would like to respond to the issue raised in the second amendment,
the amendment offered by the Senator from California, relative to the
use of funds for abortions in the District of Columbia. It is clear, as
the Constitution so states, that article I, section 8, gives this
Congress exclusive legislation over all cases whatsoever in the
District of Columbia. It is stated in the Constitution clearly. It has
been the basis on which we have operated, and it is a constitutional
basis. In all matters relative to the District of Columbia, the
responsibility for protection of those and implementation of those and
establishment of those is established in the Constitution of the United
States.
Public law 931-98, the home rule law, is consistent with this
constitutional mandate, because it charges Congress with the
responsibility for the appropriation of all funds for our Nation's
Capital. The Congress, then, bears the ultimate constitutional and full
responsibility for the District's abortion policies.
Second is the question of separating or mingling.
I ask the Senator from Maine if I could have an additional 2 minutes
from her time?
Ms. SNOWE. Mr. President, how much time do I have left?
The PRESIDING OFFICER. The Senator from Maine has 17 minutes
remaining.
Ms. SNOWE. Yes, I yield the Senator 2 additional minutes.
Mr. COATS. Second, let me state this idea of separating Federal from
District funds is nothing more than a bookkeeping exercise.
Essentially, what would happen is that the so-called District funds
would allow the local government to continue funding abortion on
demand. I do not believe that is something this Congress endorses. I do
not believe that is something that we should not deal with as
[[Page S2270]]
we have dealt before. The separation of Federal funds from District
funds is a distinction without a difference, given the constitutional
mandate and the practice of this Congress to appropriate all funds for
expenditure in the District. We all know that the District has one of
the more permissive, if not one of the most permissive abortion funding
policies in the country. It is essentially unrestricted abortion on
demand. I do not believe that is what this Congress wants to authorize
for the District of Columbia, and we have, on numerous instances,
addressed this issue.
In the conference report that is before us on the omnibus funding
bill, this was discussed at length. The language that is incorporated
is language that has been agreed to by the conferees. It does allow the
use of funds for abortions to protect the life of the mother or in
cases of rape or incest. Members need to understand that. What we are
not trying to do, what we are opposing, what I am opposing and others
are opposing, is the use of those funds for unrestricted abortion,
abortion on demand. That is the issue before us on the Boxer amendment,
and I urge my colleagues to vote no on that and vote yes for the Coats
amendment, which is a separate issue, and that is the discrimination
issue relative to the use of Federal funds for hospitals that provide
abortion.
I yield.
Mrs. BOXER addressed the Chair.
The PRESIDING OFFICER (Mr. Campbell). The Senator from California
[Mrs. Boxer] is recognized.
Mrs. BOXER. Mr. President, Senator Feinstein offered me her time. I
ask unanimous consent that I be allowed to use her time.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. BOXER. I ask the President how much time Senator Feinstein has.
The PRESIDING OFFICER. Senator Feinstein has 7\1/2\ minutes.
Mrs. BOXER. And I believe I have a minute and some?
The PRESIDING OFFICER. The Senator from California has 1 minute 15
seconds.
Mrs. BOXER. Mr. President, will you let me know when I have 5 minutes
remaining?
The PRESIDING OFFICER. Yes, the Chair will.
Mrs. BOXER. Thank you very much, Mr. President. I want to respond to
Senator Coats' point on the D.C. issue when he says, ``Look, we still
allow them to use their own local funds for rape and incest but not for
abortion on demand, not for unrestricted abortion.'' I want to make
this point because over and over again in this debate by the anti-
choice Senators, they use the terms abortion on demand and unrestricted
abortion. They use the terms and ignore the holding of Roe versus Wade.
Anyone who has read Roe versus Wade knows the anti-choice Senators
are not using the terms correctly. According to Roe, in the first 3
months of a woman's pregnancy, she has a right to choose. That is her
legal right. The Supreme Court has decided it, and even in this more
conservative Court, has reaffirmed it.
Clearly, a poor woman in Washington, DC, cannot get access to
Medicaid funding, and the only option she would have, except for
charity, would be Washington, DC's own locally raised funds, Mr.
President. We do not stop any one of the 3,000-plus counties in this
country from using their local funds if they wish, if they desire to
help a poor woman. We do not tell the 19,100 cities that they cannot
use their locally raised funds.
Washington, DC, does have property tax funds, and they have other
funds that clearly are raised by them. If they feel it is a priority to
help a woman in poverty in a desperate situation exercise her right to
choose, I do not think the long arm of U.S. Senators ought to reach
into that situation. That ought to be her own private personal decision
and the decision of the locality to help her out.
So I hope that there will be support for the Boxer amendment.
Amendment No. 3513
As to the Coats amendment regarding Federal funding to medical
schools, I want to reiterate what I think is a very important point.
The Senator from Indiana says, ``There is not going to be any danger,
no one is going to be put in danger by this. So what if every single
teaching hospital and medical school says, `We will not teach our
residents how to do surgical abortion.''' He says, ``Oh, they will have
enough training in emergency areas, D&C's, and other ways.''
I do not think the Senator from Indiana would get up here and say it
is not necessary for residents to learn how to do a bypass if it was
their heart. ``Oh, you can just learn it from reading a book, you can
look at a computer simulation.'' No one would ever suggest that.
I really have to say, with due respect, total respect for my
colleague, that we are treating women in this circumstance quite
differently than a person who had a heart condition, than a person who
needed a kidney operation. We would never stand up here and say that
doctors do not have to be trained in actually doing those procedures.
Mr. COATS. Will the Senator yield on that point?
Mrs. BOXER. I will yield on the Senator's time, because I am running
out of time. I will yield on Senator Snowe's time.
The PRESIDING OFFICER. The Senator asked to be notified when she had
5 minutes remaining. She has 5 minutes.
Mrs. BOXER. Why do I not yield to the Senator on Senator Snowe's
time?
Mr. COATS. If that is appropriate with the Senator from Maine.
Mrs. BOXER. I retain my 5 minutes.
Ms. SNOWE. I yield 2 minutes.
Mr. COATS. Mr. President, I just want to inform the Senator from
California and our colleagues that what I stated was that on the basis
of letters that we have received from a number of trained physicians in
obstetrics and gynecology that the similarities between the procedure
which they are trained for, which is a D&C procedure, and the
procedures for performing an abortion are essentially the same and,
therefore, they have the expertise necessary, as learned in those
training procedures, should the occasion occur and an emergency occur
to perform that abortion.
But to compare that with not having training for a bypass operation
or kidney operation or anything else would not be an accurate
comparison. There are enough similarities between the procedure they
are trained for and the procedure the Senator from California is
advocating they need to be trained for that is not a problem.
I ask unanimous consent to have printed in the Record, Mr. President,
letters that I have received which so state that training is adequate.
There being no objection, the letters were ordered to be printed in
the Record, as follows:
National Federation of
Catholic Physicians' Guilds,
Elm Grove, WI, March 23, 1995.
Re the amendment offered by Senator Coats to S. 555, Health
Professions Education Consolidation and Reauthorization
Act of 1995.
Members,
Senate Labor and Human Resources Committee, U.S. Senate,
Washington, DC.
Dear Senator: I am writing on behalf of the National
Federation of Catholic Physicians' Guilds which is the
Catholic medical association in the United States,
representing physicians and physician's guilds from all over
the U.S. I respectfully urge you to support Senator Coats'
Amendment, specified in Sec. 407. Civil Rights for Health
Care Providers.
Senator Coats' amendment is certainly accurate in finding
the ACGME's revised regulations on Residency Training for
Obstetrics and Gynecology a violation of the civil rights of
individuals and institutions that are morally or
conscientiously opposed to abortion. The revised regulations
would require, under penalty of loss of accreditation,
Catholic Ob-Gyn training programs, or any training program
for that matter, to provide for training in the performance
of induced abortion. As you probably know, Catholic moral
teaching holds abortion to be a grave moral evil. What might
not be as clear is the fact that not only may a Catholic not
participate in the procurement of an abortion, they may also
not cooperate in any way with the procurement of an abortion;
not only may they not offer training in abortions, they may
also not provide for the opportunity of training in
abortions. Such cooperation would give the cooperator a share
of the culpability. The ACGME's regulation would be coercion,
an attempt, under severe penalty for failure to comply, to
force the institution to participate in the performance of an
activity which it, in conscience, considered evil. This would
seem to be a clear violation of the civil rights of the
individuals and institutions involved.
It is of significant note that the ACGME's regulation
revision in this matter comes at a
[[Page S2271]]
time when fewer and fewer Ob-Gyn physicians will do
abortions. Ob-Gyn training programs that require abortion
training are also declining in number. Physicians do not want
to be involved in this procedure. Why they do not want to be
involved is understandable. The medical profession has always
held the moral belief that it's charge is the care of the
life of the human being. The Obstetrician has always been the
doctor who takes care of the mother and the baby until the
baby is born and the Pediatrician can take over the baby's
care. It is not in the professional ethos, in the soul of the
physician, to take life. It is his or her charge to protect
it! Abortion is a surgical procedure that intentionally takes
the life of the baby and exposes the mother to a normally
unnecessary operation. All of this violates the moral basis
of the physician's code. The physician cannot be cast as a
killer. He or she is a healer and an agent of the patient for
healing. If the regulation mandate from the ACGME is an
attempt to require physicians to perform a morally
reprehensible act to serve a political charge, then the ACGME
has stepped well beyond it's reason for existence.
The stated premise behind the ACGME's revision of the
standards was to ``address the need for enhanced education in
the provision of primary and preventative health care for
women by obstetrician-gynecologists''. (ACGME Press Release,
16 Feb. 95) How does abortion training enhance the provision
of primary and preventative health care for women? Primary
health care involves the prevention of pathology. Pregnancy
is not a disease that must be treated by termination. Primary
health care provides medical care for the mother and the
child she is carrying. Primary care cares for the well-being
of mother and child. To talk of abortion as primary care is a
distortion of the meaning of care. We cannot define killing
as care. Does abortion training enhance preventative health
care for women? What does it prevent? Exposure to sexually
transmitted diseases? No. Pregnancy? It certainly doesn't
prevent pregnancy. The woman is already pregnant (which means
she is already carrying a very dependent human life whom the
Ob-Gyn is normally committed to care for, too, working to
ensure the baby's successful entrance into the world). What
does it prevent, then? Responsibility for my actions?
Maternal love? Enhanced education in the provision of primary
and preventative health care for women could cover a lot of
territory. The destruction of one of the most natural
functions of the human person; the characterization of
pregnancy as a pathological condition; the denial of
professional responsibility to two patients when the pregnant
woman comes to your clinic; the acceptance of a cooperative
role with the woman in the ending of her child's life . . .
these do not seem to fit into this educational objective.
It must be noted that all Ob-Gyn physicians are trained to
do D&C's and to handle fetal demise. The training in the
specific procedure of induced abortion, especially
considering the great moral questions involved, probably has
no place as a requirement in Ob-Gyn training. If the ACGME
believes it is responsible for providing physicians to do
abortions, it needs to find a way to do it other than
mandating that training programs include this procedure in
their curricula.
Thank you for reading through a somewhat lengthy letter.
The issue really is significant. It deals with a
controversial area; a procedure that is legal to perform, but
morally questionable and lamented by most Americans as an
indication that something has failed. Also at stake are the
civil rights of those who morally and religiously object to
induced abortion and who are now being told that they must,
under penalty, provide for training in abortion procedures.
There is, as Senator Coats points out, the effect of
``running out of business'' training programs that could not
obey the ACGME mandate. And, there is the chilling advocacy
of the notion that the doctor should be killer.
I ask you, on behalf of the many members of the NFCPG, and
other medical professional men and women of conscience who
cannot obey this regulation, to support Senator Coats'
amendment and keep true choice available to us.
God bless you in your many varied and difficult duties.
Sincerely,
Kevin J. Murrell, M.D.,
President.
____
The University of
Texas Medical Branch at Galveston,
Galveston, TX, March 23, 1995.
Vincent Ventimiglia,
Office of Senator Dan Coats,
U.S. Senate, Washington, DC.
Dear Mr. Ventimiglia: I am a Professor of Obstetrics and
Gynecology at the University of Texas Medical Branch at
Galveston. It has come to my attention that Senator Coats,
during upcoming hearings to reauthorize the Health
Professions Education Act, will make efforts to protect the
rights of Obstetrics and Gynecology training programs who
choose not to teach techniques of abortion for contraception.
For this I am deeply grateful.
The Commission which accredits training programs for
residents in Obstetrics and Gynecology has made significant
changes in requirements for accreditation. In the near
future, ``hands on'' experience with elective abortion will
be a required component of an approved residency training
program. Although an individual trainee may invoke moral
grounds to excuse himself from participating, no approved
program, or program director, may excuse themselves.
Requirements for an accredited residency training are
ultimately approved by the AMA's Committee on Graduate
Medical Education (ACGME), and are listed in the Essentials
of an Approved Residency. Under the current Essentials of an
Approved Residency, an approved program is required to teach
its trainees about management of abortion related
complications, and provide some exposure to the technique of
abortion. Currently a program may fulfill this requirement by
providing instruction to residents in the care of women
with spontaneous incomplete abortions or missed abortions.
Requirements that become effective January 1 1996
specifically require training in the performance of
elective abortion as a contraception technique.
Those involved in resident education at the University of
Texas Medical Branch made a decision in the mid 1970's not to
teach elective abortion as part of our curriculum. This
decision was based, originally, on concerns other than moral
issues. We encountered two significant problems with our
``Pregnancy Interruption Clinic,'' or the PIC as it was known
at the time. First, the PIC was a money loser. Since there
was no reimbursement for elective abortions from either state
funds or Medicaid a great deal of the expense of the PIC was
underwritten by faculty professional income. Faculty income
was used without regard to the moral concerns of individual
faculty members who generated the income. A second problem
was more significant and involved faculty, resident, and
staff morale. Individuals morally opposed to performing
elective abortions were not required to participate. This led
to a perception, by trainees performing abortions, that they
were carrying a heavier clinical load than trainees not
performing abortions. As fewer and fewer residents chose to
become involved in the PIC, this perceived maldistribution of
work became a significant morale issue. Morale problems also
spilled over to nursing and clerical personnel with strong
feelings about the PIC. It is a gross understatement to say
that elective abortion is intensely polarizing. Because of
bad feelings engendered by a program that was a financial
drain, the PIC was closed.
Regardless of our reasons, the failure to teach the
technique of elective abortion has never been a factor in the
approval of our program by an accrediting agency. When the
changes to the Essentials of an Approved Residency become
effective next January, I will never be forced to participate
in the performance of abortion; but I am distressed that, to
keep my current job, I would be forced to cooperate in an
educational mission that espouses these objectives. To me, a
``non-combatant'' working to advance amoral objectives bears
significant culpability. How could a pro-life physician ever
become a Program Director if required to teach this
curriculum? How could any Catholic hospital support such a
training curriculum, even if its trainees went elsewhere to
obtain the skills? Shouldn't program directors have freedom
of choice to decide if a morally controversial area is
included in their program? Where does a pro life medical
student obtain training in an abortion free environment?
Aside from my personal problems there are larger issues.
Due to a number of forces, there recently has been a de facto
segregation of the abortionist from the mainstream of
practitioners of Obstetrics and Gynecology. The abortionist
has become a specialist apart from the rest of us--they
are practitioners of a peculiar paraspecialty. Trainees
completing a residency program in Obstetrics and
Gynecology recognize that the professional community
considers the abortionist to be a physician on the fringe
of respectability. In addition to this marginalization by
the professional community, marketplace forces make a new
practitioner avoid abortions. Patients do not tend to seek
obstetric services from physicians heavily identified with
abortion. Young physicians who start doing abortions soon
have a medical practice which only does abortions.
Residents, hoping to practice the breadth of our
specialty, structure their new practices accordingly.
Changing the Essentials of an Approved Residency is a
deliberate attempt by those wishing to disseminate
abortion services to try to reintroduce abortion into the
``everyday practice'' of our specialty. Their claim that
unique technical skills are involved in performing
elective abortions, that are different from technical
skills involved in treating spontaneous abortions, is
ridiculous and a clear attempt to mislead. The changes in
training requirements were not made to serve an
educational agenda--only a political agenda.
This change in the Essentials is coercive. It will make my
participation in furthering an amoral educational objective a
condition of employment. I currently have the right not to
teach that which is morally repugnant. I hope my right can be
protected.
Sincerely,
Edward V. Hannigan, M.D.,
Frances Eastland Connally Professor.
____
Congress of the United States,
Washington, DC, August 2, 1995.
Dear Colleague: There is one thing that can be said with
certainty about the abortion training mandate of the
Accreditation Council for Graduate Medical Education: it has
nothing to do with ensuring that medical residents receiving
training will be better equipped to provide appropriate
health care
[[Page S2272]]
to women and children. OB/Gyn residents already learn the
techniques to handle pregnancy, miscarriages and
complications from abortions and, in learning these, learn
the medical techniques to handle those extremely rare
situations in which an abortion is actually performed in
response to a women's health emergency.
So, if the ACGME directive is not really about providing
medically necessary training for medical residents, what is
it about? Simply, to accomplish what 20 years of legalized
abortion have failed to do: to make abortion a part of
mainstream of medical care and force doctors and hospitals to
do abortion as if a refusal on their part would constitute
substandard medical practice. Can there be any doubt
whatsoever that after they define abortion as a part of
standard medical care for residents, they will move on to
declare it standard care for every hospital? Can there be any
doubt the directive that we would overturn is only the first
step in a battle against every medical facility which would
dare claim that abortion is not ``health care,'' that it is
no part of standard medical practice?
The way in which ACGME and their friends in the pro-
abortion community are going about this is deeply disturbing.
They are not merely forcing doctors and hospitals to adhere
to a particular ideology, they are requiring them in the name
of practicing good medicine--to actually kill defenseless,
unborn human lives. It is not enough for them that medical
residents are already learning the techniques that could be
used in abortion, but learning these without using them to
destroy live human beings. Abortion advocates are not
satisfied unless these techniques are used to kill unless
residents resistance in this killing is actually numbered.
This attempt to overturn the healing ethic that is the very
lifeblood of medical residency programs and medicine itself
must be rejected. I ask that all Members support the
provision in the bill to overturn the ACGME's directive and
to oppose any motion to strike it.
Sincerely,
Tom Delay,
Majority Whip.
Tom A. Coburn, M.D.,
Member of Congress.
____
St. John Hospital
and Medical Center,
Detroit, MI, March 27, 1995.
Dan Coats,
Russell Senate Office Building,
Washington, DC.
This is a letter of support for any legislation that would
prevent a residency program from being forced to implement a
special kind of training that would be against the ethical
and moral teachings of the institution in which the residency
program resides. Specifically, we decry the decision made by
the ACGME to mandate induced abortion training in all
residency programs. There are major flaws in the reasoning of
the ACGME: 1) an assumption that somehow abortions are not
being carried out because of lack of providers: there is
certainly no evidence of this locally or nationwide; 2)
failure of the ACGME to recognize the fact that training to
perform an induced abortion is exactly the same training as
to perform a uterine evacuation procedure in the context of a
missed abortion; 3) assuming that OB/GYN residency graduates
are not performing induced abortion because they don't know
how to; clearly every graduating OB/GYN resident from any
program in the United States has the capabilities of being
able to perform induced abortions but chooses not to on the
basis of conscience and possibly also for a concern for
personal rather than because they don't know how to do it; 4)
by coming out so strongly for induced abortion, the ACGME
creates further polarization in the United States over a very
inflammatory issue when further polarization is counter-
productive, 5) failing to recognize the philosophical
integrity of an institution by arbitrarily forcing health
care providers or individuals to do something against their
institutional ethics.
In conclusion, the directors of the St. John Hospital and
Medical Center's OB/GYN residency program strongly support
legislation preventing coercion of a residency program toward
implementing an unnecessary training that is against any
institution's ethical and moral philosophy and thereby only
contributes to the further polarization of the abortion issue
in the United States.
Michael Prysak, Ph.D., M.D.,
Program Director
and Vice Chief of Obstetrics.
____
Providence Hospital and
Medical Centers,
Southfield, MI, March 29, 1995.
Hon. Dan Coats,
U.S. Senate, Russell Senate Office Building, Washington, DC.
Dear Senator Coats: I urge the Senate Labor and Human
Resources Committee to adopt the amendment you offered to S.
555, Health Professional Education Consolidation and
Reauthorization. This amendment would neither limit abortion
services currently available in this country, nor would it
prevent physicians from seeking the training they might
choose in order to perform abortions. This amendment would
not interfere with a woman's legal right to choose an
abortion. This amendment is about the right of institutions
to refuse participation or cooperation in procedures which
directly violate their ethical codes.
The reason that our organization, Providence Hospital and
Medical Centers, supports this is because:
As a Catholic institution, we hold that direct abortion is
a grave evil. It is therefore not an optional procedure for
us, since we are bounded by Catholic ethical standards of
health care. Since Catholic teaching classifies the direct
killing of innocent human life to be among the gravest forms
of evil, cooperating with the new ACGME OB/GYN residency
guidelines by sending our OB/GYN medical residents to other
facilities for training in induced abortions may not be a
moral option for us.
There are over 45 OB/GYN residency programs in Catholic
hospitals, about a third of all OB/GYN residency programs in
the United States. We cannot afford losing these programs.
Trying to coerce health care facilities who are morally
opposed to direct abortions into cooperating with the new
ACGME guidelines will not resolve the issue of the dwindling
number of physicians being willing to perform abortions in
the United States. It will only exacerbate the situation.
How would mandating abortion training enhance the provision
of primary and preventative health care for women? Primary
health care involves the prevention of a pathology. Pregnancy
is not a disease to be treated by termination. Furthermore,
all OB/GYN medical residents are currently trained to do
D&C's, to handle fetal demise, and are trained in techniques
such as early induction of labor when the pregnancy
constitutes a serious life-threatening condition for the
mother.
Thank you for considering adoption of this amendment.
Sincerely,
Sister Jane Burger, D.C.,
Vice President--Mission/Ethics Services.
____
Christian Medical & Dental Society,
Richardson, TX, February 15, 1995.
Christian Doctors Protest Abortion Training Mandate
Dallas, TX.--The Christian Medical & Dental Society (CMDS)
announced today that it is protesting a medical council's
decision to mandate abortion training as politically induced,
personally coercive and professionally unnecessary. The
Council for Graduate Medical Education, which oversees
physician training, announced yesterday that obstetrical
residents must be taught how to do abortions.
Dr. David Stevens, executive director of the Dallas-based
CMDS, said, ``The Council is clearly out of touch with its
constituency, the vast majority of whom oppose abortion on
demand.'' He cited the results of an independent nationwide
poll of obstetricians, conducted in 1994 by the PPS Medical
Marketing Group in Fairfield, New Jersey, that revealed that
over 59 percent of obstetricians disagreed with the statement
that ``every OB/GYN residency training program should be
mandated to include elective abortion training.''
Stevens says the Council's decision ``is apparently induced
by political pressure from pro-abortion groups who want to
force their belief system on a medical community that has
largely rejected abortion.'' Stevens said that ``pro-abortion
leaders are worried that few doctors are willing to perform
abortions, based on personal convictions as well as the sheer
repugnancy of the act itself.''
Stevens said that despite the Council's technical
allowances for moral or religious objections, the practical
effect of the Council's ruling will be to pressure every
resident and teaching hospital into performing abortions.
``Throwing in a little verbiage about `moral or religious
objections' does little to remove the intense pressure these
residents will now face to perform abortions,'' Stevens
explained. ``The threat of failing to meet GME requirements
will now be like a sword of Damocles hanging over their heads
as well as over the heads of program administrators,''
Stevens noted.
``In everyday practice, when one resident attempts to opt
out of the procedure, he or she can face intense pressure
from colleagues who would be forced to take up the slack by
performing more abortions,'' Stevens asserted. ``The mandate
will also effectively discourage those opposed to abortion on
demand from entering the OB/GYN field.''
CMDS chief operating officer Dr. Gene Rudd, an OB/GYN
physician, explained that abortion training is unnecessary.
``The skills required to perform first trimester abortions
are acquired through learning dilation and curettage (D&C)
and other procedures involving spontaneous abortions,'' Rudd
noted. ``Only the more controversial second and third
trimester abortions require additional training.
``Does the Council's new policy mean,'' Rudd posited,
``that all OB/GYN's who have not been trained to do abortions
are inadequately prepared for professional practice? Of
course not! There is absolutely no practical reason to force
residents to learn to perform abortions if those residents do
not intend to perform abortions in practice. Abortion
training need not be considered an integral part of OB/GYN
training, as evidenced by the fact that roughly a third of
all residency programs in the U.S. do not even offer it.''
To receive a free booklet on bioethical issues or for more
information on the Christian Medical & Dental Society,
contact CMDS at P.O. Box 830689, Richardson, TX 75083 or
phone (214) 479-9173.
[[Page S2273]]
Mr. COATS. Mr. President, I will also just state, with what little
time I have remaining, that the Coats amendment has the support of the
AMA, the American Medical Association, the American College of
Obstetricians and Gynecologists and the Accrediting Council for
Graduate Medical Education. So the very organizations that are most
directly involved in this have looked at the Coats amendment, and they
have said it is a reasonable amendment and they not only do not oppose
it, they support it.
So the very organizations that are held up as being the objectors to
this are supporters of the Coats amendment, and I hope my colleagues
will use that as a basis for their determination.
The PRESIDING OFFICER. The Senator from California.
Mrs. BOXER. Mr. President, on my own time, and I ask that I have 3
minutes remaining so that I can close on those 3 minutes.
Mr. President, let me say to my friend from Indiana, I just talked to
the representative of the American College of Obstetricians and
Gynecologists. They much prefer the existing policy. The reason they
are on this particular amendment is because they feel this is far
superior than the House language, but they prefer the current policy.
I will further say, just trying to exercise a little common sense--
and, Mr. President, I feel many times we think these things are over
our head--if your daughter found herself in a circumstance where she
was raped, let us say, and, let us say she found out within a month
that she was pregnant and she made the decision to end this pregnancy,
she did not want to bear this rapist's child, and someone asked you,
``Senator, I've got two doctors available to do this. One of them
performed a D&C a few times and never did a surgical abortion and one
has the experience,'' I do not think it takes a degree in science to
know that if you want her to be safe, you want her to go to someone who
had the actual experience of performing a surgical abortion.
So I simply do not buy into this argument that because someone
performed a D&C and it is similar--it is not the same thing, by any
stretch of the imagination.
The PRESIDING OFFICER. The Senator has 3 minutes.
Mrs. BOXER. I ask for another 30 seconds. What this amendment would
do is basically say you do not have to teach your ob-gyn residents how
to perform surgical abortion and you would still get Federal funds.
That is why it is opposed by Planned Parenthood, National Women's Law
Center, American Association of University Women, National Abortion
Federation, Women's Legal Defense Fund and NARAL. I think it is very
clear where this comes down. This takes a situation and makes it
dangerous for women.
Is it better than the House language? Sure it is, but why should we
go forward with something that is worse than the current policy and I
think open up a grave risk to the women of this country?
I retain the remainder of my time.
Mrs. FEINSTEIN. Mr. President, I oppose the Coats-Snowe amendment to
the continuing resolution, S. 1594.
This amendment does two things: It puts into law a prohibition on
Federal and State governments from discriminating against institutions
that refuse to provide training for abortion procedures; and, it
undermines the long-respected accreditation system by allowing programs
to opt out of meeting the required medical training standards set by
the ACGME and still receive Federal funds as if these programs met
those standards.
The Coats-Snowe amendment is unnecessary, it undermines the integrity
of Federal and State medical educational and licensing standards, and
it represents another step in the erosion of freedom of choice in this
country.
UNNECESSARY
First of all, this amendment is unnecessary because its
antidiscrimination section is redundant. Although earlier standards set
by the Accreditation Council for Graduate Medical Education, the
accrediting body for medical residency programs, did require abortion
training in ob-gyn residency programs, ACGME revised those requirements
in February 1995 to explicitly exempt ob-gyn residents or institutions
with religious or moral objections to performing abortions.
The policy states: ``No program or resident with a religious or moral
objection will be required to provide training in, or to perform,
induced abortions.''
The revised standard does not require programs to make alternative
arrangements for abortion training. The only obligations on programs
that do not provide the training are to inform applicants to the
residency program that they do not provide abortion training and to not
impede their residents from obtaining the training elsewhere for those
who wish to do so.
These requirements strike a balance between the program's desire not
to be involved in abortion training and fairness to residents who
desire to obtain such training.
So I fail to see any need for this amendment other than to inject
Congress further into the abortion decision and into questions of
medical curriculum.
UNDERMINES ACCREDITATION SYSTEM
This amendment, even with the compromise language, still undermines
the system for evaluating the quality of medical training programs in
this country. Under current law, medical training programs may only
receive Federal funds if they are an accredited institution.
This amendment creates a loophole by allowing entities to not meet
educational and training standards for ob-gyns set by ACGME, the
independent accrediting body of medical experts.
Does anyone in this body think Congress is better equipped to
determine the educational requirements for a medical specialty such as
obstetrics and gynecology than the medical professionals who actually
practice medicine?
The ACGME, a private-sector, professional entity, is the only
graduate medical education accreditation organization in the United
States, responsible for evaluating over 7,000 medical residency
programs throughout the United States.
ACGME is sponsored by five of the leading medical organizations in
the Nation: the American Medical Association, the American Hospital
Association, the American Board of Medical Specialties, the Association
of American Medical Colleges, and the Council of Medical Specialty
Societies.
Accreditation by medical experts provides the only method the Federal
Government has to assure that residency programs meet appropriate
medical training standards. Congress should not undermine that system
by supplanting political judgment in place of medical expertise.
FEDERAL INTRUSION INTO STATE LICENSING STANDARDS
Accreditation is relied upon not just by the Federal Government, but
also by State governments, private funding sources, students and
patients to ensure quality in medical training.
Even if the Federal Government is willing to abandon educational
standards in medical training, which it should not be, it should
certainly not prevent the States from maintaining standards.
All 50 States currently require an individual to participate in an
ACGME accredited residency program to obtain a right to practice
medicine. The Coats-Snowe amendment would prevents States from
requiring that ob-gyn residency programs meet ACGME standards in
abortion training for those they are licensing to practice medicine in
their States. The alternative for States that wish to maintain ACGME
training standards is the loss of Federal funds.
This is an unconscionable intrusion by the Federal Government into
State licensing procedures.
The ACGME standards, which were unanimously approved by the
sponsoring medical organizations, reflect the input of physicians,
medical specialists, hospital administrators, clinicians, researchers,
and educators who bring decades of medical judgment to their decisions.
The Federal Government has long recognized the specialized expertise
that formulates the ACGME accreditation standards and we should not
reject that expertise now simply because the issue is abortion.
EROSION OF CHOICE
This amendment is yet another effort to chip away at a woman's right
to
[[Page S2274]]
choose--a constitutionally protected right that the Supreme Court has
clearly affirmed. This is one more in a series of steps Congress has
taken to destroy that right:
The 104th Congress, in particular, has enacted an unprecedented
number of laws threatening access to safe and legal abortion for many
women:
Ending access to abortion for U.S. servicewomen overseas by barring
abortions on military bases even if the woman used her own money. This
is particularly harsh on servicewomen overseas where private facilities
may be inadequate or abortion is illegal.
Prohibiting Federal employees from choosing health insurance plans
with abortion coverage.
Maintaining the prohibition on Medicaid coverage for abortion for
low-income women--except in cases of rape, incest, or life
endangerment.
Denying access to abortion for women in Federal prisons.
Prohibiting the District of Columbia from using its own locally
raised money to pay for Medicaid funded abortions.
Banning Federal funds for human embryo research.
Most significantly, Congress for the first time directly challenged
Roe versus Wade by passing legislation that criminalizes a particular
and rarely used abortion procedure and jails doctors who perform them.
All of these represent a steady march by the Federal Government into
the abortion decision, and the weakening of a woman's constitutional
right of personal privacy. The Coats amendment is yet another erosion
of that right.
But it is an extremely important one. This is a direct attack on
maintaining access to quality reproductive health care for women.
SHORTAGE OF DOCTORS
There is already a severe and escalating shortage in the number of
physicians who are trained and willing to provide abortion services.
The total number of abortion providers in the country decreased by
nearly 20 percent since 1982--from 2,908 to 2,380--in spite of a 10-
percent increase in the population.
Eighty-four percent of the counties in the United States have no
physicians who can perform abortions. States such as North and South
Dakota have only one provider each.
Only 25 percent of obstetrician-gynecologists in the southern United
States are trained to perform abortions. Only 16 percent of doctors in
the Midwest are trained.
With the violence and harassment aimed at abortion providers
increasing steadily in recent years, fewer doctors are willing to risk
their lives or the safety of their families, to provide abortion
services.
This amendment is a thinly veiled attack on freedom of choice. By
making abortion unavailable, opponents of abortion will do what they
cannot do legislatively--eliminate abortion as a safe and legal option
for women in this country--one State, one doctor, one piece of
legislation at a time. I strongly urge my colleagues to oppose this
amendment.
Ms. SNOWE addressed the Chair.
The PRESIDING OFFICER. The Senator from Maine.
Ms. SNOWE. Mr. President, I think it is always important that, when
we are discussing legislation, we get a chance to read the legislation,
in this case, the amendment that is before this body. The fact remains
that this compromise amendment allows that anybody who wants to
participate in training of abortions is allowed to do so. Nothing
changes from the current circumstances. Any agency or institution that
wants to provide the training of abortions to medical residents can do
so. That is how the legislation reads. That is fact.
I regret the fact that there has been so much misinformation
circulated about what this amendment does and does not do. This
amendment avoids getting the U.S. Congress involved in setting
accreditation standards, because that is exactly what is happening with
the legislation that passed in the House of Representatives. The
Senator from Indiana and I worked with the American College of
Obstetrics and Gynecologists on this very language. Sure we prefer not
to be here today discussing this issue, but that is not reality.
I am looking down the road. What I do not want to have happen is to
have the U.S. Congress overturning the one set of accreditation
standards that is predicated on quality care. If we do nothing, we run
the very serious risk of having the U.S. Congress, because of the House
language, overturn that one set of standards that everybody in America
uses to determine the standards and the quality of care.
If you think that is a risk worth taking, then vote against this
amendment. I do not happen to think so. This accreditation standard
that we are talking about in this legislation is the accreditation
standard that has been developed by the Accrediting Council for
Graduate Medical Education. You might say, Who sits on this
accreditation council? This is the one council that everybody looks to
for setting the standards for medical institutions and residents in
this country.
The organizations that sit on the council are: the American Medical
Association, the American Hospital Association, the Association of
American Medical Colleges, the American Board of Medical Specialties,
the Council of Medical Specialties Societies. Then you have the
residency review committee that reviews the ob-gyn programs that set
the standards for the accreditation council, the American Board of
Obstetricians and Gynecologists, the American College of Obstetricians
and Gynecologists, and the Council on Medical Education of the American
Medical Association.
These standards have been set with the conscience clause for medical
residents since 1982. There has always been a conscience clause. That
is what this legislation does. It allows for that. The accreditation
council had to go a step further and establish a conscience clause for
institutions because of a recent court case. That is a fact.
Not one institution in America--even when it was implicitly required
in the accreditation council standards before their proposed change
this year, they did not deny accreditation to one institution in
America because they solely refused to provide abortion training. It
was for a host of other issues.
So even when it was required, 88 percent of the institutions did not
provide for abortion training. So this amendment basically preserves
the status quo under the Accrediting Council for Graduate Medical
Education, the one set of standards that everybody uses from the
Federal Government on down.
If we fail to support this amendment, I hesitate to think what
message it is going to send to the conference committee on this issue.
It is important that the Senate send a very strong message that we
reject the intervention of Congress in establishing a different set of
standards. That is what this is all about.
Mr. President, how much time do I have remaining?
The PRESIDING OFFICER. The Senator has 7 minutes 20 seconds.
Ms. SNOWE. I would like to quote part of a letter that was sent by
Dr. James Todd, executive vice president of the American Medical
Association, which he sent in March 1995 to Senator Kassebaum. I quote:
The Accrediting Council for Graduate Medical Education
standards were developed by professional medical educators in
the field of obstetrics and gynecology. The standards were
developed with great sensitivity to the differing moral and
ethical views about abortion and after substantial
consultation with medical societies, program directors, and
obstetrics and gynecology and other individuals and
organizations.
So that is the standard that is embodied in this compromise
legislation. If individuals who are participating in medical training
programs want to get training for abortion, they will be allowed to do
so. If an institution wants to provide it, they will be allowed to do
so, just like it is under current circumstances.
We, also, preserve the accreditation standards of the one group in
America that sets those standards, rather than running the risk of what
has been established in the House of Representatives that says that
Federal funds can go to any institution in America that is unaccredited
if those standards mention abortion. That is what the legislation says
in the House of Representatives. That is what we are dealing with here.
They would allow Federal funds to go to any institution that is
unaccredited if those institutions use the accreditation standards, of
which there is only one set in America, if they refer to abortion in
whatever way.
[[Page S2275]]
That is what I do not want to have happen in this body. That is why I
supported and worked on this compromise legislation. The fact is the
House goes further. Every State has a licensing board. Every State
looks to the Accrediting Council for Graduate Medical Education
standards in order to determine the licensing. So, if we are saying it
does not matter anymore, then they are going to have to go back, and
every State will have their own set of standards for medical
institutions, of which there are 7,400 in America.
So is that what we want to create? I do not think so. I think there
is a time when you have to accept what is before you and work together
in reaching a consensus, which is what the Senator from Indiana and I
have done. I think that is what the American people want. We are never
going to get unanimity on the issue of abortion. Far from it.
But I do think it is important that we work together in the best way
that we can to ensure that we have legislation that will benefit, in
this case, the women of America, because this is who will be most
directly affected by this legislation, and to ensure that our medical
institutions are dealing with one set of accreditation standards rather
than 50 different sets because that is, in essence, what will happen if
we reject this amendment. That is the risk that we are running. That is
why I would urge adoption of the Coats-Snowe amendment.
Mr. President, I yield the floor.
Mrs. BOXER addressed the Chair.
Mr. McCAIN addressed the Chair.
The PRESIDING OFFICER. The Senator from California.
Mrs. BOXER. I will yield to the Senator from Arizona for a question.
Mr. McCAIN. I was going to call up an amendment of mine. I will be
glad to wait until the Senator from California finishes.
Mrs. BOXER. I thank the Senator.
Mr. President, I am assuming we are debating the abortion amendment
that is----
The PRESIDING OFFICER. That is correct.
Mrs. BOXER. Mr. President, I think the Senator from Maine makes a
good point when she says we have to work together. That is what we did
to get to where we are with the current policy. Current policy says
that, if you are an ob-gyn resident with a religious or moral objection
to learning to perform surgical abortion, or if you are an institution
with a religious or moral objection to teaching abortion procedure, you
do not have to learn it and you do not have to teach it.
I support that. I am pro-choice. I believe very much in Roe versus
Wade and a woman having the right to choose to make this decision
without Government interference. But I believe that if someone has a
deep religious or moral objection, and they are a medical school or an
ob-gyn resident, they should have the right to say, I really do not
want to learn this. However, if there is no religious or moral
objection, I believe that it is very important that these ob-gyn
residents learn how to perform surgical abortion until there is another
safe alternative. And what the Coats amendment does, regardless of the
kind of spin we hear, is basically says to us that an institution that
has no religious objection can just decide, because they bow to public
pressure, we are not going to teach our residents how to perform
surgical abortion, and we will get Federal funds anyway.
Now, just to stand up here and say, ``I have a compromise'' is not
enough.
I ask unanimous consent that I be allowed to take Senator Murray's
time. She has offered it to me.
The PRESIDING OFFICER. Is there objection?
Ms. SNOWE. Reserving the right to object. How much time is that?
The PRESIDING OFFICER. Senator Murray has 7\1/2\ minutes reserved.
Ms. SNOWE. How much time do I have remaining?
The PRESIDING OFFICER. Three minutes 30 seconds.
Mr. BUMPERS. Mr. President, was there some kind of an agreement about
time?
Mrs. BOXER. Mr. President, if I may answer the question, I asked if I
could take Senator Murray's time as it relates to the abortion issue.
She has 7 minutes. I do not think I am going to use it all, but I need
to make a couple of points.
Mr. BUMPERS. Mr. President, I have no objection. I was under the
impression that we were going to recess at 12:30. I thought I would
speak on the Murkowski Greens Creek amendment prior to the recess.
The PRESIDING OFFICER. The Senator is correct that we were to adjourn
at 12:30.
Mr. BUMPERS. I do not understand the time. How much time is left on
the Coats amendment?
The PRESIDING OFFICER. The Senator from Maine has 3 minutes 30
seconds. Senator Boxer used her time, and Senator Murray had reserved
7\1/2\ minutes.
Mrs. BOXER. Mr. President, I ask unanimous consent that the Senator
from Arkansas have 15 minutes to speak immediately following the hour
of 12:40, and that we extend the time.
The PRESIDING OFFICER. That will require postponing the recess.
Mrs. BOXER. That is correct, until 12:55, so the Senator can have his
15 minutes.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mrs. BOXER. I say to my friend that we may not use all this time. I
think it is important that when we stand on the floor of the Senate and
talk about a compromise, we understand what we are compromising. A
compromise was made on this issue previously. Institutions and ob-gyn
residents already have a very generous and appropriate clause for a
religious or moral objection. So not only individual doctors and
residents in medical school, but also we, the institutions themselves,
may exercise a conscious clause exemption.
So now to take that compromise and say we need to compromise because
the House has some terrible language--Mr. President, I came here to
fight for the issues that I think are right. I came here to fight for a
woman's right to choose. I believe that there are some things you can
compromise, and I was very pleased to support a religious conscience
clause.
But if you take it further, theoretically, under the Coats amendment,
every single medical school in this country could say that they were no
longer going to teach residents how to perform surgical abortions, and
they would still get their Federal funds.
Now, you can stand up here and read off everybody who belongs to the
American College of Obstetricians and Gynecologists. The fact is that
they prefer current policy. Yes, they are willing to go with the Coats
amendment as a lesser of two evils, but why are we not fighting this,
straightforwardly fighting this, and saying this is nonsense--saying it
is nonsense that institutions who have no religious problem would still
be able to not teach surgical abortion and get Federal funds?
On the issue of Washington, DC, they would be the only one of 19,000
cities to be told by the Federal Government what they can or cannot do
with their local funds.
Mr. President, I see that the Senator from New Jersey has just come
on the floor. We have precious few moments remaining. I would be very
pleased if he is ready to yield to him the time I have remaining, if I
might inquire how much that would be.
The PRESIDING OFFICER. There are 4 minutes 52 seconds of Senator
Murray's time remaining.
Mrs. BOXER. I ask the Senator from New Jersey if he would like my
remaining time?
Mr. LAUTENBERG. I would appreciate having some time from the
distinguished Senator from California.
Mrs. BOXER. I yield the Senator from New Jersey the remainder of my
time.
Mr. McCAIN. Will the Senator allow me 30 seconds to make a request to
modify my pending amendment?
Mr. LAUTENBERG. I am happy to do it, and I ask unanimous consent that
it does not come off the remaining time.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 3521, As Modified
Mr. McCAIN. Mr. President, I ask unanimous consent to modify my
amendment No. 3521.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 3521), as modified, is as follows:
On page 756, between lines 10 and 11, insert the following:
[[Page S2276]]
SEC. 1103. ALLOCATION OF FUNDS.
Notwithstanding any other provision of this title, funds
made available under this title for emergency or disaster
assistance programs of the Department of Agriculture,
Department of Housing and Urban Development, Economic
Development Administration, National Park Service, Small
Business Administration, and United States Fish and Wildlife
Service shall be allocated in accordance with the established
prioritization process of the respective Department,
Administration, or Service.
Amendment No. 3513, as Modified
Mr. LAUTENBERG. Mr. President, the one thing that mystifies me about
some of the actions that we take here is, why is it that a few want to
control the thoughts for so many? It is an assault on one's human
rights, one's civil rights. It is inappropriate to be introducing this
kind of legislation that has to deal with things other than the funding
issue, and to intrude on people's private lives.
To suggest that the way to deal appropriately with the sparseness of
funds is to take away people's right to learn as part of a medical
education, and that they might lose their Federal funding--not might,
but will--it is outrageous. God was good to me yesterday. My oldest
daughter delivered a beautiful baby boy, and I was in that hospital on
the maternity ward, and I was looking around, and I thought, thank
goodness, they have the facilities that they have to be able to bring
new life into being. I thought about those poor women who, at the same
time, who may be distressed by the fact that there was a conception. It
was bizarre, but in the news today was a woman who was 10 years
comatose, was raped by someone in the institution she was in, and she
delivered a child. Is that not ridiculous that we would object to
having someone learn the abortion technique, so that in the case of a
request or a need, that it is unavailable?
I think this is mischievous, I think it is unfair, and I think that
the American people ought to rise up and say: Listen, enough of that
stuff. You do what you want to. If you do not believe that a woman
ought to have choice in an unwanted pregnancy, then do not do it. But
why should someone else lose their right to make that choice if they
are in such a situation? It is outrageous. We have these sneak attacks
constantly--do it one way, do it another way. You violate the
principles that we operate under. Privacy--that is what the Supreme
Court said. Why is it OK for some people to decide what is appropriate,
private or not? The courts have made a decision.
So, I hope, Mr. President, that both bodies will reject this. I hope
the Senate will decline to support this. The notion that the city of
Washington should not be able to use its own funds as it sees fit, I
think, is a disgrace. So I hope that we will reject this invasion of
privacy, of decency, if you will. This issue is not about abortion, it
is about Federal intrusion into a private decision.
With that, I yield the floor back to my colleague, if any time
remains.
The PRESIDING OFFICER. The Senator from California has 28 seconds
left.
Mrs. BOXER. Mr. President, the ACLU opposes this amendment, as does
the Center for Reproductive Rights, Planned Parenthood, and on and on.
I just hope my colleagues will stand up and say that we already
compromised and gave a good conscience clause. That was a compromise.
Let us not open this up wide and have women's lives put at risk. Say
``no'' to this Coats amendment and ``yes'' to the Boxer amendment. Let
us protect the lives of women.
The PRESIDING OFFICER. The time of the Senator has expired.
Ms. SNOWE addressed the Chair.
The PRESIDING OFFICER. The Senator from Maine.
Ms. SNOWE. Mr. President, to sum up on where we stand with respect to
the Coats-Snowe amendment, first of all, I remind this body what we are
dealing with here. This amendment modifies an underlying amendment, and
that underlying amendment would allow Federal funds to go to an
unaccredited institution. That is what I wanted to prevent. That is the
issue. That is what we are modifying through this compromise amendment,
so that does not happen. Who supports this amendment? I think that is
important since we are naming groups.
The Accreditation Council for Graduate Medical Education, which is
the entity that establishes the one set of standards in America for the
medical institutions; the American College of Obstetricians and
Gynecologists--it is very important because we are talking about ob-gyn
programs, and the medical association is made up of the profession of
physicians. That is who supports this amendment. They say it is
acceptable. They saw what I saw. What were the choices? What we will be
facing here potentially is a major risk and threat to women's health.
The House language, which gives Federal funds to unaccredited
institutions, basically guts the accreditation standards for ob-gyn
programs if those standards mention ``abortion.'' Then we have the
original--the underlying--amendment which we are now seeking to modify
through this compromise amendment which would have also let funding go
to unaccredited medical institutions.
Finally, you have the Coats-Snowe amendment--the compromise
amendment--which says we will prevent Congress from engaging in the
accreditation standards of medical institutions, will preserve those
very important standards for health care in America, and at the same
time we will also protect the accreditation standard when it comes to
abortion. And that is what it has always been. Nothing has changed. It
has always been that, if an individual, who is in a medical training
program, does not want to get training for abortion, he or she does not
have to. The same is true for institutions. They will be able to exempt
the institution from providing that training if it is contrary to their
belief. That is what it has always been. The accreditation council has
never denied an institution accreditation based on the fact that they
refused to provide abortion training. It was always for a host of other
standard equality reasons.
I want to make sure that we preserve those reasons by preventing
Congress from engaging in establishing, or overturning, accreditation
standards which is our only guidepost for quality care for women in
America.
That is the reality. I hope the Senate understands that because to do
otherwise, if this amendment is rejected, is that we will face the
language in the House which would basically gut and do away with
accreditation for all medical institutions in America. That is not a
choice nor a decision that we should have to make.
Thank you. I yield.
The PRESIDING OFFICER. Under the previous order, the Senator from
Arkansas has 15 minutes.
Amendment No. 3525
Mr. BUMPERS. Thank you, Mr. President.
Mr. President, I rise in support of the amendment by the junior
Senator from Alaska [Mr. Murkowski], which authorizes the Greens Creek
Land Exchange. This amendment gives the Kennecott mining company 7,500
acres in the Admiralty Island Monument area of Alaska, in addition to
the 340 acres they already own. They received the 340 acres they
already own from the U.S. Government in the traditional way. They paid
$2.50 an acre for it. For a while Kennecott had to shut down their
silver, copper, and gold mine at the site because they were losing
money. Now metal prices are higher and Kennecott has reopened the mine.
I am glad they reopened the mine because it is good business for them.
But more than anything else, Kennecott has agreed to pay a 3-percent
net smelter return royalty on everything they mine from the additional
7,500 acres they are receiving as long as metal prices are at least
$120 a ton. If prices go below $120 a ton, their royalty will decline.
I want to pay a little tribute to Kennecott. That is what I call good
corporate citizenship.
They got the 340 acres for a song because of the 1872 mining law
which continues to this day to be the biggest scam in America. And the
U.S. Senate has consistently ratified that scam at the same time this
body is willing to cut Head Start, student loans so kids can go to
college, school lunches, Medicaid, 40 percent of which is used to keep
elderly people in nursing homes, and another 40 percent for children.
They are willing to cut all of that but not to address this scam.
As I say, I am happy to support the amendment of the Senator from
Alaska. It is a good deal for them. It is a
[[Page S2277]]
good deal for the taxpayers of America. That is what we ought to be
doing around here. But that is not what we are doing.
Mr. President, when I took this issue on 7 years ago, 7 long years
ago, the price of gold in this country was $300 an ounce. Every time I
have attempted to stop the giveaway of Federal lands for $2.50 an acre,
I got my brains beat out. Fortunately, I have been successful in
gaining passage of a moratorium on the processing of new mining patent
applications.
The small progress I have made has been glacial. The mining companies
want the taxpayers of this country to deed them Federal lands that
belong to all of us for $2.50 an acre, $5 max, mine the gold, silver,
copper, platinum, and other minerals off of this land and then,
oftentimes, leave an unmitigated environmental disaster for the
taxpayers to clean up--and not pay one thin dime.
When I first took this issue on, gold was $300 an ounce. And the
mining industry said, ``Well, if you put a 3- or 4- percent royalty on
us, we will go broke. We will have to shut down, and all of these poor
miners will be out of a job.'' Today gold is $400 an ounce. And what do
you think their argument is? ``We will lose money. We will have to shut
down and put all of those poor miners out of work.'' And like Pavlov's
dog, Senators in the U.S. Senate grab it like a raw piece of meat and
think that is the most wonderful thing they ever heard--``Keep all of
these people working, if we will just not put a royalty on it.''
We charge people 12.5 percent for every ounce of coal they take off
Federal lands--12.5 percent. We make people who mine underground coal--
a very expensive undertaking--pay 8 percent for every ounce of coal
they mine. We make the natural gas companies and the oil companies pay
12.5 percent for every dollar's worth of oil and gas they take off
Federal lands. And here is what we get for gold--zip. Here is what we
get for silver--zip. And here is what we get for platinum--zip.
Do you know what platinum is selling for as of this moment? It is
$413 an ounce. We have given billions and billions of dollars worth of
platinum and palladium away in Montana in the process of doing it, and
we will not get one thin dime out of it.
Just look at this chart: ``Miners Get the Gold and the Taxpayers Get
the Shaft.'' Here is Barrick Gold Co., the stock of which has climbed
in accordance with the price of gold. About a year and a half ago
Secretary Babbitt was required by law to give Barrick Resources 11
billion dollars' worth of gold. Do you know what the Secretary and the
taxpayers of the United States got for that $11 billion? Yes, $9,000.
Ask Senators who own land with gold or silver or platinum or palladium:
How many of you are willing to give the gold companies that kind of a
deal? You know the answer to that question.
Then just recently the Secretary was required by law to give a Danish
company--Faxe Kalk--1 billion dollars' worth of travertine. Travertine
converts into a powder which has very special uses. What do you think
the taxpayers of the United States got for that $1 billion? Why, they
got a whopping $700--enough to take your family out to dinner about
five times.
Do you think I am making this up? If you think I am making it up,
invite all Senators who think this is just such a wonderful thing to
come to the floor and refute it.
In the past year, we gave Asarco, a copper and silver company, lands
that have underneath them--who cares about the value of the surface? We
just gave Asarco 3 billion dollars' worth of copper and silver. What
did the taxpayers get for their $3 billion? Yes, $1,745. We are going
to be required--we have not done it yet, but under the law, because of
the 1872 law that Ulysses Grant signed when he was President, we are
going to be required to give the Stillwater Mining Co. 44 billion
dollars' worth of platinum and palladium. Mr. President, this is their
figure, not mine. You want to go and find out where I got that figure?
Look at their prospectus. And the taxpayers of this country in exchange
for their $44 billion are going to get the whopping sum of $10,000.
We are trying to balance the budget. It makes a mockery of it. It
makes an absolute mockery of it. You talk about corporate welfare. That
is the reason I applaud the Kennecott Co. At least in the land
exchange, the grant we are going to give Kennecott in the Murkowski
bill, they had the decency to say, ``We will give you a 3-percent net
smelter return for all the copper we mine.'' That is still less than
private property owners charge, but it is at least reasonable. If the
taxpayers of this country were getting a severance tax or a net smelter
return royalty over the next 7-year period when we are trying to
balance the budget, it is a big piece of money.
When we look at some of the things we are doing to the environment,
even after the add-back in the amendment we are going to vote on here
in about 2 hours, even after we add that back into the environmental
fund, EPA is still going to be cut significantly. Mr. President. When I
came to the Senate, 65 percent of the streams and lakes of this country
were not swimmable and not fishable. Today, in 1996, that figure has
been reversed; 65 percent of the streams and lakes are fishable, are
swimmable. And I do not care where you go. If you go to Main Street
America--you pick the town--and you ask people: Do you think we are
doing enough for the environment? Seventy percent of the people say,
no. Do you want to reverse that figure to 35 percent of the streams and
lakes not being fishable and swimmable from the point that 65 percent
of them are? No. Nobody wants to turn the clock back on the
environment.
The air we breathe, the water we drink goes to the very heart of our
existence, and we are cutting the Environmental Protection Agency's
budget. Too much regulation, they say. That may be true. Cut the
regulations back, but do not cut back the quality of water and air.
Here is an opportunity to find an awful lot of money that we have
been giving away since 1872, originally to encourage people to move
west. You think about the rationale for the 1872 law--to encourage
people to move west--124 years ago. What is the rationale now?
Corporate greed. Political campaign contributions. That is it, pure and
simple. People will not vote to impose a royalty on mining companies
because they give away a lot of money around here. Until we straighten
that out, this is not going to be straightened out.
Mr. President, I have made the same speech on this floor many times.
The figures keep changing. The companies that are benefiting from it
keep changing. I do not know how much longer I am going to be in the
Senate, but I promise you one thing: The last day I serve here I will
be standing right here, unless this is rectified, making the same
speech.
I yield the floor.
____________________