This story was updated April 6 at 10:40 p.m.

NASHVILLE — Tennessee's mental health therapists and counselors could turn away gay patients because of their own "sincerely held principles" under a bill now on its way to Republican Gov. Bill Haslam.

Senators took final action Monday on the bill, opposed by the American Counseling Association, that would make Tennessee the only state allowing therapists to refuse to treat patients out of hand if Haslam signs it into law.

Sen. Jeff Yarbro

Tennessee state Sen. Jack Johnson

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Senator agreed to a House amendment that changed the bill's original language from "sincerely held religious beliefs" to "sincerely held principles."

Tennessee's lesbian, gay, bisexual and transgender community has objected to the legislation, saying it could prove especially harmful to young LGBT students bullied at school.

Sen. Jeff Yarbro, D-Nashville, an attorney, said the original bill was already giving Tennessee "somewhat of a black eye" with the religious exemption.

But he said while the "sincerely held religious belief" language has at least been litigated in courts for decades, "as far as I know, 'sincerely held principal' is an unheard-of concept, at least as a legal matter.

"There's no ligitation on what those 'principles' are," Yarbro argued.

The bill would allow someone who is racist to reject someone based on the color of their skin, Yarbro warned.

But Sen. Jack Johnson, R-Franklin, the bill's sponsor, retorted that if Yarbro "doesn't like the language in the House bill," he can take up the reason for his bill with the American Counseling Association, which he blames for the need.

Johnson said the ACA changed its "time immemorial" ethics policies because of a 2014 6th U.S. Circuit Court of Appeals decision that went against a Michigan university. The school kicked out a counseling student who refused to counsel a would-be gay client, citing her religious beliefs conflicting with the client's goals.

The court held the ethical standards were too vague and the ACA moved to adopt the new standard.

Johnson's bill says the counselors should refer the patient, who may be in the midst of therapy before a counselor has an issue, to another professional. The senator said some therapists may not have training on such issues.

The senator also noted "attorneys don't even have this in their ethics code. But counselors do." He cited the example of an attorney specializing in writing wills having no ethical problem turning down a would-be client charged with first-degree murder.

Sen. Richard Briggs, R-Knoxville, a physician, said doctors are allowed to re-refer or reject clients based on their religious views or principles. For example, they don't have to treat a patient seeking an abortion, Briggs noted.

They could also turn down a state government request for assisting with the execution of a convicted murder, he added.

Sen. Mike Bell, R-Riceville, who has a controversial student transgender bathroom bill restricting common restroom use to students' gender designation at birth, said the Tennessee Constitution says "no human authority can interfere with rights of conscience."

Therapists and counselors, as well as the ACA, say professionals can re-refer clients to colleagues if patients' problems are outside their skill sets.

But they say it goes against everything counselors are trained to do if they allow their personal beliefs to outweigh their obligations to patients in need.

Contact Andy Sher at asher@timesfreepress.com, 615-255-0550 or follow via Twitter @AndySher1.