Washington State

Office of the Attorney General

Attorney General

Bob Ferguson


Unprecedented rule put providers’ personal beliefs ahead of patient needs

SPOKANE — A federal judge in Spokane today ruled that the Trump Administration’s so-called “conscience rule” is unlawful, granting summary judgment in Attorney General Bob Ferguson’s legal challenge. The rule would have given health care professionals broad discretion to refuse lawful and medically necessary care to patients for religious or moral reasons, even when the patient’s life is at risk.

This case represents the Washington Attorney General’s 25 consecutive legal victory against the Trump Administration. The Washington Attorney General’s Office has yet to lose a case against the Trump Administration.

“The court agreed that all Washingtonians deserve to receive the full range of health care services,” Ferguson said. “This rule would have disproportionately harmed rural and working poor Washington families, who have no alternatives to their local health care providers, as well as LGBTQ individuals, who already face discrimination when they seek medical care.”

The lawsuit, filed in U.S. District Court for the Eastern District of Washington, argued that the rule would jeopardize access to reproductive health care, particularly for low-income, rural and working poor patients and allow providers to discriminate against LGBTQ individuals.

The Trump Administration’s “conscience rule” would have allowed health care workers to deny a patient access to medical care and services — including reproductive care, end-of-life decisions, and care for transgender patients — for moral or religious reasons, with no exception for medical emergencies. Under the rule, if the federal government believed Washington, its health care institutions, or other recipients of federal health care funds violated the rule, the federal government would be allowed to cut off all health care funding to the state — more than $10 billion per year.

Ferguson filed the lawsuit in federal court in Spokane because rural communities, including those in Eastern Washington, have fewer health care providers and would be more likely to be harmed by the rule.

On Nov. 6, a federal judge in New York found the rule was unlawful and struck it down nationwide. Today’s ruling provides an extra layer of protection against appeal by the Trump Administration.

The conscience rule

The rule would have significantly expanded the number of individuals eligible to make refusals based on religious or moral beliefs. The rule applies to any employee providing any service to any patient, from ambulance drivers to receptionists to customer service representatives at insurance companies.

Some examples of potential impacts under the rule:

  • A woman experiencing a life-threatening miscarriage calls an ambulance to her home. The EMT or paramedic who arrives could refuse to transport her to the hospital because they may terminate the pregnancy, despite the risk to the health of the mother and the fact that the pregnancy is not viable.
  • A patient in need of an IUD to treat a condition such as endometriosis could be denied coverage by her insurance company on moral grounds because an IUD is also birth control. The patient would be responsible for the entire cost of her treatment.
  • A patient who suffers debilitating pain with menstruation, or constant menstruation, could be cured with a surgery to remove her uterus. Her doctor could refuse to tell her about that option if he or she personally opposed sterilization.
  • An employer could offer unmarried employees only health coverage that does not cover birth control, or choose to provide only plans that do not cover birth control at all.
  • A receptionist, citing religious or moral objections, could refuse to schedule an appointment for an LGBTQ patient.
  • A pharmacist could refuse to fill a prescription for hormone therapy for a transgender person.
  • If a doctor who objects to physician-assisted suicide on religious grounds treats a patient with a painful, terminal disease who wants to use Washington’s Death with Dignity Act, the doctor may refuse to transfer that patient’s medical records to a participating provider.

Impacts on Washington

The rule threatened severe sanctions on states that do not comply. Any failure  — or apparent failure — to follow the rule would jeopardize all federal health care funding, which states rely on to provide critical and often life-saving care.

Washington receives $8.2 billion annually for its Medicaid and Children’s Health Insurance programs, and more than $10.5 billion every year in federal funding from the U.S. Department of Health and Human Services. Washington relies on those funds for essential public health programs, including the Children’s Health Insurance Program, HIV/AIDS and STD prevention and education, and substance abuse and mental health treatment. 

The rule provided no information on how the federal government will determine the rule has been violated.

The rule would have substantially increased the risk of discrimination against patients on the basis of sex, sexual orientation or gender identity. Transgender patients already face discrimination in the health care industry, including denial of routine medical care, like physicals, diabetes treatments and flu shots. The rule would give providers more leeway to refuse to provide care to transgender patients and discriminate based on gender identity.

Washington has a network of laws that balances patient’s right to health care treatment with respect for personal conscience. These laws allow medical professionals to refuse to provide certain services based on conscience, except in an emergency to save a human life. They also require health care institutions and providers to ensure that no one is denied information about or timely access to health care, by, for example, advising patients of all options required by today’s medical standards.

Assistant Attorneys General Jeff Sprung, Martha Rodriguez Lopez, Zach Jones, Jeffrey Grant and July Simpson are handling the case for Washington.

Ferguson has filed 51 lawsuits against the Trump Administration and has not lost a case. Ferguson has 25 legal victories against the Trump Administration. Fourteen of those cases are finished and cannot be appealed. The Trump Administration has or may appeal the other 11, which include lawsuits involving Dreamers and 3D-printed guns. No court to rule on the merits of the Attorney General’s arguments in a lawsuit against the Trump Administration has ruled against the office.



The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 27 divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Visit www.atg.wa.gov to learn more.


Brionna Aho, Communications Director, (360) 753-2727; Brionna.aho@atg.wa.gov