Montana proposes a bill that would allow doctors to opt out of certain medical procedures

A woman comes into an emergency room, and she has a placental abruption. Clinicians pull together a team to get a blood transfer, and things are chaotic in the ER, a scenario painted by Rep. Laura Smith. There’s still a fetal heartbeat, but in order to save the mom’s life, they have to remove tissue from the uterus.

“Am I understanding section nine right that everyone needs to stop what they’re doing to sign paperwork to say they can participate?” Smith, D-Helena, asked Dr. Nathan Allen, an emergency physician at the Billings Clinic who spoke in opposition to a law being considered by the Montana Legislature.

Allen said based on how abortion is defined in Montana, “prospective written consent will be required from any and all personnel” in advance.

The doctor was one of nearly two dozen professionals and representatives for medical organizations in the state to testify against House Bill 303, which would provide protections for medical practitioners and facilities who object to participation in health care services based on conscience, defined as “ethical, moral, or religious beliefs or principles.”

Proponents argue that the bill would help with the current shortage of healthcare staff, as staff with reservations about performing procedures against their faith would not have to perform them.

“Montana physicians gladly serve our diverse communities, but they may have an objection of conscience to a specific procedure, and no one should be forced to choose between their profession and their faith,” said Dr. David Ingram, an anesthesiologist from Kalispell.

Rep. Amy Regier, R-Kalispell, Chairwoman of the House Judiciary Committee and bill sponsor, listed several procedures that “involve objections concerning lifestyle and elective procedures and treatments:”

• assisted suicide,
• dispensing marijuana and opioids,
• gene editing or other genetic manipulation on children in utero abortion procedures, and
• surgeries that remove healthy body parts on minors or that result in permanent sterilization.

However, opponents said that medical staff already have the ability to refuse participation in procedures and the bill would be both a violation of federal law and a violation of patients’ interests.

The Emergency Medical Treatment & Labor Act (EMTALA) requires that hospitals that accept Medicaid provide medical care in emergency situations.

Proponents point to language in the bill that would protect people needing emergency care. Those supporters referenced a section in the bill that said healthcare institutions are required to provide emergency medical treatment to all patients, according to federal law.

Ezekiel Clark, a transgender man who spoke in opposition, said he was worried if something were to happen that would require medical attention while he was out recreating, like going to the gun range or hiking in the mountains, a medical provider could refuse to care for him under this law.

“It may not mean anything to someone who doesn’t know me, but my wife, family and friends would be denied my dad jokes, slick dance moves, steadfast loyalty and unwavering devotion,” he said.

Rep. Zooey Zephyr, D-Missoula, asked Regier if staff, including a receptionist, could refuse gender-affirming care. Zephyr is the first trans woman elected to the state legislature.

Regier said that the bill was regarding the procedure, not the person.

Regier said five other states allow conscientious objection for medical professionals, including Illinois, Arkansas, Mississippi, South Carolina and Ohio.

Rep. Laurie Bishop, D-Livingston, said in a quick search that Illinois’ conscientious objection allows for the facility to plan around a provider’s objection to performing a service and would require a referral be made. However, in opponents said Montana’s bill would neither have to provide warning, nor refer clients to other medical professionals who would perform the service they’re seeking.

There were twice as many opponents than proponents.

Opponents objected to not only the contents of the bill, but the procedure to set the hearing. They said the hearing wasn’t scheduled properly with three legislative days’ notice, since the Monday meeting was posted Friday afternoon.

The Rules Committee will be meeting Tuesday morning at the request of Minority Leader Rep. Kim Abbott, D-Helena. Rep. Casey Knudsen, R-Malta, who is also in House Judiciary, will report from the meeting on the House floor.