The Right to Discriminate Against a Patient

https://www.medpagetoday.com/opinion/second-opinions/116741

Tennessee’s vague conscience protections offer an avenue for legal discrimination

When the woman stood up to speak in a Washington County town hall meeting, she had no idea her story would go viral on social media

Having recently realized she was pregnant, she sought out a physician for prenatal care — but was denied service.

“That provider told me that thanks to [the 2025 Medical Ethics Defense Act, they were not comfortable treating me because I am an unwed mother and that goes against their Christian values.” She revealed she must now cross state lines for basic prenatal care.

“I call Marsha [Blackburn’s] [R-Tenn.] office twice a day. I’m either blocked or she has all calls going directly to voicemail...When I contacted [Sen.] Bill Hagerty’s [R-Tenn.] office, I was told he’s not obligated to listen to his constituents.”

The allegations appalled everyone present. “If you were in that room, you believed her,” Tennessee State Rep. Gloria Johnson (D-90), who had attended the meeting to answer questions about Medicaid cuts, said to me. The video rapidly circulated online, attracting ire from reproductive rights advocates and critics alike. Its subject was unprepared for and overwhelmed by the attention.

“She’s afraid for her job and her child,” Rachel Wells told me. Wells is the journalist who first broke the storyon her Substack, TN Repro News, and had spoken to the woman on the grounds of anonymity.

It is important to know that these are allegations. I imagine someone will speculate that it’s a hoax, which would be extremely disappointing and attack the credulity of other female patients, who already struggle to be believed. However, beyond the particulars of these allegations, a state law exists that appears to permit doctors to discriminate when providing medical care. That is dangerous.

Conscience Rights

Historically, conscience protections are usually applied to abortion and other aspects of reproductive healthcare. If you truly define life as beginning at conception, I can appreciate why you personally would not want to be involved in an abortion. A religious institution may similarly object to specific services. For instance, many Catholic hospitals will not participate in sterilization, abortion, or contraception as a matter of religious principle, which is a federally-protected right

But denying a patient general care based on the patient’s lifestyle choices is a different matter — and not a new one.

In 1999, Guadalupe Benitez was denied artificial insemination by physicians who claimed that providing such treatment to an unmarried individual violated their religious beliefs. Benitez argued that they declined to treat her because of her sexual orientation (she had disclosed she was a lesbian, and statements made by staff members at the clinic suggested that her sexual orientation was the real issue at hand).

A Catholic physician would likely decline to provide this procedure regardless of the patient’s marital status, because artificial insemination is “unnatural.” But, to my knowledge, caring for an unmarried person does not violate any religious tenet. The California Supreme Court unanimously decided in favor of Benitez in 2008, holding that physicians do not have the right to refuse care based on sexual orientation, even on religious grounds. The question of Benitez’s marital status was left largely unresolved but is relevant under this Tennessee law.

I cannot understand why treating an individual whose lifestyle does not align with your own would violate any religious principle. I’m a Christian, and know of no Biblical verse prohibiting me from caring for anyone, even if I believe they have sinned — in fact, I distinctly recall Jesus ministering to sinners.

Rep. Johnson told me that the issue of conscience protections for physicians was predominantly pushed forward by the Alliance Defending Freedom, whose senior counsel, Greg Chafuen, applaudedTennessee’s Medical Ethics Defense Act when it was signed into law in April 2025.

The law states

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.

But Tennessee already had conscience protections in place for physicians, argued Amy Gordon Bono, MD, MPH, alarmed by the bill’s vague language. She testified unsuccessfully against it. “Time and time again, I see this legislative body choose to politicize talking points rather than prioritize real solutions to the issues at hand. This bill will not heal the moral injury present in our healthcare system.”

The law does not apply to services governed by the Emergency Medical Treatment and Active Labor Act (EMTALA). In short, emergency protections are safe (for now), but are seemingly the only thing preventing a potentially bigoted doctor from actually denying a vulnerable patient vital care.

Unintended Consequences

The vagueness of this bill is troubling: a doctor could feasibly refuse to treat anyone, claiming that doing so violates their deeply-held beliefs — highly unclear language that could mean anything.

What if doctors at academic medical centers did this? Our most complex patients, who might not be able to receive appropriate care elsewhere, would suffer disproportionately.

What if such legislation came to my home state of New York? Could I then decline to care for a child abuser, someone with racist tattoos, or an adulterer? These choices disagree with my own Christian faith. Yet, I have treated all, adhering to the standard of care without hesitation.

I wonder if the bill’s authors have considered other consequences of its enactment. How might they feel if a doctor claims that a certain religion is inconsistent with their values and refuses that patient treatment? We can all agree this would be outrageous. But technically, it would be legal.

Or, hypothetically, doctors might invoke conscience protections if a former governor with an alleged history of sexual harassment, a twice-divorced real estate magnate with a sexual abuse conviction, or a CEO having an affair with the head of human resources at a Coldplay concert showed up in clinic. Would politicians pushing vague conscience protections feel differently if doctors declined to treat them on moral grounds?

Tennessee may not be alone; similar legislation exists in Illinois, Florida, Mississippi, and potentially other states, and has not been challenged.

So, it falls on us as a profession to ask ourselves: given the opportunity to discriminate, is this who we want to be as a field?

Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York. The views in the above piece reflect only the author’s and not any institution with which she is affiliated.

Filed under: General Problems