At the start of 2024, the Iowa legislature introduced and began consideration of Senate Study Bill 3006. This bill would create a “conscience” clause for health care institutions and providers, allowing them to deny services of procedures that violate their personal beliefs[1].This bill allows providers and institutions to refuse services, deny referrals, and lets insurers decline coverage for services they find objectionable[2].[3].

            The bill does not require providers to disclose when they refuse services due to moral or religious beliefs[4]. This could lead to potential life-threatening effects as patients would be unaware that their providers may refuse to give them necessary care and medical treatment. Imagine a pregnant patient chooses an OB-GYN, unaware they refuse to perform C-sections due to personal beliefs. If complications arise requiring an emergency C-section, the provider's refusal could put both the patient and baby’s lives at risk. This is the kind of dangerous scenario this bill could create. 

            The bill would also give providers significate protection if they chose to refuse treatment due to their beliefs. It would protect them from legal action as it would prevent patients from being able to sue providers for any harm that results from their refusal, unless the patient is deprived of emergency care that is required by federal law[5]. It would also offer protection from disciplinary actions and termination as it would bar regulators and boards from revoking or threatening to revoke license or certification[6].

            Christian organizations were the only groups that expressed support for the bill[7]. Tom Chapman, Executive Director of Iowa Catholic Conference, said the bill is meant to protect medical providers from discrimination and punishment for exercising their “fundamental right of conscience[8].” Chapman stated “[n]o medical practitioner should be forced to participate in a procedure or medication to which he or she has an objection of conscience or violate their oath to do no harm[9].” Chapman added "[t]he right of conscience is a fundamental right in human beings[10]." Jeff Taylor, a Republican Senator from Sioux Center Iowa, said the legislation was intended to address "specific procedures, specific products in the health care realm[11]." And while specific procedures that the bill may affect were not mentioned, there was brief discussion of C-Sections during testimony[12]. However, the bill is broad, and it seems like it could apply to any type of procedure depending on a person’s religious beliefs[13]. 

Other states have also begun to consider similar bills. Just last year, Montana passed a sweeping medical conscience refusal law[14]. Montana Senate Bill 245 says “[a] medical practitioner has the right to not participate in a health care service that violates the practitioner's conscience[15].” It further says, “refusal to participate in or pay for a health care service under this section may not give rise to liability of the health care institution or health care payer for damages allegedly arising from the refusal[16].”

Medical conscience laws have received protection from federal statutes. The Church Amendments were enacted in the 1970s in response to debates over whether recipients of federal funds should be required to prove abortion or sterilization services[17]. The Amendments prohibit public officials from requiring recipients of federal funds to perform or assist with abortions or sterilization procedures against their religious or moral beliefs[18]. The Amendments also prohibit entities that receive federal funds from discriminating against health care personnel based on their religious beliefs or moral convictions[19]. The Public Service Act, also known as the Coats-Snowe Amendment, protects health care entities from discrimination based on their participation in certain medical procedures or research[20]. It prohibits the federal government and state and local governments that receive federal financial assistance from discriminating against health care entities that refuse to perform abortions, refuse to provide abortion training, refuse to make arrangements for abortion-related activities, or attend a health professions training program that does not perform abortions[21].

Federal Statutes have continued to be enacted to ensure the further protection of medical conscience laws. On January 9^th, 2024, the U.S. Department of Health and Human Services finalized the Safeguarding the Rights of Conscience as Protected by Federal Statutes. This statute clarifies the process for enforcing federal conscience laws and strengthens protection against discrimination[22]. These federal laws and statutes ensuring the continued protection of medical conscience laws could have detrimental effects on the health and safety of patients across the country as providers are enabled to deny patients’ important care. 

The United States Supreme Court has also addressed the growing issue of medical conscience law. In Alliance for Hippocratic Medicine v. FDA, the Supreme Court ruled that federal conscience laws protect doctors from being forced to provide medical care that violates their conscience[23]. The Court specifically said “[w]e agree … that federal conscience protections provide ‘broad coverage’ and will ‘shield a doctor who doesn't want to provide care in violation of those protections’[24].” Unfortunately, with this recent Supreme Court ruling, it seems that Iowa’s proposed bill may become a reality. This means that patients seeking help may be faced with the reality that they are unable to receive the care and treatment that they desperately need. 

However, medical conscience laws and the federal statutes that protect them are in clear conflict of the United Nations’ International Covenant on Civil and Political Rights, which the United States has ratified[25]. While the Article 18(1) of the Covenant ensures that everyone has a right to of religion, Article 18(3) states “[f]reedom to manifest one’s religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health or morals or the fundamental rights and freedoms of others[26].” And Iowa’s proposed would most certainly compromise public health and safety. 

Most of the feedback received for the bill was opposition from medical professionals who argued the bill could deny patients basic standards of care[27]. Several medical providers have testified against the bill. Becky Johnson, nurse practitioner, says this could lead to infectious disease outbreaks like HIV since doctors could refuse to give vaccines if they object to preventive medicine[28]. Johnson said “[t]his is a public health disaster. It’s a legal nightmare[29].” She worries it will “create more inequities and more chaos[30].” Johnson also worries that this bill would be particularly problematic in rural Iowa, where people already have limited access to healthcare[31]. There have also been no medical providers who have claimed that they have ever been required to provide care that went against their ethical, moral, or religious beliefs[32]. Opposition of the bill was not just from medical professionals. Senators also expressed their fears of what the bill would mean for access to health care. Janet Peterson, a democratic senator from Des Moines Iowa, said that she feared the legislation would worsen health care for women and mothers[33]. The consequences of Senate Study Bill 3006 are not only inconsistent with the United Nations’ International Covenant on Civil and Political Rights which the United States has ratified, but it also endangers the health and safety of all those living in Iowa who may be unable to receive the care and medical help they need.