Tennessee Overreliance on Conscientious Exemptions in Decision-Making

The Medical Ethics Defense Act (MEDA), set to take effect in Tennessee on April 29, 2025, is poised to offer broader and stronger conscience protections to healthcare professionals than typical federal laws. This legislation extends beyond the usual narrowly focused conscience clauses, covering a wide range of healthcare services, including prenatal care.

According to the act, healthcare providers—including individuals, institutions, and insurers—can refuse to participate in or pay for any medical service that conflicts with their "conscience," defined as sincerely held ethical, moral, or religious beliefs. This broad protection could potentially lead to the denial of prenatal care, as demonstrated by at least one reported case where an unmarried pregnant woman was denied care due to her healthcare provider's moral objections to her marital status.

The MEDA provides legal immunity to healthcare workers and institutions refusing care on conscience grounds, so long as refusal is not related to an imminent danger situation and complies with federal mandates like EMTALA. This means that providers could potentially refuse care for reasons subjectively associated with moral or ethical beliefs, such as marital status, obesity, poverty, vaccination status, or lifestyle choices.

This expansion of conscience protection differs significantly from federal protections for conscientious objection. While federal protections are mainly focused on specific federally regulated procedures, Tennessee's MEDA has a much broader scope, including individual and institutional beliefs grounded in ethical, moral, or religious principles stated in organizational documents.

It's important to note that the MEDA does not override federal emergency care laws (EMTALA), and it does not provide protection if a patient is in imminent danger. Additionally, it does not override contractual obligations.

In the realm of healthcare ethics, conscientious refusal to provide certain types of care is an ethical right for healthcare professionals. However, this exception should remain narrow to ensure that all patients receive the care they need, regardless of the personal beliefs of their healthcare providers. Most religions, including Judeo-Christian traditions, emphasize love, compassion, and service as foundational elements for providing care to others.

In contrast, the speaker argues against the expansion of the objection to the person in front of the healthcare professional. They believe that the objection should focus primarily on the procedure or intervention and not the personal characteristics of the patient. In their own practice, they have provided care to patients who hold views that they vehemently disagree with.

The speaker also emphasises that legal protections against discrimination in the workplace do not specifically extend to establishing a patient-physician relationship or providing medical care. This means that healthcare professionals can legally decline to accept patients into their practice and deny care absent an emergency.

However, it's crucial to remember that every case is unique, and the application of these principles can lead to complex ethical dilemmas. As we navigate these challenges, it's essential to prioritise the wellbeing and rights of patients while respecting the ethical and moral beliefs of healthcare professionals.

References:

[1] Tennessee Medical Ethics Defense Act (MEDA) [2] National Conference of State Legislatures (NCSL) [3] American Civil Liberties Union (ACLU) [4] Guttmacher Institute

Louise P. King, JD, MD, the director of reproductive bioethics at the Harvard Medical School Center for Bioethics, is a member of the board of trustees of The Bioethics website.

The Medical Ethics Defense Act (MEDA) will offer stronger conscience protections to healthcare professionals in Tennessee, extending beyond typical federal laws, covering a wide range of healthcare services such as prenatal care, chronic diseases, and even skin conditions.
Healthcare providers, including individuals, institutions, and insurers, can refuse to participate in or pay for any medical service that conflicts with their conscience, which is defined as sincerely held ethical, moral, or religious beliefs.
This expansion of conscience protection could potentially lead to the denial of care for patients with medical-conditions like cancer, respiratory-conditions, and cardiovascular-health issues.
The MEDA provides legal immunity to healthcare workers and institutions refusing care on conscience grounds, but not in imminent danger situations or if it violates federal mandates like EMTALA.
The broad protection offered by MEDA differs significantly from federal protections for conscientious objection, which mainly focus on specific federally regulated procedures.
It's important to ensure that all patients receive the care they need, regardless of the personal beliefs of their healthcare providers, as conscientious refusal to provide certain types of care is an ethical right for healthcare professionals.
In contrast, the speaker argues against the expansion of objection to the personal characteristics of the patient, suggesting it should focus primarily on the procedure or intervention.
Legal protections against discrimination in the workplace do not specifically extend to establishing a patient-physician relationship or providing medical care, allowing healthcare professionals to decline patients or deny care absent an emergency.
Education and self-development, such as skills-training in patient-care and career-development, can equip healthcare professionals with the tools needed to navigate these ethical dilemmas in a compassionate and inclusive manner.
In the realms of health-and-wellness, family-health, mental-health, sexual-health, and womens-health, it's essential to prioritize the wellbeing and rights of patients while respecting the ethical and moral beliefs of healthcare professionals.
Personal-finance considerations, such as budgeting and managing personal-finance, may play a role in a healthcare provider's decisions regarding the care they are able to provide, as well as their career-development opportunities in sports or sports-betting industries.