A years-long tug-of-war pits the rights of patients against those of physicians and healthcare organizations—all of whom have legal rights to refuse certain medical procedures on moral or religious grounds.

There’s a peculiar footnote buried deep inside a dense document drafted by the Department of Health and Human Services.

That document, which spans 51 pages in last Friday’s edition of the Federal Register, outlines proposed rulemaking for the HHS Office for Civil Rights (OCR), which recently announced it would add a new Conscience and Religious Freedom Division as part of an effort to ramp up enforcement of existing laws that protect a healthcare worker’s right to decline to participate in abortion and other services on moral or religious grounds.

The document argues these conscience laws, some of which have been on the books for decades, went under-enforced during President Barack Obama’s eight years in office. And it argues that many doctors and nurses across the U.S. would benefit from the government taking a renewed interest in guaranteeing their conscience rights are respected.

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