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COLUMBIA, S.C. — Amberlyn Boiter worries that doctors in South Carolina now have a legal excuse to deny her health care. "I haven't felt comfortable going to a doctor in well over a year," says Boiter.

That's when Boiter, who is 35 years old, began transitioning into the woman she believes she's meant to be and doctors would not give her the hormones she needed.

Boiter bought them online and found an out-of-state doctor she sees via telehealth — care that she says most of her transgender friends cannot afford.

"The truth is, it's dangerous for a lot of trans people out there who don't have access to mainstream health care," says Boiter. She fears the situation will only get worse now that the Medical Ethics and Diversity Act has been signed into law by Gov. Henry McMaster.

The new law lets health care providers refuse nonemergency care that conflicts with their religious, moral or ethical beliefs. Supporters 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," says South Carolina state Sen. Larry Grooms, who championed the law.

The law gives medical practitioners the freedom to refuse any nonemergency service they object to morally, such as family planning, end-of-life care or prescribing medication. Grooms insists the bill does not discriminate, explaining, "It's based on procedure, not on patients."

But Ivy Hill, the community health program director for the LGBTQ rights group Campaign for Southern Equality, says you can't separate a person from the medical procedure that the person needs.

"It is absolutely targeting people," says Hill.

Hill says the bill adds another barrier to medical care that's already scarce for LGBTQ people, especially in rural South Carolina. In fact, Hills says it's so difficult that the Campaign for Southern Equality put together a directory of LGBTQ-friendly medical providers across the South, inspired by the Green Book that Black people used to find services when they faced discriminatory laws.

"These are real people in our community who need help and who need care," says Hill.

A doctor who is not listed in the directory is Alex Duvall, a Christian family physician who practices in coastal Georgetown, South Carolina. He wrote to lawmakers to support the Medical Ethics and Diversity Act when it was before the legislature.

"Anything that is considered immoral behavior I can't condone or I can't help them participate in it," says Duvall, like giving hormone therapy to transgender patients.

He's relieved the new law protects him from being sued or fired for abiding by his religious beliefs and says patients can still get gender-affirming hormone treatment elsewhere, though the new law does not require him to provide a referral.

"It's a battle of conscience. It doesn't mean that you don't care about patients and love patients or want to do your best for them," Duvall says.

The new law states, "the right of conscience is a fundamental and unalienable right." But Allen Chaney, the director of legal advocacy for the ACLU of South Carolina, counters that discrimination is discrimination. "Saying that your conscience compels your discrimination doesn't make it lawful," says Chaney.

He expects the law to be challenged because discrimination based on sexual orientation and gender identity is prohibited under federal law. The American Civil Liberties Union is challenging a similar medical conscience clause in Ohio.

A group of 50 medical practitioners asked South Carolina's governor to veto the Medical Ethics and Diversity Act.

Dr. Elizabeth Mack, a spokesperson for the American Academy of Pediatrics, testified against it. She says health care should be based on science, not beliefs.

"The evidence supports gender-affirming care, dignified end-of-life care and contraception," says Mack. "We might think that these things are controversial, but the evidence is really supportive."

In a written statement, the Human Rights Campaign said the new law negatively impacts the medical care of all South Carolinians, including those in the LGBTQ community. "It dangerously legitimizes non-medical opinions of health care institutions, medical providers, and even insurance companies at the cost of critical patient care, compromising the health and safety of all South Carolinians," states the Human Rights Campaign's legal director, 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 consistent with their oath to 'do no harm.' The MED Act ensures that medical professionals are not compelled to breach this oath by being required to participate in specific procedures or treatments that violate their ethical, moral, or religious beliefs," said senior counsel Matt Sharp in a written statement.

For some, like Amberlyn Boiter, the care that doctors can refuse under the new law means life or death. If Boiter could not receive gender-affirming hormones, she says, "I know beyond any shadow of a doubt that that would kill me."

She still wants to find a doctor to see in person and not online. But she's hesitant because she says being refused care legally would be too painful.

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