The Ever-Expanding Right to Refuse to Provide Healthcare

by Elizabeth Sepper

For the past decade, a blockbuster religion law case has been a feature of every Supreme Court term. The Court dramatically eased the ability of employers to claim religious exemptions. It overturned long-standing Establishment Clause precedent. And it revolutionized Free Exercise Clause doctrine to favor objectors to public health measures and antidiscrimination laws.  With no religious liberty claim on the docket, the 2023-24 term promised to be the exception.

Nevertheless, in a pair of abortion cases, the Court took the opportunity to broadly interpret federal conscience law to override patients’ rights to emergency care. The first, Food and Drug Administration v. Alliance for Hippocratic Medicine (AHM), challenged the FDA’s approval of mifepristone, the abortion pill. The second, Moyle v. United States, involved the conflict between state abortion bans and the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires life- and health-saving care, including abortion, in emergency departments. Neither seemed to implicate the Church Amendment of 1973, which allows individual providers and institutions to refuse to perform or participate in abortion for religious or moral reasons.

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Polar chart depicting state conscience protection laws for abortion (46 states), sterilization (17 states), contraception (16 states), or emergency contraception (5 states).

New Dataset: Conscience Protections for Providers and Patients

Scholarship and public debate about law’s role in protecting health care providers’ conscience rights often focus on who should be protected, what actions should be protected, and when and whether there should be any limitations on conscience rights.

But the how of these legal protections is rarely addressed – that is, when health care providers decline to participate in medical services that violate their deeply-held beliefs, exactly what consequences do state laws protect them from? The new dataset I’ve just released on LawAtlas answers this question in the context of reproductive health conscience laws, and reveals some surprising trends.

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