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.   

'Conscience Rule' Dead...For Now

By: Sarah Hooper,  intern, ADAP Advocacy Association, and rising senior at East Carolina University

In early November 2019, a federal district judge voided the ‘Protecting Statutory Conscience in Healthcare’, declaring it was unconstitutional, in a defeat for the Trump Administration. The former rule had allowed healthcare workers to refuse to perform lifesaving medical procedures on patients based on their personal moral and religious beliefs.

The CEO of the National Women’s Law Center, Fatima Goss Graves, released a statement shortly after the ruling was announced, stating: “We are thrilled that the court saw the Trump-Pence refusal of care rule for what it is- unlawful, discriminatory, and an unconscionable attack on our health care.” (News@Jama)

The U.S. Department of Health & Human Services ("HHS") promulgated the regulation, which delved into hot topic issues including abortion and assisted suicide.

Photo Source: MedPage Today

"This rule ensures that healthcare entities and professionals won't be bullied out of the health care field because they decline to participate in actions that violate their conscience, including the taking of human life," said HHS Office of Civil Rights Director Robert Severino after the initial law was brought up. (NPR)

Had the law been ruled constitutional, it would have applied to both state and local governments and public and private healthcare. Those under Medicare of Medicaid would have been affected as well, impacting nearly 74 million people in the United States. (Statistica)

The final ruling would have allowed health care professionals to deny services constitutionally protected, such as abortion, treatment to the LGBTQ+ community, and others. The ruling would have allowed parents to object care on religious or moral grounds for their children- including suicide prevention, child abuse prevention, and vaccines.

For the many people, this is not the first time their access to healthcare has been threatened. Since the HIVAIDs epidemic first took place in the 80s, doctors and communities alike have alienated patients from treatment for fear of transmission. Since then, medical practices have improved care for HIV-infectio drastically, but the HHS law threatened to endanger more lives.

Currently a federal court case in Wisconsin is claiming violation of federal and state anti-discrimination laws. When an HIV positive woman sought treatment for a necessary gallbladder surgery, the surgeon denied the surgery because he was worried about HIV exposure to his medical team. Another hospital then removed her gallbladder in a “routine surgical procedure, which includes universal precautions taken to prevent the transmission of bloodborne pathogens such as HIV,” said the AMA Journal of Ethics. (AMA)

According to a study conducted by the National Women’s Law Center, approximately 8% of LGB individuals, nearly 27% of transgender and nonconforming individuals, and almost 20% of HIV-positive individuals report being denied needed healthcare outright. In another case, a 53-year old man was denied a kidney transplant by his insurance company because of his HIV-positive status, putting his life at risk. (NWLC)

“A patient with HIV who was admitted to a hospital reported that after he disclosed that he had sex with men, the hospital staff ignored him, refused to allow his family to visit, and did not honor his requests for his HIV medication.16 The doctor at the hospital told the patient’s personal doctor, “This is what he gets for going against God’s will” and “You must be gay, too, if you’re his doctor.”17 Despite explaining to the nurses the importance of taking his HIV medication, the patient missed five doses.18 Because some HIV medications are highly time-sensitive, a missed or delayed dose can make the medicine less effective or even completely ineffective,” said NWLC.

“Two judges in two days have recognized the Denial of Care Rule for what it is, an egregious and unconstitutional attack on women, LGBT people and other vulnerable populations. The Denial of Care Rule targets some of our most marginalized and vulnerable communities and deserves to be relegated to the dustbin of history,” said Jamie Gliksberg, a senior attorney at Lamda Legal, after the law was ruled unconstitutional.

References:

• Anderson JD, Bebe J. (December 2019). HIV Stigma and Discrimination Persist, Even in Health Care. AMA Journal of Ethics. Retrieved online at https://journalofethics.ama-assn.org/article/hiv-stigma-and-discrimination-persist-even-health-care/2009-12. 
• Gever, John (2018, November 6). Federal Judge Voids 'Conscience Rule' - Policy would have allowed providers to refuse care because of "moral objections". MedPage Today. Retrieved online at https://www.medpagetoday.com/publichealthpolicy/healthpolicy/83166?xid=NL_breakingnewsalert_2019-11-06&eun=g1295317d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=ConscienceAlert_110619&utm_term=NL_Daily_Breaking_News_Active. 
• Gostin, Lawrence O. (2019, May 15). JAMA Forum: The “Conscience” Rule: How Will It Affect Patients’ Access to Health Services? JAMA. Retrieved online at https://newsatjama.jama.com/2019/05/15/jama-forum-the-conscience-rule-how-will-it-affect-patients-access-to-health-services/.
• Kodjak, Alison (2019, May 2). New Trump Rule Protects Health Care Workers Who Refuse Care For Religious Reasons. NPR. Retrieved online at https://www.npr.org/sections/health-shots/2019/05/02/688260025/new-trump-rule-protects-health-care-workers-who-refuse-care-for-religious-reason.
• Mikulic, Matej (2018, October 26). Medicaid - Statistics & Facts. Statista. Retrieved online at https://www.statista.com/topics/1091/medicaid/. 
• National Women's Law Center (May 2014). Health Care Refusals Harm Patients: The Threat to LGBT People and Individuals Living with HIV/AIDS. Retrieved online at https://nwlc.org/wp-content/uploads/2015/08/lgbt_refusals_factsheet_05-09-14.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.

Trump & HHS Sanction Healthcare Discrimination

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The ADAP Advocacy Association earlier this week joined with the Community Access National Network (CANN) in issuing a strong rebuttal to the expected approval of new federal rules sanctioning discrimination by healthcare workers. The “Moral Exemptions & Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act” — which was initially published in the Federal Register on October 13, 2017, and subsequently on January 26, 2018 — harkens the United States back to the dark, early days of the AIDS epidemic. It is absolutely deplorable!

Photo Source: BSNtoMSN.org

The impending federal rules are not surprising since the current occupant at 1600 Pennsylvania Avenue has systematically embraced the hateful rhetoric and policy positions of the extreme religious right in this country! In the Oval Office, our beloved Bill of Rights has been replaced with advise from Tony Perkins. In the U.S. Department of Health & Human Services, our sacred Hippocratic Oath has been shoved aside to make room for James Dobson. In the HHS Office for Civil Rights, primum non nocere (first, do no harm) has been flushed down the toilet to make way for the bullsh#t being spewed by Jerry L. Falwell, Jr.

Clearly, most of the anti-gay and anti-AIDS posturing is coming from our esteemed Vice President (pun intended). The buck stops with the (crazy) man at the top, and he is who must be held accountable for sanctioning this discrimination.

In fairness, such laws are nothing new. So-called "Church Amendment" laws date back to the 1970s. Most recently it was the Affordable Care Act (Pub. L. No. 111-148 as amended by Pub. L. No. 111-152) itself that included such conscience protections regarding abortions and assisted suicides. The newly released proposed federal rules go further, though.[1]

The target of the so-called "Conscience Rule" are women seeking abortions, but also an entire group of people who identify as gay, lesbian, bisexual, or transgender (LGBT). Its potential reach has broader implications. And as such the reaction from the medical community, scientific organizations, patient advocacy groups, mainstream religious institutions, and so many others has been overwhelmingly negative.

It was summarized best by our board member and former Registered Nurse, Wanda Brendle-Moss:

"As a practicing nurse in Winston-Salem, North Carolina during the early 1980s, I witnessed firsthand the devastating impact of a new illness that was wreaking havoc on the gay men. What made the circumstances robbing so many lives even harsher was medical professionals refusing to treat these patients because they feared the illness. That illness would soon have a name, and it remains with us today: AIDS. Though we’ve made a lot of progress in fighting this deadly epidemic — which as taken nearly 40 million souls from us globally — that fear remains today. Unfortunately, new guidance issued by our government only makes matters worse."

According to Brendle-Moss, trying to comprehend the long range impact of the changes is incomprehensible. In her estimation the "First, Do No Harm" oath taken by all medical students could now be replaced with the prejudicial refusal to provide care and treatment. As a woman living with HIV/AIDS, she fears for the future of her longtime profession if it is allowed to be held hostage to religious fanaticism. She rhetorically asks, "What will be the standard of care for persons diagnosed with AIDS, or women seeking family planning services?"

It isn't only the LGBT community that is concerned. Women are also rightfully worried, especially those who are battered women or rape victims. We've already seen how people living with HIV/AIDS were treated at the outset of the AIDS epidemic. All of these groups...and others...could be faced with legalized refusal to treat under these new federal regulations.

Read the Joint Statement on Discriminatory Proposed Healthcare "Conscience Rule".

__________

[1] Mohr, Aaron, and Allison Smith (2018, February 9); How HHS’s New Division in the Office for Civil Rights Will Enforce Rights of Conscience and Religious Freedom; JD SUPRA. Retrieved from https://www.jdsupra.com/legalnews/how-hhs-s-new-division-in-the-office-38382/.