The US Department of Health and Human Services issued a last minute rule to protect healthcare workers from discrimination if they refuse to participate in medical care to which they have religious or moral objections (BMJ 2008;337:a1509 and a1889).

Such edicts are called “midnight rules” because they are issued at the last moment before an administration leaves office.

The ruling comes into effect on 18 January, the day before President George Bush leaves office. It covers doctors and nurses who do not want to participate in specific procedures, and many other workers, including those who clean instruments, schedule appointments, or file insurance claim forms.

Press attention has focused on health workers who object to abortions. However, the ruling can apply to health workers who object to providing …