Legal rules and regulations that protect the exercise of conscience are referred to as “conscience clauses.” The first US federal health care conscience clause, the Church Amendment (42 U.S.C. § 300a-7(a–b)), was enacted in 1973. It protects conscience-based refusals related to abortion and sterilization. Subsequently, numerous federal and state laws and regulations have been enacted that protect the exercise of conscience by health care professionals. At the federal level, sections were added to the Church Amendment, significantly expanding its scope. One additional section (42 U.S.C. § 300a-7(c)) prohibits discrimination against a practitioner for refusing to perform or assist in the performance of “any lawful health service or research activity on the grounds that his performance or assistance in the performance of such service or activity would be contrary to his religious beliefs or moral convictions …” Another added section (42 U.S.C. § 300a-7(d)) states:

Additional federal legislation includes the Coats Amendment (42 U.S.C. § 238n) and the Weldon Amendment (121 Stat. 1844, 2209).