On August 30th, 2016, Evan Minton’s physician, Dr. Lindsey Dawson, scheduled a hysterectomy for Minton at Mercy San Juan Medical Center (Mercy) in Sacramento County, California. Minton is a transgender man diagnosed with gender dysphoria which is constituted as a serious medical condition codified in the Diagnostic and Statistical Manual of Mental Disorders. Transgender men often decide to undergo hysterectomy as a gender-affirming surgical treatment for gender dysphoria and according to the majority of medical experts, treatments for gender dysphoria include surgical procedures such as a hysterectomy.
Dr. Dawson schedule the hysterectomy as a course of treatment for Minton’s diagnosis, along with the professional opinion of two mental health professionals who counseled Mr. Minton and found it “medically necessary care to treat his diagnosis.” On August 28th, 2016, Minton mentioned to a nurse at Mercy that he is transgender. The next day, Mercy notified Minton that the procedure was cancelled.
Mercy’s president, Brian Ivie, informed Dr. Dawson that she would never be allowed to perform a hysterectomy on Minton at Mercy because it was scheduled as part of a course of treatment for gender dysphoria. Ivie suggested, only after Minton and Dr. Dawson exerted pressure on Dignity Health through the media and political connections, that Dr. Dawson could get emergency admitting privileges at Methodist Hospital, a non-Catholic Dignity Health hospital about 30 minutes from Mercy. Dr. Dawson was able to attain emergency surgical privileges and performed the hysterectomy at Methodist Hospital on Friday, September 2.
Minton stated, “I had no idea prior to this that my local, community hospital was a Catholic hospital, or that they would argue that religious doctrine permits them to prevent doctors from providing patients with the care they need just because those patients are transgender.” Minton filed against Mercy, a Dignity Health medical center, for withholding medical care because of a patient’s gender identity, amounting to sex discrimination in violation of California’s Unruh Civil Rights Act (Unruh Act).
The lawsuit presents a conflict between Minton’s right to full and equal access to medical care and the hospital’s right to observe its religious principles. Dignity Health argued that as a Catholic hospital, Mercy is bound to follow its facially neutral “Ethical and Religious Directives for Catholic Health Care Services” (the Directives) issued by the United States Conference of Catholic Bishops. Milton argued that gender dysphoria is “a medical condition unique to individuals whose gender identify does not conform to the sex they were assigned at birth and thus usually experienced by transgender people.” Mr. Minton also argued that to receive a hysterectomy at one of its hospitals other than the hospital where he desired to receive that procedure violated Dignity Health’s obligation “per Civil Code 51(b) to provide full and equal access to medical procedures without regard to gender.”
The precedent of North Coast Women’s Care Medical Group v. Superior Court supports Mr. Minton’s arguments of being provided full and equal access to medical procedures. The case ruled that physicians must offer IUI infertility services to gays and lesbians despite religious objections or find a colleague in their office who will do so. The court held that the California Constitution’s guarantee of free exercise of religion does not exempt physicians from conforming their conduct to the Unruh Act's anti-discrimination requirements even if compliance substantially burdens their religious beliefs.
In my opinion, Mr. Minton’s cause of action for violation of his civil rights bar Dignity Health’s federal and state constitutional rights of free exercise of religion and freedom of expression in this specific case. To begin, Minton was diagnosed with gender dysphoria by medical and mental health professionals which found it necessary for the hysterectomy to be done. Aside from Minton being a transgender man, this surgical procedure was necessary to treat his diagnosis. It is a medical condition unique to and usually experienced by transgender folks. Therefore, Dignity Health’s obligation “per Civil Code 51(b) to provide full and equal access to medical procedures without regard to gender” outweighs their requirement to follow the “facially neutral Ethical and Religious directives.”. Additionally, I believe that Dignity Health violated their obligation to the Civil Code because Mr. Minton was denied service at his closest and local hospital, in which he preferred and should be granted regardless of religious obligations by the hospital because of the medical necessity for the procedure because of his diagnosis, aside from being a transgender man. Mercy’s President Ivie did not suggest the alternative until after pressure was put on them. Also, I want to note that Dr. Dawson was personally okay with executing the medical procedure on Minton. Her personal religious beliefs were not a barrier in this case, which I think is a vital point to make. Thus, I side with Minton and believe that the hospital should have put aside their religious beliefs to assist in a necessary medical treatment.
From a legal standpoint, this case may seem open and shut, but I would challenge, on definitional grounds, what exactly constitutes a necessary surgery. I don't think this question is as clear as everyone would like to make it seem. Independent of personal opinion or a general citation to a vaguely relevant authority, what state or condition would someone have to be in, in order for them to receive "emergency surgical privileges?" Privileges, presumably that would place your appointment ahead of those suffering from deadly illnesses or injuries. I am no medical expert, but I would venture to say that a hysterectomy is largely, if not entirely a surgical procedure of an aesthetic nature. Assuming this is the case, I would think it profoundly inappropriate to suggest that a cosmetic surgery should be considered essential to someones wellbeing. There are obvious exceptions to this, like burn victims or people who have mangled body parts, possibly due to a car accident, or any other such serious issue. You may choose to challenge what exactly I mean by serious, and to this I would suggest that the answer is intuitive, but will concede that whether by sincerity, or whatever other motivating factor, there is a reason this case has made its way to the courts. Certainly, when I say essential, I mean to talk about things dealing with problems that require immediate attention and have primarily to do with deadly injury. While it wasn't completely clear, perhaps because I overlooked it, what the exact grounds were for Minton's dismissal from the Catholic Hospital, I assume it was due to an implicit or explicit violation of law, doctrine or other such rule of faith. I would say to the notion that someone should set aside their worldview and all the materials, morals and laws that they hold to make sense of reality, is unfair or rather, unrealistic.
ReplyDeleteI tend to agree with Dominic's sentiments about this case. I would not consider gender-affirming surgery as imminently necessary as something like an emergency appendectomy. It may still be dangerous given the high comorbidity rate of gender dysphoria and suicide, but is it clear cut that transition surgery reduces that suicide rate in a statistically significant manner? I personally have not seen the data. However, my initial inclination is that the Supreme Court should overturn North Coast v. Superior Court and rule Civil Code 51(b) as unconstitutional on free exercise grounds.
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