By Brianne Helfrich and Joseph Bertino

Not all lifestyles or beliefs align perfectly, but in a healthcare system that ought to prioritize just practices, moral or spiritual objections should never impede a patient’s access to necessary care. Across the United States, healthcare workers’ right to conscientious objection—refusing participation in certain procedures that conflict with their personal beliefs—has become a contentious issue. While such objections are rooted in deeply held convictions rather than institutional policies, they raise profound questions about the balance between individual conscience and patient rights.

Consider the following: a staff member at a women’s health clinic declining to assist with abortions; a pharmacist refusing to dispense medications used for pregnancy termination; a nurse objecting to participating in blood transfusions due to religious beliefs; or a healthcare provider refusing vaccination, citing personal or religious objections.

These cases are generally addressed through organizational policies that allow providers to abstain from duties conflicting with their conscience, aiming to balance moral freedom with the obligation to serve patients in need.

However, recent legislative developments threaten to shift this delicate balance. States such as Tennessee are expanding legal protections for healthcare providers’ conscientious objections—sometimes to an alarming degree. The Tennessee Medical Ethics Defense Act, enacted in April 2025, expressly authorizes physicians, hospitals, and insurers to deny care to patients based on their own moral, religious, or ethical beliefs. Proponents argue that such laws protect religious liberty and individual moral agency. Critics contend they threaten the very foundation of equitable healthcare, risking discrimination and compromised patient safety.

The implications are chilling. A recent case where a woman in her thirties was denied prenatal care because her healthcare provider objected to her unmarried status, despite her longstanding relationship and a child they are raising together. This denial, rooted in moral objections to her lifestyle, exemplifies how legislation like Tennessee’s law can facilitate discrimination in healthcare and undermine core medical ethics.

Denying care based on a patient’s lifestyle or identity is fundamentally unethical. It contravenes the principles outlined in the American Medical Association’s (AMA) Code of Ethics, which emphasizes physicians’ duty to prioritize patient welfare and uphold nonmaleficence—the foundational and ancient precept to  “do no harm.” Disregarding clinical necessity in favor of personal beliefs does grave harm, especially for vulnerable populations in rural or underserved communities where alternative providers are scarce.

These actions threaten broader societal harm. Legislation permitting refusal based on personal beliefs risks emboldening providers to deny care to marginalized groups—including the LGBTQIA+ community, people of color, and those facing socioeconomic barriers. The slippery slope from conscientious objection to discriminatory practice is a real concern, threatening to erode trust in the medical profession and the healthcare system at large. If patients fear rejection or moral judgment, they might withhold vital information or avoid seeking care altogether—an unacceptable prospect in a nation already grappling with a healthcare crisis.

For conscientious objection to remain ethically justifiable, it must not diminish patient rights or cause unnecessary suffering. Providers’ moral convictions should be respected, but not at the expense of patient dignity or access. When a healthcare worker refuses care, there should be a moral obligation to refer the patient to another provider willing to deliver the necessary treatment. This compromise upholds both provider conscience and patient welfare.

Ultimately, the current legislative trend underscores the need for nuanced policies that navigate the moral complexities of medicine. Respect for individual moral agency must coexist with the ethical imperatives of medical practice—primarily, ensuring all patients receive equitable, compassionate, and competent care. Achieving this balance requires ongoing public debate, transparent policymaking, and a steadfast commitment to the core principles that underpin both medicine and democracy.

In confronting these challenges, we must remember: healthcare is a right, not a privilege. Protecting conscience while safeguarding patient access is essential to preserving the integrity of our healthcare system—and the trust of the communities it serves.

Authors: Dr. Brianne Helfrich and Dr. Joseph Bertino

Affiliation: BH: The Hospital for Sick Children in Toronto, Ontario

Conflicts of Interest: None to declare