He needed a gender-affirming procedure. The hospital said no.
November 1, 2019 3:09 PM   Subscribe

As rural hospitals shutter, and faith-based care grows, “religious refusals” are leaving some patients without options. In the summer of 2016, Evan Minton was preparing for his scheduled hysterectomy at Mercy San Juan Medical Center in Carmichael, California, just outside Sacramento. The procedure, part of his gender-affirming care, should have been routine. But the day before, the hospital abruptly canceled his surgery; the hospital was Catholic, and a procedure that results in sterilization is a violation of the Ethical and Religious Directives that, with rare exceptions, govern Catholic hospitals. Minton had experienced what’s known as “religious refusal,” a growing — and divisive — phenomenon in which health care is denied on the basis of religious beliefs.
The implications here are clear for patients like Minton, but the Ethical and Religious Directives also frown on fertility treatment. When former California resident Michelle, 37, and her husband, Josh, 42, learned that something had gone wrong in the early stages of her IVF pregnancy, they were advised to terminate. But when she went to the doctor’s office, the couple alleges, the doctor grumbled about the paperwork needed to get authorization from the Catholic facility for the medically necessary shot of methotrexate, which would have stopped the cells from growing. (Michelle’s then-physician and affiliated hospital did not respond to a request for comment.)

Michelle says the doctor told her, “What did you expect, getting someone pregnant who shouldn’t be?” The couple, who asked that their last names be withheld for privacy reasons, say they felt like an unwelcome burden. They sought treatment elsewhere, but by that time she required general anesthesia and a surgical procedure, which came with increased risks including infection, infertility, and even death. The memory haunts Michelle, preventing her and her husband from “emotionally being able to move forward with our remaining frozen embryo,” she says. They fear a repeat denial of care if something goes wrong with another pregnancy.
posted by Homo neanderthalensis (65 comments total) 33 users marked this as a favorite
 
I have a lot of complicated feelings about the choice to feature a transmasculine person in this story and what it means for the ways we are allowed to be visible and the ways cis people use us
posted by hoyland at 3:23 PM on November 1, 2019 [16 favorites]


So happy to be subsidizing these folks, for just hundreds of years. So happy.
posted by Freedomboy at 3:28 PM on November 1, 2019 [5 favorites]


I am uncomfortable that "Catholic" hospitals still exist and get away with pulling shit like this.
posted by jenfullmoon at 3:32 PM on November 1, 2019 [77 favorites]


In particular, the issue was not that he was trans, but that he wished to divest himself of a uterus, a situation that disproportionately affects women. But instead of forcing the reader to confront misogyny from the get go, we get used to make them feel like such good allies before they're asked to stand up for women. And that's noble, but we exist on our own terms and deserve to be visible, not to exist as props to be used to subtly reinforce a sexist and transphobia society. (We're conveniently invisible until someone wants a "good" trans person. Which is using us to prop up transmisogyny and a product of misogyny in itself.)
posted by hoyland at 3:35 PM on November 1, 2019 [27 favorites]


This is a complicated issue.

I've actually been close to two cases where the doctor had moral issues with a particular medical procedure, but in both cases they said "I have personal issues with this, but I will find you someone who will perform it".

There is some way to draw a line that lets health providers be respectful of their own personal beliefs while simultaneously ensuring that they provide the medical care that is, after all, their job.

I have no idea where to draw that line.

What did you expect, getting someone pregnant who shouldn’t be?

This guy is sure as hell on the wrong side of it, however.
posted by It's Never Lurgi at 3:35 PM on November 1, 2019 [15 favorites]


This becomes even more of an issue as hospitals, medical groups, and insurance companies consolidate. See this article talking about the dangers of our local Catholic health conglomerate merging with our largest Medicaid provider.

I don't understand how the Catholic church can have all this stuff and not "afford" to pay damages for pedophile priests...
posted by elmay at 3:37 PM on November 1, 2019 [31 favorites]


Not only do they exist, but they are often up to half of the available hospitals available even in cities that aren't necessarily traditionally Catholic--and they don't always advertise up front that they have these restrictions or even that they're Catholic, either. I had a vague memory that of the three or four hospitals in my city proper, two or three were Catholic institutions. St. David's is an obvious gimme, looking at the list, and I'd guess from the name that Seton and Dell Medical Center are both secular...

...but Seton Medical Center is a Catholic institution.

We need to fund our own health care as a nation, and we need to do it in a secular fashion that is available to all.
posted by sciatrix at 3:38 PM on November 1, 2019 [33 favorites]


1) Doctors have moral quandaries, corporations should not.

2) Treat them like you would say a trauma center certification. Have a full hospital certification. If a hospital can't perform a specific operation for lack of staff, it loses accreditation while it can't patients get diverted and the ER shuts down.

3) Should a hospital fail to have someone on staff to perform a standard set of procedures it temporarily loses its accreditation and said hospital gets slaped with a financially crippling fine for endangering public safety by not having a functioning ER.

4) Should a hospital fail below a certain availability (say 95%) in a procedure they get nationalized or the state can bring in management to run the hospital to ensure availability to the community.

Want to keep being a hospital? You don't cancel a hysterectomy because you can't find someone who doesn't think their imaginary friend up in the sky says it's a no-no procedure.
posted by Your Childhood Pet Rock at 3:47 PM on November 1, 2019 [60 favorites]


I don't understand how the Catholic church can have all this stuff and not "afford" to pay damages for pedophile priests...

It’s not a monolith. Catholic health systems are typically run by orders of nuns traditionally dedicated to caring for the sick. And as problematic as that can be, the quality of care generally declines when their hospitals are taken over by larger, more corporate health systems.

Then there’s Providence and its ilk which do a good job being the worst of both worlds.
posted by snuffleupagus at 3:56 PM on November 1, 2019 [4 favorites]


There are also a lot of places where for-profit health systems have completely withdrawn and state health systems have been shut down; non-profit religious hospitals are the only game in town. There are something like 39 counties in Illinois that only have Catholic health services available, which typically operate at a loss and are subsidized by the parent hospital -- the largest of which in Illinois makes a billion dollars in don't-call-it-profit a year, so I'm not crying for them, but at least the nuns are sending (some of) that money out to rural counties that otherwise have NO HEALTH CARE AT ALL, whereas the private, secular hospitals just keep the profits.

There just isn't any plan to provide healthcare to those places except to shrug and say "well, the Catholics do it at no cost to us, as long as we let them refuse a variety of reproductive-related procedures, so ..." I don't have an answer, but private hospitals could be required to operate a rural clinic to be allowed to operate in the state. The state could attach to the university hospital system a bunch of rural clinics that could be used to help train med students. There could be med student loan forgiveness for doctors willing to serve 3 years at a rural clinic. (Catholic hospitals right now recruit doctors to those rural clinics by sponsoring visas for doctors who want to move to the US -- that's another option, although there's already concern about that pipeline shutting down b/c Trump.) Or the state could just FUCKING RUN SOME PUBLIC HOSPITALS but given Illinois's finances, that seems vanishingly unlikely.

When you live in these places with limited health care, it's hard to be "shut it all down" furious at the only people who can be arsed to offer you health care because you dare to live outside a major metro area and are therefore considered unworthy of care. And a lot of advocacy around the issue revolves around "shut it all down," without considering the many people who have no other access to health care and will not have any access to healthcare if they leave, but also that a lot of people are grateful to the Catholic organizations that provide health care in parts of the country where nobody else will, even if they acknowledge the problems, and will fight to defend their doctors. It's hard to know how to attack the problem, since the government paying for any reproductive/sexuality-related health care is ALSO a giant fucking problem in the US (otherwise building a system of sexual health clinics alongside the rural Catholic clinics would make a lot of sense, and gradually supplanting them).

But it's hard to see how we solve this problem without government-run hospitals and clinics on a large and geographically widespread scale, and it's hard to see how we get THERE without a) massive, New Deal-level investments; and b) Republicans abandoning culture wars over abortion and sexuality.

(I also have some big somewhat related rants on property tax exemptions for hospital systems BUT I SHALL REFRAIN.)
posted by Eyebrows McGee at 4:25 PM on November 1, 2019 [41 favorites]


This is a complicated issue...

There is some way to draw a line that lets health providers be respectful of their own personal beliefs while simultaneously ensuring that they provide the medical care that is, after all, their job.

I have no idea where to draw that line.

It's Never Lurgi

It's not complicated at all. "[R]espectful of their own personal beliefs"? Fuck that. There's no line to be drawn. A doctor refusing to provide required care for any non-medical reason should not be a doctor and should have their license revoked. On an institutional level, something like what Your Childhood Pet Rock suggests above.

The only actual complicated issue is the one that Eyebrows McGee and others have alluded to, that public funding and infrastructure for health care has been allowed to get to this state in the first place, where people in poor and rural areas are forced to rely on these religious institutions. And, of course, a big reason for this is the influence of these very religious institutions on government.

Freedom of religion can only ever mean freedom from religion.The day when we can make decisions and policies without wondering what goat herders who lived 3,000 years before cell theory or the germ theory of disease would think can't come soon enough.
posted by Sangermaine at 4:35 PM on November 1, 2019 [43 favorites]


Sangermain: It's not complicated at all. "[R]espectful of their own personal beliefs"? Fuck that. There's no line to be drawn. A doctor refusing to provide required care for any non-medical reason should not be a doctor and should have their license revoked.

I said I had a couple of examples. Here's one.

California has a death with dignity law (there are legal challenges, but I believe it is still in effect). Roughly (I don't know all the details), if doctors agree you have less than six months to live then you can be prescribed a lethal dose of painkillers. A couple of doctors have to sign off on it and there are other rules going along with that.

I personally know someone who wants to have that option due to inoperable cancer and their doctor said roughly "I'm not comfortable being one of the doctors, but I will give you the names of some who are and they may consult me if they wish".

As it happens, the person in question is doing pretty well right now, so the issue is moot, but they didn't have any problem with the doctor's position. I think factors that have to be weighed include whether it is a personal vs. institutional position and whether it imposes an undue burden on the patient.
posted by It's Never Lurgi at 5:21 PM on November 1, 2019 [7 favorites]


[Hello, I'm getting a lot of flags in this thread, from two different positions, and rather than delete anything here so far, I'm going to lay out both sides and ask you guys to step a bit more carefully. For some of our members -- principally women (cis and trans), but also trans men -- this is an intensely personal issue that goes to the heart of issues of bodily autonomy and access to medical care. They are understandably angry and should be allowed to express that anger. HOWEVER, as our members of color have pointed out to us, attacking religion and religious people is often disproportionately an attack on people of color, and often disproportionately an attack on the less-wealthy. This is a hella complicated intersection of issues around gender and sexuality, reproductive rights, religious freedom, rural access to health care, and poverty. Please try to phrase your comments in ways that don't demonize entire groups of fellow mefites or that engage in gratuitous bashing of large institutions just to get your hits in -- they're not reading, but your fellow mefites are, so your attacks hit them, not your target.

From here, I will be deleting comments that seem, to me, to cross this line, which is going to be a tricky judgment to make, so I ask for your help in trying to direct your anger/remarks/disagreements appropriately, so that ideally I don't have to do anything else in this thread.]

posted by Eyebrows McGee (staff) at 5:33 PM on November 1, 2019 [42 favorites]


the hospital was Catholic, and a procedure that results in sterilization is a violation of the Ethical and Religious Directives that, with rare exceptions, govern Catholic hospitals.

I work for a Catholic health system (the one mentioned upthread as “the worst of both worlds”), and this idea that procedures that result in sterilization are generally banned at Catholic hospitals is comically incorrect. We’ve got plenty of issues (and there are many thousands of us working on them from the inside), but this particular one is nothing like the quote portrays it.
posted by a box and a stick and a string and a bear at 5:44 PM on November 1, 2019 [4 favorites]


Ordinarily, I would be pushing back at the religious restriction of this kind of conflict by gleefully invoking my Satanic Temple Religious Reproductive Rights campaign. (Briefly, bodily autonomy is a central tenet of the Satanic Temple, and accordingly they view bodily autonomy as a protected religious belief in its own right. Temple Satanists aren't the only religion this is true for, but they're particularly cheerful about banging the drum.) That is, if we are going to enshrine religious belief in medicine, freedom of religion must apply equally to all--not simply to the sort of conservative Christians who are currently trying to extend the boundaries.

But when this becomes a question of access, because so much of American healthcare facilities are being run and owned by orders of a specific religion, I begin to eye the situation with a much harsher eye. The trouble is that there have never been enough private, secular hospitals in the US, especially in less profitable markets. Because health care is not deemed the sort of right that it is worth diverting significant resources to take care of everyone, there are many people who need to rely on charitable initiatives in order to meet their basic needs. This allows religions to dictate who, exactly, gets to access their resources and at what price and puts pressure on people to conform to specific religious tenets in order to survive. That system should be viewed as a violation of religious freedom, because the religious beliefs and practices of all people are therefore being coerced by the cudgel of poverty, sickness, or death.

This problem neatly illustrates the problem I have with charities: charities are all well and good, but no one should be forced to rely on religious charities, because this is precisely the bullshit they frequently pull, particularly Christian charities. The rights to access health care cannot be provided solely by religious donation. The only moral thing to do is to restructure our social net so that charities of all sorts are, perhaps, a pleasant luxury, but not something that anyone needs to rely on to get by. Because charities will reject the undeserving, and it's funny how wide the definition of "undeserving" can get as the crowds of people who need support grow.
posted by sciatrix at 5:48 PM on November 1, 2019 [39 favorites]


I should also add:

The only actual complicated issue is the one that Eyebrows McGee and others have alluded to, that public funding and infrastructure for health care has been allowed to get to this state in the first place, where people in poor and rural areas are forced to rely on these religious institutions. And, of course, a big reason for this is the influence of these very religious institutions on government.

The funding and infrastructure of health care has not been "allowed to get to this state." The funding and infrastructure of health care have never been better than this state. As Eyebrows points out, Catholic hospitals and orders have viewed this work as a major tenet of religious service for centuries--certainly well before the New Deal or Medicare or even socialized medicine itself. One of the largest failures of privatized medicine is that privatized medicine will not operate unless profit motives are available, and Catholic hospitals have historically filled a niche serving, specifically, the poor and people who do not have options. As health care has historically been increasingly more socialized, the Catholic influence is sometimes minimized--but sometimes not. Again, this makes it very difficult for patients to identify what their options are for treatment, particularly when complications happen.

We are in this situation because the current system of hospital creation and construction does not serve all Americans. We are in this situation because unmet needs cause people to be caught between a rock and a hard place, with no true and honest freedom of choice to allow them to follow their own hearts and minds when they are sick. We are not in this situation because some imagined socialist past solution has been degraded and destroyed; we are here because we have never had the political will and wherewithal to do something better.
posted by sciatrix at 5:57 PM on November 1, 2019 [24 favorites]


I'm with Sangermaine; this isn't complicated at all. The US has come around to the idea that bakers can't discriminate against engaged people on religious grounds. Surely something as important as healthcare can be expected to be held to the same standard.

It's completely ridiculous that the 11th richest country in the world is dependent on charity to deliver healthcare. The solution is obvious (nationalize it all under a single payer system or some other system everyone else in the world manages) and will never ever happen short of actual blood in the streets revolution.
posted by Mitheral at 6:10 PM on November 1, 2019 [9 favorites]


The US has come around to the idea that bakers can't discriminate against engaged people on religious grounds.

Has it? The baker won that case (admittedly on more narrow grounds unrelated to the fundamental issue) and lots of people supported him (polls I'm finding in searches show more than half of people agreed with the baker).

And the current administration has strengthened the so-called "conscience rule" for health workers that allows crap like this (and as the article says, even created an entire "Office" to deal with that kind of thing), so its getting worse not better.

So while some Americans would agree with that, it is nowhere near the position of the US as a whole, and its absolutely not the position of the government which is strongly pro-"religious exemption".
posted by thefoxgod at 6:17 PM on November 1, 2019 [5 favorites]


nationalize it all under a single payer

Just FYI, single payer wouldn't inherently solve this. Someone still has to provide the care and there's nothing about single payer that would prevent the Catholic church from providing care. There are Catholic (and other religious group) hospitals in Canada. I mean you totally should get single-payer healthcare, because it would solve lots of other problems, but it wouldn't solve this one.
posted by If only I had a penguin... at 6:21 PM on November 1, 2019 [7 favorites]


When I had a miscarriage in June the doctors suspected an ectopic pregnancy. If allowed to proceed, ectopic pregnancy can lead to massive internal hemorrhage and death. Methotrexate is the safest and most effective treatment for many patients, and many Catholic hospitals refuse to offer it.

If the only medical care available will allow me to bleed to death rather than offering the medicine that would preserve my life and fertility, that’s not really medical care, is it?

I am fine, by the way.
posted by mai at 6:22 PM on November 1, 2019 [73 favorites]


So let's say I'm a firefighter, but it's against my religious beliefs to put out fires in houses with basements. Nonetheless, I evidently have a right to still perform that particular job, despite the fact that I will refuse to perform part of my job duties?

If your religious beliefs conflict with your job, then you find a job that doesn't conflict with your religious beliefs. You don't demand that the job, and those your job is supposed to serve, has to accommodate you.

You a doc or a pharmacist whose religion is against RU-486 or hysterectomies? I'd tell you to mop a floor or serve a Big Mac, but there are people serving in those professions with honor already.
posted by WCityMike at 6:28 PM on November 1, 2019 [34 favorites]


the nationalize part is important
posted by Mitheral at 6:31 PM on November 1, 2019 [2 favorites]


If the only medical care available will allow me to bleed to death rather than offering the medicine that would preserve my life and fertility, that’s not really medical care, is it?

The Catholic treatment for ectopic pregnancies is to remove the "diseased portion" of the fallopian tube. The first such procedure reduces fertility, the second makes natural conception impossible. What I find interesting about this is that the Catholic church would effectively call an embryo a disease and second the philosophical/theological gymnastics involved in saying this is anything other than an (ultra-invasive, needlessly-invasive, life-altering) abortion.

I remember saying to a friend "It's like saying 'It would be wrong of me to kill you, so I'm going to blow up your house when I know you're home. If your house blows up but somehow you don't die, that wouldn't solve my problem, so I'll blow up your house again with an even bigger bomb and take out a couple of neighbours, too. But I won't kill you, because that would be wrong."

Clearly I think this is ridiculous, in case you couldn't tell. But saying a doctor shouldn't be a doctor if they would ever refuse to perform a procedure due to their moral beliefs seems like it would prevent anyone from being a doctor, except may a handful of sociopaths whom you wouldn't want to be doctors. Is there really NO medical procedure you wouldn't perform for moral reasons? Michael Jackson's 50th nose job? A patient who wants IVF though pregnancy would have a high chance of killing her? A parent requests liposuction for a chubby 5 year old? An extreme fundamentalist suffering from lust asks you to remove his eyes?

Obviously everyone has lines they woudn't cross and that (the fact of having lines) a bad thing. So how do you reconcile it: YOu shouldn't specialize in an area where there's a more than 5% chance you'd ever be called on to do this? Or 5% per year? You can't be a doctor at all if 98% of people think your lines are silly?
posted by If only I had a penguin... at 6:51 PM on November 1, 2019 [3 favorites]


I feel like the cake baker comparison here is the most relevant. There is someone "in the business of doing a thing" that just won't do it for some people. Whether you're for-profit or non-profit, if you take money for services, it should be legislated that you must provide this service for ANYONE (not just people you like and certain protected groups, but ANYONE) proffering the coin for your normal rate. It seems well within the constitutional authority of legislators to regulate commerce in this manner. I realize this isn't the current legal environment, but it could be and that's all that really needs to be discussed.

Because if you get beyond that this gets really complicated. My daughter needed a surgery that required traveling 550 miles to the nearest person capable of performing the procedure. Is she being discriminated against? If you say no, because everyone else with that need faces the same issue, what of the ADA? Everyone needing a ramp into a restaurant faces the same issue when there is not one. The majority in this town get their medical needs taken care of locally, why not my daughter? Why aren't girls with heart valve problems a protected group?

You can nationalize and subsidize health care distribution, but for the rarer and more uncommon needs, there still isn't going someone for every need in every town. A for-profit can't economically justify certain specialists in my town, but neither could any other system justify all the subsidized unused time of a local specialist.

Stick with the central issue of discrimination or it's too problematic.
posted by ixipkcams at 7:30 PM on November 1, 2019 [1 favorite]


"Whether you're for-profit or non-profit, if you take money for services, it should be legislated that you must provide this service for ANYONE (not just people you like and certain protected groups, but ANYONE) proffering the coin for your normal rate"

So the difference is that religious hospitals DO typically provide services to all patients equally, and are already required to by law -- but they refuse to perform specific services that violate their religious beliefs. (Occasionally the refusal of certain services can de facto exclude certain patients but let's leave those cases to one side for a second.) So the case isn't so much like bakers refusing to bake cakes for gay weddings; it's a baker who says "I don't bake wedding cakes at all, for anybody," which is totally fine. (Maybe he doesn't have the equipment, or maybe he objects to marriage in general, but he's not providing a service to some patrons but not others so he's in the clear.) The Catholic hospitals typically don't say "we won't treat particular types of patients"; they say, "we don't prescribe birth control, at all."

There's no question that people need access to reproductive services (in this example) that religious hospitals don't want to provide, and I'm not disputing that part of it. But the legal reasoning is very different between your anti-gay bakers claiming conscience clauses to refuse particular CLIENTS, while still performing the service overall; Catholic hospitals don't object to particular patients, they object to particular medical procedures.

Now, if they were prescribing birth control to married people but not single people, then you would (arguably) have a discrimination argument where a place of public accommodation is refusing particular clients on the basis of personal characteristics, even though you could imagine a religious hospital (although not a Catholic one) thinking birth control in marriage was ethical but not outside it -- but you're fundamentally picking and choosing among your patients at that point. But refusing to provide the service at all raises a different legal question than discrimination. Which is part of what makes this a much tougher question to solve under present American law without significant investments of public money into building a complementary, parallel, or replacement system.
posted by Eyebrows McGee at 7:54 PM on November 1, 2019 [7 favorites]


Is there really NO medical procedure you wouldn't perform for moral reasons? Michael Jackson's 50th nose job? A patient who wants IVF though pregnancy would have a high chance of killing her? A parent requests liposuction for a chubby 5 year old? An extreme fundamentalist suffering from lust asks you to remove his eyes?

Those are case-specific situations; they're not comparable to the doctors and institutions that refuse many types of reproductive health care. An equivalent would be a doctor who refuses to perform any nose jobs because noses are assigned by deity, or who refuses to do any IVF procedures because it's unnatural, or refuses to do liposuction on any patient because "they'll never learn to stop overeating if you just take away the fat," or refuses to remove eyes despite an injury that left the patient blind and with a high risk of infection, etc.

There's a big difference between, "This procedure you want, in your circumstances, is not an ethical use of my skills" and "I would never ever perform this procedure, no matter how much it would improve (or save) someone's life."
posted by ErisLordFreedom at 7:55 PM on November 1, 2019 [11 favorites]


It's really telling to see the proportion of the discussion here that treats the underlying issue as one of discrimination, and not the failure of the healthcare system in a way that has absolutely nothing to do with that kind of discrimination
posted by patrickdbyers at 8:29 PM on November 1, 2019 [3 favorites]


If your religious beliefs conflict with your job, then you find a job that doesn't conflict with your religious beliefs. You don't demand that the job, and those your job is supposed to serve, has to accommodate you.

Suppose your minority religion requires you to pray several times a day, or wear a beard, or wear a particular piece of clothing or ornament. It's perfectly reasonable to ask for your employer to make an accomodation for you to be able to do this while on the job.

It is also reasonable for the state to require employers to do so as a matter of public policy, as religious pluralism is a public good.

Many jurisdictions have these sorts of employee rights and generally it works okay.
posted by BungaDunga at 8:33 PM on November 1, 2019 [1 favorite]


This shit is one of the reasons why I don't identify as Catholic anymore.
posted by MrGuilt at 8:33 PM on November 1, 2019 [4 favorites]


Many jurisdictions have these sorts of employee rights and generally it works okay.

The things you describe (praying, wearing a beard/piece of clothing/ornament) do not typically prevent medical staff from performing their duties as well and as completely as a non-religious person. It's hard to see refusing to provide broadly accepted forms of reproductive healthcare - especially when not doing so endangers someone's health or life - as anything but an abdication of duty.
posted by Secret Sparrow at 8:45 PM on November 1, 2019 [8 favorites]


I'm just pushing back on the idea that religious accomodations for employees aren't a thing, when they are. I'm not saying that the current situation with religious hospitals is good at all.

I'm also not sure that if you legislated Catholic hospitals into providing this sort of care they wouldn't just shut down, at least the money-losing rural ones. This would be much less of a problem if the government hadn't abdicated its responsibility to make care available and let religious institutions be the last provider standing.
posted by BungaDunga at 8:59 PM on November 1, 2019 [5 favorites]


It doesn't make much sense to force a doctor to provide a treatment they are morally opposed to, but forcing a hospital to employ a doctor who will? That sounds reasonable to me.
posted by BungaDunga at 9:02 PM on November 1, 2019 [11 favorites]


Yeah, speaking as a member of a religious minority: we don’t ever get to pull this shit, and if we try, we get fired. The people advocating for this shit don’t give a flying fuck about our rights and in fact want to impose their morality on us, often in violation of our religious freedom. And I kind of wish people would leave us the fuck out of these discussions, because they have nothing to do with us, except inasmuch as we are at risk from Christian hospitals the same as everyone else.
posted by ArbitraryAndCapricious at 9:25 PM on November 1, 2019 [44 favorites]


It's like when someone starts talking about being anti- abortion as a Judeo-Christian value when according to our theology/teachings the value of a fetus is less then it's mother, and therefore even to most of the Orthodox abortion is viewed as necessary some of the time. People like to tack the prefix Judeo to justify a lot of Christian bigotry, and then hide behind a hijab to try and justify discrimination. When most people talk about religious freedom in this country they're talking about a) Christianity only (and a certain type of Christianity most of the time) and b) the freedom to discriminate.
posted by Homo neanderthalensis at 9:44 PM on November 1, 2019 [47 favorites]


Suppose your minority religion requires you to pray several times a day, or wear a beard, or wear a particular piece of clothing or ornament. It's perfectly reasonable to ask for your employer to make an accomodation for you to be able to do this while on the job.


Getting away from discrimination a bit, like comedy, "Punching up" is good and "Punching Down" is bad. In your example, that's "Punching Up". Rights for the Underdog. That's great.

But when a Catholic hospital denies common procedures carried out in a hospital to a patient, that's "Punching Down".

The problem here is the Artificial Legal Entities running these hospitals need to choose their allegiance: The principles of the United States ( either egalitarianism or capitalism, I guess ) or the principles of Catholicism.

If a hospital has individual PHYSICIANS who refuse, then they need to hire additional physicians without that issue to make up that gap.
posted by mikelieman at 5:04 AM on November 2, 2019 [6 favorites]


My daughter needed a surgery that required traveling 550 miles to the nearest person capable of performing the procedure. Is she being discriminated against? If you say no, because everyone else with that need faces the same issue, what of the ADA? Everyone needing a ramp into a restaurant faces the same issue when there is not one. The majority in this town get their medical needs taken care of locally, why not my daughter? Why aren't girls with heart valve problems a protected group?

One reason is that the ADA specifically lays out expectations based on the resources available of granting institutions and based on the needs of disabled people. The reason that the ADA mandates wheelchair accessibility rather than heart valve surgeon accessibility is that a) there are more people who use wheelchairs than people with heart valve defects in any given place and also b) wheelchair ramps cause far less effort to maintain than heart valve surgeons.

Another reason that the comparison you're bringing up isn't valid in terms of the ADA is the "reasonable" accommodation clause. If healthcare access is a basic right for which the nation is responsible, it would be a reasonable accommodation to demand that your daughter's travel to a surgeon who can treat her be subsidized or paid for, but not a reasonable accommodation to demand that heart valve surgeons be stationed every 300 miles across the US so that no one needs to travel. This is, in fact, exactly how small nations with socialized health care handle treatments for rare conditions that require very specialized health care providers.

Now, the difference here is that reproductive health care isn't something that these hospitals claim they can't do but that they are claiming they won't do, because the thing is against their religious beliefs. Yet they are the only providers of health care in the region. Local hospitals perhaps should have an obligation to treat members of the community - - at least, this is what's implied by law that prevents emergency rooms from refusing uninsured or otherwise destitute patients - - but the argument here is that Catholic hospitals don't have an obligation to care for some medical conditions, but not all. If Catholic hospitals were required to pay for the transportation and temporary housing of the patients they refuse where there is no other option for local care, we would be having an extremely different conversation.
posted by sciatrix at 7:16 AM on November 2, 2019 [7 favorites]


this idea that procedures that result in sterilization are generally banned at Catholic hospitals is comically incorrect.

Some years back we ran into this issue directly, where a proposed medical treatment that would have caused sterility could not be done at the Catholic hospital and would have had to be done at the non-Catholic hospital across town. Luckily there was a non-Catholic hospital available so the treatment remained an option, and in the end it wasn't needed so the entire issue was moot, but it was really frustrating to have that added as one more thing to have to deal with in an already stressful situation.

So no, not comically incorrect in our specific case.
posted by Dip Flash at 7:38 AM on November 2, 2019 [12 favorites]


Local hospitals perhaps should have an obligation to treat members of the community - - at least, this is what's implied by law that prevents emergency rooms from refusing uninsured or otherwise destitute patients

EMTALA can’t overcome the First Amendment, if interpreted to protect religious health care providers’ right to refuse to perform procedures incompatible with their beliefs. Plus, EMTALA is really about patient dumping for profit-driven reasons (i.e. largely of indigent patients) under our broken system. These Catholic hospitals are declining to provide care that they would be paid for. It’s different.
posted by snuffleupagus at 7:44 AM on November 2, 2019 [2 favorites]


If Catholic hospitals were required to pay for the transportation and temporary housing of the patients they refuse where there is no other option for local care, we would be having an extremely different conversation.

This, on the other hand, does come closer to being within EMTALA (which regulates what a hospital must do to stabilize a patient before transferring them, and how they may transfer), or a hypothetical expansion of EMTALA.

The question would then be whether the cost-shift is an “undue burden” on the provider; in the simplistic sense free exercise means you should not have to pay to maintain your religious freedom.

However, if you are a hospital accepting Medicare, Medicaid and state health plan patients or are otherwise receiving public funds or are in a public-private partnership of some sort, then you get into the tug of war between free exercise and establishment, as well as the anti discrimination provisions in EMTALA and the like; and arguably some of those rights may be limited or waived without an undue burden.

From a higher altitude, this is yet another depressing entry on the list entitled Why The Composition of Supreme Court Really Matters.
posted by snuffleupagus at 8:07 AM on November 2, 2019 [2 favorites]


The question would then be whether the cost-shift is an “undue burden” on the provider; in the simplistic sense free exercise means you should not have to pay to maintain your religious freedom.

Why? The only option is forcing others to pay for your religious practices. And that's infringing upon their religious freedom. If something is religiously important to you, YOU make the sacrifices to keep up the practice, not other people. Reasonable accommodation should mean should not mean someone must sacrifice their health and well being for another's religion.
posted by Zalzidrax at 8:18 AM on November 2, 2019 [3 favorites]


Because the Bill of Rights protects against government action, that’s the test under the free exercise clause, and its counter poise with equal protection is, again, why the balance of the Supreme Court matters in terms of what legislation can accomplish.
posted by snuffleupagus at 8:24 AM on November 2, 2019 [1 favorite]


(The property tax stuff plays out along similarly frustrating lines, with drier but still deleterious impacts on the community.)
posted by snuffleupagus at 8:34 AM on November 2, 2019 [1 favorite]


Another reason that the comparison you're bringing up isn't valid in terms of the ADA is the "reasonable" accommodation clause.
Reasonable accommodation is also the standard for workplace religious freedom for members of religious minorities. My employer is required to provide reasonable accommodation for my religious practice. I can, for instance, take a vacation day to celebrate important holidays as long as it doesn't unduly harm my employer. (I think it would be more reasonable if I didn't have to use one of my vacation days, but one of the cool things about being a minority is that you never get to decide what's reasonable.) If my employer deemed that my presence was critical, they could refuse to grant me the vacation day, because it would be unreasonable to put my religious observance ahead of the critical needs of my employer. The issue here has to do with what's reasonable. Powerful religious entities claim that it is unreasonable for them to be expected to yield on any matter of religious principle, no matter what the cost to other people. That's definitely not the standard for members of less-powerful religious groups, which is why I would submit that this is entirely about power, not religious liberty. Because my religion says that abortion is mandated in certain circumstances, but if a Jewish doctor ever attempted to force a pregnant woman to have an abortion on religious grounds, he or she would be rightly condemned and hopefully prosecuted.

And to be honest, that's also why I object to this:
HOWEVER, as our members of color have pointed out to us, attacking religion and religious people is often disproportionately an attack on people of color, and often disproportionately an attack on the less-wealthy.
We are not talking about entire religious communities here. We are talking about certain powerful religious institutions that are, I would argue, implicitly white and patriarchal and wealthy, even though they are affiliated with communities that are definitely not universally that.
posted by ArbitraryAndCapricious at 9:23 AM on November 2, 2019 [14 favorites]


I don't think that comment was asking us not to criticize large religious organizations but to do so with a minimum of "your imaginary friend in the sky" comments (which would target many members of this community).
posted by hannahelastic at 9:36 AM on November 2, 2019 [5 favorites]


That's definitely not the standard for members of less-powerful religious groups, which is why I would submit that this is entirely about power, not religious liberty. Because my religion says that abortion is mandated in certain circumstances, but if a Jewish doctor ever attempted to force a pregnant woman to have an abortion on religious grounds, he or she would be rightly condemned and hopefully prosecuted.


As sympathetic as I am, that is not a valid analogy. There is an obvious distinction to be drawn between not requiring a doctor to perform certain procedures on a religious basis, and allowing a doctor to bypass informed consent and commit medical battery because of their religious beliefs.

If we’re talking purely about religiously motivated pressure disguised as medical care, well, we have those damnable pregnancy “counseling” centers that are in fact pro-life operations meant to discourage or delay receiving care, so that’s the current sad state of affairs.
posted by snuffleupagus at 9:37 AM on November 2, 2019 [2 favorites]


According to my religion, if you a pregnancy endangers the life of a pregnant woman, you deny her an abortion, and she dies, you are guilty of murder. The doctor who refuses to perform that abortion is a murderer. I understand that this distinction seems obvious to you, but to me, murder is just as bad as medical battery, so the analogy is valid.
posted by ArbitraryAndCapricious at 9:42 AM on November 2, 2019 [4 favorites]


I’m Jewish, so I reject your appeal to authority on that basis, thanks. That’s not how medical consent works, nor should it be.
posted by snuffleupagus at 9:44 AM on November 2, 2019 [3 favorites]


Powerful religious entities claim that it is unreasonable for them to be expected to yield on any matter of religious principle, no matter what the cost to other people. That's definitely not the standard for members of less-powerful religious groups, which is why I would submit that this is entirely about power, not religious liberty.

I would actually say that the problem is that the standard for individuals and religious entities is too similar, and that religious entities should be either be held to a standard equivalent to secular institutions in terms of who care may be extended to or should not be allowed to occupy essential community services and control access to those services. Because the problem here isn't that Catholic individuals are exercising legal powers that are not available to Jewish individuals, but that powerful Catholic organizations are exercising powers that are not comparable to organizations operated by any other religious entity.

We are not talking about entire religious communities here. We are talking about certain powerful religious institutions that are, I would argue, implicitly white and patriarchal and wealthy, even though they are affiliated with communities that are definitely not universally that.

It's complicated. It is. It's complicated when you rely on a church that is both totally corrupt at the highest levels and also is able to provide necessary services to your community (and others) because it is a consolidated organization that does not break apart. It's complicated when much of the power of the religious institution is drawn from the services that religious institution provides to communities that are then not paid for by the secular community, and the implicit threat of withdrawing those services if certain privileges are not extended, and when the poor and vulnerable who receive those services do not trust secular governmental budgets to actually replace them if withdrawn.

I'm culturally Catholic. I think that relying on the Catholic church for educational, social, and medical services is a really, really bad idea for anyone who can afford anything better, and I think communities should politely reject these services and pay for them themselves. But that is not, historically, what American communities have opted to do. Instead, what has often happened is that American cities have historically allowed Catholic orders to volunteer a wide variety of social services specifically to the poor and patted themselves on the back for identifying such a good cost savings measure. Some of that labor has been very progressive; some of it has not; much of it has been somewhere in between. But the price of that labor coming as a donation from the church is bourne on the backs of the poor, so the wealthy can write it off as not existing at all until it trickles down and pretend that these social services don't need to be accounted for with a line item in the city or state or federal budget. If they are withdrawn, there is no plan to replace them. With that in mind, I think it's quite reasonable for folks on the margins to resent criticism of these institutions, because while they are terribly flawed they are probably better than nothing at all.

As sympathetic as I am, that is not a valid analogy. There is an obvious distinction to be drawn between not requiring a doctor to perform certain procedures on a religious basis, and allowing a doctor to bypass informed consent and commit medical battery because of their religious beliefs.

I'm not actually sure that this is the case, personally, because the lack of care for someone who is in a state of medical crisis also bypasses informed consent, and the requirements of at least some Catholic hospitals to prevent medical providers from offering true informed consent to patients interferes with this distinction.
posted by sciatrix at 9:52 AM on November 2, 2019 [9 favorites]


Moreover, that is entirely different than proposing that the current protections for religious providers, however wrongheaded they may be, would require that doctors also be able to commit battery if consistently applied.

What a religious a provider may refuse to do is entirely a different consideration than obtaining a patient’s informed consent, except in regards to situations like those counseling centers where the issues comes up in terms of the sufficiency and bias of the information provided, and it does not pay to muddy those waters for rhetorical effect.

Edit: basically, what Sciatrix said wrt to overlaps with informed consent.
posted by snuffleupagus at 9:54 AM on November 2, 2019


Because the problem here isn't that Catholic individuals are exercising legal powers that are not available to Jewish individuals, but that powerful Catholic organizations are exercising powers that are not comparable to organizations operated by any other religious entity.

Both are problems. It is a problem that Catholic -- that most Christian -- doctors take advantage of options that are essentially unavailable to anyone of a different faith; it is also a problem that hospitals are run by a religious institution that do not allow certain procedures or medications (procedures or medications which are required in some cases for other religions). The two are tied together.
posted by jeather at 10:35 AM on November 2, 2019 [3 favorites]


I know some folks who have discussed getting medic alert type bracelets that say to not take them to a health care facility that has religious restrictions on what treatments they'll offer. I don't blame them.
posted by rmd1023 at 11:14 AM on November 2, 2019 [6 favorites]


Oh, wow, Eyebrows, that comment is problematic. You really elide distinctions between race and religion in ways that seem to be appropriating racial suffering for your own ends. I am really, really uncomfortable with that, especially coming from a mod, to the point where I'm going to take a break while I decide whether to button.

(And I understand that you're going to do that thing that you do where you act like you're the voice of authority, but the history of American Catholicism is something that I studied pretty extensively in grad school, and you're full of shit here. Coercive sterilization was not directed specifically at white Catholic women in mid-20th century America, and it was directed at non-Catholic women of color. You're going to have to provide some pretty strong evidence to convince me that religion, rather than race, was the thing motivating that policy.)
posted by ArbitraryAndCapricious at 12:21 PM on November 2, 2019 [18 favorites]


The coercive sterilization that was targeted to “White women” was targeted against Italians, Irish and Jewish women, precisely because they were at the time, not considered white. (And in the case of some Jews, Mizrahi and Sephardic, would not even be considered white today) Now some of those Italians and Irish were no doubt Catholic- you might notice the third group however.
posted by Homo neanderthalensis at 1:15 PM on November 2, 2019 [11 favorites]


Oh, wow, Eyebrows, that comment is problematic. You really elide distinctions between race and religion in ways that seem to be appropriating racial suffering for your own ends. I am really, really uncomfortable with that, especially coming from a mod, to the point where I'm going to take a break while I decide whether to button.

SECONDED
posted by primalux at 2:18 PM on November 2, 2019 [1 favorite]


[Several comments deleted. Eyebrows McGee had a long comment that was badly phrased; to be clearer, she agrees that racism is the central motivator of forced sterilization. That should never be in question. She apologizes and will refrain from commenting in this thread anymore, except as part of mod duties.]
posted by LobsterMitten (staff) at 3:21 PM on November 2, 2019 [1 favorite]


[And further update, I briefly deleted and then un-deleted some replies to the deleted comment. Members have asked that we leave replies to deleted comments in more cases, and we agreed to do that. I apologize if my handling of this has been confusing.]
posted by LobsterMitten (staff) at 3:44 PM on November 2, 2019 [8 favorites]


BungeDunge: "Suppose your minority religion requires you to pray several times a day, or wear a beard, or wear a particular piece of clothing or ornament. It's perfectly reasonable to ask for your employer to make an accomodation for you to be able to do this while on the job."

That's not at all the same thing. None of those things interfere with performing the job. If you can do what the job fully requires of you with a small accommodation by your employer, then, yes, in the interests of religious pluralism, I agree the employer should in most of those cases accommodate it. But you don't get to say "I'm going to be a pharmacist, but, no, I won't fill that prescription," or "I'll be a surgeon, but, no, I won't perform that surgery." You don't get to half-ass the job. IMO at least.
posted by WCityMike at 4:57 PM on November 2, 2019 [4 favorites]


What I find interesting about this is that the Catholic church would effectively call an embryo a disease and second the philosophical/theological gymnastics involved in saying this is anything other than an (ultra-invasive, needlessly-invasive, life-altering) abortion.

The reasoning behind this is pretty simplistic, as I understand it. If you remove the fallopian tube, you're targeting the tube, not the embryo. Similar to how it's OK to use the rhythm method but not condoms. With a condom you're directly blocking the sperm, but with the rhythm method you're just taking advantage of a natural cycle. Where this gets tricky for healthcare, obviously, is that you could spin of any number of different rules to decide where to draw lines, and none of them seems any more reasonable than the other. My sense is that these rules were not created to be reasonable, or reflect any actual material or ethical principals, but rather to just be A RULE. Obviously, this is problematic when you're making health care decisions based on arbitrary bright-line rules ...
posted by schwinggg! at 6:06 PM on November 2, 2019 [1 favorite]


We are talking about certain powerful religious institutions that are, I would argue, implicitly white and patriarchal and wealthy, even though they are affiliated with communities that are definitely not universally that.

I think that any time you're deciding the 'implicit race' of a global institution, it's important to examine why you're thinking about it this way and whether 'white as default' thinking is influencing it. The Catholic church is a large and powerful and certainly patriarchal institution which is not without its problems, but the majority of global Catholics and the majority of cardinals, the 'leadership' of the church, are nonwhite. The largest growing segments of Catholicism are nonwhite. It's okay to not love religious institutions or the effects on people of those institutions, but when you talk about them as 'implicitly' white, it feels like you're lifting up and focusing on the white members as the more 'important' members of the community, rather than the communities which you know are not largely white.
posted by corb at 8:28 AM on November 3, 2019 [2 favorites]


I think that any time you're deciding the 'implicit race' of a global institution, it's important to examine why you're thinking about it this way and whether 'white as default' thinking is influencing it.
I honestly don't think so. This is not an abstract issue for me. 40% of the hospital beds in my state are at Catholic hospitals. The closest hospital to me is a Catholic hospital. I can look up who runs it, and the leadership is all white. (I actually find this a little shocking, because my city is pretty white, but that doesn't reflect our population, and it certainly doesn't reflect the local Catholic population.) It's run, at least nominally, by an order that originated in Ireland and that had a policy against admitting black nuns in the US until the 1950s. When i said "powerful religious institutions," I was talking about religious hospitals, as was the article, and the ones local to me are white institutions in fairly concrete ways. I wouldn't necessarily say that about the Catholic church as a whole.
posted by ArbitraryAndCapricious at 11:56 AM on November 3, 2019 [3 favorites]


the majority of cardinals, the 'leadership' of the church, are nonwhite

This is pretty mind-blowing - would you mind sharing a source?
posted by naoko at 1:29 PM on November 3, 2019 [3 favorites]


Looking at this Wikipedia list, it seems unlikely to be true, given that 47% of the cardinals are European and another 7% are from the US (and presumably mostly white).
posted by hydropsyche at 2:44 PM on November 3, 2019 [1 favorite]


Looking at this Wikipedia list, it seems unlikely to be true, given that 47% of the cardinals are European and another 7% are from the US (and presumably mostly white).

I think that this depends on where you class people of Latin discent. Literally Latin in many cases as a quick eyeballing showed about 40 Cardinals (out of 224) to be from Italy for obvious historical and geographic reasons.

If your definition of white is descended from Europeans the Catholic Church is centered in Italy, and the current Pope (and for that matter most Argentinian, Brazillian, Chilean, and Mexican Cardinals) appear to be of European descent - and for that matter all 14 of th living Cardinals from the US appear to be of European descent. If on the other hand by white you mean WASP then there aren't a lot of WASPs among the Cardinals.

When you're claiming a rich and powerful organisation that's based in Europe to have a non-white leadership it's important to examine why you're thinking about it this way and whether 'white as default' thinking and thus oveweighting the non-white leaders is influencing it.
posted by Francis at 2:52 AM on November 4, 2019 [1 favorite]


Interesting. In the US, people from Italy are (modernly) considered white. Latinx is generally reserved for people from the Americas--many Latinx people from the Americas identify as white, and many do not.

(I can't tell if you were being funny or not, but "WASP" means white, Anglo-Saxon Protestant, so no, no Catholic WASPs.)
posted by hydropsyche at 3:20 PM on November 4, 2019 [5 favorites]


If your definition of white is descended from Europeans the Catholic Church is centered in Italy, and the current Pope (and for that matter most Argentinian, Brazillian, Chilean, and Mexican Cardinals) appear to be of European descent

I think it isn't super helpful for us to be arguing about this as Arbitrary and Capricious was actually talking about the leadership of the specific hospitals (which does clear that concern up for me, and I can definitely see that, thank you).

I was speaking from my own count, and believe a slim majority are nonwhite, in part because Pope Francis has named a significant number of cardinals in recent years so that they are more reflective of the global Catholic population. However, on a side note just for how we're talking here, as a Latinx person myself, I will say that I honestly bristle somewhat and don't feel great about the statement that "the Argentinians/Brazilians/Chileans/Mexicans appear to be of European descent".

Firstly, because Latinx people often do possess some degree of European descent, that doesn't necessarily make them white (and Latinx people disagree, just FYI, on whether Latinx people can even be white or not)- and secondly, because I really don't love white people looking at photographs of Latinx people, or any other group of people of color, and deciding whether or not they think they have enough European descent to be white.
posted by corb at 12:36 PM on November 5, 2019 [1 favorite]


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