California Attorney General Prioritizes Patient Care Over Religious Refusal Directives

California’s attorney general has denied a proposed merger of two religious hospital chains in Northern California, citing the merger’s potential problems of increased health costs, limited access, and decreased availability of healthcare services.

The merger, if approved, would have combined four Catholic hospitals with five hospitals governed by the Seventh-day Adventist Church.  Both religious organizations impose restrictions on healthcare services, specifically in the areas of reproductive and transgender healthcare.

The Los Angeles Times highlighted an important element of attorney general Xavier Becerra’s  rejection of the merger:

“Although Becerra didn’t refer explicitly to the religious limits on the hospitals’ services in his announcement…those limits were among the concerns cited by consumer groups that filed objections to the deal, such as Health Access California and the ACLU of Northern California. No hospitals were to be shuttered after the merger, suggesting that Becerra’s reference to ‘access and availability’ of healthcare turned on religious strictures.”

Phyllida Burlingame, Director of Reproductive Justice and Gender Equity at the ACLU of Northern California, applauded the Becerra’s decision.  Burlingame emphasized that the consolidation of religious hospitals in California threatens the health of patients, particularly LGBTQ people and women, because medical treatment can be refused on the basis of religious principles.

In 2013, while serving as a congressperson, Becerra cited his Latino and Catholic heritages to explain why he supported marriage equality.

The Ethical and Religious Directives for Catholic Health Care Services, prescriptions written by the U.S. Conference of Catholic Bishops, determine the medical services that conform to Catholic doctrine. Since procedures such as tubal ligations, contraception, gender transition care, physician assisted suicide, and in-vitro fertilization (IVF) contravene these guidelines, they can be denied,  reported Modern Health Care.

The latest edition of this document, published in 2018, also advises against Catholic facilities or “its employees to even ‘assist’ or ‘make referrals’ for ‘immoral procedures’ such as abortions.”

Unfortunately, these prescriptions are not just theoretical; they have real life medical and psychological consequences.  Modern Healthcare documented an egregious incident involving the refusal of gender reassignment surgery for a transgender man immediately prior to the procedure:

“A transgender patient has a lawsuit pending against St. Joseph, claiming he was discharged from the St. Joseph Hospital in Eureka minutes before a scheduled hysterectomy in 2017, after hospital officials learned he was transgender.

“In its response to the suit, St. Joseph said it has a constitutional right to refuse to perform procedures barred by Catholic religious doctrine.”

Moreover, other Catholic hospitals have been clear about which procedures they refuse to perform.  Dignity Health, associated with Catholic Health Initiatives under the hospital conglomerate CommonSpirit Heath, told the Los Angeles Times in September 2019 that its hospitals “do not perform sterilization procedures such as hysterectomies for any patient regardless of their gender identity, unless there is a serious threat to the life or health of the patient.”

The growing wave of refusing to perform medical care on religious grounds is dramatically changing the landscape of healthcare access and availability to those who need it, particularly those in rural areas in California, where the concentration of Catholic hospitals and medical facilities is higher than in urban areas.

These restrictions, combined with a  presidential administration that is actively trying to carve out religous exemptions to anti-discrimination provisions for faith-based organizations, are particularly troubling for LGBTQ patients and women.

The California Attorney General took a firm stance in furtherance of protecting patients against medical discrimination on the basis of religion.  It is deeply disappointing, however, that the U.S. Conference of Catholic Bishops  continue to make policy that reveals a severe misunderstanding of gender identity, to say nothing of LGBTQ persons living with HIV/AIDS, or those seeking contraceptive care .

It is well documented that transgender persons, specifically transgender youth of color, face disproportionate amounts of discrimination, harassment, and prejudice in society.   The Ethical and Religious Directives for Catholic Health Care Services seems unaware of what it means to be a transgender person, created in the loving image of God,  and relatededly, the condition of gender dysphoria.

Gender dysphoria, the feeling of discomfort or distress that a person may associate with living as the gender that the person was assigned at birth, can lead to an array of psychological issuess, including suicide, if left untreated.  Transgender patients, like all of God’s creation, deserve to be treated with compassion and dignity, rather than worrying if a medical provider or institution will withhold medically necessary care.

–Brian William Kaufman, November 11, 2019