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Health care decisions should be made by doctors and patients, not priests

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derek finch zkrPU 1AwdU unsplash Health care decisions should be made by doctors and patients, not priests

I am a pretty big fan of the band They Might Be Giants. Several of their songs appear on the playlist that I listen to on my commute to work, but one of my favorites has to be “Doctor Worm.” 

For those of you who might be unfamiliar with the composition, the titular character explains repeatedly throughout the song that while he’s not a real doctor, he is a real worm, who hopes that his drumming career will take off enough that someone will use his stage name, “Doctor Worm.” I appreciate his candidness about his lack of credentials and his openness about his actual goals — traits that I think the United States Conference of Catholic Bishops (USCCB) sorely needs to learn.

As the boogeyman-du-jour of Christian nationalism, trans issues are now a major part of the current public political discourse. It’s no surprise then that in March, the Bishops’ Conference released the “Doctrinal Note On The Moral Limits To Technological Manipulation Of The Human Body” outlining its stance on gender-affirming care. 

I’ll give you three guesses as to what that stance is (hint: It’s not the one with grounding in science, respect for bodily autonomy or even basic human compassion).

Equally unsurprising is that nowhere in this 14-page document does the United States Conference of Catholic Bishops cite the overwhelming evidence that for transgender people, gender-affirming care is not only critical, but life saving. Why would it? None of the committee members is a medical doctor. In fact, none of them even has a degree in biology or sociology or any other field of study that could possibly make them qualified to speak on trans health care (or any health care issue, for that matter). Instead, the bishops focus on theological citations, with their sources ranging from scripture to doctrinal documents issued by previous popes. Now I am by no means a theologian, so you won’t see me try to take on those specific arguments. What I can do, however, is explain what this Doctrinal Note is doing, and more importantly, why it matters if you care about state/church separation.

According to its website, the United States Conference of Catholic Bishops is “an assembly of the hierarchy of bishops who jointly exercise pastoral functions on behalf of the Christian faithful of the United States and the U.S. Virgin Islands” and consists of all 434 active and retired American Catholic bishops (excluding Puerto Rico, which has its own conference). Similar episcopal conferences exist across the globe, and have the authority to make certain binding rules within their own territory. These rules or “norms” are voted on by the conference, and if they are not unanimous, must receive the approval of the Vatican in order to ensure that they are in line with Catholic canon law. This process essentially allows bishops in a certain geographical area to make culturally relevant clarifications as they come up, rather than the Vatican needing to amend canon law on a regular basis.

Doctrinal notes, however, are separate from these “norms” and do not have to be approved by the Vatican. The Bishops’ Conference has a Doctrine Committee, which includes a subcommittee on Health Care Issues. While this subcommittee does have medical providers from major Catholic health care organizations as official “consultants,” final word is ultimately up to the subcommittee members. Though not binding in the same way an official “norm” would be, a doctrinal note, as an official statement of the Doctrine Committee, still carries a lot of weight among the Catholic hierarchy. This meant that when the bishops met back in June, and the topic of transgender health care came up, the Conference’s vote to begin the process to update the Ethical and Religious Directives for Catholic Health Care Services (which currently limits access to reproductive, sexual and end-of-life care in American Catholic hospitals) to address the issue caused alarm bells to go off for many people.

To be clear, there has been no binding decision on the part of the Bishops’ Conference barring gender- affirming care . . . yet. The vote in June merely initiated the process of amending the Ethical and Religious Directives, and while the writing on the wall is pretty clear at this point, there is a microscopic chance that a total ban on gender-affirming care in Catholic hospitals might be avoided. Groups like the Catholic Health Association (the president and CEO of which is one of the Doctrine Committee’s consultants), Catholics For Choice, New Ways Ministry, and a coalition representing over 6,000 religious sisters in the United States have all released statements urging the bishops to involve and affirm transgender people in this decision-making process, as well as to keep in mind that not everyone who receives health care at Catholic institutions is Catholic. Unfortunately, this dissent is largely coming from two of the groups that the Catholic hierarchy loves to ignore most: women and LGBTQ-plus people.

The Doctrinal Note is already starting to have real impact on real people trying to access health care. In the Freedom From Religion Foundation’s own backyard, a teenager who had gone through the long and arduous process to get approved for top surgery had his surgery suddenly canceled after SSM Health made the decision to cease all gender-affirming surgeries amid clerical pressure. (FFRF Co-President Dan Barker and I recently spoke with his father. Watch the broadcast here).

Often, when discussing discrimination against members of LGBTQ-plus communities in religious institutions like businesses, schools or hospitals, someone will inevitably ask some variation of “What did you expect?” followed by a proposed solution to simply go somewhere else. While our response here at the Freedom From Religion Foundation is always that we expect all institutions to be held to the same legal standards regardless of religious affiliation, health care is an area where intrusion by the Catholic Church is particularly insidious.

According to a 2020 report from MergerWatch, Catholic control of the health care system is expanding exponentially. Somewhere around one-in-six acute care hospital beds are controlled by Catholic hospitals, and the 10 largest Catholic health care systems alone also run more than 860 urgent care centers, 380 ambulatory surgery centers and 270 physician groups. While the number of non-Catholic acute care hospitals has decreased by more than 13 percent over the past two decades, the number of Catholic hospitals has increased by 50 percent. In Wisconsin, where the teenager in question was just denied care by a Catholic clinic, more than one-third of hospitals are run by Catholics, also endangering reproductive procedures even prior to the Dobbs decision.

It becomes even more difficult to attempt to avoid Catholic health care systems for people in rural areas, as mergers and acquisitions of hospitals are increasing the number of communities where the only option is the Catholic option. Even for people living in places with secular options, it may not be readily apparent without fairly significant research that a health care provider is Catholic, thanks to management agreements that allow previously secular providers to retain their original name. And none of this even begins to account for the role that health insurance plays in limiting people’s choice of health care provider.

Legally speaking, Catholic hospitals have a well-established right to deny this type of care. Statutory protections for institutions and individuals who object to providing certain types of health care on religious or ethical grounds were first introduced in the 1970s through a series of amendments called the “Church Amendments” (ironically not named as a reference to religious institutions, but for their author, Sen. Frank Church). Created as a response to the Supreme Court’s decision in Roe v. Wade, the Church Amendments permit institutions and individuals to refuse to participate in abortion or sterilization procedures if they conflict with their religious beliefs or moral convictions.

Since then, pressure from conservative religious groups have only further expanded the right to refuse care. There are numerous state and federal laws that codify these conscience protections, and major medical associations have historically bowed to clerical pressure, causing them to support these protections and making it difficult to argue that religious refusals violate the normal requirement that health care providers must adhere to a specific standard of care. These religious guidelines have traditionally applying to reproductive, sexual and end of life health care. There is no telling how many people in the United States have been harmed and will continue to be harmed by the Catholic hierarchy’s arrogance — all while it rakes in around $48 billion in taxpayer dollars each year in the form of Medicare and Medicaid reimbursements. And now these folks have set their sights on trans people, making it increasingly clear that the fight for gender-affirming care is a fight for a secular health care system.

All of this leaves us with a very important question: What do we do now?

Although not feasible for a large number of people, if it is possible for you to no longer spend your money in Catholic health care systems, please take that step. Even if it might be a bit more inconvenient, people removing their money from Catholic health care systems can make a massive difference in terms of slowing their growth. Similarly, if you’re lucky enough to be in a situation where you have multiple options for health insurance, double-check that your insurance isn’t through a Catholic health care system.

Individual choice isn’t the only way to push back, though. You can oppose upcoming hospital mergers by voicing your dissent to state and federal regulatory agencies, as well as to elected officials. You can also discuss with your own health care providers what plans they might have should they get caught in the crossfire of a hospital merger or management agreement. It is not uncommon for care providers to adopt a policy of quietly continuing to provide certain types of health care regardless of Church teaching.

The most important thing you can do, however, is build relationships with your fellow community members. Discussing highly polarizing issues like religious intrusion in health care can be uncomfortable, but it has never been more necessary. Even if you are the only nonbeliever in your community, you will likely find that many of your neighbors value things like bodily autonomy and access to science-based health care. Having difficult conversations and finding shared values builds stronger communities that in turn can be leaned upon to coordinate opposition to mergers, create mutual aid networks to help people access secular health care, and fight back against religious organizations using their immense political and financial resources to dictate everyone else’s health care decisions.

The dominance of Catholic hospitals isn’t going away any time soon. The institution of the Catholic Church is one of the most powerful religious organizations in the world, thanks to centuries of hoarding misbegotten wealth and psychologically torturing believers with the threat of damnation. But that does not mean we should simply roll over and allow the violation of our right to make informed, science-based health care decisions to continue. And just like Doctor Worm truly believes that he can become a professional drummer, I too believe that we can build a world where everyone can receive health care regardless of the opinion of a handful of priests with no medical training.

Kat Grant (they/them) joined the Freedom From Religion Foundation as an Equal Justice Works Fellow (sponsored by the Wm. Collins Kohler Foundation) in September 2022. Their fellowship project focuses on state/church issues that specifically impact the LGBTQ-plus community. Kat first worked for FFRF as an intern while attending law school at the Indiana University Maurer School of Law. Originally from southern Indiana, they received their B.A. in political science from Indiana University Bloomington in 2019, and graduated with their Juris Doctor from IU Maurer in May 2022.

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