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COLUMBIA, SC — Amberlyn Boiter worries South Carolina doctors now have a legal excuse to deny her health care. “I haven’t felt comfortable going to a doctor in over a year,” Boiter says.
That’s when Boiter, 35, started becoming the woman she thought she was meant to be and doctors failed to give her the hormones she needed.
Limping bought them online and found an out-of-state doctor she sees via telehealth — care she says most of her transgender friends can’t afford.
“The truth is, it’s dangerous for a lot of trans people who don’t have access to mainstream health care,” Boiter says. She fears the situation will only get worse now that the Medical Ethics and Diversity Act has been signed into law by Governor Henry McMaster.
The new law allows health care providers to refuse elective care that conflicts with their religious, moral or ethical beliefs. Proponents say it protects doctors, nurses and medical students from being forced to violate their conscience. However, critics call the law a license to discriminate, especially against LGBTQ people.
“This is America, where you should have the freedom to say no to something you don’t believe in,” said South Carolina state senator Larry Grooms, who championed the law.
The law gives physicians the freedom to refuse any non-emergency service they morally object to, such as family planning, end-of-life care, or prescription drugs. Grooms insists the bill does not discriminate, explaining, “It’s procedure-based, not patient-based.”
But Ivy Hill, community health program director for the LGBTQ advocacy group Campaign for Southern Equality, says you can’t separate a person from the medical procedure they need.
“It absolutely targets people,” Hill says.
Hill says the bill adds another barrier to medical care that is already scarce for LGBTQ people, especially in rural South Carolina. In fact, Hills says it’s so hard that the Southern Equality Campaign created a directory of LGBTQ-friendly medical providers in the South, inspired by the green book that black people used to find services when faced with discriminatory laws.
“These are real people in our community who need help and need care,” Hill said.
One doctor not listed in the directory is Alex Duvall, a Christian family physician who practices on the coast of Georgetown, South Carolina. He wrote to lawmakers supporting the Medical Ethics and Diversity Act when it was before the legislature.
“Anything that’s considered immoral behavior, I can’t tolerate or I can’t help them participate in it,” Duvall says, such as giving transgender patients hormone therapy.
He is relieved that the new law protects him from prosecution or dismissal for adhering to his religious beliefs and says patients can still get gender-affirming hormone treatment elsewhere, although the new law does not require him to provide a reference.
“It’s a battle of conscience. It doesn’t mean you don’t care about patients and love them or want to do your best for them,” Duvall said.
The new law stipulates that “the right of conscience is a fundamental and inalienable right”. But Allen Chaney, director of legal advocacy for the ACLU of South Carolina, counters that discrimination is discrimination. “Saying your conscience compels your discrimination doesn’t make it legal,” Chaney says.
He expects the law to be challenged because discrimination based on sexual orientation and gender identity is prohibited by federal law. The American Civil Liberties Union is challenging a similar medical conscience clause in Ohio.
A group of 50 doctors have asked the governor of South Carolina to veto the Medical Ethics and Diversity Act.
Dr. Elizabeth Mack, spokeswoman for the American Academy of Pediatrics, testified against. She says health care should be based on science, not belief.
“Evidence supports gender-affirming care, dignified end-of-life care, and contraception,” Mack says. “We might think these things are controversial, but the evidence is really supportive.”
In a written statement, the Human Rights Campaign said the new law negatively impacts medical care for all South Carolina residents, including those in the LGBTQ community. “It dangerously legitimizes the non-medical opinions of health care facilities, medical providers, and even insurance companies at the expense of critical patient care, jeopardizing the health and safety of all South Carolina residents. “, says the legal director of the Human Rights Campaign, Sarah Warbelow.
Alliance Defending Freedom, a conservative Christian advocacy group, commends McMaster for signing the bill. “Patients are best served by medical practitioners who are free to act in accordance with their ‘do no harm’ oath. The MED Act ensures that medical professionals are not obligated to violate this oath by being required to participate to specific procedures or treatments that violate their ethical, moral or religious beliefs,” lead attorney Matt Sharp said in a written statement.
For some, like Amberlyn Boiter, the care doctors can refuse under the new law means life or death. If Boiter couldn’t get gender-affirming hormones, she says, “I know beyond a shadow of a doubt it would kill me.”
She still wants to find a doctor to see in person and not online. But she hesitates because she says being denied care legally would be too painful.