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No Bigots Need Apply

Refuse to provide comprehensive health care to LGBTQ patients? Don’t bother applying for a job at my practice.

This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

If you are a healthcare provider who doesn’t want to treat LGBTQ people or their families, please don’t waste your time and mine applying for a job in my practice.

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This should be a universally applicable statement. The fact that I happen to be a gay man in a decision-making capacity at a private practice should be incidental. No medical facility should grant anyone a pass when it comes to offering discrimination-free care to any patient who needs it. And yet, the Trump administration is poised to start handing out those passes, so long as people asking for them couch their bigotry in religious terms.

A new division of Conscience and Religious Freedom within the Department of Health and Human Services (HHS) was recently announced, with a mission to protect medical professionals who refuse to provide certain kinds of care or treat certain groups of people because of some moral or religious objection. If a medical professional is penalized for refusals of this kind, HHS will investigate it as a case of potential religious discrimination. (Donald Trump’s HHS was initially led Tom Price, a deeply homophobic former orthopedic surgeon and Republican representative.)

Because many people justify their bigotry against gender and sexual minorities in religious terms, this new division is quite alarming news for LGBTQ people. The creation of this division appears to open the door for medical providers to, for example, refuse to provide gender confirmation treatment for trans people, or refuse to treat children with same-sex parents.

One attendee at the ceremony announcing this new division was Sara Hellwege, a nurse-midwife who sued in 2014 after being denied a job at a Florida health center. The reason she didn’t get the job? She admitted that she would refuse to prescribe birth control pills because of her religious beliefs—and prescribing birth control pills was part of the job she applied for.

She had no business seeking the position in the first place.

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David Gorski, a surgeon and editor of the website Science-Based Medicine, expressed the views of many medical providers, myself included, when he tweeted that “physicians who refuse to treat certain patients based on their religious beliefs are in the wrong profession and should never have become doctors in the first place.”

“Doctors are people; people love and hate, and have biases and blind spots,” Zackary Berger told me. Berger is an internal medicine physician in Baltimore and treasurer of Clinicians for Progressive Care. “On the other hand, as professionals and as members of the US health care system, doctors must treat everyone no matter who they are.”

“The idea of a carte-blanche religious permission to not treat classes of individuals is morally repugnant and professionally indefensible,” Berger continued. “It lacks any sense of medical history, because many doctors already do abandon classes of individuals. We just shrug our shoulders and chalk up this abandonment to system characteristics, or the fault of the patient.
Pasting a religious label on such invidious distinctions vulgarizes what medicine should be and sullies any God worth the name.”

Safeguarding patients’ wellbeing is the primary obligation of anyone who enters a healthcare profession. If there is something that inhibits a person from providing the care a patient needs, then that person should not be in a position to render care in the first place. Just because some people think their religion gives them an exemption doesn’t mean they’re actually entitled to it.

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If you don’t think same-sex couples should be raising children, you won’t be interacting with families in my practice at all. If you’re not willing to discuss PrEP with your gay male patients, and think HIV prevention funding would be better spent on conversion therapy, you won’t be seeing any patients here. If you’re going to ignore the needs of our trans patients or insist on mis-gendering them, we have no opening here for you. And I don’t care at all if you justify any of that with your religion.

By painting themselves as victims, medical providers who cite their beliefs when refusing to deliver care are obscuring the reality of what they actually want: carte blanche to cherry-pick the care they’re willing to deliver based upon their prejudices.

At the ceremony announcing the creation of the new division at HHS, Hellwege said, “I hope that everyone can agree that no doctor or nurse should be denied employment or fired on account of their faith.”

Of course I can agree with that. The religious beliefs, or lack thereof, of the people who work in my office aren’t my business at all. I would never hire or fire anyone because of how they pray or where they worship.

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But that’s not what happened to Hellwege. She was denied employment because she was unwilling to do what the job demanded of her. Anyone who thinks they’re entitled to prioritize their religious beliefs over patients’ needs should find a new line of work.

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