Committee debates medical ‘right of conscience’ bill
“If I’m in an accident or medical emergency, with a law like this in place, a medical care provider could raise the right of conscience card, disregard their Hippocratic oath, and refuse to treat me,” said Ezekial Cork, a transgender man and Missoula resident who testified against HB 303. If that decision led to his death, Cork continued, the health care provider who refused services “would apparently sleep well at night while those I left behind were left to grapple with their grief.”
As written, the bill says that “a health care institution or health care payer may not be required to participate in or pay for a health care service that violates the health care institution’s or health care payer’s conscience.” A later section adds that a health care institution or provider would not be liable for refusing to participate or pay for services, and that those actions could not be “the basis for any discrimination, discipline, or other recriminatory action against the health care institution, health care payer, or any personnel, agent, or governing board.”
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Industry opponents included the Montana Medical Association, Montana Hospital Association, Montana chapter of the American Academy of Pediatrics, the Montana Nurses Association, the Montana Primary Care Association, Planned Parenthood of Montana and Blue Mountain Clinic, all of whom said the bill would undermine the medical profession’s obligation to act in the best interest of patients. The ACLU of Montana and the Montana Human Rights Network lodged additional opponent testimony, saying HB 303 would lead to patients being denied care “with impunity.”
Opponents, including a medical ethicist, also said the bill was unnecessary given the existing protocols health care providers have for filing conscience-based objections, such as hospital ethics committees.
“Rights of conscience can exist and do exist in health care, but must be balanced with protections for patient rights. They cannot exist carte blanche without qualification or as a get-out-of-jail free card,” said Dr. Nathan Allen, an emergency physician at Billings Clinic and one of three health care ethics consultants in Montana.
The American Medical Association Code of Ethics, Allen said, allows providers to object to services based on moral and religious grounds but stipulates that patients must be treated in emergencies, receive informed consent about their medical care, and are protected from discrimination. Those checks and balances, he continued, don’t exist in Montana’s proposed law.
“Patient protections are absent from HB 303. There are not guardrails on what types of ethical, moral or religious beliefs ‘conscience’ can be based on. No explanation can be required other than simply stated ‘conscience,’” Allen said. “This creates a discrimination loophole, which would allow health care workers, organizations and payers to decline to provide care to a patient because they are a man, a Native American, have HIV, committed a crime or a member of a different religious faith.”