Minton vs. Dignity Health

In August of 2016, Evan Minton was denied healthcare by Mercy San Juan Medical Center because he was transgender. Mercy San Juan Medical Center, located in Sacramento, California, is a branch of the Dignity Health Chain. Two day before his scheduled hysterectomy, Minton received a call from a nurse who appeared to be concerned about his transgender idenity. The following day, Dignity Health canceled the procedure and claimed that the hysterectomy was “part of a course of treatment for gender dysphoria, as opposed to any other medical diagnosis.” Minton was successfully able to schedule his hysterectomy three days later at Methodist Hospital, a non-Catholic Dignity hospital about 30 minutes away. Despite receiving treatment elsewhere, Minton filed a lawsuit against Dignity Health medical center for withholding medical care on the basis of gender identity. Although this incident occurred in 2016, this has been an ongoing battle which has steadily moved up the court ranks. As we have seen in various other cases, there is a great deal of controversy regarding reproductive health and free exercise of religion.

In the present case, we must assess the claim of discrimination against the claim of religious freedom. Is it constitutional under the First Amendment to allow Dignity Health to deny medical procedures that go against their religious convictions?  

On one side of this debate, there is a claim of discrimination against the LGBTQ community. In one statement, Minton says, “Trans people exist. And we have medical needs just like all other people.” Minton sued under the Unruh Civil Rights Act (Civil Code 51), which guarantees “full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind.” Minton and his lawyers argue that he was selectively discriminated against because a hysterectomy is a normal procedure offered at Dignity Health. The selective discrimination that we see in this case is greenlighted under particular policies that the Trump administration attempted to pass. For example, the Refusal of Care Rule was brought up in the 2017 and 2019 sessions of Congress issued by the Department of Health and Human Services (HHS). This rule gave religiously affiliated health care institutions more power to deny abortion and sterilization care. Many argue that this rule is a tool used by doctors to impose their own beliefs and discriminate against patients (specifially women and LGBTQ members). Despite these arguments, this rule was intended to protect religious liberties. It appears that the Refusal of Care Rule tiptoes the line between protecting and abusing religious liberty. There are multiple perceived problems with the Refusal of Care Rule. First, it violates the provisions of the Health Care Rights Act which was established in March of 2010. This act attempts to alleviate discrimination based on race, ethnicity, sex, age, and disability. Although this rule was struck down, Minton and other members of his defense believe this is a clear illustration of the ways in which the government mediates discrimination under the disguise of religion. It is also important to note that Dignity Health claimed to have facial neutrality in their “Ethical and Religious Directives for Catholic Health Care Services,” however, we have learned in class that facial neutrality does not always eliminate discriminatory actions. In this case, we see disparate impact on LGBTQ members such as Evan Minton.

 

On the other side of the debate, we can view Dignity Health as practicing their constitutional right to freedom of religion. As a Catholic hospital, Dignity Health claimed to be bound to follow its facially neutral “Ethical and Religious Directives for Catholic Health Care Services.” This was issued by the U.S. Conference of Catholic Bishops (USCCB), which prohibits direct sterilization or alteration of bodily and functional integrity. Dignity Health is sworn by religious convictions. Another partner of Mercy Health, also sworn by the USCCB, faced a lawsuit in 2015 dealing with similar questions of religion. In Means V. United States Conference of Catholic Bishops, Tamesha Means was refused appropriate medical treatment (induction of labor) based on Catholic ethical guidelines resulting in the stillbirth of her fetus. The American Civil Liberties Union and the ACLU of Michigan filed on behalf of Means claiming that the directives written by the USCCB prohibited standards of care. This case was dismissed in the 6th circuit court in 2016 due to failure to state a claim of ordinary negligence, but it gives us some insight into understanding the present case. Another point to highlight is that Minton was successfully able to receive this procedure at a non-Catholic hospital. Due to the availability of other medical centers, some would consider it an unconstitutional act to force Dignity Health to conduct procedures that violate their ethical and religious directives.

This case is clearly related to the 'free establishment clause' as we see Dignity Health practicing this right. The controversy come to light when practicing free religion interferes with other people, especially other peoples access to medical care. This is a tough case considering we have not discussed the relationship between religion and reproductive health in class. We are facing two large moral issues: denying someone health services and forcing someone to break sacred bonds. Despite my struggles to make a decision, I would argue that Dignity Health should not be allowed to deny medical services based on religious sacrament. The facts from this case make it clear that Dignity Health has offered hysterectomies for women in the past, making their actions toward Minton overtly discriminatory. In addition, allowing Dignity Health to deny services is not neural toward the health and safety of everyone (specifically women and the LGBTQ community). This poses risk to public peace, good order, and safety. This issue is extremely important because allowing medical communities to practice their religious freedom can open the door to forms of discrimination. To a greater extreme, practicing religious freedom in the medical community may also lead to detrimental harm to humans, as briefly mentioned in the case of Means V. USCCB. As we learned from West Virginia Board of Education V. Barnette (1943) and other instances, we have an immunity for offending others when practicing our religion. But when do we draw the line? When is offending someone taken to the extreme of emotional or physical harm? 

I leave this blog post with the all-encompassing question of whether Dignity Health should be forced to violate its long standing, deep religious convictions?