Effective July 1, 2025, Idaho House Bill 59 (“HB 59”), also known as the Medical Ethics Defense Act (the “Act”), establishes sweeping legal protections for the conscience rights of health care providers, institutions, and payers across Idaho. With its passage, HB 59 not only codifies but also significantly expands the ability of health care professionals and organizations to decline participation in, or payment for, medical procedures, treatments, or services that conflict with their religious, moral, or ethical beliefs.[i]

The broad protections of HB 59 may be welcomed by providers, institutions, and payers with conscience-based missions, but, as discussed below, those protections may come at the expense of some patients’ ability to access the full range of medically accepted treatments. It remains to be seen how those tensions will be resolved in practice.

This article will discuss Idaho’s Medical Ethics Defense Act (“HB 59”) and its implications for provider conscience rights, with particular attention to the federal Emergency Medical Treatment and Labor Act (“EMTALA”). It will also compare HB 59 to Colorado’s recently enacted Senate Bill 25-130, highlighting key differences in how each state addresses conscience-based objections in healthcare.

Overview and Scope of the Law

The Medical Ethics Defense Act’s primary aim is to shield health care professionals, institutions, and payers from “discrimination, punishment, and retaliation” when they refuse to participate in or pay for medical services that violate their beliefs.[ii]

The Act’s protections are broad in scope, applying to any health care professional, including doctors, nurses, pharmacists, researchers, and social workers, as well as to health care institutions such as hospitals and clinics, and payers, including insurance companies and employers.[iii] Under HB 59, these parties may refuse to provide, assist with, refer for, or pay for any medical procedure, treatment, or service that conflicts with their conscience.[iv] Health care professionals are required to notify their employer of a conscience-based objection as soon as possible, allowing staffing adjustments; employers of health care professionals may also require written notice or disclosure at the time of hiring.[v]

While the law allows health care payers to invoke conscience objections, it does require them to honor existing contractual obligations to pay for services.[vi] Importantly, the law prohibits adverse employment or professional actions against providers who exercise their conscience rights.[vii]

Legal Protections and Remedies

HB 59 provides robust legal protections, including civil, criminal, and administrative immunity for providers and institutions that refuse to participate in or pay for services on conscience grounds.[viii] The Act also establishes a private right of action, enabling aggrieved parties to seek injunctive relief, damages, and attorney’s fees for violations.[ix] Notably, the law specifies that any additional burden or expense resulting from a provider’s refusal is not a valid defense for violating the Act.[x]

Additionally, HB 59 incorporates strong whistleblower and free speech provisions. It protects providers who report violations of the Act, ethical breaches, or patient safety concerns from retaliation.[xi] The law also limits the ability of regulatory agencies to sanction or deny licensure for speech protected by the First Amendment, unless such speech directly causes physical harm to a patient.[xii]

Limitations and Exceptions

HB 59 does include certain limitations on its conscience protections. These protections do not extend to situations in which an employee is unable, for conscience-based reasons, to perform the essential functions of their position and where no reasonable accommodation can be provided without imposing an undue hardship on the employer.[xiii]

For instance, HB 59 is unlikely to prohibit an employer from terminating a nurse’s employment, where the nurse was employed specifically to assist with blood transfusions, but the nurse expresses a conscience-based objection to performing blood transfusions.

Additionally, the law explicitly permits religious health care providers to make employment, staffing, contracting, and administrative decisions in accordance with their religious beliefs, provided they hold themselves out to the public as religious and maintain internal policies that reflect their religious mission.[xiv]

Potential Issues and Legal Tensions

While HB 59 is designed to safeguard the conscience rights of health care providers, it may give rise to conflicts with existing federal laws, standards for emergency medical care, and professional oversight mechanisms.

One significant area of potential conflict is with federal anti-discrimination laws, particularly Section 1557 of the Affordable Care Act, which prohibits discrimination in health care based on sex (including gender identity), race, disability, and other protected characteristics.[xv] If Idaho providers refuse care to certain groups, such as LGBTQ+ patients or women seeking reproductive services, citing conscience objections, these refusals could be challenged under federal law.

Although HB 59 seeks to immunize providers from liability for conscience-based refusals, it does not override federal statutes. Providers or institutions could still face lawsuits, investigations, or the loss of federal funding if found in violation of federal anti-discrimination protections. The law’s broad definition of “conscience” and its application to a wide range of providers could also make it difficult to distinguish between legitimate conscience objections and refusals based on personal prejudice, raising challenges for both patients and providers.

Although HB 59 explicitly states that it does not override the federal EMTALA,[xvi] which requires emergency medical care in hospital emergency departments, the Act does not mandate that employers or emergency departments ensure another qualified provider is always available to deliver care when a conscience objection is asserted.[xvii] Instead, it requires only that providers notify their employer of a conscience-based objection as soon as reasonably possible to allow for staffing adjustments, but it does not guarantee continuity of emergency services or require the immediate availability of an alternative provider. In life-threatening situations where no alternative provider is present, EMTALA’s federal obligation to stabilize the patient may override state-level conscience protections, in which case the provider or institution remains legally required to provide emergency care.

This federal preemption was recently reinforced by the Supreme Court’s decision to dismiss Moyle v. United States, which effectivelyupheld a lower court ruling that blocks Idaho from enforcing its near-total abortion ban when it conflicts with EMTALA’s requirement to provide necessary emergency care.[xviii] Although Moyle focused on abortion, its reasoning applies more broadly: any state law, including HB 59’s conscience protections, cannot override EMTALA’s mandate to deliver stabilizing treatment in emergencies, regardless of the medical condition.[xix] Importantly, EMTALA includes a private right of action, meaning that even if state enforcement is limited, individuals can still bring lawsuits under EMTALA for violations, so providers and institutions may still be implicated under federal law.

Further, the potential for confusion or delays remains if a provider asserts a conscience objection during a time-sensitive emergency. This is because uncertainty about the law’s application or the availability of alternative staff could jeopardize patient outcomes and expose providers or institutions to liability under EMTALA while legal or administrative questions are resolved.

As applied in non-emergency circumstances, while HB 59 does not specifically include the “discussion” or “disclosure” of treatment options in its definition of treatment, its broad definition of “participate” could arguably encompass these activities.[xx] However, the Act does not impose an explicit obligation on providers to inform patients when a conscience objection is invoked, nor does it require referral to an alternate provider.

This lack of statutory duty raises concerns about informed consent and patient autonomy, as providers may invoke their rights under HB 59 to refuse to disclose medically acceptable treatment alternatives to the patient, where the provider has a conscience-based objection to that alternative treatment. As being informed of all reasonable medically acceptable alternative treatments is a cornerstone of the concept of “informed consent,” HB 59 may erode this important patient protection.[xxi]

Moreover, Idaho’s HB 59 contains explicit protections against providers being sued for medical malpractice if they invoke a conscience-based objection. As a result, in non-emergency circumstances, patients have no legal remedy if a provider refuses to disclose or provide a medically acceptable alternative due to a conscience-based objection, even if this refusal means the patient was not properly informed and, arguably, was subjected to “medical battery.” As HB 59 is implemented, there may be increasing calls for patient-centered amendments, such as mandatory disclosure or referral requirements, to help ensure that patients remain fully informed and have meaningful access to all appropriate care options.

Another area of concern involves the Act’s free speech provisions, which restrict the circumstances under which licensing boards can discipline health care providers for their speech. Under HB 59, regulatory action can only be taken if it is proven by clear and convincing evidence that the speech directly caused physical harm to a specific patient within the preceding three years.[xxii] This high threshold may affect enforcement of medical standards and oversight of provider communications, potentially undermining public trust and the integrity of medical practice.

Contrast with Recent Colorado Legislation on Conscience Based Objection

In contrast to Idaho’s HB 59, Colorado’s recently enacted Senate Bill 25-130 (“SB 25-130”), which was signed into law on May 14, 2025, takes a distinct approach from HB 59 in addressing provider conscience rights. While both statutes allow for conscience-based refusals, SB 25-130 specifically requires emergency departments to ensure that another qualified provider is available to deliver care when a provider declines on conscience grounds.[xxiii]

The Colorado law also includes anti-discrimination provisions, comprehensive documentation requirements, and detailed protocols for patient stabilization, transfer, and discharge.  However, while Idaho’s HB 59 primarily focuses on protecting providers’ rights to decline participation in certain services and centers anti-discrimination protections on providers, Colorado’s law incorporates additional measures to maintain patient access and continuity of emergency medical services while still accommodating provider conscience objections.

Conclusion

The Medical Ethics Defense Act represents a significant expansion of legal protections for conscience rights in Idaho’s health care sector. It grants providers, institutions, and payers broad latitude to decline participation in services that conflict with their beliefs, while establishing strong legal remedies for those providers who believe their conscience rights have been violated.

However, it does not supersede federal requirements such as EMTALA, and its broad scope may invite legal challenges or create tensions with existing anti-discrimination and professional oversight laws. As of the time of writing, the authors are not aware of any pending litigation challenging HB 59. However, given the law’s sweeping scope and significant implications for both providers and patients, it is likely that HB 59 will face legal challenges in the future. While Idaho prepares for HB 59’s implementation, providers and institutions will need to navigate these evolving legal and ethical landscapes with care.

[i] Idaho Code Ann. § 54-1302(4).

[ii] Idaho Code Ann. § 54-1302(5).

[iii] Idaho Code Ann. § 54-1303(6)–(8).

[iv] Idaho Code Ann. § 54-1304(1).

[v] Idaho Code Ann. § 54-1304(3)–(4).

[vi] Idaho Code Ann. § 54-1304(5).

[vii] Idaho Code Ann. § 54-1304(6).

[viii] Idaho Code Ann. § 54-1304(7).

[ix] Idaho Code Ann. § 54-1307(1)–(2).

[x] Idaho Code Ann. § 54-1307(1).

[xi] Idaho Code Ann. § 54-1305(1)–(2).

[xii] Idaho Code Ann. § 54-1306(1).

[xiii] Idaho Code Ann. § 54-1304(12).

[xiv] Idaho Code Ann. § 54-1304(8).

[xv] 42 U.S.C. § 18116.

[xvi] Idaho Code Ann. § 54-1304(11).

[xvii] 42 U.S.C. §1395dd.

[xviii] Moyle v. United States, 603 U.S. 324 (2024).

[xix] Given Moyle’s less than clear outcome, however, there may well be room for the Supreme Court to modify its holding and find that EMTALA does not pre-empt a state-law restriction on abortion.

[xx] Idaho Code Ann. § 54-1303(8).

[xxi] Idaho Code Ann. § 39-4506; Idaho Code Ann. § 39-4507.

[xxii] Idaho Code Ann. § 54-1306(1).

[xxiii] Noncompliance of emergency departments can result in investigation by the state health department and imposition of civil monetary penalties.