Tennessee Over-Relying on Moral Exemptions in Policy Making
In a world where most religions, including Judeo-Christian traditions, emphasize love, compassion, and service as foundational elements for providing care to others, a recent law in Tennessee has sparked a heated debate over patient rights and provider conscience.
The Tennessee Medical Ethics Defense Act, enacted on April 29 of this year, permits healthcare providers to refuse participation in or payment for any healthcare procedure, treatment, or service that conflicts with their sincerely held ethical, moral, or religious beliefs. This protection extends broadly to any medical service, not limited to specific situations like abortion, and also shields providers from civil lawsuits, criminal prosecution, or discrimination related to their conscientious refusals, except when federal law mandates care.
Critics argue that this law enables providers to deny care based on personal beliefs or even the patient's personal characteristics—such as marital status, obesity, or vaccination status—without requirement to refer patients elsewhere or provide alternative care options. This potential has materialized in the first reported case under the act, where a Tennessee woman was denied prenatal care because she was unmarried.
Louise P. King, the director of reproductive bioethics at the Harvard Medical School Center for Bioethics, emphasizes the importance of treating all patients equally and providing compassionate care. In her own practice, she provides care to all patients who seek it, including those with differing beliefs or backgrounds. As a Jewish physician, she has cared for patients who hold white supremacist views, despite strongly disagreeing with them.
However, the law lacks safeguards ensuring continuity of care, such as mandatory referrals, nor does it provide effective recourse for patients who face denial due to providers’ conscientious objections. This alters the traditional patient-physician relationship by prioritizing provider conscience over patient care needs, risking widening healthcare disparities and eroding trust.
It's important to note that the American Medical Association (AMA) Code of Ethics acknowledges that physicians are not ethically required to accept all prospective patients, but cautions that refusals should not be due to personal or social characteristics that are not clinically relevant to the individual's care. Conscientious refusal to provide certain types of care is an ethical right, but this exception should remain narrow and not encompass an objection to the person in front of you.
The speaker does not explicitly state whether they support or oppose the Tennessee Medical Ethics Defense Act, but they emphasize the importance of treating all patients equally and providing compassionate care. The debate surrounding this law continues, with ethical, legal, and public health implications at its core.
[1] Tennessee Medical Ethics Defense Act (2025) [2] Title VII of the Civil Rights Act [3] EMTALA (Emergency Medical Treatment and Active Labor Act) [4] Conscientious objection in healthcare [5] The Bioethics website (where Louise P. King is a member of the board of trustees)
In the midst of this debate, it's crucial to consider the implications of the Tennessee Medical Ethics Defense Act on women's health, particularly when it comes to medical-conditions unique to women, such as prenatal care or gynecological services. Additionally, the lack of regulations enforcing healthcare providers to provide alternative care options or make referrals, as stated in the act, could potentially impact health-and-wellness outcomes for many individuals, especially women.
