Monday, September 23, 2019

Gender discrimination claims in a Catholic hospital

On September 19, 2019 a California Appeal Court ruled that a transgender patient seeking a hysterectomy as treatment for their gender dysphoria, at a Catholic hospital, was allowed to sue for refusal of the operation.  In 2016, Evan Minton, informing the hospital of their transgender status, intended on using this surgery to further the transition from female to male.  The hospital refused to proceed with this operation on the grounds that the procedure was only to be used in cases such as uterus cancer, or other such circumstances that would cause such debilitation.  The hospital referred to the United States Conference of Catholic Bishops’ writings on ethical medical practices to make this decision.  The California court stated that these writings indicated that Catholic institutions, such as the Mercy San Juan Medical Center (the hospital in question), should “prohibit direct sterilization and require that bodily and functional integrity be protected and preserved.”  This is why as a Catholic Institution, the hospital holds that there is no necessary medical treatment here, as the patient is just looking to change their bodily appearance.  The hospital, a part of a larger network of medical services, instructed Minton’s physician to use another institution within that network that would have no issue with the reasoning for the hysterectomy.  The same operation was provided to Minton three days after the intended date, with the help of Mercy San Juan Medical Center’s referral and advice.  Still Minton sued Mercy for discriminating health care provision, as well as for causing “great anxiety and grief” as a result of the initial cancellation.  The case was initially dismissed, but is now being pushed up to the Superior Court of San Francisco for further consideration.


This situation presents a two-fold problem.  The first, regarding the free exercise of religion, is that by the states allowance of this patient to sue over their claims of discrimination, they then are imposing on the institutions free practice of religious belief.  This would seem to go against the First Amendment, as the hospital is being prohibited of free exercise.  The hospital is a Catholic Institution, and as such, especially in this case, should not be penalized for practicing their beliefs.  The hospital is not basing their refusal of the operation off of the identity of Minton as a transgender, rather they are looking at the actual  surgery that they would have to perform on an individual.  There is no discrimination here, which is the grounds for this case, and there is an imposition of state power on a religious organization by allowing the patient to sue for such.  The second problem is the issue of provision of health care.  The court ruled that the hospital should only be allowed to practice its religious freedom should it be able to “provide all persons with full and equal medical care at comparable facilities not subject to the same religious restrictions.”  To require this of medical institutions is a difficult argument.  Not all institutions may have the ability to do this.  Additionally for other matters, such as abortion for instance, should there be an emergency situation brought to a Catholic institution that requires immediate care, there would be a dire situation for all parties involved.  While health care is not a civil right, there are serious implications in such situations.

I believe that the Court that approved this appeal is wrong in its ruling on this situation.  They are enacting an unconstitutional intervention in religious beliefs by allowing for such a dispute to be heard.  The patient was in no immediate danger, and Mercy referred the operation to another institution within their network in just three days.  To think that a Catholic institution should be required to provide an unnecessary surgery that is against their beliefs is a clear infringement of free exercise of religion.  Minton seems disillusioned in thinking that their own beliefs should be taken care of by any organization, and is attacking the institution that disagreed with their views.  Minton, and apparently this California Appeal Court, do not realize that there is a difference between adhering to others beliefs and tolerating them.  To argue that the institution is discriminating based on identity is not realistic in my opinion  This is not in any way an institution discriminating by someone’s identity, rather they are looking at a medical procedure with regard to their own values.  While I do think that Minton’s allegations will be dismissed, it does point towards a larger picture for the problems that come with these such scenarios.  Going back to the example of abortion, or considering the actual medical use of a hysterectomy, these things can provide life or death situations.  One example that is relevant in the news is the Ascension health network.  This is a Catholic hospital organization that is pushing for the ability to withhold care even from pressing matters because of their religious affiliations.  I just see these things as being a tricky intersection.  Someone who is in a life or death situation should be provided care, but this brings problems with ethics in religious groups.  While I know nothing about healthcare really, I do not think that these such issues will see easy resolve.  As far as this particular case I do think that the court is breaching the Institutions right to free exercise, and the approval of the appeal was unconstitutional.
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5 comments:

  1. I agree with Brendan in this case. The hospital should not be required to perform this procedure and should not be sued (particularly if the treatment is not medically necessary). I see this case as like many of the Wedding Cake vendor cases previously discussed. If the doctors and Catholic Institution see this surgery as promoting sinful behavior, requiring the doctor complete this procedure would be requiring him by law to sin. The same as requiring bakers to support a gay marriage. If this treatment were medically required, the argument would be entirely different.

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  2. There's several different pieces that go along with this case that make it tricky. The court must determine whether the hospital is making their decision strictly based on their religious views, or if they have secular purposes as well. It seems as though they evaluated the procedure and determined it medically unnecessary, and also referred the patient to another location that would do the procedure. This is a tough case because it makes me think of the difference between belief and action. One could argue the hospital is entitled to their own belief, but when it comes to acting upon that belief, that could be dangerous if it harms other people whether physical or emotional. Although, I do not believe it is the hospital's job to make people emotionally happy, their job is to care for health and they are doing that here.

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  3. I agree with Brendan that the appeal should have not been approved and the Hospital was not acting unconstitutionally. It is important to look at the facts of the case in order to come to this conclusion. The hospital was within its rights to excessive their freedom of religion because they offered an alternative to treatment and the alternative was arranged in a timely manner. Also as Brendan mentioned the hospital was not discriminating based of his identity but making a decision on the necessity of the medical procedure.

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  4. I think the two most important parts of this case is that there is no medical emergency involved and that the hospital's policy is not solely discriminating against transgenders. I think that the hospital has every right to refuse a procedure as long as it is not blatantly discriminatory of a group or groups of people and that there is no medical emergency that would lead to significant harm or death in the short term. The article specifically says that the ruling was made "even though its (the hospital's) policy broadly bans sterilization surgery generally (not just for trans individuals) and even though the hospital referred the patient to a non-Catholic facility in the same network." This neutrality is extremely important and in my opinion gives the hospital the right to refuse the hysterectomy.

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  5. I totally agree with WIll's comparison to the bakers in some of the wedding cake cases. Compelling the bakers to make wedding cakes for same-sex couples is the same compulsion as doctors performing a gender reassignment surgery. This is directly infringing on the bakers/doctors right to free exercise. To Jacob's point, there was also an alternative provided within the patient's network, so it's not like he couldn't have the surgery if he really wanted to. Minton's claim that the hospital caused him "great anxiety and grief" is not justification to infringe on Constitutional rights.

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