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Kentucky lawmakers are considering Senate Bill 72, titled the “Health Care Heroes Recruitment and Retention Act.” The bill would allow health care professionals — and institutions — to refuse participation in non-emergency medical services that violate their “sincerely held religious, moral, or ethical principles.” It would also shield them from civil and criminal liability and prohibit employers or licensing boards from disciplining them for exercising those rights.
Protecting conscience is a serious and legitimate concern.
Physicians are not interchangeable technicians. They are moral agents. In a free society, the government should not force a doctor to participate in a non-emergency procedure that violates deeply held beliefs. Whether the issue involves abortion, assisted suicide, or gender-transition procedures, compelling participation through state power raises important questions.
If SB 72 simply ensured that the government cannot coerce unwilling professionals into performing non-emergency services, the issue would be straightforward.
But the bill goes further — and it is also being framed as a response to Kentucky’s physician shortage. That claim deserves scrutiny.
As someone who has practiced medicine for decades, I can say with confidence that most physicians do not choose where to practice based on whether they might someday be forced to perform a procedure they oppose. Doctors consider reimbursement levels, malpractice climate, regulatory burden, hospital infrastructure, call responsibilities, professional autonomy, and quality of life. Those are the factors that drive recruitment and retention.
If Kentucky wants to attract more clinicians to provide more health care services, reducing regulatory friction, expanding scope-of-practice flexibility, and eliminating unnecessary barriers to entry, such as certificate-of-need laws, would likely have a far greater impact than expanding conscience protections.
That does not mean the bill’s core principle is unimportant. It means we should be honest about what will and will not solve workforce shortages.
There is another structural issue within the bill itself: freedom in health care runs in more than one direction. It includes the freedom of professionals to practice according to conscience. It also includes the freedom of private hospitals and clinics to define their missions and set expectations for employees.
If a hospital openly provides certain services and hires physicians for that purpose, that arrangement is voluntary. If a physician later decides they cannot in good conscience provide those services, they are free to seek employment elsewhere. Likewise, the institution should retain the ability to determine whether it can continue employing someone who declines to perform core duties.
If SB 72 prevents private employers from enforcing contractual expectations, it does more than protect conscience. It reshapes private employment relationships.
The bill also grants immunity from civil liability for professionals who exercise conscience rights. That provision deserves careful attention.
In most areas of law, disputes are resolved through established legal standards. Granting blanket immunity in advance shields one group from ordinary accountability. Health care already operates within a complex legal and regulatory framework. Adding additional layers of statutory immunity risks unintended consequences.
During debate, lawmakers also raised the question of whether broadly defined “sincerely held beliefs” could justify refusing care to a person rather than declining a specific procedure.
Supporters emphasize that objections are limited to particular services, not patients. That distinction is crucial. Refusing to perform a procedure is categorically different from refusing to treat someone because of race, religion, or sexual orientation.
Patients need confidence that when they seek care, they will not face arbitrary denial. Trust is foundational in medicine.
There is a narrower path available.
The state should not compel participation in non-emergency procedures. Licensing boards should not punish professionals solely for declining to perform services outside emergency care. Protecting individuals from government coercion is a sound principle.
Beyond that, private institutions should remain free to define their missions and employment standards, and ordinary contract and tort law should continue to govern disputes.
Kentucky can protect conscience without overstating its impact on physician shortages or weakening accountability.
If lawmakers truly want to strengthen recruitment and retention, the most effective reforms will be those that reduce regulatory burdens and expand professional opportunity — not those that assume doctors are making career decisions based on hypothetical moral conflicts.
Conscience deserves protection. But doctors are not choosing where to practice based on theoretical moral disputes. They are choosing based on whether the environment allows them to practice medicine freely and sustainably. If Kentucky wants more physicians, it should start by removing the barriers that stand in their way.
Dr. Jeffrey A. Singer is a practicing surgeon and senior fellow in health policy at the Cato Institute. This piece was cross-posted at cato.org.
