A controversial new Florida bill will allow physicians to opt out of performing certain services because of "sincerely held" religious, moral, or ethical beliefs.
The bill, part of a "medical freedom" legislative package signed by Gov. Ron DeSantis (R) last week, permits healthcare providers to make conscience-based objections to providing medical care and protects them from getting sued or losing their licenses. It takes effect July 1.
Healthcare providers are broadly defined to include physicians, medical students, residents, and licensed professionals like nurses, mental health providers, and emergency medical services personnel. Facilities like hospitals, nursing homes, and pharmacies are included too.
Insurers can also deny payment for treatment, but they must remove it from their annual contracts first.
Florida is one of about a dozen states that did not accept federal funding for Medicaid expansion and currently ranks 48th in healthcare access. Critics say the new law could exacerbate health disparities and lead to discrimination against certain groups of patients, including LGBTQ+ individuals and women seeking reproductive healthcare.
Psychologists could refuse to treat someone for gender dysphoria, for example. Doctors could refuse to prescribe birth control, administer childhood vaccines, or accept patients with state insurance.
Kenneth W. Goodman, PhD, professor and director of the University of Miami's Institute for Bioethics and Health Policy, told Medscape Medical News the legislation could upset a longstanding precedent.
"To deny care based on unspecified and unarticulated 'moral, ethical, or religious reasons' opens the door to neglect, abandonment, and suspicion," Goodman said. "It undermines two millennia of a cornerstone of medical ethics: take care of your patients — no matter who they are."
Providers must submit written notice of an objection to their supervisor or employer and document it in the patient's medical record. Medical students must notify their educational institution. Objecting to a service cannot result in adverse actions, such as demotion, salary reduction, or loss of privileges. Plus, objecting healthcare providers and insurers will receive immunity from civil liability.
The bill creates more ethical and legal uncertainty for Florida healthcare providers.
In April, DeSantis signed a 6-week abortion ban with limited exceptions and felony charges for participating providers. Last week, he approved separate legislation requiring hospitals to ask patients about their immigration status and report that information to the state. The mandate contradicts the American Medical Association's stance opposing documentation of immigration status in the health record and proof of citizenship as factors in receiving healthcare.
While conscience-based objections can apply only to a "specific healthcare service," the term is expansive. It can apply to medical research, surgical procedures, and services involving testing, diagnosis, and referral. In addition, providers can opt out of recordkeeping, dispensing or administering medication, or "any other care or services."
The law prohibits denying care based on a patient's race, color, religion, sex, or national origin. It also carves out an exception for care related to the federal Emergency Medical Treatment and Active Labor Act.
Damian Caraballo, MD, president of the Florida College of Emergency Physicians, told Medscape the state's emergency physicians will continue to "see, evaluate, and emergently treat any patient that enters the emergency department regardless of their beliefs, ability to pay, or reason for seeking care."
The American Civil Liberties Union of Florida opposes the bill, noting that moral and ethical beliefs are inherently subjective and should not guide medical treatment. The Human Rights Campaign, an LGBTQ+ civil rights organization, also condemns the bill, saying that while religious beliefs are fundamental rights, the bill uses those beliefs to distort the rights of others, especially vulnerable groups. And another civil rights group, Equality Florida, criticized the bill, saying that refusing services "is antithetical to the job of healthcare providers and puts the most vulnerable Floridians in danger."
Goodman said it is unclear what problem the law is attempting to solve. With abortion care, for example, healthcare professionals have "always been extended the courtesy of opting out of that component of reproductive medicine," he said.
The legislation extends free speech protections by prohibiting employers, the Department of Health, and licensing and specialty boards from taking disciplinary action against providers who have "spoken or written publicly about a healthcare service or public policy," including on social media.
As for the other components of the legislative package, businesses and governmental entities will be prohibited from requiring individuals to mask, test, or provide proof of vaccination or post-infection recovery from any disease to gain entry or access services. A ban on gain-of-function research will also take effect on July 1.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Cite this: Florida Docs Can Soon Deny Patient Care Based on Personal, Religious Beliefs - Medscape - May 18, 2023.