S.B. 174 Exercise of Religious Beliefs and Conscience Amendments: transcript

Alright, let's go to, let's go to second substitute, uh, Senate Bill seven, uh, 74. On, on this one. I do have, if I may, I guess 1 74. It's okay. Chair. I, I would like to pass out a little bill analysis. Thank you for this, please.

And I, I, I want to acknowledge, uh, Dr. Williams online as well. She's not able to be here, but I want to, I I'm gonna have invite her to be part of the presentation. I was asked yesterday, what is the genesis of this piece of legislation? And my reply was, is in Utah, we, we, we have a, a powerful and, and wonderful tradition of leading out on sensitive issues and trying to, trying to get it right. There's a, a, a state or two that has, has got in into this space of, uh, exercise, religious beliefs and conscience in healthcare. And, uh, they, they've done a good job plowing, but there's a lot of refinement that could, and a lot of improvement that could take place. We've sought to look at across our state, where would we have some gaps in our, our, uh, religious liberty and freedom critical area. Uh, for us, we recognize that all of our liberties and freedoms, a taproot of them is how we deal and, and work through these very important sensitive issues as foundational in our country. Uh, and, and how we treat this. As we know, many of our immigrants came here for religious liberty and freedom. Uh, and it's, it's a, it's a cornerstone, even a keystone of our society and our country making us what, what it is. And this is, this is an attempt to help and, and provide a, not only help in our space, but provide an example for, for, uh, what, what, as people work together, what we can come up with to be our best version. So with that, I would like to turn the time to that segue. I'd like to turn the time to Professor Wilson to go through some, some, uh, information and then will bring it back to me. If you will. Chair, please. Thank you.

Um, sorry. Of course. I would make a motion that we, uh, substitute, embody, and title, first substitute SB 1 74 to be replaced with second substitute 1 74.

Uh, yes. Senator Stratton, thank you for allowing me to be with you. I'm Robin Fretwell Wilson, a law professor, and in a consultant to the Utah Senate. I speak in my personal professional capacity and do not speak for the University of Illinois, the Senate, or anyone else. I have published on Healthcare Conscience Clauses for 20 years, including book chapters published by Cambridge University Press. Senate Bill 1 74 strikes a delicate balance between protections for religious belief and conscience in the interest of patients and the public. In lines 5 28 and beyond. Senate Bill 1 74 keeps existing protections for objections to abortion, but it also protects refusals based on religious belief and conscience to modern practices that many providers would see as doing a harm. And this happens in line three 13 to 3 29, including the withdrawal or withholding of care, or providing something like emergency contraceptives or prescribing a drug like marijuana and so forth. Senate Bill 1 74 recognizes that providers can experience a moral angst by being forced, for example, to withdraw care from an infant born with anencephaly when providing the care is futile, but withdraw hastens death, many providers simply do not want to hasten death without SB 1 74. They are at risk of demotion or other adverse actions. This happens in 2 27 to 2 44 after Senate Bill 1 74 facilities could not quote, discriminate against refusing providers, uh, against refusing providers like by, in hiring or admitting privileges. And that's in lines 4 34 to 4 45. Senate Bill 1 74 permits individual practitioners to step aside, but it does not deprive the public of services. I'm happy to see President Adams here online with me, and he knows well that this extends a Utah tradition of allowing persons of faith or conscience to live with integrity. So in the Utah Compromise, Utah, for example, charged county licensure offices with a duty to marry all couples while also requiring willing providers to ize marriages. What was the effect? No gay couple was turned away and no clerk was fired. How was that accomplished? It was done by making the office's staff in such a way that an insured services to the public, but did not force people of faith to choose between their conscience and their livelihood. SB 1 74 uses a similar device to protect both individuals of conscience or religious belief and preserve patient access. Individual practitioners are permitted to step aside from an elective service outside the emergency department for reasons of religious belief or conscience. That's in 3 49 to three 50. Now, we should be loathed to force providers to choose between their conscience and their livelihood, especially when we face the scarcity of providers in some fields like the clerk. Step off. SB 1 74 forces institutions to staff around objectors where the facility has notice of the objection. And can Practicably do so? That's in line 4 0 7 to four 19. Now, a duty to staff around is not radical, although some people might try to, to, to suggest it is, as I show in one of the appendixes to my book, to a book of mine, virtually every state in America mirrored the federal government's protection of abortion conscience without a parade of horribles for access. And the conscience protection in 1 74 is different. It is not an unqualified right as is nearly every abortion conscience clause in America. Instead, 1 74 erects numerous guardrails. First, it allows objections to services, not people. This is in lines 3 72 to 73. This means that an objector, for example, could refuse to do cosmetic surgery for all patients, but they could not pick and choose. Second, SB 1 74 allows no objections in emergency settings. There's no objection inside the emergency department to services mandated by antala, which are basically screening for active labor and emergency treating to stabilize to transfer. And that's in 360 6 to 3 71. And there are no objections for transport and emergencies. That's in three 30 to 3 31, excluding EMT services from the definition of a healthcare service. Third, SB 1 74 requires notice. Notice, notice individual providers give advance notice to facilities in 4 0 7 to four 14 facilities post a notice to the public and report to DHHS in 3 78 to 3 96. DHHS provides a list of willing providers, either on a website or when the public calls in 3 98 to 4 0 6. These notices are classic information forcing rules, a kind of preset referral that Utah has used in other laws. Nonetheless, 1 74 builds in flexibility for institutions. The duty to staff around is only to the extent reasonably practicable as you see in line 4 4 4 15 to four 19. And transferring an objecting provider at reasonably equal pay is not an adverse action, which is in 2 45 to 2 48. Moreover, if a provider says there'll be in a network by contract, that contract operates, and that's in line 4 24. Now, SB 1 74 does protect individual institutional conscience, but it is limited to religious or conscience space institutions. And that's in 3 53 to 360. And those institutions have to reflect that commitment in their governing doctrines, their institutional procedures, and how they hold out to the public. 3 35 to three 40. So there is no surprise. Importantly, we have long allowed hospitals to offer a subset of services. Not every hospital, for example, has a burn unit or a nicu, and we wouldn't want them to, as I explained in an article about President Bush's conscience regulations a number of years ago, facilities have a choice too. If their conscience objections as a religious institution are not respected, they can close a unit entirely, which is a worse outcome. Senate Bill 1 74 also allows health plans to tailor offerings, but again, only if the health plan is religious or conscience based. That's in 3 30, 3 53 to 360 as well. This may seem odd to some people, but it is consistently protected in federal law. The Affordable Care Act plans. Obamacare, for example, did not have to cover abortion. Instead, individuals can vote with their feet for a plan that does, if that's what they choose in the employment context. This option is likely to be elected only by plans offered by religious employers. Think little sisters are the poor. The handout, I think is strikingly good, so I'll recommend it to you. It emphasizes more on the other side of the ledger, the protections for providers who object, but I'll stop on this point. The biggest strength of SB 1 74 is how nuanced it is using common sense mechanisms to make sure that one individual's rights, the providers do not come at the expense of another, the patients. Thank you.

Thank you Dr. Wilson and thank you committee for opportunity to present this. I think I'll go ahead and conclude and see how, uh, how the committee would like to proceed at this point.

Senator Stevenson. Thank You. Just a quick comment. You know, um, uh, Robin, it's good to see you. Uh, we've, uh, there's been a, she's done a lot of work for the Utah legislature in the past and considered an expert in the field that she works in. Um, very impressed with her, and we have been for a long time. We've, uh, I think we could go back. I dunno, uh, maybe she could, I'm sure it's 10 or 12 years, maybe longer than that, that she's worked with Utah legislature, uh, certainly the right expert for the occasion. So I just, just want to thank Her for her participation. Thank you.

Oh, Mr. Chair presenters. I'm struggling. Uh, anyone else have anything to say while I get it together?

Thank, thank you, Mr. Chair. I do have a couple of questions for the sponsor, and that's an order process. Thank you. I'm trying to follow the, the mechanism for notification to the public, and if you can take me by lines on the bill, I wanna make sure that I'm clear on how, um, if a, um, a provider, healthcare provider will, they have to in advance delineate what, um, type of, um, medical provider, I mean medical services, they're willing to, they're gonna be not providing. Is that the intent? Like there will be an an in advance notification and if I'm the doctor, I will say I'm not willing to do the following, um, services. And then will those be available for the public to see somewhere? Uh, I think the, one of the presenters mentioned, um, department of Health and Human Services website. Can you just, um, help me just see those, uh, where they are in the bill?

then I'll, I'll, uh, thank you. This is a, a great question. This is an important device to give advance notice. You have to give advance notice to the facility in 4 0 7 to four 14. Then the facility takes that piece of information. This is unusual and I think doesn't really happen anywhere in the country except here. It would, and that's in 3 78 to 3 96. They post a prominent notice on the wall, and they also have to tell DHHS. So they're telling the public in the notice what can't be provided in that facility if they're unable to staff around. And they report this to DHHS in 3 78 to 3 96. And then in something that I think is completely unique, DHHS takes a role in, in directing the public to places where those services that can't be obtained at an objecting facility or because of an objecting provider who, who, um, uh, an objecting provider, they have to show that either on a website or if a public member of the public calls in, and that's in 3 98 to 4 0 6. And those rules are there to, to their information forcing rules to reduce any dislocation to the public.

I would just add to that, thank you for the question. There was, in the first draft, it was, uh, by phone call only, but we felt it would be a, a more, what would I say? Sometimes people don't want to talk, talk to a stranger. So there's an opportunity then in line 4 0 2 is stated to go online. And if they're not data don't have access online, there's, there's the phone number that's there that's available as well.

Follow up question, Mr. Mr. Chair. Thank you. So I'm, I'm reading those lines. Thank you, um, Senator for that answer. So I, it says, for each healthcare service that a healthcare provider or a healthcare institution does not provide due to exercise of the right or religious belief or conscious maintain information. So this will be the actual names of the providers that will be listed on the website. Am I, am I understanding this clear? The, the location and, and and the name again, this, this, this is somewhat unique. If, if there's individuals in a facility that that's one thing, it would, there there would be a workaround. And the reasonable is, is, uh, Dr. Wilson stated, if it's not available in the facility, then there would be the, the names, locations and, and opportunities for the service. Yes.

Okay. So I yeah, that, that Question in non, in I, I don't know if this was clear, it's in non-emergency as well. Correct? The the emergency room is exempted out. Yeah. So emergency, just to be clear, Mr. Chair, emergency room. So Tala overtakes over proceeds that? Correct. Thank you. So we're not dealing with the emergency room. It's a good, um, clarification. But in this one, it will just be any other services outside of emergency. There will be a full disclosure prior, so that doctors have to be forced. So they cannot suddenly wake up one morning and in the middle of a, a procedure and be like, oh, my conscious tells me not to do this right now and stop the procedure. Is that possible under your bill?

It's not. There's is, is dr. I love Dr. Wils possess. Notice, notice, notice is required. It's throughout the genuine, again, it's that that prevents the undesirable outcome of based on the individual, it's based on procedure that that is not people but PA procedure that, that's well ahead and noticed Well ahead of time. Thank you. Thank

You. Thank you, Mr. Chair.

Thank you. I think a little Kleenex helped me get a long ways. I, I think maybe something that will help me frame, since I haven't been here in the time with Dr. Wilson, would be to understand a little bit, is this a clinical physician? Is this a PhD physician? Just so I can relate to the background, I don't know if Dr. Wilson would like to answer that or if you'd like to answer that. Is this someone who actually provides, provides care for patients?

Thank you. Dr. Wil is, is, uh, a professor, uh, a law school professor that has worked in this space and has a, a national reputation that's very helpful in this Discussion. So coming from the ethics and the pr kind of the process side as opposed to the practice side. Okay, That's why you're here.

That that helps me frame that out. Bring practice side. Yeah, exactly. That helps me frame that out.

Well, and also helps me perhaps address some of the disconnects that I'm feeling with this because, and as you can tell, I had a pretty visceral reaction to this, and the implication that people providing certain kinds of care have lower morals or ethics is a challenge to somebody who's done this for two and a half decades. Right? So I think that one of the things that I would really like to, to bring up if I could, is that right now in, in my practice and in the practice of many of the physicians I know, and I'll tell you, I I took a straw poll, which is certainly not scientific, but of all the physicians I have in my phone last night, or as many as I could reach, is this something you want? Is this something you need? Is this something in your practice that you feel like is missing and not a single one of them wanted it, needed it or felt good about it becoming a thing? And so that, that's kind of how, for me, framing this out, I've tried to say, all right, well, what do we have in medicine that allows us to deny or decline to provide care to people? And we have, for example, I can't provide care to someone. I don't have a doctor patient relationship. Or if I've had someone who's non-compliant, there's a reason there to, to decline, to provide care. Uh, when there's patients are abusive, physicians can decline to provide care. We have scope of practice limitations or something that's outside of your expertise. I'm a pediatrician. If someone were to ask me to deliver a baby, that certainly would not be appropriate and I could decline there. And then there's this kind of upholding your physician duties. And whether that's the Hippocratic oath or uh, uh, a kind of a guideline that we try to keep antibiotic stewardship and not prescribe antibiotics for every viral infection. We have certain duties that we see as being appropriate in the care to humans that we commit to. I suppose this also, I tried to figure out, because we have reasons to refuse care based on if something is medically inappropriate. If someone asks me, and I've had this happen in the emergency department, they would like their child entirely CT scanned because they just wanna know what's in there. And I get it 'cause the what ifs are concerning, but that is a whole lot of radiation that's medically inappropriate. It's not the right thing to do. I've had people ask all sorts of bizarre requests that are not medically appropriate, and I think other providers have too. And you have a right to say, no, that's not going to happen. Or, okay, it's also okay to say no if something's futile. It's also okay to say no if it's against the patient's best interest. And so what I think I'm feeling is that we have really good within the practice of medicine, really good boundaries set up that allow us to find ways out of care that we don't think is appropriate for a patient. And we also have ways if we don't feel like we're the one to pass it on to another provider. And I almost feel like if I can't provide a care for a patient, it's incumbent upon me to make sure somebody else cares for them. I think these pieces already exist. And what I worry about with a bill like this, and I'm just running through my list of what if scenarios. I don't like the idea that there are gaps that could open up and someone could say, oh, I'm not going to provide care because I don't like your vaccine status. I don't like that you're not vaccinated. I don't wanna care for you or your children. I don't, I don't like that. I don't like the idea that someone could say, I don't, I don't know that I'm comfortable with your religion or your religious practices. I don't wanna care for you. How about even your career? What's pretty feisty times right now? What if someone said, you Uintah work for ice? I am not going to care for you. All of these things are horrifying to me. And how about this space? That's been really important to me. And that's addiction. People going through addiction are a rough lot. They make choices that make you just, you don't understand You get mad, you get frustrated, and sometimes you wanna say, get outta here. I can't take care of you. You're not taking care of yourself. I can't fathom the idea that someone could say, I morally cannot take care of this person because they're making poor illegal choices that I don't agree with. So I know this didn't turn into much of a question, but boy did it come flying out of me. I've never once in my now coming up on 30 years of medicine, left a patient's room and called any of you to ask what's best for my patient. And I think that probably makes you all happy. I call you on all sorts of other random stuff. If you looked at the text threads from Senator Vickers when I got him at the Rose Bowl to ask him about natural organic reduction is a perfect example. I think that this is not needed. And I think we're crossing into some very dangerous space here. And, and I, I wish I could think of more questions to be more lawyerly, but right now I feel like a provider and I feel like it's so crucial that you hear me say, this is not the right direction. Thank you for my non-question question.

Okay. Uh, sorry if this was already asked when I was, uh, trying to defend a bill and committee. Um, so I'm just trying to understand how this bill would interact with existing federal protection since federal law already provides certain conscience uh, protections for healthcare providers. Um, if you could clarify what gap this bill is intended to fill and or whether we're duplicating or expanding beyond those protections, that'd be helpful.

Thank you. I'm gonna ask Dr. Wilson to, to respond first, but I would just like to, to the good senator, our, our medical expert. Uh, I, if it's okay, chair, I'd just like to respond on, on, on a couple front, couple things. One of the things that really concerned me that she said is this could be appeared to make some less than because of what they're willing to do. And the, uh, that that would certainly not be accurate or true and certainly not the intent of, of what we're trying to do. Because as described, there are valid reasons to already in, in place to the scan, you know, the full body scan of a child. Uh, what what this is trying to say is if you have upfront, give a notice and, and, and put put notice there, it's not about the person receiving care. It's about, and it's not about the person. Many of the concerns that you stated about those that are making choice about vaccines or those that are, that are struggling with addiction that are very real. These, these, we wrestle with these issues are very real. That's the, that's I think the strength of what this does. We're not talking about people and choices. We're talking about procedures. And there's a, there's a real distinction there. And I don't think any of us want, if there's a, we do have a shortage in the space. If we, if if someone has a, because of their religious belief and conscience, they're concerned about a procedure, the one that we've already talked about, abortion, for example, that we state at well ahead in a non-emergency. It's not a question in, in the space that you do so well in. And by the way, I, I, I love to get a text from you saying, I'm dealing with this right now. Can you believe it? I'm dealing with this. It's so frustrating, the issues we're working on. And you're, I I love and appreciate what you're saying and, and want to be very respectful. That's the spirit of this. I think someone that has the same emotion, passion, and and love of this, uh, and has, has a, it's just that's what their religious conscious is. They're not, they, they want it, it, and that's goes to the heart of what religious liberty and freedom is. We lift together and we make sure that everyone has, there's a respect that taproot of our liberty and freedom. And they have the opportunity certainly to have care that access to the care that that's the spirit. That's, and I so grateful for the non questions, and maybe that's an answer to non-question. Thank you, chair. Now to, uh, the good center buses.

Yeah. When we come back to Senator Plumer too, and just to build on what you've said, Senator Stratton this question of not you, for example, not your vaccine status, not you as an ice worker that is taken out specifically banded in 3 72 to 3 73. You can choose not to do a service, but you cannot choose to not serve a particular category of person. Um, so you wouldn't be able to, to do either of those two things under the bill as it stands. I think there's a question, um, that both, uh, Senator Bus and Senator Plumer are raising is, do you even need this law one to Senator Buss? This extends beyond the abortion conscience clauses. So at the federal level since 1973, we've said that no one's had to do an abortion or sterilization where a person might not feel that they can do that service. Um, this is really expanded beyond that. But I think the most important thing to look at is the withdrawing and withholding of care. And there are people who would like not to be the agent of the hastening of death. And that is part of, I think, the Hippocratic oath in particular, to not do harm. And if someone else can do that service, it's a kindness that allows that provider to stay in the profession without being the agent of that. All of this rests, as Senator Stratton said, on the fact that there's notice, notice, notice, but somebody else is available and willing to do that specific service. So I think our exploding aging population combined with the fact that many providers are, you know, uh, would prefer not to do that particular kind of harm. Now, there is a literature in the bioethics literature about providers who experience moral angst. There are cases that I've written about Kathy Sunset, DeCarlo at Mount Sinai Hospital, who had given Mount Sinai Hospital five years notice that she didn't wanna do, uh, a particular kind of procedure. In that case, it wasn't abortion. They staffed around her. Um, and then a supervisor simply said, eh, I don't really wanna do that. So I think there is a need to stay in advance of these questions with an exploding population. And I'll stop there.

Thank you, chair. That answer your question? Um, yeah, I guess I'll just, uh, statement I have, um, um, I, I have serious concerns from, uh, I personally experienced a life-threatening ectopic pregnancy, and my treatment was delayed for several weeks because the provider was concerned about treating me too early because of abortion laws. And so just different feelings about that, um, make me concerned that this could happen to other people who may be experiencing an ectopic pregnancy, uh, because I almost lost my life because of that.

Um, my name is Sarah Strub and I am the legislative chair for the Utah Association for Marriage and Family Therapy. I'm also a licensed marriage and family therapist and a private practice owner. Um, we're talking about procedures, but we are talking about people. This bill defines healthcare services, um, as including psychological therapy or counseling, diagnosis and therapy. Um, by allowing this broad definition, we are concerned that this will create barriers to treatment. Um, and sometimes these are life. This is lifesaving mental health care. Um, we are also concerned that this would allow insurance companies to change their bylaws, um, so that they can have a right of conscience and deny, um, mental health care. Also, this creates an impossible mandate for employers. I cannot legally ask someone I'm interviewing what their beliefs are, um, and yet this could harm my business if they decide not to treat someone, it hurts their reputation, and I have no way of correcting that later. Um, I did have a colleague reach out to me last night and express concern about how this would impact her work, um, in treating sex offenders and how she would be able to hire and possibly have employees who didn't want to work with sex offenders. Um, and we were, we, I heard that this is not gonna be applicable to broad groups, but I could argue what about a specific type of sex offender, and that's gonna put her and her business and the offender's mental health care in the crossroads of this bill. So we would ask that you also oppose this bill. Thank you.

Gal Zeki with Utah Eagle Farm, and I am here to speak in favor of this bill. I believe that, uh, conscious is very important. Your, your personal religious belief. I think it would be helpful to young people who are trying to decide whether they're gonna go into the medical profession. Uh, there are things that are probably very near and dear to them that they wouldn't want to have to do or would want to do. Uh, everybody has a different place, I'm sure, with their, with their personal thoughts and conscience and religious belief. Uh, I mean, this might be surprising, but not everybody thinks the same way I do. And, uh, I don't judge them if they don't think the same way I do. In fact, some of my closest friends don't think the same way I do. But that doesn't change how I feel and how I think. And it doesn't change how I feel about my friends. But I think I, I don't think just because somebody says I can't do this because of my personal religious belief, that, that it should be demeaning in any way to somebody who doesn't have that same religious belief. And so I think this is a good bill that has a good balance. And, uh, and because I think the best part is the fact that they, they give notice and they give notice ahead of time what you know, what they will and will not do. And that helps everybody with their choices because they know ahead of time what to expect. So I would ask you to please vote yes for this bill. Thank you.

Yes. Thank you. Okay, great. My name is Ti. My name is Tiana McCall. I am a licensed clinical social worker, and I'm representing the National Association of Social Workers, the Utah Chapter today. Um, NASW Utah respects the importance of protecting sincerely held religious beliefs. And we recognize that this bill requires that, that advanced notice public posting and coordination with DHHS, which I think is very important. Um, advanced notice is certainly helpful, but our question is whether notice alone is sufficient to protect clients in practice, particularly in behavioral healthcare. Um, in mental health treatment, continuity and stability are essential. If a patient is already in care or if a clinic hires a provider for a specific service and later cannot provide them a posted notice does not necessarily prevent disruption. Uh, ethical standards require us to avoid harm in and ensure continuity of care, especially for vulnerable individuals. Similarly, if exclusions are disclosed in advance by a religious based insurance plan, employees typically don't get to choose their coverage. Advanced notice does not always create a meaningful alternative option. Our concern is not about eliminating conscience, pro conscience protections, it's about ensuring that practical access and continuity are protected alongside them. Uh, we would really encourage, uh, this committee to clarify the guardrails that are in place to ensure that notice translates into real access in all communities, especially where options are limited. Thank you.

Maryanne Christensen, executive Director of Utah Legislative Watch. I'm here to speak in favor of the bill. I think it, um, draws a perfect balance between allowing people to exercise their right of religion and conscience. Um, you're all familiar with it, but I'd like to remind you that the very first sentence of the Bill of Rights is that Congress shall make no law respecting an establishment of religion or prohibiting the free exercise thereof. And when anyone can tell you that there's a time and a place when you can, and when you can't exercise your freedom of belief, then we really don't have any first Amendment right at all. And so I love the bill for that respect. But then on the other hand, it also creates the responsibility to never put anyone in a, in a position where a doctor is right in the moment of need, saying, I'm not gonna do that because of my religion. And that's just as important as protecting the religious light, right? Is to set up this exact process for making sure that that never happens. In fact, the way I read the bill, it actually creates a duty for a doctor to go ahead and perform a needed treatment if they have not given the proper notice. Ahead of time. So I think it protects all of us all the way around. And so I appreciate you voting yes on the bill. Thank you so much. Thank

Good Morning committee. My name is Jessica Black and I am from the, um, Utah Mental Health Counselors Association. And I am speaking in opposition to SB 1 74, just for a couple of reasons. Um, first I'm very concerned about the, um, adverse action. Um, specifically for those clinics that have a specialty, um, either working with a specific population or having a clinic that specializes in L-G-B-T-Q affirming care, um, they would then be able to, um, hire someone that maybe says that they do that, but then refuses that care to a specific population. So, although I do see that there, these are supposed to be procedures, however, there are certain practices that are specific to populations. Um, my other concern is that this bill is granting moral beliefs to million dollar insurance companies. Um, they can deny payment for basic medical care, like psychological therapy or diagnostic testing. Um, and although there must be some notice, I do think that just allowing any insurance company just to change their bylaws on a whim could impact Utah employees. Um, because employees have no choice as to what insurance the employer has. Um, if a corporate payer just decides to drop mental health coverage based on their moral mission statement, then the employee is then trapped. Um, so I do support religious liberties. I absolutely support, um, a lot of the content in this bill. However, those two areas I'm very concerned about. So I really urge you to protect Utah workers and small businesses, um, by voting no or adding some amendments for SM 74. Thank you.

I would move chair, uh, exercise religious beliefs and conscious. Second, uh, second substitute with a favorable recommendation. I'd like to speak to

Appreciate the good discussion that's taken place and the input. I think there's been some, some, uh, good public input and, uh, like to be able to move this forward and continue to work with those stakeholders to see if we can even come up with a better version. Thank you.

Uh, yeah, I think that there's a ton of work to be done, especially the insurance company piece part. So I, I look forward to what those conversations are.

To adjourn. Oh, yes. Motion To adjourn.

Thank you. Thank you, chair. Grateful for the opportunity to be here. And, uh, I am I, this is where we need to be, uh, on this bill. SB 1 74. I, I want to say three quick things. We really start even before this bill from a really good place. And, uh, that, that, that's very, very positive. Second, uh, grateful and appreciate all the input and what a wonderful opportunity is to, to talk to such, such a remarkable brain trust, uh, wherever you stand, uh, on, on issues and, and, and gain the benefit of that. And we want to continue those discussions. Third, uh, when we talk about protecting religious liberty and freedom, there's probably not a more sensitive issue than in this healthcare space. And, and, and so it is, we need to work really, really hard together to come up with the best version. I don't think the bill is in its best version of state right now. There's a substitute online that'll reflect some of the input we're continuing, uh, uh, probably will adopt, uh, all of that substitute plus some additional things as, as we're listening and trying to work through this issue, these issues. But it's so important that we give this critical, uh, aspect of, of who we are as, as, as human beings, as citizens of this great nation standing on the wonderful shoulders of gone before, uh, recognizing all the good that comes from, uh, giving proper, uh, space and, and room for this exercise of religious freedoms. So important, like the canary in the coal mine. We know where we stand on so many issues as we deal properly with this, with that chair. We did, we had some tech technological problems last time. We weren't able to get all the votes in. I know I've talked since our last meeting. I've talked to every one of the committee members, grateful for that opportunity. And, uh, I will turn the time to you.

My name is Madam Alyssa. TI am a transgender utan, who's embraced being a elgan, hardworking, confident woman of eight glamorous years. In those eight years, whenever I stood in public, I have been named by strangers, the following, beautiful, a doll, an icon, a diva, a queen, all in the case of being my true, authentic transgender self. The same eight years, I, along with others, have been a target for hate from the government passing unnecessary laws that limit mine and others' freedoms to live to the eyes of those who claim to be faithful and loving of all, only to prove themselves wrong, are prove otherwise by stating I am destroying, quote unquote, God's beautiful creation.

Um, Senator Kevin Stratton. I in Utah alone, the L-G-B-T-Q beings that I've met, including myself, have been nothing more than blessed beings of society. We all carry faith and hope along with dreams and aspirations. We can't achieve that with a bill like SB 1 74. In the event of tragedy, we must have care from a doctor who does one and only one job, and that is to care for the sick and injured, regardless of skin, age, religion, or gender identity. At the end of the day, the blood that comes out of my body is the same that comes out of yours and others, human beings, state, community, my community. And I ask you to vote no on this bill. We ask for freedom of fear. We ask for Utah to make a difference and vote forward to a better future for all. We ask for fair peace in our community and in our state in a way where everyone shall feel welcome. Thank you.

Back to the bill sponsor. Thank, Thank you for the motion. Appreciate the, the, the testimony of the, uh, the public, public, uh, comment period. And just want to assure that, uh, the thing that this bill does is we talk about procedures and not people. The idea is we treat all people, all human beings equally in, in this bill and deal with procedures as we respect, uh, what we're trying to do here. Appreciate all the perspective as well, and appreciate the motion. Thank you, chair.

Thank you, chair. It's always a privilege to be here. And on this side of the microphone, uh, grateful for all the good work you're doing, uh, exercise of religious beliefs and conscience. I've been asked, where did this bill come from? And as we entered, uh, the, the, in the summer, we had a working group looking at asking the question as it relates to religious liberty and freedom, do we have any gaps here in Utah? And I want to say first that there's a lot of good, a lot of positive and, and, and a lot of things in place, but we do have some gaps. And so what we're trying to do here is very intentionally and surgically, so to speak, uh, a, a address, a concern, a gap in our, uh, landscape, religious liberty and freedom. Why would we care about religious liberty and freedom? It's a tap root of all of our freedoms. Liberties, very, very important for who we are as a people. We've, uh, this i this, we've spent tremendous amount of effort and time on getting to this point. Uh, tried to listen very intently and carefully. I'm grateful to be joined by Mr. Duncan, uh, uh, in the presentation. Also, professor Wilson is online, is back east, and wasn't able to make it here, but grateful for her being online. I'd first like to turn a minute to, uh, uh, Mr. Duncan, and certainly he'll introduce himself and for, for some, uh, presentation then, uh, to, uh, uh, professor Wilson, if that's okay. Chair. And then, yep. We'll, we'll open it up. Thanks. Good. Thank

Thank you. Good. Thank you. Uh, my name is Bill Duncan. I represent the Sutherland Institute. I, I need to apologize. I I have class that I've gotta teach in a few minutes, so I'll walk out, but it's not any, any disrespect intended for the committee. We really appreciate your efforts and the Senator Vickers efforts in bringing this forward. I think that the simple message that, that, that that's come to my mind a lot as I've thought about this bill, is that the, the many of these protections are provided in federal law, but the enforcement of those protections has changed over time. Every time there's a new presidential administration, one will will say, this is worth really focusing on. The other will say, it's not so much. And, uh, the, the, the reason this, as Senator Stratton described that we have a whole here, is that federal law is, uh, is subject to the whims of federal enforcers. Utah needs its own, uh, uh, provision to protect those people who, uh, they, they're relatively rare instances, but there are instances where someone, because of their faith or, or, or some conscience, uh, that that's important to them, want to step away from providing some services that can be provided by others. And the bill is written in a way to ensure that it doesn't affect the provision of services. Certainly not, it doesn't imply at all in an emergency context. And it allows for employers to have notice so they can staff around that person and allow a reasonable accommodation. The question that comes to my mind as I hear people, uh, have been critical of the bill is that, um, why would we want to require someone who can, is doing a good job in an important profession, to do something that they feel uncomfortable with because of their beliefs, when it would be reasonably easy to, to allow them to step away. And that's, uh, that seems, seems to me to be a, a, a, a fair way in a society like ours to, uh, accommodate the beliefs of everyone and encourage them to be as involved as any other person in, uh, providing, uh, healthcare services. So that's why we're supportive and, and, and really appreciate the Senator Vickers, uh, uh, leadership on this issue.

Thank you. Uh, professor Wilson. Will will turn the time to you, if that's okay. Chair.

Sure will. Where calling from. Yes. Thank you, chair. I'm Robin Twell Wilson, a law professor and a consultant to the Utah Senate. I am speaking from Illinois. I speak in my personal professional capacity and don't speak for the University of Illinois, the Senate, or anyone else. I have published on Healthcare Conscience Clauses for over 20 years, including book chapters published by Cambridge University Press. Can't agree more with Bill Duncan. SB 1 74 strikes a delicate balance between protections for religious belief and conscience, and the interests of the public, uh, and patients. I'm gonna go quickly through lines since it's a long bill, and I think it may orient us. So in line 4 87 and beyond, you see that SB 1 74 keeps existing protections for objections to abortion, but it also protects refusals based on conscience or belief to modern practices that many providers would see as doing a harm. And this is in lines three 14 to 3 29, including things like the withdrawal or withholding of care, or providing emergency contraceptive, or prescribing a drug like marijuana and so forth. Senate Bill 1 74 recognizes that providers can experience moral angst by being refused, for example, to withdraw care from an infant foreign within anencephaly, where providing that care is futile, but the withdrawal hastens death. And many providers simply don't wanna be the agent to hasten death without SB 1 74. They are at risk of demotion or other adverse action. You see this in 2 22 to 2 38. After SB 1 74 facilities could not discriminate against refusing providers and hiring or admitting privileges. That's at lines 4 34, 4 35, excuse me, to 4 46. Now, as, as Bill Duncan said, this extends a Utah tradition of allowing persons of faith to live with integrity without harming the public. So you may recall that in the Utah Compromise, Utah charged county licensure clerks with the duty to marry all couples while requiring willing clerks to ize marriages. And the effect was that no gay couple was turned away and no clerk was fired. That happened by forcing the offices to staff around. And SB 1 74 uses a similar device to protect persons, um, and providers of conscience, while also protecting patient access. Individual providers are permitted to step aside from an elective service outside the emergency department. You see that at 3 38 to 3 43. And we should be loath when we have such a scarcity of providers to force people to pick between a profession and their conscience. Like the clerk step off. SB 1 74 moves the question of staffing around up to the facility, um, which has notice of the objection and writing in advance, and can practic, and when they can practically do so. And that's in lines 3 92 to 4 0 4. Now, virtually every state in America has mirrored the federal government's protection of abortion conscience. And the experience has been that there is not a parade of horribles for individual provider protections. That said, this is not an unqualified right. And I'm gonna very quickly go through multiple go guardrails. First, it allows objections to services, not people in line 3 58 to 3 59. So that means that, for example, a provider could refuse to dispense contraception to all patients, but they could not pick and choose. Second, SB 1 74 allows no objections in the emergency setting. That's at 3 51 to 3 57, where Tala continues to govern. And there's even a, a further extension to no objections for transportation and emergencies at three 30 to 3 31 third, SB 1 74 requires notice. Notice, notice individual practitioners give notice to facilities. And 3 92 to 3 99 a notice gets posted to the public and reported to DHHS and 360 3 to 3 82 DHHS then provides notice to the public, either through a webpage or public, uh, phone calls at three eighty three to 3 91. Now, these are classic information forcing rules. You can think of them as a preset referral for other people to provide those services. Nonetheless, SB 1 74 builds in a ton of flexibility for institutions. The duty to staff around, as I said before, is to the extent reasonably practicable at four 15 to four 19. Transferring an objecting provider at reasonably equal pay is not an adverse action, and neither is, uh, refusing numerous requests when they become so numerous that the person can't perform the job. And neither is refusing requests that nullify the primary or essential functions that the person was hired to do. And all of this is at 4 0 9 and four 18 to 4 34. All in all, I will say that the biggest strength of SV 1 74 is how nuanced it is using common sense mechanisms to make sure that one person's individual rights, the providers do not come at the expense of another, the patients. Thank you.

I think chair with, uh, with that, I, I'll just state we've really tried to be, uh, intentional in creating the safeguards. Again, the focus is on, on, uh, procedure, not people. We, we don't want to get, we want to be respectful. And the intent is that all we have, the healthcare they need in a timely and appropriate manner while we, uh, protect the, the, that religious, religious and conscience of, of those that are providing it in a, in a very appropriate way, uh, they have to give notice and take responsibility. And, uh, certainly we have safeguards, uh, to make sure that we're not, uh, putting that above life for those that are in need in, in emergency. And so, so open it up to turn the time to you. So

Thank you, Madam Vice chair. Some of these things seem to slot easily into my head. Some of 'em, I, maybe you could help me understand how it works. So, if there was a provider who was working in an outpatient clinic, and that provider had a moral objection to writing prescriptions for contraception, and someone just scheduled a visit with them, they, that person might not have known that they had that objection and came in and wanted to get their blood pressure medicine and also a contraceptive. What would the procedure be? How would that patient still get served? And what would the provider or clinic be expected to do in a setting like that?

The first, the first, uh, uh, threshold would be that, that there would need to be, as, as mentioning the, the county clerk, that there's a workaround and opportunity for that. First, there's notice given ahead of time. And, and what it is, is that that, that that's a procedure, procedure that the, the provider would never perform. And, and so there's notice ahead of time, if you do it for one, you do it for all. The second would be, uh, if there's, is, if the part of it is, if it's not function, the provider can't perform their job with that, then, then there's an opportunity and protection for the, for them to be replaced without a, a challenge. But there's also a notice provision that, uh, if there's certain procedures that are not there, that that's provided, uh, uh, a notice is provided where that can be, uh, obtained. Uh, professor Wilson, you add anything to that?

No, I think that's essentially right. So the individual provider provides advanced notice. They have to be staffed around to the extent, uh, that it's practicable. So it moves the objection or up to the outpatient clinic as your question posed. Mm-hmm. Um, uh, that has to the clinic, well, the individual provider on their webpage has to tell the world that sometimes when you go to an outpatient clinic, you're in fact selecting the particular provider. That might be sometimes Yeah. In network. Yeah. So if that's true, their webpage would've put you on notice to that. Um, if the facility as a facility isn't staffing around, then it has to post a prominent notice. If I Uintah see the individual practitioner in their own space, like their own office practice, they would have to post a great big notice. DHHS would be alerted in either event, the person who Uintah the clinic would be able to call DHHS if they weren't getting it at that facility and get the names of providers beyond that.

Um, let's see. Let me go back for one second. Wait, I'm sorry. They would have to call DHHS to get a provider.

Well, no, if, so, like, let's say your, your fact pattern made it a little bit harder because you said it was an outpatient clinic where I imagine that there's multiple providers. So this is envisioning that the person staffed around. But let's say that, that it was harder than that, and it was my individual office space, and I was an individual objector, I would have to give notice to the public on a webpage and also in the office reception room. So bigger than life, right up front, they see that. Um, and then beyond that, the person would be told how they can find another provider for that specific thing. And that does remind me of the point I forgot. There is a provision that says that if individual providers have agreed to be in a contract, so they've contractually be agreed to be in a contract, and that is at line 4 0 9 that the contract governs.

Okay. So if, for example, I signed a contract, um, to be in network and to see all patients, and that required that I dispense emergency contraceptive or whatever the fact pattern was, that contract governs over the individual objection, because you can't have it both ways. Sign a contract and then back out of the contract with a conscience. Objection. Okay. Thanks. Yes, Thank you.

Gail Ika with Utah Eagle Foreman. I just want to speak in favor of this bill. I think for all the obvious reasons that we've just heard, nobody should, uh, have to violate their deeply held a religious belief or their conscience, uh, in their profession. And it would be almost unconscionable to think that there would be those who didn't enter the medical profession because they didn't have these protections. So please vote yes for this bill.

This is the first time I've actually used the app to do this. Maryanne Christiansen, executive Director of Utah Legislative Watch, I'm here to speak in favor of the bill. I think it is very well balanced between the needs of patients and the rights of conscience of providers. Um, I I don't think that in either, from either perspective, anyone is really, um, inconvenienced by the, the policy. So, um, I appreciate your support. We have a shortage in the healthcare professions, and, um, it would be a shame to have people choose to not enter that field because they're afraid of circumstances where they might have to do things that violate their religious conscience. So, thank you very much for the yes vote.

Hello. Can you all hear me? Yes, go ahead. Thank you. Hello, chair and the members of the committee. My name is Kaitlyn Jason back, and I live in Sunset, Utah. And I'm here as a representative of the Utah Public Health Association's Immunization Advocacy Coalition. Our goal is to advocate for evidence-based immunization legislation, and to educate legislators and the public about the importance of vaccines. And I'm speaking today with concerns about Senate Bill 1 74. This is not about opposing conscious protections. Utah already has some of those protections in place, as was already mentioned with the federal safeguards. Um, the concern is that Senate Bill 1 74 goes much further with a potential hammer approach instead of a scalpel approach. And Manti may unintentionally create barriers to vaccine access for Utah families. And part of this gets down to true informed consent, and that parents are told, um, are given all of the medically appropriate options. So some folks, I mean, we're making the assumption that folks are coming to an appointment knowing what they want, but maybe they need to receive education and counseling on those decisions. And, um, are they able to get that at their medical provider? Um, and so I just urge you to carefully consider how to preserve conscious protections while ensuring transparency, accountability, and meaningful access to preventive care. Thank you.

Thank, thank you. I have another question for the sponsor, if I might. So, the bill down in court actions allows a healthcare provider to bring a suit against the Department of Health. What, talk me through what would have to happen before that person could then bring a lawsuit against the Department of Health? You have a line you're referring to? Yeah, Like 4 67 through four 70. Well, 4, 4 67 talks about filing a complaint with them, and then 4 76 talks about bringing a court action against them. Thank you for that. Uh, professor, do you wanna take a crack and then I'll

Yes, sir. Thank you. Um, I think this is actually, um, maybe a question of how it's read, but I think we meant to be clear. So let me take a crack. You first make a complaint with DHHS if the conscience objection isn't being respected within all of those guardrails, okay. But then if they fail to investigate or take action, the healthcare provider that filed a complaint can bring an action in a court, not necessarily against DHHS. Um, it could be the facility that failed to staff around. So I think we might need to take some advice back on that, Senator, uh, and make sure that that's clear.

Yeah. But thank you on, on the question. Uh, chair, it sound like the, the DHSS would be the one under litigation, but they, the notice is given and there's remedies that are put in place in investigation, uh, recommendation on whether there needs to be any action. It may be, uh, uh, there is, there is an, um, a notion of immunity with, with DHSS, is that the, the, so it's a process of, of where the, the right has not been protected. The first remedy is to avoid, avoid, uh, litigation and, and, and work it out through, through the process with the agency. That's the intent. Okay.

May I add Yes. May I add one more point? If you look at four 80 and 4 81, the re it's clearer there. The remedy is for an alleged violation of this part, injunctive relief or damages. But the only party that could have, um, allegedly violated the part would be the healthcare facility. That's not respecting the conscience Objection. In other words, your rem the, your violation. It, it is referencing the violation. But I do see why it wasn't so clear. And maybe we need to add a couple of words at 4 77 and 4 78 about precisely who could be sued. You don't have a remedy against DHHS because it didn't do anything, I suppose. Um, it's really the facility that refused to respect the objection.

Thank you. If I might one, one follow more follow-up question. So, does the language mean that if the department, uh, because right, the whole phrase at what, at 4 76 starts by saying, if the DHHS fails to investigate and take action, then the per healthcare provider may bring a complaint. So does that mean that if DHHS does investigate that the person may not bring a complaint?

I read it, and I think we need to take this back, senator and, and be a little more clear. It's an exhaustion requirement. So first you have to go to DHHS, you don't get to go, then avail yourself of the courts directly. And if DHHS gives you satisfaction, in other words, they investigate and they took action, then there is no point in, in bringing a lawsuit. So I took it as an exhaustion requirement, but we can be more clear about that. It's meant to be a buffer between litigation. Yeah. And, and the, the one that's accused of not, not doing it. And, and to your question directly, if DHSS does not take action through the investigation, it doesn't, doesn't remove the opportunity to be a remedy. But that's gonna be a really uphill battle to, to do that after there's, there's been investigation. It's the, the defendant in that cause of action would have good cause to ask for a, a, uh, summary judgment fairly quickly.

Well, maybe we could talk about it offline after the committee. I don't. Okay. I mean, if there is something that needs to be more clearer, I'd be happy to talk it through. Okay. Thank you. Representative Ward.

Thanks. I move that we move SB 1 74 forward with a recommend, uh, positive recommendation. Favorable recommendation. Fourth sub, right. Fourth sub. All right. That motion is in order. Do you wanna speak to it? I do not. Thank you.

Thank you for the opportunity to present this and appreciate the questions and the consideration. It's obviously been, uh, prob it's, it's been a heavy lift, but we've really tried to, in the Utah Way set, set a pattern similar bill in North South Carolina, that, that, uh, this is really much better, much improved, and it, it, it's an opportunity for us to put our very best foot forward in this space. Appreciate the support of the committee.

Yes, I would, uh, had some great input from our, uh, uh, escamia regarding the, uh, original underlying bill. We looked at some guardrails. We've, we've tried to really listen, and this is probably the 12th, uh, iteration. Uh, but I want to get the this out, but appreciate the, the good sender's input on, uh, the logic in removing payers from this, uh, from this, uh, there's some great logic there, like if I may, to yield to, to, uh, a good Senator Cullimore to explain that. But then also we we're moving the, the, the, uh, institutions themselves.

For the, we're on the motion to substitute. Thank you. And, and I, I wanna thank the good sponsor in listening and working with some of those concerns. Um, this is a, I think it's a delicate, um, process to allow people to have this, um, beliefs and their conscious to be protected, like I think it's intended, but the biggest concern was related to payers. Those are large companies, and the concern was, who, how do we make sure and we regulate those pieces. I, during committee, he answered, and I think he put enough protections on the individuals in terms of how their employers will have to deal with that. And how is in, kinda like before time and all that disclosure will be in place with payers. It, there was a lot of concerns and I, I, you know, he was very open to having the conversation multiple times. And I think this new sub allows, um, at least for me to feel comfortable to, with all the different, um, safeguards in place that this is a right, the right move, that the intent is really being met and that everyone will be protected based on transparency and information. And I, I really encourage the, um, body to support the, the substitute. Thank you, Mr. President.

Thank you. Just by way of summary, Mr. President, we've really worked hard to, to create a delicate balance here. We want to make sure that we put human life first of what what we're dealing with is, uh, procedures and not people. We wanna be respectful of every, every, everyone that is in need, as well as those that choose, uh, to exercise right of conscience on certain procedures. There's, uh, exemptions for the emergency room that, uh, and those transporting there and some guardrails to make sure that, uh, the care that is needed is available to those that are, are in need. And with that, I'll be glad to yield any questions.

Thank you Mr. President Sponsor yield. Senator Stratton, will you yield?

Yes, go ahead, Senator Victors.

Yeah. Question, how is, how is this different from all from the current protocol for a practitioner to, you know, decline to perform certain procedures or get involved in certain types of treatments or I guess bottom line, how is this different from what's already the normal protocol?

Thank you. What, what it does, first of all, it, it exempts certain areas that the word that, that the, the, the, uh, right cannot be exercised, for example, in the emergency room. If the, the, if there's not a, a adequate workaround, if there's, if there's not notice, it puts in place a process, uh, that allows when the uh, right is desired and exercised up front that there has to be notice given. Uh, there has to be the posting of opportunities for others, uh, for other avenues and providers. And it really puts in place, uh, balanced, uh, uh, protocol and cadence to make sure that we're, we're individuals have the opportunity to have the healthcare that's needed and also, uh, have, have the rights that, that, that we're trying to protect the religious freedom.

Just a follow up. I, i, I guess I'm, maybe I'm missing something. I tried to go through the, the, the four sub quickly to try to see if there was something different, but I'm, I'm still struggling. I'm trying to figure out what's different than what we already have. 'cause we already have protections in place as healthcare providers to decline certain things, but, so I'm, I guess maybe I'll just talk to you offline and try to figure that out.

Appreciate the opportunity to have this presented. Recognize that, uh, this is ongoing process. Continue to work with, uh, those and, and, and seek to do the best we can to address the concerns while protecting the intent of the bill and appreciate the support of the body. And, uh, move the, the move that this substitute for be read for the third

Thank you. We had a good discussion. This was just waiting for the fiscal note to catch up, uh, on this substitute. Really been a positive, uh, opportunity for us to talk about this space and appreciate the, the work of the stakeholders. Uh, with that I'll be glad to yield to any questions.

Thank you, Mr. President Pro Tem and, and I, um, do applaud the sponsor for the direction and the changes that have been made. Um, in this bill space. I think it's especially important, um, that some of the payer's information, et cetera, came out. But I've heard from so many, um, fellow physicians and people in the medical space that I do want to speak to some of their concerns and thoughts on this. And largely that revolves around the fact that medicine and healthcare already have strategies by which someone can refuse, uh, to provide, uh, certain care or to a certain person. Um, that's, for example, if something's medically inappropriate or if it would be futile or if it were against, against the patient's best interest. There are already processes intact for this. There's also ways, if I, for example, as a physician, don't have a doctor patient relationship with someone, uh, if they've been a patient's been non-compliant, if patients have been abusive, if something's asked for that's outside of a, a practice limitation or outside of somebody's expertise, or if perhaps you're not, um, you're concerned that a, a particular type of medical care would not uphold physician duties, like practicing antibiotic stewardship. And we talked about all of these when we were in committee, and I think that we all learned a bit from one another. But ultimately, I think that the biggest concern for me, and this is something that I learned when I was a medical student almost 30 years ago here at the University of Utah, when we had an incarcerated individual come in and this person, uh, had apparently committed some, some pretty hard to stomach crimes and they were also desperately ill and being cared for at the University of Utah Hospital. And there were a whole lot of conversations about that care and about the provision of that care and about why should we, should we, who should, all these sort of questions. And ultimately, the biggest learning lesson that came out of that for me was that it doesn't matter the patient, it doesn't matter their history. It doesn't matter how they may have lived or how they still live. We take care of that individual and, and allowing some of those possibly ethical or moral thoughts to come into the mind is not good for patients. I really am grateful for the position that this bill has gotten to, but the territory that this is starting to wade into makes me very uncomfortable as a physician. And, and every physician that has at least reached out to me has expressed the same. So thank you for allowing me to share these thoughts. And, um, onward we go with dialogue.

Thank you, Mr. President Pro Tem. Um, when I think about some of the things mentioned in this bill on line 2 28, birds board certification lines 2 31 grants, and then lines 3 33 licensure, I think about how these indications span our state boundaries. And if we make a state law that would allow someone to gain board certification under their, um, conscious amendments, would that erode their trust in the institutions that are providing these board certifications? When I think about grants that we're gonna get from federal governments, can we say that you're not going to be a part of this conscious decision to move forward If you're gonna have a grant, if we're gonna have licensing be something that is on the line because of your conscience, does that erode your trust in those licenses? So I, I understand that in the state of Utah, we might have these beliefs and we might pass this law, but as we start to erode our trust in these words with grants licenses, certifications with this compromise, our ability to work through interstate policies and, um, reciprocity in education and reciprocity in healthcare and reciprocity in services.

Yes. The question is, is this gonna erode our ability to provide healthcare? Thank you. My Response? No, no. My question is, if we are gonna have grants licenses and certifications that are federally identified, and we are going to change that level in this state, will that compromise our ability to have reciprocity with our certifications? Will that have the ability to compromise our ability to get grants federally and interstate? And will that compromise our ability to have board certifications if we're going to be interstate, uh, compacts? Senator Stratton?

Thank you Mr. President ProAm. What what the bill contemplates in the way that, that the, the guardrails are in place is that we have healthcare provided, that everyone has an opportunity to get the cares that they need. We're dealing with is a case by case if someone has because of their conscience. Uh, and, and again, upstream of that, it, it's, it's declared and there's, there needs to be workarounds in place and opportunities for that healthcare to be taken care of. We're not talking about people or choices or decisions of individuals. We're talking about procedures. And that's, that's a very important distinction in in, in what we're doing here. And as we look at the, the, the grants and the, the cross pollination with other states, my understanding is is that we've sought and have addressed those concerns with the guardrails are in place on, on legislation.

Thank you. Um, so that didn't really answer my question. On line 2 33, it said, adverse actions means denial, deprivation or disqualification of a licensure. How in the state of Utah can we take a license that might be in a compact with other states and say, all right, in this state you're gonna have a license even though you won't provide this, um, you won't adhere to the, the, the, the needs of that license. But then we're gonna be part of that compact. Would that erode our ability to have that license here in the state? And would that erode our compacts with other states if our license meant something different? 'cause I believe it would, What the adverse, go ahead.

What the adverse actions are is those adverse actions are prevented from being taken. And in that case, the answer as I understand the question would be No.

Thank you. Um, so my second question is, what would, uh, if you decided that you, um, I mean we have nefarious employees sometimes and you know, there are some kind of, uh, events that we have in healthcare that are distasteful and these are things that people don't willingly wanna do, but that's part of your job. How would we deal with the fact that you could just say, well, that's against my conscience amendments to not provide, um, think of any type of procedure that's uncomfortable. And how would you prevent people from just increasingly saying that they didn't want to do that? Is there some way we can put guardrails around that?

Senator Vickers? Yeah. The answer is yes. And, and what, what the, the guardrail is in this is procedures are declared ahead of time. Uh, one guardrail is if the person's not able to perform their job, their work, then there, there, there can be a actually a termination of the, of the employment. But it's not something on the spot that we declare. It's, we we're coming way upstream. There's some areas emergency, the emergency room transportation are exempt from this, but, but there is, the guardrail is in place to prevent on the spot, boy, I don't like this. Or for, for whatever reason, the objection that's not included and protect it in the legislation.

Thank you. Can you give me an example of a, um, what was the catalyst for this law? Like gimme an example of something that a person would be required to do that would be against their conscience. Senator Stratton,

as we look at our aging senior population, uh, one of the things, and this goes to, to the points that that, uh, we have discussed in for other discussions, but, but an example would be we don't, we haven't dealt with several issues that are emerging. Uh, one, one would be, uh, someone that would want to have, have assistance in, in terminating their life, uh, because of their perception of viability. So that, that's an example. Senator Rebe, thank you.

But that's not something that we can do in the state right now. Is that something we can do in the state right now? Terminate somebody's life. Senator Stratton, The, the question was, give me an example and I gave the example. Can you give me an example that happens in the state?

I don't have one on the tip of my tongue at this point.

Thank you. Um, the, the, if we don't have an example of something that you would not wanna do against your conscience. I, I, I can think of a couple of examples that just seem that it would be, um, problematic to say that I would deny somebody healthcare because of their stance on L-G-B-T-Q trans, um, race, religion. I mean, this could go to a circumcised person to be really glib about it. I don't believe that would be to the extent of this. But if we don't have an example of what we're trying to protect, I don't understand why we're running this law. Thank you.

The reference there for individuals in our state, but this is for procedures, not individuals.

Yeah, I would speak in support of the bill. There's a few examples that come to mind, particularly in the medical field. Example. For example, if you have dietary restrictions, you need to eat kosher, you need to eat halal. Uh, if you have, uh, those are things that this bill would help accommodate. Additionally, if there's testing concerns with regards to procedures, this bill would help accommodate that. Uh, additionally, other examples would include, and, and we do have an exemption, you know, an ex, this is an example that we already have. Uh, but if you preferred not to provide an abortion within a medical context and you are asked to do so, uh, this bill would provide an additional protection in addition to the laws that we already have. Further, there are instances with regards to coverings where a person of religious, uh, affiliation may have modesty restrictions that the hospital could easily accommodate if they were requested. You know, when we, when we look back at our founding, there were a few fathers that were specifically dealing with the issue of free exercise of religion. And they were specific as to the term free exercise. Many were arguing and, and specifically the ones I'm talking about are James Madison and then Roger Mason. Were talking about should we say toleration of the exercise of religion or should we say the free exercise of religion. And they were quite specific that in our constitution, in our first amendment in America, we believe in the free exercise of religion and not the mere toleration when it is convenient to the institution. Which is, which is, which is looking at it. So, you know, to answer some of the questions that were, you know, there's an answer to several of the questions that were raised earlier. Additionally, I hope that we can all support this bill. We're talking about the some of the base core first freedoms of America and that's the free exercise of religion. So I hope everyone will support this. Thank you. Thank

Yes. I'd like to call the Senate please.

Yes. My motion is we pass four substitute SB 1 74 exercise, religious beliefs and conscious amendments. And the question is, shall of four substitute Senate Bill one seventy four pass roll call vote.

Thank you Mr. Speaker. This bill is an important bill. It establishes a broad right of religious belief or conscience for healthcare providers and institutions and payers. It defines conscience as a sincerely held belief regarding the rightness or wrongness of an action or an inaction. And it provides a right to refuse for entities, participants, and for payers for healthcare services if they're, if they believe it violates their religious belief or conscience. There's limited immunity, anti-retaliation and administrative resource, um, components to this bill and it requires advanced notice. So if somebody, um, wants to hold out a religious right of conscience, they need to give advanced notice. This respects existing contracts and future contracts and, um, it's really important that we recognize that there are healthcare providers and payers in the state who have sincerely held religious beliefs. And we wanna make sure that we are balancing that with safety for patients. So this also provides in emergency situations for safety and protection for patient care. And with that, Mr. Speaker, I'm open to questions.