“Medical Conscience” bills would allow providers to deny more health care

Legislation in at least eight states would expand the right 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 vaccinations — that conflicts with their religious or moral beliefs.

For years, most states have had so-called Medical Conscience Laws These are primarily aimed at discouraging providers or hospitals from engaging in abortions. But conservative lawmakers in several states are pushing to expand those protections as cultural clashes over health care have exploded in recent years.

Advocates say the measures protect providers from being sued, fired or demoted for following their deeply held beliefs. At least five states have enacted expanded medical conscience laws in recent years.

“There is no political advantage in requiring people to engage in a practice that violates their beliefs,” said Bill Duncan, a constitutional law and religious freedom scholar at the Sutherland Institute, a conservative think tank in Salt Lake City that is supporting a medical conscience bill in Utah.

“The right kind of legislation is to allow these beliefs to be taken into account,” Duncan said.

But critics warn that the measures are so sweeping that they would allow doctors, pharmacists, hospitals and insurers to say “no” to almost everything, undermining patients’ expectations of 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) have introduced expanded medical conscience laws. Many of these efforts are supported by national anti-abortion groups such as the Alliance Defending Freedom, a conservative Christian legal advocacy organization.

The debate crystallized last month in Tennessee, which already has an expanded medical conscience law. A local woman told Nashville television station WSMV that she was already hooked up to an IV and being prepared for a sterilization at Ascension St. Thomas Midtown Hospital when hospital staff told her the surgery could not be performed. The hospital’s medical ethics committee, she said, cited a “duty to protect their sacred fertility.”

The hospital is part of Ascension, one of the largest nonprofit Catholic health systems in the country, and follows a set of Catholic church guidelines that include direct sterilization among the procedures it calls “inherently immoral.”

It is unclear why the woman was admitted for surgery in the first place. Similar cases of denied sterilization operations have been reported in Michigan And Wisconsin.

Ascension did not respond to Stateline’s request for comment.

Last summer, a pregnant woman stood outside a town hall in northeast Tennessee and announced her state’s statement up-to-date law — which had taken effect three months earlier — allowed her doctor to refuse her prenatal care after learning that she and her partner were unmarried.

“This provider told me that this act made them uncomfortable treating me because I am an unwed mother and that goes against their Christian values,” she said in a widely shared video from the town hall.

From doctor to pharmacist

Many conservative-led states already offer protections for providers who do not want to participate in abortions. However, expanded protections are needed as more scenarios emerge that could violate a person’s religious freedom or conscience, said Duncan of the Sutherland Institute.

“There may be other situations that really haven’t come up because the legal issues are fairly new and people haven’t been asked to do this in the past,” he said, pointing to services like gender-responsive care. With more comprehensive state laws, “we can create a general template to figure out how we address this.”

Duncan said Utah’s bill is a good attempt to balance the rights of providers and patients. For example, providers would be required to post prominent statements on their websites and in reception areas informing patients of the services they do not offer. The notice would be required to include a government website listing providers offering these services.

However, in rural communities with few health care providers or for people whose insurance is only accepted at a local hospital or by a narrow number of doctors, the notification may not make much of a difference.

Caitlyn Jasumback, vaccine advocacy program manager at the Utah Public Health Association, warned that Utah’s bill – which the legislature has passed and sent to the governor — could lower vaccination rates by allowing providers to refuse to offer certain vaccines or even discuss them 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 other services you receive, other staff involved in that care may decline to participate,” she said.

“The nurse could refuse to administer the vaccine. A pharmacist could refuse to dispense it. A staff member could refuse to help with documentation.”

National groups like the American Medical Association support providers who act according to their conscience but their freedom is not unlimited: According to AMA policy, physicians are expected to provide emergency care, respect patients’ informed decisions, and not discriminate against individuals.

Before Idaho enacted his comprehensive medical conscience law Last March, Republican Rep. Bruce Skaug, the House sponsor, listed the Types of services that a provider could refuse the offer, including medical assistance in dying, dispensing marijuana or mind-altering drugs, gene editing, gender-affirming care such as surgery or puberty blockers, and “injectable products.”

Mistie DelliCarpini-Tolman, Idaho state director for Planned Parenthood Alliance Advocates, told lawmakers that the Idaho law would also allow a pharmacist to refuse to dispense antidepressants, an insurer to refuse to cover birth control or a doctor to refuse services to a gay couple or their children.

“No free ticket”

Last month, Democratic Kentucky state Sen. Reginald Thomas asked Kentucky’s Republican sponsor Medical Conscience Bill Whether it would allow a doctor with “sincere” racist beliefs to refuse treatment to a black patient.

The bill sparked heated debate in the Kentucky Senate before passing the Senate without Democratic support. It is currently in a House committee.

Thomas told lawmakers that the bill “incorporates prejudices that we have fought hard to overcome in this country” and “opens the door for legally protected discrimination.”

The bill’s sponsor, Republican Senator Donald Douglas, who is also a doctor, and other supporters pointed out that conscientious objections would only be allowed to the provision of certain services, not to the care of certain patients.

And like other medical conscience laws, it would not apply to emergency care that doctors and hospitals are required to provide under federal law.

“It is not a free pass for doctors not to treat patients,” Douglas told his fellow MPs.

Douglas and other advocates also argue that protections from criminal and civil liability would make their states more attractive to practitioners, helping to reduce the shortage of doctors and nurses.

In Tennessee, Democratic Senator Aftyn Behn is trying to limit the scope of her state’s law. Behn presented a The invoice This 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. The bill is supported by Planned Parenthood.

Behn said medical conscience laws could create a slippery slope toward criminalizing certain types of health care. In recent years, hundreds of women were prosecuted for behavior related to pregnancy and pregnancy loss.

“Right now, this is all in the realm of professional subjectivity and responsibility,” Behn said. “But once the threshold is crossed where someone is arrested, to me that’s a point of no return.”

It’s unclear how many providers, hospitals or insurers will take advantage of laws that provide broader immunity for refusing treatment. Jasumback of the Utah Public Health Association believes such providers are “rare and far between.”

And yet, she said, they still create barriers to care. Even if a patient can have the same procedure with a different doctor or in a different hospital, it still represents an additional burden: another appointment, an additional co-payment, more time off work, arranging additional child care or transportation.

“It’s not really about resisting conscious protective measures,” she said. “It’s really just about expanding the idea of ​​true informed consent and ensuring that patients have all the information they need to make the most informed decision about their health and that of their children.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.