A pregnant woman in Tennessee was recently denied prenatal care because her doctor did not approve of her unwed status. The 35-year-old woman, who has been with her partner for 15 years and is the mother of the couple’s 13-year-old child, was told during her first prenatal appointment that the physician could not in good conscience treat her due to her marital status. The doctor offered no referral. She now has to travel to Virginia for care.
This is the first publicly reported case of a patient being denied prenatal care under Tennessee’s Medical Ethics Defense Act (MEDA), a sweeping piece of legislation passed by the Republican-dominated state government. The law grants health care providers, hospital systems, insurers, and others the legal authority to deny care based on “religious, moral, or ethical” objections without any obligation to refer patients elsewhere.
These laws are not about “medical ethics” or the rights of individual conscience. They are part of a broader reactionary assault by the capitalist ruling class, spearheaded in particular by Trump and the extreme right. The overturning of Roe v. Wade and the wave of conscience-based denial laws are the opening salvo in an historically unprecedented attack on democratic rights.
The incident in Tennessee comes as Congress passed Trump’s “Big Beautiful Bill,” which includes over $800 billion in cuts to medicaid. Under Health and Human Services Secretary Robert F Kennedy Jr, and other anti-science quacks medical science in general is under concerted attack. Behind this ideological campaign lie class interests: the ruling class considers medical care for the working class to be an intolerable deduction from their profits. This is why the coronavirus was allowed to kill over 1 million Americans with no serious attempts to stop transmission, then was falsely declared “over” under the Biden administration.
Tennessee has the highest maternal mortality rate in the United States. The woman expressed deep fear about continuing her pregnancy in the state, stating, “I can’t guarantee that the provider I see is going to value my life over the life of this fetus.”
She referred specifically to the case of Adriana Smith, a pregnant woman in Georgia who was declared brain-dead after a medical emergency. Georgia’s abortion law, which bans the procedure after detection of cardiac activity, mandated the woman be kept on life support until the fetus could theoretically survive outside of the womb. The family was stripped of all decision-making power and forced to endure this horrific situation for three months, despite medical consensus that Smith was legally dead and despite grave concerns about the fetus’s viability.
Laws like Tennessee’s Medical Ethics Defense Act are part of a growing wave of anti-democratic legislation sweeping Republican-controlled states. So far, seven states have passed “conscience” laws allowing healthcare providers, insurers, and institutions to refuse care based on religious or moral beliefs. These include Arkansas, Florida, Mississippi, Montana, Ohio, South Carolina, and Illinois. In most of these states, the laws allow refusals not only for abortion but also for contraception, gender-affirming care, and other essential services—even when the denial of care could endanger a patient’s life. Additionally, at least four more states—Idaho, Alabama, New Mexico, and Washington—have introduced legislation modeled on these conscience protections.
These laws allow a doctor’s personal beliefs to override medical judgment, stripping patients, particularly women and LGBTQ individuals, of the right to medical care. The laws include no requirements to refer patients elsewhere and no mechanisms for oversight or accountability.
Many doctors worry the language of the law is vague and provides no guidelines for care. It creates a dangerous gray area between what qualifies as “urgent” versus “emergent” care. While federal law requires hospitals to treat patients in emergency situations, many serious conditions—especially in pregnancy—are urgent but not classified as emergencies.
Dr. Amy Gordon Bono, a Tennessee physician, explained the danger this creates: “You can still have medical issues that are urgent, but are not [emergencies], that would still lead to a delay in care of the patient, potentially. We’ve encountered this plenty of times, especially in the care of pregnant patients. Where do we draw the line between what is urgent versus emergent?”
The implications of MEDA for access to healthcare are magnified in rural Tennessee, where over 34 percent of the population, approximately 2.4 million people, live with limited or no access to inpatient or emergency treatment.
More than one-third of Tennessee counties are considered maternity care deserts, and half of the state’s rural hospitals no longer provide obstetric services. Since 2012, ten rural hospitals have closed, and nine more are at risk due to funding cuts included in President Donald Trump’s “One Big Beautiful Bill”, which also threatens to strip Medicaid coverage from 300,000 Tennesseans.
Tennessee lawmakers such as Rep. Bryan Terry (R–Murfreesboro), the bill’s sponsor, absurdly claimed that MEDA would encourage doctors to move to Tennessee by protecting their “freedom of conscience.” In reality, Tennessee is experiencing a sharp and accelerating medical exodus.
During the 2023–2024 academic year, obstetrics residency applications fell by 21 percent, and applications across all specialties declined by 12 percent. Many young physicians are unwilling to train or practice in a state where providing evidence-based care may place them at legal or ethical risk. “Women don’t have fair access to health care in the state,” said one OB-GYN. “And the women that don’t have that access suffer the consequences.”
As the World Socialist Web Site warned at the time of the Supreme Court’s 2022 Dobbs decision, the goal is not simply to outlaw abortion, but to dismantle constitutional protections, legitimize state coercion, and roll back the social gains won by generations of workers.
Laws like Tennessee’s enshrine the power of the most backward and reactionary layers of society, empowering them to deny treatment to those who fail to meet their religious or moral standards. The consequence is not only the erosion of reproductive rights, but the consolidation of state-backed discrimination and moral policing in every area of medicine.
Speaking out at a local town hall, the 35-year old asked the most basic of questions: “Why are we denying care to pregnant women who want to have babies?” She condemned the hypocrisy of those who claim to be “pro-life,” saying, “If you are ‘pro-life,’ you believe in supporting and protecting all lives: the born, the unborn, and that includes insurance coverage, food, protecting them at school, and protecting marginalized communities.”
Rep. Gloria Johnson (D-Knoxville), declared, “If you can just refuse treatment to anyone whose lifestyle you disagree with—that’s not medical ethics. That’s fascism.” This is true. But the Democratic Party bears responsibility for this because it has refused to take any serious measures against Trump’s plans to overturn the Constitution and construct a dictatorship. This is because they are far more terrified of a mass movement of the working class that this might provoke than they are of fascism.
The working class must see this for what it is: a political attack on the democratic rights of an entire class, not just women or families in isolated cases. Reproductive rights, health care access, and medical decision-making are being stripped away in service of capitalism’s demands for austerity, privatization, and social control.
These attacks cannot be fought by appeals to the courts or the Democratic Party, which bears its own responsibility for decades of retreat and compromise. The defense of health care and all democratic rights requires the independent political mobilization of the working class, united across all boundaries and armed with a socialist program based on human need, not profit.
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