Conscience Laws Expanded

Conscience laws are rooted in the First Amendment’s freedom of religion. The U.S. Supreme Court has interpreted the First Amendment to require that state actors maintain a non-hostile neutrality toward religion and ensure freedom of conscience – the right to hold and act on one’s own moral beliefs.
The landscape of conscience law is complex and evolving. Federal and state elections often result in new legislation, regulations, and policies related to conscience objections. Additionally, there are ongoing court cases which may impact future legislation and policies. This course is meant to be an introduction to this complex topic, and is not an exhaustive exploration of all the laws related to conscience rules. It is important for providers to educate themselves on the specific policies and procedures in the locations and facilities where they practice. The information included in this course is current as of January 31, 2025.
Click on each title below to learn more about each conscience law.
The Church Amendments – 42 U.S.C. § 300a-7 et seq.
- Enacted in the 1970s, they are considered the original Conscience Rules.
- They protect individuals and entities who receive federal funds from being required to perform or assist in abortions or sterilizations if doing so is against their religious beliefs or moral convictions.
- They also prohibit discrimination against health care professionals for choosing to perform or not to perform such procedures.
- They prohibit federally funded educational institutions from discriminating in admissions based on applicants’ willingness or reluctance to engage in certain health services due to religious or moral beliefs.
- They protect individuals who object to performing or assisting with any part of a federally funded health service program or research activity because of their religious beliefs or moral convictions.
Public Health Service Act – 42 U.S.C. § 238n (“Coats-Snowe Amendment”)
- Enacted in 1996, prohibits the federal government, along with any state or local government receiving federal financial assistance, from discriminating against any health care entity on the basis that the entity:
- Refuses to undergo training in the performance of abortions;
- Refuses to require or provide abortion training;
- Refuses to perform abortions, or to provide referrals for abortion training or for abortions;
- Refuses to make arrangements for any of the above activities related to abortion; or
- Attends (or attended) a post-graduate physician training program, or any other program of training in the health professions, that does not (or did not) perform induced abortions or require, provide, or refer for training in the performance of induced abortions, or make arrangements for the provision of such training.
The Weldon Amendment
Enacted in 2009, prohibits federal funding for federal agencies and programs or state and local governments that discriminate against any “health care entity” that refuses to provide, pay for, provide coverage of, or refer for abortions.
The definition of “health care entity” is broad, and includes individual healthcare professionals and health insurance plans, as well as hospitals, provider-sponsored organizations, health care maintenance organizations, or “any other kind of health care facility, organization, or plan.”
In effect, this statute permits individual health care providers and health care institutions to refuse to provide, pay for, provide coverage for, or refer for abortions should the provider/institution have a religious or conscience objection to abortion.
The Affordable Care Act (the “ACA”)
Section 1557 of the ACA is the nondiscrimination provision of the Affordable Care Act. Specifically, it prohibits any health care provider receiving federal funding from refusing to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability. Originally, this applied regardless of whether a conscience objection arose. Essentially, this provision allows health care providers to object to providing medical goods or services (e.g., medications, procedures, etc), but they cannot discriminate against or object to treating a person.
For example, a health care provider can object to providing a medical good or service for all patients (e.g., we don’t prescribe emergency contraception here), but cannot object to providing the medical good or service only to members of a protected class (e.g., we provide emergency contraception here, just not to LGBTQ+ individuals). An important additional consideration is that not all states recognize sexual orientation and gender identity as falling under the umbrella of “sex” as protected identity markers. These, and other rules, are subject to change.
Section 1557 was revised in 2011 and 2020 to require that the Church, Weldon, and Coats-Snowe Amendment protections be incorporated into Medicaid and Title X family planning programs.
In 2024, a Final Rule was issued for Section 1557. The 1557 Final Rule:
- Strengthens the civil rights protections under Section 1557.
- Applies nondiscrimination protections to the use of technologies such as telehealth and AI.
- Recognizes that the protections against discrimination on the basis of sex include sexual orientation and gender identity, consistent with the U.S. Supreme Court’s holding in Bostock v. Clayton County.
- Includes an exemption based on religious freedom and conscience. This exemption holds that the provisions of the Final Rule can be superseded by federal protections of providers’ religious freedoms and conscience.
- Does NOT mandate coverage or the provision of treatments such as hormone therapy or surgery for individuals with gender dysphoria. The rule does not require a specific standard of care or course of treatment for any individual, minor or adult. Providers do not have an affirmative obligation to offer any health care, including gender-affirming care, that they do not think is clinically appropriate or if religious freedom and conscience protections apply.
Source: Section 1557 Final Rule: Frequently Asked Questions
Other pertinent sections of the Affordable Care Act:
- Section 1553 includes conscience protections regarding physician aid-in-dying, which is sometimes referred to as assisted suicide or death with dignity.
- Section 1303 allows a qualified health plan to determine whether or not to provide coverage of abortion services and prohibits a qualified health plan offered through an Exchange from discriminating against “any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.”
- Section 1411 addresses exemptions to the ACA’s “individual responsibility requirement.” Under this section, the Department [Health and Human Services (HHS)] may grant exemptions based on hardship. The Department has stated that hardship includes an individual’s inability to secure affordable coverage that does not provide for abortions, membership in a particular religious organization, or membership in a “health care sharing ministry”.
Source: Your Protections Against Discrimination Based on Conscience and Religion
The OCR Final Rule
On January 9, 2024, the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) announced a Final Rule entitled Safeguarding the Rights of Conscience as Protected by Federal Statutes.
The OCR Final Rule clarifies the process for enforcing federal conscience laws and strengthens protections against conscience and religious discrimination.
Specifically, the OCR Final Rule:
- Clarifies the OCR as the office designated to receive, handle, and investigate complaints regarding the various statutes.
- Restores the OCR’s long-standing enforcement process for the Federal health care conscience protection statues, including exercising its investigation, compliance, and enforcement powers.
- Strengthens protections against discrimination on the basis of conscience.
- Encourages entities to post a notice of rights.
Read the fact sheet: Safeguarding the Rights of Conscience as Protected by Federal Statutes.
Key Take-aways:
- Conscience laws are rooted in the First Amendment’s guarantee of freedom of religion and conscience. The principle of protecting the right to act according to personal religious or moral beliefs while maintaining neutrality toward religion is central to conscience law.
- The legal landscape surrounding conscience laws is intricate and continually changing due to new legislation, regulations, and court rulings. Providers must remain informed about federal laws and state-specific policies that may affect their practice.
- Conscience laws protect healthcare providers’ rights to object to specific services and also uphold nondiscrimination principles. They do not mandate a particular standard of care.
For further reading:
- Food and Drug Administration v. Alliance for Hippocratic Medicine (U.S. Supreme Court; Decided – 2024)
- The Church Amendments – 42 U.S.C. § 300a-7 et seq.
- Public Health Service Act – 42 U.S.C. § 238n (“Coats-Snowe Amendment”)
- The Weldon Amendment
- The Affordable Care Act (the “ACA”)
- Four Key Takeaways from a Health Care Civil Rights Landmark: The Final Section 1557 Rule