Can a Catholic Hospital Refuse a Gender-Transition Surgery?

As the new year began, LGBT groups denounced a decision by a federal judge in Texas that blocked, nationwide, federal regulations issued under the Affordable Care Act that barred discrimination against transgendered patients.

As the Washington Times reported, “U.S. District Judge Reed O’Connor is the same judge who, four months earlier, blocked President Obama’s order compelling public schools nationwide to permit bathroom and locker room access on the basis of gender identity.”

The lawsuit against the transgender anti-discrimination rule was brought by the Becket Fund for Religious Liberty, representing the Franciscan Alliance.

“Judge O’Connor’s decision to prevent the Department of Health and Human Services from implementing crucial protections for transgender people seeking healthcare services puts thousands of people at risk of marginalization, harassment, and discrimination at a time they are most vulnerable and in need of inclusive, respectful care,” Sarah Warbelow, legal director for the Human Rights Campaign, said in a statement.

Writing in the blog Health Affairs, Timothy Jost, a professor at the Washington and Lee University School of Law in Lexington, Va., said, “Nothing in the [Affordable Care Act’s] section 1557 rule specifically requires practitioners or health care facilities to provide gender transition services. … The rule does not impose on health care professionals an obligation to provide gender transition services…. It is troubling that this litigation has been promoted based on false statements about the requirements of section 1557, which Judge O’Connor has to a certain extent uncritically accepted.”

But just a few days later, the Washington Post reported that Jionni Conforti, a 33-year-old transgender man, is suing a Catholic hospital for not accommodating his transition-related hysterectomy. The suit referenced both the (now blocked) Affordable Care Act rule and New Jersey’s anti-discrimination statute.

Lambda Legal, which is representing Conforti, said the hospital was not entitled to “decide who their patients are.”

But suing a Catholic hospital for not accommodating a gender-realignment surgery raises many issues about the failure to recognize the difference between a private/religious and public/government facility. If a Catholic hospital has no right not to host a gender transition-related surgery, can a patient demand it also allow elective abortions to be performed?

34 Comments for “Can a Catholic Hospital Refuse a Gender-Transition Surgery?”

  1. posted by Houndentenor on

    The problem, of course, is that in large parts of the country, including parts of the midwest and the pacific northwest, you may have to go hundreds of miles to get to a hospital not affiliated with the Catholic Church. There aren’t any choices, especially not in an emergency situation. So we are heading towards a real problem in which a church can decide what medical procedures may or may not be performed within a reasonable distance from where you live.

    Reply
    • posted by TJ on

      Case in point is Minnesota;

      Now Mayo Clinic is a very well respected (globally) medical center and they probably (under certain medical guidelines) would do the procedure. However, that does not necessarily help you if you are transgender (seeking the transition surgery) and don’t live in the same city as the hospital.

      Quite a few of the hospitals (even mental health facilities) in Minnesota/North Dakota are run by/affiliated with the Catholic Church on some level. This is not — often a problem — but if you are LGBT then it can be a problem when seeking mental health care services or say, AIDS/HIV education, or visiting your same-sex partner in the hospital, etc.

      See The Ethical and Religious Directives For Catholic Health Care Services (2009) (which you can find online as a PDF file)

      Reply
    • posted by Tom Scharbach on

      A fair example is the rural area that I lived in until last year.

      The area where I lived was served by three Catholic hospitals. The nearest non-Catholic hospital was 38 miles away from my home. The closest urban area with hospital choice (the area where I now live) was 67 miles away. The Catholic hospital in R (population 9,000, 15 miles away) was a hospice and urgent care facility. The Catholic hospital in B (population 12,000, 18 miles away) was a standard, if small, hospital, as was the Catholic hospital P (population 10,000, 22 miles away). Almost all doctors in the area were affiliated with the Catholic hospitals, and practiced out of clinics owned and operated by the Catholic health care systems (SSM and SDS) owning and operating the Catholic hospitals. Between R, B & P, and the surrounding rural areas and small towns, the three hospitals and affiliated clinics provided the only convenient medical care for a combined population of about 40,000 people.

      All of the three hospitals and all of the affiliated clinics complied with the USCCB directives, spurred on by our diocese’s extremely conservative bishop, whether through coercion (which I suspect, based on comments from my former doctor and a friend who was the head of nursing at one of the hospitals) or Christlike persuasion, I do not know.

      But the end result was simple. The only source of medical advice about artificial contraception in the area was a small, storefront Planned Parenthood facility in P, a facility that offered birth control information and services, STD testing, prevention counseling and treatment, and emergency contraception (think morning-after pills). Think about that — one small, storefront facility offering medical advice about contraception serving about 40,000 people.

      I didn’t realize how pervasive the Catholic ban on medical advice about contraception was until I moved, walked into the clinic where my new doctor (affiliated with UW Health Care) practiced. Information about contraception, STD prevention and family planning was right out in the open in relevant (e.g. family medicane, internal medicine) patient waiting areas. I realized that I never saw anything along those lines displayed in any of the Catholic health care facilities I visited during the previous decade, when my medical care was provided by SSM.

      It was an eye-opener, a bit like visiting family in Chicago after a decade in rural Wisconsin and realizing that everyone isn’t white or Native American.

      You should realize that patients in the rural area I’m describing are much better off than patients in many rural areas. In northern Wisconsin distances to get to non-Catholic health care are often double the distances in the area where I used to live. It is even worse in more sparsely populated areas of the country, as I understand it.

      Now, obviously, having no hospital at all is worse than a Catholic hospital. But it does seem to me that if a Catholic hospital is subsidized by the government to provide health care, then the hospital can be required to provide health care in accordance with standard medical practices.

      Reply
    • posted by TJ on

      1. No “extra” rights for gay people, says top man in Trump administration. Cant wait for the spin on that.

      2. Comparing abortion to a sex change operation is dishonest.

      Reply
  2. posted by Jorge on

    If a Catholic hospital has no right not to host a gender transition-related surgery, can a patient demand it also allow elective abortions to be performed?

    Of course. Isn’t that why they pass the Hide Amendment every year? :-J

    Thanks to upstanding laws passed in the South, where the word “faggot” rings in the air as a mating call between straight men, women in over 85% of US counties lack access to an abortion provider in their home county. The Supreme Court has held such schemes to be constitutional under the time honored principle that wealthy people have more civil rights than poor women. But since transgender people weren’t part of the original discriminatory intent of the Constitution, they have more rights. That’s something even I, in the comfort of my blue state heaven, know.

    It’s time to pass the Hate Amendment to ENDAACA to protect the alternate rights.

    Reply
    • posted by Doug on

      The Hyde Amendment only forbids certain government funding of abortion.

      Reply
  3. posted by Kosh III on

    The Hyde Amendement; named for an adulterer who spawned a bastard child.

    Reply
    • posted by Tom Scharbach on

      Reminds me of a joke that circulated amongst my Catholic friends: As a Papal Knight of the Order of St Gregory, Hyde is permitted to bring his horse into church for Mass. I wonder if he’ll bring the front half of the horse.”

      Reply
  4. posted by Tom Scharbach on

    But suing a Catholic hospital for not accommodating a gender-realignment surgery raises many issues about the failure to recognize the difference between a private/religious and public/government facility.

    Only 25% of hospitals in the United States are public, a percentage that includes VA facilities, which are publicly funded by limited to veteran care. The other 75% are private/religious profit or non-profit. In many areas, it it not uncommon for all hospitals within a 50-mile radius are private/religious hospitals. In rural areas (think upper Midwest, for example), it is not uncommon for all hospitals within a 100-mile radius to be private/religious hospitals.

    Although in conservative/libertarian thinking all private/religious hospitals should be allowed to refuse medical services and patients at will, all but a few very specialized private/religious hospitals provide a full range of medical services, and denial of service issues arise primarily with Catholic hospitals that comply with the USCCB “Ethical and Religious Directives for Catholic Health Care Services” on medical care.

    The number of Catholic hospitals complying with the directives is relatively small, accounting for roughly 16% of hospitals nationwide. However, because Catholic hospitals historically have disproportionally served areas with a significant Catholic population, denial of services is not evenly distributed across the country. Catholic hospitals are few and far between in the 16 states with small Catholic populations, but Catholic hospitals account for 40% or more of all hospital beds in roughly the same number of states, mostly in the midwest.

    And because Catholic hospitals have historically served rural areas disproportionally, the prevalence of Catholic hospitals in rural areas is higher than in urban areas. It is not uncommon in many rural areas for the closest non-Catholic hospital to be a significant distance away. I lived in such an area until last January, served by three small Catholic hospitals within a 25-mile radius, the nearest non-Catholic hospital 38 miles away, and the nearest public hospital 57 miles away. I have since moved, for health reasons, to a more urban area that provides a full range of hospitals, including a major research hospital. Easy enough for me to do, but what is easy for me is virtually impossible for many/most of the people living in such areas.

    The distinction between public hospitals and private/religious hospitals is not as clean as conservatives/libertarians would suggest, though. Almost all hospitals in the United States receive a significant proportion of their revenues from the government, directly or indirectly. Emergency and acute care services, in particular, are heavily funded by the government, and government emergency response policies direct emergency responders to transport patients to designated hospitals. In rural areas, the federal government designates hospitals (many among them Catholic hospitals) as “sole community hospitals” for a geographic region, entitling them to even higher levels of government funding.

    At what point is the distinction between public hospitals and private/religious hospitals erased by public funding of private/religious hospitals?

    If a Catholic hospital has no right not to host a gender transition-related surgery, can a patient demand it also allow elective abortions to be performed?

    Although gay/lesbian/transgender health care is important, the denial of services extends far beyond such services, and far beyond elective abortion:

    USCCB directives prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments. Studies by the ACLU and others support the thesis that many Catholic hospitals across this country are withholding emergency care from patients who are in the midst of a miscarriage or experiencing other pregnancy complications.  Catholic hospitals also routinely prohibit doctors from performing tubal ligations (commonly known as “getting your tubes tied”) at the time of delivery, when the procedure is safest, in effect requiring patients to undergo an additional surgery elsewhere after recovering from childbirth.

    Denial of services by Catholic hospitals is not a problem in most urban areas, because alternatives exist. Not so in many areas of the country, as Houndentenor and others have pointed out.

    In an efficient market, Catholic hospitals would not enjoy the privileged status as “sole community hospital” (de facto or designated) in rural areas, as is now often the case. An efficient market would quickly provide competition for Catholic hospitals in such areas with full-service public or private hospitals. However, the health care market is not efficient, particularly in rural areas. Government funding of private/religious hospitals distorts the market, and is a significant reason why Catholic hospitals exist without competition in many areas.

    Reply
  5. posted by JohnInCA on

    Just checked the Jersey case.

    Whataya know? Everything was scheduled appropriately, surgeon was ready, but literally *on the day of the surgery* the hospital decided they couldn’t used the facilities.

    Cause remember, if you aren’t dicking someone over in the process, it isn’t *really* religious liberty. To be clear, is be far more sympathetic to the hospital if they had simply refused to stay with. But this guy did everything right, and the hospital waited till the day of the surgery to pull the rug.

    If you’re going to discriminate, at least do it up front so people can make other plans in a timely manner.

    Reply
    • posted by JohnInCA on

      Okay, double-checked that article, I misread. It was the day of an appointment, not the surgery itself. But the guy went above and beyond making sure his trans status wouldn’t be a problem, got assurances it wouldn’t be, only to have them Welch.

      And to be clear, or want the surgeon that has Ann issue with it, so out want any *person* who wasn’t being asked to violate their conscience.

      Which is part of the issue with Catholic hospitals. In most cases, is the admin forcing their views on doctors who have limited options (as discussed above, in many parts of the country is Catholic or nothing).

      Hospital fucked up.

      Reply
  6. posted by Jorge on

    In rural areas, the federal government designates hospitals (many among them Catholic hospitals) as “sole community hospitals” for a geographic region, entitling them to even higher levels of government funding.

    This federal government is pretty smart for being so powerful.

    USCCB directives prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments.

    I realize we’re rapidly moving to the point where such reproductive health services will be considered vital to our society.

    And to this I say no. I would tell the non-Catholics to build their own hospital or pay the government to build one. I’d say a lot more than that actually. But health care is apparently one of the most difficult businesses to succeed in, even for the government.

    Maybe we should pass some kind of really big law to solve our health care problems.

    (We did that already.)

    The Democrats did, and that bill now has to be “repealed and replaced”. That’s why it’s important to vote Republican.

    In all seriousness, the confirmation hearings going on at Capitol Hill right now are making me optimistic that if our elected representatives and our federal agencies study an issue long enough, there can be constructive collaboration that leads to good solutions…

    Government funding of private/religious hospitals distorts the market

    …it’s just that it take a decade or two to get things right.

    Whataya know? Everything was scheduled appropriately, surgeon was ready, but literally *on the day of the surgery* the hospital decided they couldn’t used the facilities.

    You are either reading the article wrong or finding a significant factual inaccuracy in it. The Washington Post article states this occurred on the date of a scheduled consultation with the surgeon about the surgery, not the date of the surgery.

    This does not make me less sympathetic to your argument, but it makes me slightly more certain of my position. I don’t know that this situation is common enough that the policy is well-enough known up and down the chain of command.

    I do have one question. Do Catholic hospitals perform hormone therapy and other treatments for gender dysphora that fall short of sex reassignment?

    I can find no direct answer to this question (or even to the question of sex reassignment surgery–oops!) in the article’s linked Ethical and Religious Directives for Catholic Health Care Services. This is because with new medical discoveries and advances raise new questions. “In consultation with medical professionals, church leaders review these developments. . . . While the Church cannot furnish a ready answer to every moral dilemma, there are many questions about which she provides normative guidance and direction. In the absence of a determination by the magisterium, but never contrary to church teaching, the guidance of approved authors can offer appropriate guidance for ethical decision making.”

    To be frank, if it weren’t for statements such as “contrary to Church teaching”, other sections of this document would lead me to conclude that treatments falling short of sex reassignment surgery should be covered for exactly the reasons mentioned in the referral letters–the health and functioning of the patient. But if the Church only has a prohibition on sex reassignment surgery, I can well imagine a hesitation to agree to procedures that may or may not lead to it in the future.

    Anyway, it seems to me that guidance with church officials on certain moral questions is available if not mandatory to such hospitals. And such guidance comes with certain constraints in time and money. While I would not do things this way, I do not think it is entirely unreasonable to refrain from seeking such guidance until the point mentioned in the article–the time before the key surgeon consultation.

    Also I would like to point that in large organizations it is not unheard of for mid-high level administrators to be overruled by even higher level administrators and for chaos to be sown in their wake.

    Reply
    • posted by JohnInCA on

      Yeah, caught my own error already. But it remains: this dude went above and beyond to make sure it wasn’t a problem, and was given false assurances.

      Arbitrary rules become less defensible when they are arbitrarily applied. When they are arbitrarily applied *late*, after consensus had already been reached and agreed to? They are indefensible.

      Which is a large problem with these “religious liberty” claims. No one is willing to be up front with their intent. They say “can’t we just agree to live and let live”, but then refuse to be say what that actually means in a timely manner.

      Whether we’re talking about cakes, pizza parlors, pediatricians, or hospitals, they always discover their religion after folks have already started making plans based on what they were first told.

      Stop presenting as open to all of you aren’t. Stop agreeing to obligations if you plan to abandon them. Give people enough information to make informed decisions. This isn’t complicated, and are basic rules of ethics. And “Christians” keep violating them in the name of God, and want to be given a pass on it (both legal and social).

      Reply
      • posted by Jorge on

        A rule that says prohibits medical procedures that are inconsistent with Catholic doctrine that there are two sexes, male and female, that are immutable and permanent, is not arbitrary.

        It is vague.

        And the proper interpretation of it does not rest within the medical profession with whom a patient contracts with.

        There is a difference.

        Senior management exists in an organization for a reason. That reason often boils down to what at work I call politics, to represent factors beyond my professional understanding. That a “consensus” might be reached on a matter by the interdisciplinary team, the authorized line professional, and middle management, is nothing if senior management looks at the decision from its broader perspective and realizes there is something fundamentally unjust, obscene, or careless about the decision, or simply that the decision does not match company resources.

        I’m the line supervisor in my agency. Of the various decisions I supervise or am a part of, most require just my approval; some require two approvals (mine and my bosses), some require three approvals, some require a convoluted sequence of usually my approval but sometimes the interdisciplinary team can activate an appeal to the lowest rung of our mutual chain of command, some expenditures require *five* approvals proceeding linearly through two departments (those take a while). In fact certain decisions of a rare nature require approval by senior management of a department different than that of the line worker and supervisor–decisions about treatment of gender dysphora (that’s usually outside my department but it’s today’s example) among them.

        It’s made me very cautious of telling clients anything other than “this is what I recommend/am in support of”–a line worker staple that most of my more experienced line supervisors have long since been weaned off of as being too incautious.

        I think you should cut the hospital some slack. Not every bad situation that a large organization visits on someone is because of arbitrary or ill intent.

        Reply
      • posted by Jorge on

        (Ugh, typos galore in that one.)

        “that most of my more experienced line supervisors” >> that most of my more experienced fellow line supervisors

        Reply
  7. posted by Jorge on

    One more thing.

    I realize there is an incentive to hire the attorneys who are best able to represent you and hire the case you are best able to win.

    The very fact that he is suing on the basis of sex discrimination instead of exclusively on the basis of discrimination against people with disabilities is to me itself evidence that the Catholic hospital was making a factually accurate determination that the procedure was, in addition to treatment of gender dysphora, for the purposes of sex reassignment surgery. It’s hard to say he’s being discriminated against on the basis of the fact that he is a man without revealing that the surgery has the impact or intent of changing him into one.

    (Dear, the argument is that he’s being discriminated against for being a woman who is only being denied medical treatment for reasons related to the fact that he is a woman whose circumstances do not conform to the way the hospital would like to discriminate women into.)

    Oh.

    Lambda Legal it is.

    Reply
  8. posted by Tom Scharbach on

    Tom: In rural areas, the federal government designates hospitals (many among them Catholic hospitals) as “sole community hospitals” for a geographic region, entitling them to even higher levels of government funding.

    Jorge: This federal government is pretty smart for being so powerful.

    The idea behind the designation and funding is to provide funds for advanced medical technologies (e.g. CAT scans and so on, and trained personnel to operate them) that are out of reach for many hospitals in rural areas.

    The unintended consequence (at least in Wisconsin, where 48% of all hospitals are Catholic, and Catholic hospitals are designated as Sole Community Hospitals in rural population centers like Rhinelander and Marshfield) is to heavily subsidize hospitals providing nonstandard/substandard levels of care.

    I wouldn’t characterize that as “smart”. The better solution, as you point out, would be for the government to provide the funds to build and operate hospitals providing standard levels of care. As you point out, though, that would be a process that would take a decade, at least, even if it were possible given the strength of the Catholic health care lobby.

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  9. posted by Tom Scharbach on

    Tom: USCCB directives prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments.

    Jorge: I realize we’re rapidly moving to the point where such reproductive health services will be considered vital to our society.

    Contraception is used by 62% of women of reproductive age, according to the NIH. I don’t have numbers for condom use in men, but I imagine that it is at least that high.

    Sterilization (tubal ligation, vasectomy) is less common (17% of women, 5% of men) but common enough, particularly among married couples over the age of 40-something with children.

    I don’t know about “vital to our society”, but I think that a strong case can be made that medical advice about contraception is standard medical practice.

    I can’t speak to all Catholic hospitals, of course, but I know that in two Catholic hospitals serving the rural area I lived in until recently (both the sole source of hospital services in towns of roughly 10,000 plus the population of surrounding rural areas), the hospitals prohibited any discussion of contraception on hospital premises, by doctors, nurses and/or staff, and prohibited referrals to medical service providers that would provide advice about contraception.

    To my mind, that’s substandard medical practice. I don’t think that the government should be subsidizing substandard medical practice. As I see things, if a hospital takes government funds, it should provide standard medical care.

    Reply
  10. posted by Throbert McGee on

    you may have to go hundreds of miles to get to a hospital not affiliated with the Catholic Church. There aren’t any choices, especially not in an emergency situation. So we are heading towards a real problem in which a church can decide what medical procedures may or may not be performed within a reasonable distance from where you live.

    Um, okay. Gender transitioning is NEVER an emergency situation, period, full-stop. No one would ever confuse it with an emergency situation. So allowing a Catholic hospital to refuse to provide gender-transitioning services will NOT impinge on emergency life-threatening someone-is-bleeding-out situations, EVER.

    Rebut that if you can.

    Now, in the case of late-pregnancy abortions, are there ANY cases on record where a Catholic doctor has said, “You know what? Even though the pregnant woman is hemorrhaging all over the place, I think this is NOT an emergency situation; this is a purely ELECTIVE abortion, and I refuse to perform it because it would make the Blessed Virgin cry”???

    Reply
    • posted by Tom Scharbach on

      Now, in the case of late-pregnancy abortions, are there ANY cases on record where a Catholic doctor has said, “You know what? Even though the pregnant woman is hemorrhaging all over the place, I think this is NOT an emergency situation; this is a purely ELECTIVE abortion, and I refuse to perform it because it would make the Blessed Virgin cry”???

      I don’t know about the Blessed Virgin, but I do know of two legal actions that are relevant:

      (1) The Centers for Medicare & Medicaid Services (CMS), a federal agency with authority to hold hospitals accountable for EMTALA violations, penalized St. John Hospital and Medical Center in Michigan in 2012 for denying a woman miscarriage treatment because of the Directives. The woman had to be driven by a family member to another hospital, where she needed emergency surgery and seven pints of blood.

      (2) In a complaint filed in October 2015, the ACLU brought a lawsuit against Trinity Health Corporation, one of the largest Catholic health systems in the country, for its repeated and systematic failure to provide women suffering pregnancy complications with medically indicated emergency abortions as required by federal law. Among the other allegations in the Complaint, Paragraphs 38 and 39 allege:

      38. At least one of Plaintiffs’ members has already been denied stabilizing treatment (termination of the pregnancy) at one of Defendants’ hospitals, in violation of EMTALA, solely because that treatment conflicted with the Directives.

      39. In 2012-2013, a public health educator discovered that at one of Defendants’ hospitals alone, several women who were suffering from preterm premature rupture of membranes were denied appropriate stabilizing care, namely the termination of the pregnancy. The denial of such treatment resulted in these women becoming septic, hemorrhaging, contracting life-threatening infections, and/or unnecessarily suffering severe pain for several days.

      The lawsuit was dismissed for lack of standing (not on the merits) in April 2016.

      You can do your own research and probably find more if you want to do so.

      Reply
    • posted by Jorge on

      Um, okay. Gender transitioning is NEVER an emergency situation, period, full-stop. No one would ever confuse it with an emergency situation.

      Or in other words, if this bill contains any language mandating hiring quotas based on race, I will eat the pages of the bill.

      Your confidence in the human race’s capacity for honesty and wisdom in the area of language comprehension is very reassuring, Throbert. I’m wondering if you ever considered a career in law in, perhaps, Iran? Or Libya? Maybe Venezuela?

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    • posted by TJ on

      Hmm…

      OK, I agreed that small-business owners and self-employed types should probably a general exemption from public acc. laws when it comes to a gay or straight marriage that they object to. Assuming that this was part of a larger civil rights bill and we didn’t have situations where a bakery or photographer initially takes the couples money and then (at a bad time) refuses.

      Part of the reasoning behind this position was that (1) it would help pass a civil rights bill for things like employment and housing, and (2) a gay or straight couple having to shop around a bit more for a wedding photographer or caterer, ain’t quite the same thing as say, health care….hmm.

      Essentia Health is a major health care provider in Minnesota (and parts of North Dakota as well) it is (from what I gather) affiliated with the Catholic Church on some level and, in quite a few cases, it may be the only hospital in your community or the only one that your health plan allows you to go with.

      Their certainly are situations where a sex change operation would be a serious, life or death issue. Although, most of the time it is a situation that occurs only after quite a bit of preliminary work is done with therapists and the like.

      Yet, if the person seeking the surgery goes out of his or her way to ensure (beforehand) that “it aint going to be a problem”, it does make me less willing to buy the “religious freedom” argument when the hospital reverses itself.

      Reply
      • posted by Throbert McGee on

        There certainly are situations where a sex change operation would be a serious, life or death issue.

        Sez you. I sez there are no such situations. Let’s try this:

        “There certainly are situations where a butt-liposuction operation would be a serious, life or death issue.”

        I say, when an anorexic threatens to commit suicide if you don’t give her or him a butt-liposuction, the proper course of action is to take away the anorexic’s belt or shoelaces, but you don’t give them a butt-liposuction. And you definitely don’t pass statutes requiring private hospitals to perform a butt-liposuction for any anorexic who makes suicide threats.

        [Meanwhile I’m brushing up on my Farsi, just in case I have to emigrate to Iran, as Jorge predicts.]

        Reply
        • posted by Jorge on

          My fellow commenters will of course refrain from great emotional outbursts to the deliberate provocation of taking the comparison between anorexia and gender identity talking point and using it in a fair and half-reasonable manner.

          Anorexia is a disability. It is a scientifically recognized body image disorder that can become life-threatening. Cosmetic surgery is not a medically indicated treatment for improving the well-being and reducing the risks related to this disorder.

          You have allowed yourself to fall for the trap of shifting goalposts. An emergency situation is not the same as a situation that is a matter of life or death. Cancer is a diagnosis that is a matter of life or death, but it is not an emergency. Nor are curative treatments for cancer ethically preferable to pallative treatment in every situation under every reasonable moral standard of medical care. The same is true of gender dysphora.

          Where the medical risks can be managed with appreciable protection to medical, patient, and community benefits under a certain standard of medical care, a hospital should be permitted to offer that standard of care. I am well aware that I am arguing in favor of death panels.

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    • posted by JohnInCA on

      “[…] are there ANY cases on record where a Catholic doctor has said, “You know what? Even though the pregnant woman is hemorrhaging all over the place, I think this is NOT an emergency situation; this is a purely ELECTIVE abortion, and I refuse to perform it because it would make the Blessed Virgin cry”???
      Yes.

      It’s Ireland, not the US, but check the story of Savita Halappanavar. She died from a septic miscarriage because no one would perform a medically necessary abortion.

      More generally, you can find a bunch of (admittedly vague) cases where Catholic hospitals arguably committed malpractice because of their directives.

      And make no mistake, Catholic authorities know this can happen. They consider it acceptable collateral damage.

      Reply
  11. posted by Jorge on

    To my mind, that’s substandard medical practice. I don’t think that the government should be subsidizing substandard medical practice. As I see things, if a hospital takes government funds, it should provide standard medical care.

    You will not be surprised to learn that I think the above statements are a horrifying example of using an emotional appeal to mask what is in effect a plot to use the power of government control to subject an entire society to a single cookie policy of a tiny medical establishment’s design, regardless of the damage it inflicts on community values, or worse, the damage it inflicts on the values that a community derives from their religious beliefs. The primary effect is not, contrary to the argument, to improve public health. It is to improve the reputation and social power of the medical establishment. Public health in the United States will improve by leaps and bounds with advances in medicine and healthy lifestyles, and there is little that government regulation of health care can do about it.

    The way I see it, if a hospital takes money from the people, it should adopt with that money the standard of medical care that the people direct. That means if someday sex as a means of procreation becomes effectively replaced with artificial insemination, and elective abortion becomes a standard medical practice to avoid premature multiple births, whether or not we should keep the Hyde Amendment shall be the people’s choice, “standard medical practice” be damned.

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  12. posted by Jorge on

    38. At least one of Plaintiffs’ members has already been denied stabilizing treatment (termination of the pregnancy) at one of Defendants’ hospitals, in violation of EMTALA, solely because that treatment conflicted with the Directives.

    ….

    Question. This question will be based on the the first part of the Directives’ definition of abortion being a termination of pregnancy before viability.

    How do Catholic hospitals treat ectopic pregnancies?

    http://www.cuf.org/2004/04/ectopic-for-discussion-a-catholic-approach-to-tubal-pregnancies/

    “Most recently, the U.S. Conference of Catholic Bishops reiterated these principles:

    In the case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.

    Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.

    This principle applies in other pregnancy complications as well.”

    I see. Sounds expensive.

    The lawsuit was dismissed for lack of standing (not on the merits) in April 2016.

    Reading the dismissal order, the court wrote that it’s “dubious” that the complaint “contains sufficient factual matter to establish past actual harm”–that any particular woman was in fact severely injured in any specific way. Even that was irrelevant for the legal purpose of justifying an injunction. The court otherwise seemed to think that the ACLU’s case was speculative in nature. Perhaps they’d have had better luck with that argument if they were suing for damages instead of to bully the hospital into changing its practices, which have surely, if there is aught to complain about, been around long enough to produce a lot of damage.

    The Centers for Medicare & Medicaid Services (CMS)… penalized St. John Hospital and Medical Center in Michigan… The woman had to be driven by a family member to another hospital, where she needed emergency surgery and seven pints of blood.

    But why would we expect such a thing from the ACLU?

    Reply
  13. posted by Throbert McGee on

    Cancer is a diagnosis that is a matter of life or death, but it is not an emergency. Nor are curative treatments for cancer ethically preferable to palliative treatment in every situation under every reasonable moral standard of medical care. The same is true of gender dysphoria.

    Jorge, if I understand your analogy correctly, you mean to say that in some cases, “medical transitioning” with hormones/surgery is a morally appropriate palliative treatment for gender dysphoria, even if it fails to cure the dysphoria?

    I sort of half-agree, but not totally. At first, it sounds reasonable — if the patient’s gender dysphoria is so bad that they might REALLY resort to self-harm unless they medically transition, then you should morally approve of the transition (even when you suspect that the dysphoria will only be partly relieved, and not cured). I mean, they might still have “issues,” but at least their psychological health is better than it was. And “better than it used to be” is sometimes all you can hope for.

    The problem is: What expectations does this create for other patients with gender dysphoria? In particular, what about patients whose dysphoria wasn’t SO severe that they truly felt inclined to hurt themselves? Now you’ve given them the message that reporting thoughts of suicide — whether they’ve had such thoughts or not — is The Path Forward to the gender-reassignment surgery they desire.

    This is not to say that medical transitioning should never be done, but only to suggest that not every self-diagnosed trans-person who THINKS they’ll benefit from hormones and surgery actually WILL benefit from the procedures. Some may be better off if you say “You’re not a man trapped in a woman’s body; you’re an interesting form of third-sex mutant. But mutants are cool and you should let your freak flag fly, like Wolverine, instead of physically altering your body just to conform with binary standards.”

    From what I’ve read, the term “gatekeepers” is commonly used for those healthcare professionals whose job is to sort gender-dysphoric patients into “Probably will be helped by transitioning” and “Unlikely to benefit from transitioning.” Or, if you prefer, separating the “fully identified with the opposite sex” from the “confused homos with Asperger’s.”

    And forcing a Catholic hospital to do a transition-related hysterectomy diminishes the hospital’s ability to support this crucial gatekeeping function. Granted, this patient was already well through the gate, having had a double mastectomy and being on testosterone and so forth. But what about patients down the road who are questioning their gender identity and thinking that they might want to do some bod-mod in the future? I would imagine that the hospital administrators are wary of setting a precedent by waiving the church’s rules in the current case. Also, if you’re willing to yank out the uterus and ovaries of a woman who prefers to socially identify as a man, it makes it awkward to say No to a woman who merely wants a tubal ligation that’s in theory reversible.

    Reply
    • posted by Throbert McGee on

      A man having lunch in Peru
      Found a half-eaten fly in his stew.
      Said the waiter, “Don’t shout
      And wave it about,
      Or the rest will be wanting one, too.”

      Reply
  14. posted by Throbert McGee on

    Regarding Tom’s point about the long drive that rural folks face if they want to go to a non-Catholic hospital, it occurs to me that for procedures like tubal ligation or vasectomy (or a hysterectomy for a FtM transman!), it’s generally going to be a one-time round-trip, not a burdensome weekly routine.

    As for contraception, the question is: how far is the nearest non-Catholic pharmacy? Or, failing that, you can order contraceptives online once you’ve made the long drive to obtain the prescription.

    Reply
    • posted by Tom Scharbach on

      As for contraception, the question is: how far is the nearest non-Catholic pharmacy? Or, failing that, you can order contraceptives online once you’ve made the long drive to obtain the prescription.

      The question is why the government should heavily subsidize hospitals that mandate nonstandard/substandard care.

      Reply
      • posted by Throbert McGee on

        The question is why the government should heavily subsidize hospitals that mandate nonstandard/substandard care.

        If the ER doctors in a Catholic hospital insist on treating a choking victim by crossing two beeswax candles over the patient’s throat, instead of performing the Heimlich maneuver, THAT’S “substandard” care. But if the Catholic hospital offers overall high-quality OB-GYN care, but doesn’t include contraceptive prescriptions or tubal ligations among its services, it seems a stretch to call that “substandard” — all the more so if the subsidies are more directed towards their emergency and acute-care services.

        Reply
      • posted by Tom Scharbach on

        But if the Catholic hospital offers overall high-quality OB-GYN care, but doesn’t include contraceptive prescriptions or tubal ligations among its services, it seems a stretch to call that “substandard” …

        I don’t think so. The term I used was “substandard/nonstandard”. Breaking that down, the term “substandard” means “below the usual or required standard”, and the term “nonstandard” means “not average, normal, or usual”.

        With respect to the practice of Catholic hospitals and clinics prohibiting doctors, nurses and staff from providing contraception counseling and/or prescriptions to women of childbearing age, the practice is nonstandard.

        With respect to the practice of Catholic hospitals and clinics prohibiting doctors from prescribing certain contraceptive medications when the medications are the accepted/recommended form of treatment for medical conditions other contraception, the practice is substandard.

        With respect to tubal ligations, the standard medical practice is to perform the ligation immediately after delivery for women who have the procedure after childbirth. The standard is based on sound medical grounds in addition to sparing the cost of a second surgical procedure. In this case, the practice is both nonstandard and substandard.

        … all the more so if the subsidies are more directed towards their emergency and acute-care services.

        If the subsidies were limited to emergency and acute-care services, you would have a point. But they aren’t.

        Reply
  15. posted by Jorge on

    Jorge, if I understand your analogy correctly, you mean to say that in some cases, “medical transitioning” with hormones/surgery is a morally appropriate palliative treatment for gender dysphoria, even if it fails to cure the dysphoria?

    Oh, no. You have it backwards. I consider that transitioning through hormones and operations can cure the dysphoria. Perhaps I should use the old term gender identity disorder here to make it clear I am referring not to whether someone is transgender, but whether one has a clinically significant impairment to their well being because they are transgender. By pallative care I am referring to engaging in therapy without transitioning to another sex. (There is a large in-between that is the subject of a certain regressive law in North Carolina.)

    By curing the disorder through transition, the patient can drastically reduce suicide risk.

    Or, he can manage the suicide risk as a known symptom or risk without transitioning, for life. He accepts the increased risk that he will die of suicide and works to improve or maintain his functioning as best as he can.

    Or he does something in between.

    And forcing a Catholic hospital to do a transition-related hysterectomy diminishes the hospital’s ability to support this crucial gatekeeping function.

    I think prohibiting a Catholic hospital from doing a transition-related hysterectomy does the same thing. The patient wants the surgery and is a “good candidate” for it, but is denied because the surgery itself is unethical. It’s the same principle with in vitro fertilization and contraception.

    Reply

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