2023 -- S 0959

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LC001682

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- MEDICAL ETHICS DEFENSE ACT

     

     Introduced By: Senator E Morgan

     Date Introduced: May 01, 2023

     Referred To: Senate Judiciary

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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CHAPTER 99

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MEDICAL ETHICS DEFENSE ACT

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     23-99-1. Short title.

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     This chapter shall be known and may be cited as the "Medical Ethics Defense Act".

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     23-99-2. Definitions.

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     As used in this chapter:

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     (1) "Conscience" means the ethical, moral, or religious belief or principles held by any

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medical practitioner, healthcare institution, or healthcare payer. Conscience with respect to

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institutional entities or corporate bodies, as opposed to individual persons, is determined by

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reference to that entity or body’s governing documents, including, but not limited to, any published

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ethical, moral or religious guidelines or directives, mission statements, constitutions, articles of

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incorporation, bylaws, policies, or regulations.

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     (2) "Disclosure" means a formal or informal communication or transmission, but does not

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include a communication or transmission concerning policy decisions that lawfully exercise

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discretionary authority unless the medical practitioner providing the disclosure or transmission

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reasonably believes that the disclosure or transmission evinces:

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     (i) Any violation of any law, rule, or regulation;

 

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     (ii) Any violation of any ethical guidelines for the provision of any medical procedure or

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service; or

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     (iii) Gross mismanagement, a gross waste of funds, an abuse of authority, practices or

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methods of treatment that may put patient health at risk, or a substantial and specific danger to

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public health or safety.

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     (3) "Discrimination" means any adverse action taken against, or any threat of adverse

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action communicated to, any medical practitioner, healthcare institution, or healthcare payer as a

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result of their decision to decline to participate in a medical procedure or service on the basis of

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conscience. Discrimination includes, but is not limited to, termination of employment; transfer from

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current position; demotion from current position; adverse administrative action; reassignment to a

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different shift or job title; increased administrative duties; refusal of staff privileges; refusal of

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board certification; loss of career specialty; reduction of wages, benefits or privileges; refusal to

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award a grant, contract or other program; refusal to provide residency training opportunities; denial,

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deprivation, or disqualification of licensure; withholding or disqualifying from financial aid and

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other assistance; impediments to creating any healthcare institution or payer or expanding or

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improving said healthcare institution or payer; impediments to acquiring, associating with, or

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merging with any other healthcare institution or payer; the threat thereof with regard to any of the

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preceding; or any other penalty, disciplinary, or retaliatory action, whether executed or threatened.

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Discrimination excludes the negotiation or purchase of insurance by a non-government entity.

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     (4) "Healthcare institution" means any organization, corporation, partnership, association,

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agency, network, sole proprietorship, joint venture, or other entity that provides medical procedures

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or services. The term includes, but is not limited to, any public or private hospital, clinic, medical

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center, physician organization, professional association, ambulatory surgical center, private

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physician’s office, pharmacy, nursing home, medical school, nursing school, medical training

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facility, or any other entity or location in which medical procedures or services are performed.

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     (5) "Healthcare payer" means any employer, health plan, health maintenance organization,

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insurance company, management services organization, or any other entity that pays for or arranges

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for the payment of any medical procedure or service provided to any patient, whether that payment

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is made in whole or in part.

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     (6) "Medical practitioner" means any person or individual who may be or is asked to

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participate in any way in any medical procedure or service. This includes, but is not limited to,

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doctors, nurse practitioners, physician’s assistants, nurses, nurses’ aides, allied health professionals,

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medical assistants, hospital employees, clinic employees, nursing home employees, pharmacists,

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pharmacy technicians and employees, medical school faculty and students, nursing school faculty

 

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and students, psychology and counseling faculty and students, medical researchers, laboratory

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technicians, psychologists, psychiatrists, counselors, mental health professionals, social workers,

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or any other person who facilitates or participates in the provision of a medical procedure or service.

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     (7) "Medical procedure or service" means medical care provided to any patient at any time

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over the entire course of treatment, or medical research. This includes, but is not limited to, testing;

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diagnosis; referral; dispensing and/or administering any drug, medication, or device; psychological

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therapy or counseling; research; prognosis; therapy; record making procedures; notes related to

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treatment; set up or performance of a surgery or procedure; or any other care or services performed

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or provided by any medical practitioner including, but not limited to, physicians, nurses, allied

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health professionals, paraprofessionals, contractors, or employees of healthcare institutions.

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     (8) "Participate" in a medical procedure or service means to provide, perform, assist with,

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facilitate, refer for, counsel for, advise with regard to, admit for the purposes of providing, or take

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part in any way in providing any medical procedure or service, or any form of such service.

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     (9) "Pay" or "payment" means to pay for, contract for, arrange for the payment of, whether

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in whole or in part, reimburse or remunerate.

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     23-99-3. Rights of conscience of medical practitioners, healthcare institutions and

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healthcare payers.

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     (a) Freedom of conscience. A medical practitioner, healthcare institution, or healthcare

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payer has the right not to participate in or pay for any medical procedure or service which violates

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their conscience.

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     (b) Limitations. The exercise of the right of conscience is limited to conscience-based

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objections to a particular medical procedure or service. This section shall not be construed to waive

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or modify any duty a health care practitioner, health care institution, or health care payer may have

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to provide other medical procedures or services that do not violate the practitioner’s, institution’s

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or payer’s conscience.

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     (c) Immunity from liability. No medical practitioner, healthcare institution, or healthcare

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payer shall be civilly, criminally, or administratively liable for exercising their right of conscience

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not to participate in or pay for a medical procedure or service. No healthcare institution shall be

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civilly, criminally, or administratively liable for the exercise of conscience rights not to participate

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in a medical procedure or service by a medical practitioner employed, contracted, or granted

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admitting privileges by the healthcare institution.

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     (d) Discrimination. No medical practitioner, healthcare institution, or healthcare payer

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shall be discriminated against in any manner as a result of their decision to decline to participate in

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or pay for a medical procedure or service on the basis of conscience.

 

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     (e) Exception. Notwithstanding any other provision of this chapter to the contrary, a

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religious medical practitioner, healthcare institution, or healthcare payer that holds itself out to the

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public as religious, states in its governing documents that it has a religious purpose or mission, and

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has internal operating policies or procedures that implement its religious beliefs, shall have the right

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to make employment, staffing, contracting, and admitting privilege decisions consistent with its

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religious beliefs.

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     (f) Opt-in required. A health care practitioner may not be scheduled for, assigned, or

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requested to directly or indirectly perform, facilitate, refer for, or participate in an abortion unless

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the practitioner first affirmatively consents in writing to perform, facilitate, refer for, or participate

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in the abortion.

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     (g) Emergency medical treatments. This chapter shall not be construed to override the

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requirement to provide emergency medical treatment to all patients as set forth in 42 U.S.C. §

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1395dd.

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     23-99-4. Whistleblower protection.

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     (a) No medical practitioner shall be discriminated against in any manner because the

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medical practitioner:

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     (1) Provided, caused to be provided, or is about to provide or cause to be provided to their

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employer, the attorney general, department of health, any state agency charged with protecting

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health care rights of conscience, the U.S. Department of Health and Human Services, Office of

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Civil Rights, or any other federal agency charged with protecting health care rights of conscience

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information relating to any violation of, or any act or omission the medical practitioner reasonable

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believes to be a violation of, any provision of this chapter;

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     (2) Testified or is about to testify in a proceeding concerning such violation; or

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     (3) Assisted or participated, or is about to assist or participate, in such a proceeding.

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     (b) Unless the disclosure is specifically prohibited by law, no medical practitioner shall be

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discriminated against in any manner because the medical practitioner disclosed any information

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that the medical practitioner reasonably believes evinces:

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     (1) Any violation of any law, rule, or regulation;

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     (2) Any violation of any ethical guidelines for the provisions of any medical procedure or

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service; or

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     (3) Gross mismanagement, a gross waste of funds, an abuse of authority, practices or

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methods of treatment that may put patient health at risk, or a substantial and specific danger to

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public health or safety.

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     (c) The board of medical licensure and discipline shall not reprimand, sanction, or revoke

 

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or threaten to revoke a license, certificate, or registration of a health care practitioner for engaging

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in speech or expressive activity protected under the first amendment of the U.S. Constitution, unless

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the board demonstrates beyond a reasonable doubt that the practitioner’s speech was the direct

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cause of physical harm to a person with whom the health care practitioner had a practitioner-patient

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relationship within the three (3) years immediately preceding the incident of physical harm.

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     (1) The board of medical licensure and discipline shall provide a medical practitioner with

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any complaints it has received which may result in the revocation of the medical practitioner’s

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license, certification, or registration, within seven (7) days after receipt of the complaint.

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     (2) The board of medical licensure and discipline shall pay the medical practitioner an

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administrative penalty of five hundred dollars ($500) for each day the complaint is not provided to

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the medical practitioner after the seven (7) day period set forth in subsection (c)(1) of this section.

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     23-99-5. Civil remedies.

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     (a) Civil action for violation of right of conscience. A civil action for damages or injunctive

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relief, or both, may be brought by any medical practitioner, healthcare institution, or healthcare

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payer for any violation of this chapter. Any additional burden or expense on another medical

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practitioner, healthcare institution, or healthcare payer arising from the exercise of the right of

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conscience shall not be a defense to any violation of this chapter. However, no civil action may be

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brought against an individual who declines to use or purchase medical procedure or services from

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a specific medical practitioner, healthcare institution, or healthcare payer for exercising the rights

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set forth in § 23-99-3.

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     (b) Other remedies. Any party aggrieved by any violation of this chapter may commence a

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civil action and upon a finding of a violation, shall be entitled to recover threefold their actual

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damages sustained, along with the costs of the action and reasonable attorneys' fees. Such damages

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shall be cumulative and in no way limited by any other remedies which may be available under any

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other federal, state, or municipal law. A court considering such civil action may also award

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injunction relief, which may include, but it not limited to, reinstatement of a medical practitioner

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to their previous position, reinstatement of board certification, and re-licensure of a healthcare

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institution or healthcare payer.

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     23-99-6. Severability.

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     Any provision of this chapter held to be invalid or unenforceable by its terms, or as applied

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to any person or circumstance, shall be construed so as to give it the maximum effect permitted by

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law, unless such holding shall be one of utter invalidity or unenforceability, in which event such

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provision shall be deemed severable herefrom and shall not affect the remainder hereof or the

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application of such provision to other persons not similarly situated or to other, dissimilar

 

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circumstances.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- MEDICAL ETHICS DEFENSE ACT

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     This act would establish the right of a medical practitioner, healthcare institution, or

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healthcare payer not to participate in or pay for any medical procedure or service that violates their

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conscience. This act would further protect medical practitioners and institutions from lawsuits or

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criminal charges for exercising their right of conscience. This act would ensure that a doctor or

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nurse cannot be fired, demoted, or otherwise discriminated against by their employer for declining

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to participate in a procedure that violates his or her conscience.

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     This act would take effect upon passage.

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