Conservative lawmakers in many states are pushing to expand medical conscience protections for doctors, hospitals, pharmacists and other providers as cultural battles over health care have erupted in recent years. (Photo: John Partipilo/Tennessee Lookout)
Legislation in at least eight states would expand the rights of doctors, nurses, hospitals and even insurance companies to refuse to provide or pay for care — from contraception and fertility services to medical marijuana and childhood vaccines — that conflicts with their religious or moral beliefs.
In most states, the so-called the law of medical conscience whose primary purpose is to prevent providers or hospitals from having to participate in abortion. But conservative lawmakers in many states are pushing to expand such protections as cultural battles over health care have erupted in recent years.
Supporters say these measures protect providers from being sued, fired or demoted for adhering to their deeply held beliefs. In recent years, at least five states have passed expanded medical awareness laws.
“There is no political advantage in requiring people to engage in practices that violate their beliefs,” said Bill Duncan, a specialist in constitutional law and religious liberty at the Sutherland Institute, a conservative think tank in Salt Lake City that supports Utah’s medical conscience law.
“The right kind of legislation is to allow for accommodation of those beliefs,” Duncan said.
But critics warn that the measures are so broad that they will allow doctors, pharmacists, hospitals and insurers to deny almost anything, undermining patients’ expectations for comprehensive and informed care.
This year, conservative lawmakers in at least eight other states (Kentucky, Missouri, New Hampshire, Oklahoma, Rhode Island, South Carolina, Utah and West Virginia) introduced expanded medical conscience legislation. Many of these efforts are supported by national anti-abortion groups such as Alliance Defending Freedom, a conservative Christian legal defense organization.
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The debate crystallized last month in Tennessee, which already has an expanded medical conscience law. A local woman told Nashville TV station WSMV that at Ascension St. Hospital. Thomas Midtown was already on a drip and preparing for sterilization surgery when hospital staff told her the surgery would not proceed. She added that the hospital’s medical ethics committee quoted “duty to protect her sacred fertility“
The hospital is part of Ascension, one of the largest nonprofit Catholic health care systems in the country, and follows a set of Catholic Church directives that list direct sterilization among procedures it calls “intrinsically immoral.”
It is unclear why the woman was admitted for surgery in the first place. Similar cases of refusal of sterilization surgery have been reported in: Michigan AND Wisconsin.
Ascension did not respond to Stateline’s request for comment.
Last summer, a pregnant woman stood up at a northeast Tennessee town hall and declared that she was in her condition. novel law – which had gone into effect three months earlier – allowed her doctor to refuse prenatal care when he learned that she and her partner were not married.
“This health care provider told me that because of this bill, they didn’t feel comfortable treating me because I was an unwed mother, and that went against their Christian values,” she said in a widely shared video from the town hall.
Doctors for pharmacists
Many conservative-led states already offer protections to health care providers who choose not to participate in abortions. But expanded protections are needed as more scenarios emerge that could violate someone’s religious freedom or conscience, said Duncan of the Sutherland Institute.
“There may be other situations that haven’t actually happened because the legal issues are quite new and people haven’t been asked to do these things in the past,” he said, citing services such as gender-affirming care. With broader state regulations, “we can create a general template to figure out how to approach this.”
Duncan said Utah’s bill is a good-faith effort to balance the rights of healthcare providers and patients. For example, it would require providers to prominently post statements on their websites and at reception desks informing patients about services they do not offer. The announcement would have to include a state website listing providers offering these services.
However, notification may not make much difference in rural communities with few providers or for people whose insurance is accepted only at one area hospital or by a confined number of doctors.
Caitlyn Jasumback, immunization outreach program manager for the Public Health Association of Utah, warned that the Utah bill – passed by the Legislature passed and sent to the governor – could lower vaccination rates by allowing providers to refuse to offer or even discuss certain vaccines with patients.
The bill’s broad scope means it touches every aspect of health care, Jasumback said.
“What people may not consider is that while your doctor may support vaccinations or any other service you use, other staff involved in that care may decline to participate,” she said.
“A nurse may refuse to administer the vaccine. A pharmacist may refuse to give it out. An employee may refuse to help prepare documentation.”
National groups like the American Medical Association support healthcare providers acting in accordance with their conscience but retaining that freedom is not unlimited: It is AMA policy that physicians are expected to provide emergency care, honor patients’ informed decisions, and not discriminate against individuals.
Before Idaho passed a wide-ranging law on medical conscience Last March, Republican state Rep. Bruce Skaug, the House sponsor, put the bill on the list types of services that a provider could refuse, including physician-assisted death, dispensing marijuana or mind-altering drugs, gene editing, gender-affirming care such as surgery or puberty-blocking drugs, and “injectable products.”
Mistie DelliCarpini-Tolman, Idaho state director for Planned Parenthood Alliance Advocates, told lawmakers that Idaho’s law would also allow a pharmacist to refuse to dispense antidepressants, an insurer to refuse to cover contraception or a doctor to refuse services to gay couples or their children.
“It’s not a free ticket”
Last month, Kentucky state senator Sen. Reginald Thomas, a Democrat, asked the Republican sponsor of the Kentucky event Act on medical conscience whether it would allow a doctor with “sincerely held” racist beliefs to refuse care to a black patient.
The bill sparked heated debate in the Kentucky Senate before it passed the Senate without Democratic support. He currently serves on the House of Representatives committee.
Thomas told lawmakers the bill “builds on biases that we have fought hard to end in this country” and “opens the door to discrimination protected by law.”
The bill’s sponsor, Republican state Sen. Donald Douglas, who is also a physician, and other supporters have pointed out that it only allows conscientious objections to the provision of certain services, not the care of specific patients.
Like other medical conscience laws, it would not apply to emergency care that doctors and hospitals are required to provide under federal law.
“Not treating patients is not a free ticket for health care providers,” Douglas told fellow lawmakers.
Douglas and other advocates also argue that providing protections from criminal and civil liability would make their states more attractive places for providers to practice, helping to reduce shortages of doctors and nurses.
In Tennessee, Democratic state Sen. Aftyn Behn is trying to limit the scope of his state’s law. Behn introduced A Bill it would prevent health care providers and insurers in Tennessee, which has a strict abortion ban, from using the law to refuse to provide pregnancy-related services. Planned Parenthood supports the bill.
Behn said medical conscience laws could create a slippery slope toward criminalizing certain types of health care. Hundreds of women in recent years they heard criminal charges for proceedings related to pregnancy and pregnancy loss.
“Right now, all of this is in the realm of professional agency and responsibility,” Behn said. “But as soon as it crosses the threshold where someone has been arrested, for me that’s the point of no return.”
It is unclear how many providers, hospitals and insurers will take advantage of the provisions providing broader immunity for denial of care. Jasumback of the Utah Public Health Association believes such providers are “few and far between.”
And yet, she said, they still create barriers to care. Even if the patient can find the same procedure with another doctor or in another hospital, it is still an additional burden: another visit, additional payment, more days off from work, organizing additional child care or transport.
“It’s not really about opposing conscious conservation,” she said. “It’s really just showing the concept of true informed consent and wanting to provide patients with all the information they need so they can make the most informed decision about their health and the health of their children.”
Stateline reporter Anna Claire Vollers can be reached at: avollers@stateline.org.
This story was originally produced by state linewhich is part of States Newsroom, a nonprofit news network that includes the Ohio Capital Journal and is supported by grants and a coalition of donors as a 501c(3) public charity.
