Tennessee Lets Doctors Deny Treatment on Moral Grounds
Critics warn the "Medical Ethics Defense Act" will jeopardize care for LGBTQ patients, HIV prevention, and reproductive services.
Tennessee Governor Bill Lee, a Republican, has signed a bill into law to allow healthcare providers the right to refuse to perform or pay for a procedure or prescription that runs counter to their personal moral, ethical, or religious beliefs.
The “Medical Ethics Defense Act” applies to doctors, nurses, and pharmacists, as well as insurance companies who wish to deny coverage for procedures or treatments that individual people may find morally objectionable, such as gender-affirming surgeries, HIV prevention protocols, or abortions.
It also includes non-medical actions, such as the compelled use of pronouns in professional settings.
The bill contains exceptions for when people can exercise the so-called “conscience clause,” such as during emergencies when delivering medical care is necessary to save a patient’s life or when an insurance provider is contractually obligated to cover the cost of a specific treatment.
State Rep. Bryan Terry (R-Murfreesboro), the bill’s sponsor, argued that the law was needed to protect healthcare providers from “moral injury,” which he claimed is contributing to a shortage of physicians needed to treat people in Tennessee.
“Patients and providers have rights,” Terry said. “Providers should not give up their rights to best serve their patients’ [rights]. Patients need to know that our doctors are advocating for them with a clear conscience.”
Dr. Jonathan Shaw, an OBGYN, testified in favor of the bill, claiming that he relocated to Tennessee after being nearly forced out of his previous practice in the Northeast due to his refusal to announce his pronouns to his patients.
“I used the term ‘conscientious objection’ to describe my position on the practice of being forced to announce my own pronouns, but this was seen as a barrier to patient care,” Shaw said. “The ability to do my job was called into question, and human resources were consulted. The implication was clear: conscience needs to be limited or consider an alternative career path. I decided to look for a job elsewhere.”
Dr. Amy Gordon Bono, a primary care physician in the Volunteer State, argued that Terry’s bill violated the Hippocratic Oath, which requires doctors to prioritize their patients’ well-being.
“When legislation is not patient-centered, it’s morally compromised to begin with,” she said, according to Nashville-based ABC affiliate WKRN. “Politicians need to stop dictating medical care, and this bill allows politicians to take their intrusive efforts even further to dictate medical conscience. In my opinion and the way I like to practice medicine is to honor the patient first. That’s where my conscience lies.”
Eight other states have similar “conscience clause” laws enabling medical providers to refuse to perform procedures or prescribe treatments to which they have moral or religious objections.
The U.S. Supreme Court recently heard oral arguments in a case regarding employers who do not wish to pay for insurance coverage of pre-exposure prophylaxis, or PrEP, a treatment that prevents transmission of HIV.
While the employer in question, Braidwood Management, has claimed that providing such care encourages homosexual behavior and extramarital sex, thereby violating their religious beliefs, the court is not dealing with the moral or religious arguments put forth by Braidwood.
Rather, the court will decide whether a task force recommending what types of preventative care should be covered by insurers is constitutional.
Future litigation may arise, challenging various types of preventative care on moral or religious grounds.
If such litigation were to be brought, and the courts were likely to rule in favor of religious objectors, any number of treatments or procedures could potentially be denied, forcing patients who might need to either pay out of pocket, change their insurance carrier, if possible; or change their medical provider.
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