How Tennessee’s 2025 Medical Ethics Defense Act enabled a physician to withhold care—and why that matters
Case Study: Jonesborough, Tennessee – First Reported Denial of Prenatal Care to an Unmarried Woman
In a Jonesborough town hall on July 2025, a 35‑year‑old woman shared her story: she was denied prenatal care by her OB‑GYN because she is unmarried—even though she’s been in a committed 15‑year relationship and already has a child. The provider cited their “Christian values” and refused further care without offering any referrals (Wells, 2025).
Under Tennessee’s Medical Ethics Defense Act, effective April 24, 2025, healthcare providers—including hospitals and insurers—are now legally permitted to refuse any service based on religious, moral, or ethical beliefs, with no obligation to refer an alternative provider .
This is the first known case in U.S. history where prenatal care was denied to someone solely for being unmarried. The patient now travels out-of-state (to Virginia) to receive the care she needs (Weiss-Wolf, 2025).
Ethical & Medical Implications
Hippocratic Principles and Medical Ethics
- The Hippocratic Oath, in both its traditional and modern forms, mandates non-maleficence (“do no harm”) and impartial care.
- The AMA Code of Medical Ethics emphasizes that personal beliefs must not impede the delivery of care or compromise patient dignity.
- Denial of care based on marital status violates the core ethical obligation to treat all patients without discrimination
Medical Risks
- Delay or denial of prenatal services can result in unmanaged complications for pregnant individuals and their fetuses.
- In regions like Tennessee—already suffering from the highest maternal mortality rate in the U.S.—denials like this exacerbate existing health disparities (Weiss-Wolf, 2025).
Psychological and Social Consequences
- Patients may feel blamed, stigmatized, or terrorized by providers, discouraging them from seeking future care.
- Even those with means—like the woman in this case—are forced to travel, but many others in rural or underserved areas lack that option.
Legal Context & Accountability Gaps
Tennessee’s Medical Ethics Defense Act (MEDA)
- Enacted April 2025, MEDA allows broad healthcare refusal rights and shields providers from civil or criminal liability based on these refusals (Walker, 2025).
- There is no requirement to notify patients of refusal in advance nor to provide referrals.
National Context
These laws have typically targeted abortion, gender-affirming care, and contraception—but Tennessee’s law extends to standard prenatal care without limitation.
MEDA follows similar “conscience” laws in states like Alabama, Florida, Mississippi, and South Carolina (Weiss-Wolf, 2025)
Political and Representational Concerns
The affected woman reported repeated attempts to contact representative offices—including Senators Marsha Blackburn and Bill Hagerty—with little response. One staffer reportedly told her, “he’s not obligated to listen to his constituents” (Wells, 2020).
Ethical Analysis Through Scholarly Lens
1. Conscience vs. Conscience Clause Limits
- Scholars such as Wicclair (2011) argue that conscience protections must be narrowly defined: ethical objection should not justify denial of basic, nondisruptive medical care.
- Broader refusals undermine professional standards and transform medical ethics into moral gatekeeping rather than care provision.
2. Discrimination & Rights Framework
- Denying care to unmarried individuals—particularly women—can amount to discriminatory medical neglect, violating federal laws like Title II of the Civil Rights Act and Section 1557 of the Affordable Care Act, which protect from sex- and marital-status-based discrimination.
- Even if protection under federal law is murky, the denial conflicts with principles of equity, justice, and non-discrimination upheld by professional medical codes.
3. Public Health Fallout
- Targeting vulnerable individuals via refusal laws contributes to deterioration of maternal health systems, especially in rural and underserved communities.
- When providers opt out of care based on belief, it fragments continuity and widens systemic access disparities (We, 2025)
Final Thoughts: Case Study Takeaways
- This Tennessee case exemplifies how religious or moral refusal laws, when broadly applied, can enable provider judgment over patient need—in direct conflict with the Hippocratic ethos.
- The woman’s experience illustrates the ethical, legal, and medical dangers of permitting providers to deny routine prenatal care based on lifestyle or marital status.
- Lawmakers, advocacy groups, and healthcare professionals must take meaningful action to restore access, limit conscience clauses, and uphold non-discriminatory medical care for all.
References
- Weiss-Wolf, J. (2025, July 24). Pregnant and Unmarried? In Tennessee, That’s Now Grounds for Denial of Care. Ms. Magazine
- Wells, R. (2025, July 20). Pregnant Mother in Tennessee Denied Care for Being Unmarried. Nashville Banner
- Walker, C. (2025, July 22). Doctor Refused to Give Prenatal Care. Truthout
- Wicclair, M. R. (2011). Conscientious Objection in Health Care: An Ethical Analysis. Cambridge University Press
- American Medical Association. (2023). Code of Medical Ethics
- National Women’s Law Center. (2022). Survey on conscience laws oppose—public polling data