Conscience Trumps Care under the Medical Ethics Defense Act

By: Ranier Simons, ADAP Blog Guest Contributor

The basic expectation that one can go to a hospital or other healthcare facility to receive needed healthcare is increasingly under attack. Federal and state actors are pushing legislation that allows providers to deny care to patients. The legislation purports to protect practitioners from being discriminated against for declining to participate in medical procedures that violate their religious beliefs. The reality is that patients are being discriminated against by being denied medically necessary treatment. These 'conscience protections' began to allow healthcare professionals to deny abortion care. However, these legal efforts are expanding in ways to permit a wider lens of patient care denial based on providers' personal beliefs.

Photo Source: Hall Benefits Law, LLC

The Weldon Amendment has been a driving force used to give cover to those who wish to deny abortion care. It denies federal funding to any provider or entity that discriminates against those who do not provide abortion care in response to religious objection. The amendment is not a law, but rather a provision that has been approved and added to annual appropriations bills since 2005, involving funding provided through the U.S. Department of Health and Human Services (HHS) and the U.S.Department of Labor (DOL). 

Some private health plans and those offered on the Affordable Care Act (ACA) marketplace are required to cover abortion care. Nevertheless, 

Tennessee has made conscience protection into law to an extent, reaching much farther than abortion care, allowing patients to be legally discriminated against, which can result in harm from denied care. The state signed the Medical Ethics Defense Act (MEDA) into law in April 2025 (Lee, 2025). The law states that "A healthcare provider must not be required to participate in or pay for a healthcare procedure, treatment, or service that violates the conscience of the healthcare provider." Emergency services are protected by the Emergency Medical Treatment and Active Labor Act (EMTALA) (Lee, 2025). 

Nevertheless, the markedly vague language of MEDA gives providers and entities broad latitude to refuse care simply based on deeply held beliefs. The language of the bill defines conscience as, 'sincerely held ethical, moral, or religious beliefs or principles held by a healthcare provider. The bill also makes the following distinctions:

• "Healthcare professional" means a person who participates in any way in a healthcare procedure, treatment, or service;
• "Healthcare provider" means a healthcare professional, healthcare institution, or healthcare payer; and 
• "Participate” means to provide, perform, assist with, facilitate, refer for, counsel for, advise with regard to, admit for the purposes of providing, or take part in any way in providing any healthcare procedure, treatment, or service.

Photo Source: The New York Times

The vague distinctions defined by the statute verbiage potentially allow doctors, nurses, phlebotomists, and even front desk staff to refuse service to patients based on personal bias or bigotry unassociated with specific religious doctrine, such as Catholicism's views on contraception and abortion. A doctor could refuse HIV care to someone who presented as LGBTQ because they view homosexuality as aberrant. If doctors in academic medical centers freely discriminated against patients, those with complex conditions untreatable elsewhere would have no recourse for treatment (Lee, 2025). 

Back in 1999, a California resident, Guadalupe Benitez, was denied artificial insemination fertility services because she was single. The practitioner stated it was against her religious beliefs to perform such services on unmarried women (Patsner, 2008). Ms. Benitez was referred to another doctor in the same medical practice and was unsuccessful after eleven months of infertility treatment. She was subsequently referred to a practitioner outside of the initial practice's medical group. It was later revealed that the true motivations for the initial doctor's treatment denial were because Ms. Benitez was open about being a lesbian. Ms. Benitez sued the practice for the denial.

When she first sued, she won her case with a ruling that physicians in a for-profit medical practice group must comply with California's anti-discrimination law (Patsner, 2008). The decision was appealed and overturned in the appellate court, and then appealed to the California Supreme Court. The California Supreme Court asked the question, "Does a physician have a constitutional right to refuse on religious grounds to perform a medical procedure for a patient because of the patient's sexual orientation?" (Patsner, 2008). Ultimately, the state Supreme Court ruled that a physician or practice group cannot refuse care to gay men or lesbians on religious grounds. There was no determination or discussion on the issue of being unmarried as a means of denial.

Federal laws don't allow claims of conscience to enable the violation of federal discrimination laws, which is why so much state-level legislation has been proposed. Iowa tried to pass House Study Bill 139, which eventually died in committee. It would have allowed providers and payers to deny medical services they felt violated their conscience (Opsahl, 2025). Most importantly, it would have shielded them from any civil, criminal, or administrative penalties for exercising their rights of denial. Kentucky tried to pass a similar bill, SB132, which also died in committee. It would have also provided legal protection to providers who deny services due to sincerely held religious, moral, or ethical concerns (Acquisto, 2025).

These medical conscience protection laws are perilous because they prioritize the personal beliefs of providers or payors over patients' evidence-based medical needs. Refusal of care is dire when there is a paucity of options for providers. A patient cannot be simply referred to another provider if one does not exist or is located prohibitively far away. Moreover, these laws are being written to provide those who deny care due to conscience with the means to seek a legal remedy if they feel their conscience rights are being violated. Politicizing population health is a disservice to society and deadly for patients. Patients and stakeholders who prioritize patient welfare must remain vigilant in monitoring conscience protection legislation, as efforts to deny care will continue.

[1] Acuisto, A. (2025, March 10). 'Medical conscience' bill advances in KY. Opponents say it's a license to discriminate. Retrieved from  https://www.msn.com/en-us/health/other/medical-conscience-bill-advances-in-ky-opponents-say-it-s-a-license-to-discriminate/ar-AA1AB3G2?ocid=socialshare

[2] Lee, C. (2025, July 30). The Right to discriminate against a patient. Retrieved from https://www.medpagetoday.com/opinion/second-opinions/116741

[3] Opsahl, R. (2025, February 12). Conscience protections for medical providers move ahead in the Iowa House. Retrieved from https://www.yahoo.com/news/conscience-protections-medical-providers-move-004022512.html?guccounter=1&guce_referrer=aHR0cHM6Ly9tYWlsLmdvb2dsZS5jb20v&guce_referrer_sig=AQAAAKtwUParB4LffkgGpSK52f_FBRbutTYwDMV1zJckter97uFn-H2rfAcHZfgoXX_2RNk4PJ3TDEafRuLaP0E7LuC_fJNmln8VAgdrfi9LIgu6l_v1YJq_6NojSKIh95up8_ZzFjyYWtkXh_3x_rKewVvk5VnZDD4OYDRMWEaoUa5B

[4] Patsner, B. (2008, August). Refusing to Treat: Are There Limits to Physician "Conscience" Claims?. Retrieved fromhttps://www.law.uh.edu/healthlaw/perspectives/2008/(BP)%20conscience.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.