In 2025, at a time when ethical issues in health care have received increased attention, Tennessee adopted the Medical Ethics Defense Act.
It provides that a healthcare provider “must not be required to participate in or pay for a healthcare procedure, treatment, or service that violates the conscience of the healthcare provider.”
Government can’t revoke doctor’s license for denying service based on conscience
In a provision labeled “Free speech protection,” the law also provides that no government entity in the state shall “reprimand or sanction a healthcare provider, nor deny or revoke, or threaten to deny or revoke, a license, certification, or registration of a healthcare providing for engaging in speech, expression, or association that is protected from government interference by the First Amendment to the United States Constitution, unless the government entity demonstrates by clear and convincing evidence that the healthcare provider’s speech, expression, or association was the direct cause of physical harm to a person with whom the health care provider had a practitioner-patient relationship within the three (3) years immediately preceding the incident of physical harm.”
The law appears to have been modeled on laws in other states that are designed to protect the right of conscientious objectors from participating in activities that violate their beliefs. It further appears to have been chiefly directed to prevent doctors from being forced to provide abortions, birth control, or gender-adjusting medical procedures to which they are ethically opposed.
Woman says she was denied prenatal care because she was unmarried
After the law was signed into law in April 2025, a 35-year-old unmarried woman from Jonesborough in East Tennessee who had been living with a man for 15 years reported in a July 2025 town hall that a doctor had refused her prenatal care because she was unmarried.
Although it is not clear whether the physician specifically relied on the Medical Ethics Defense Act, the woman said that the doctor refused care because her pregnancy violated his Christian values. As a consequence, she reported having to seek care further away in Virginia.
This incident had stirred considerable controversy that is likely to result in judicial challenges. One writer had observed that other medical conscientious objection laws have focused “on the procedure or intervention” rather than “the personal characteristics of the patient,” to which antidiscrimination laws might apply (King 2025). Thus, doctors are expected to provide the same kind of aid to shooters who are wounded as well as to their victims.
John R. Vile is a political science professor and dean of the Honors College at Middle Tennessee State University.