Photo: National Cancer Institute, via Wikimedia.
A federal court has struck down a Trump administration rule allowing health care institutions and providers to deny information and treatment to LGBTQ people based on their personal religious or moral beliefs.
The rule, which was scheduled to take effect on Nov. 22, would have allowed a broad-based religious exemption whereby health care workers could refuse to provide medical services if they object to the type of treatment or procedure that a patient has chosen to undergo, without having to take into account the patient’s health or wellbeing.
For instance, a hospital receptionist could have refused to schedule an appointment for a transgender patient seeking gender-affirming care, or an orderly could have refused to transfer a patient to an operating room for an emergency abortion.
Critics of the rule also claim that it would have a disproportionate effect on the ability of low-income people, including a substantial number of people of color, to access reproductive health care, including counseling and referrals for abortion under Title X, a federal program providing access to family planning services for low-income or uninsured patients.
The American Civil Liberties Union and the New York Civil Liberties Union filed a lawsuit on behalf of the National Family Planning & Reproductive Health Association and Public Health Solutions, challenging the rule by alleging it fosters discrimination by giving a wide swath of people an overly broad religious exemption, prioritizes providers’ beliefs over patients’ medical needs, and would force family planning providers to hire and employ individuals “who will withhold and obstruct access to complete, accurate, and unbiased information about abortion from their patients.”
The providers also claim the rule violates the Establishment Clause of the U.S. Constitution and deprives patients of their Fifth Amendment rights to privacy and liberty, without due process of law, specifically in cases where procedures, like emergency abortions, are necessary to preserve a patient’s life.
In striking down the rule, the court agreed with the family planning providers that the rule dramatically alters the playing field by expanding the meaning of statutory terms and granting the Department of Health and Human Services overly broad power in attempting to enforce the rule.
“Although the 2019 Rule has housekeeping features, plaintiffs’ description of it as largely substantive — and, indeed, in key respects transformative — is correct,” U.S. District Judge Paul Engelmayer of the Southern District of New York wrote on behalf of the court. “And HHS’s characterization of the Rule as solely ministerial cannot be taken seriously. (Indeed, at argument, HHS abandoned this position.)
“Whether or not the Rule was properly adopted…the Rule unavoidably would shape the primary conduct of participants throughout the health care industry. It would upend the legal status quo with respect to the circumstances and manner in which conscience objections must be accommodated.”
The court also characterized the rule as “a classic solution in search of a problem,” noting that the Trump administrations claims that it was necessary to respond to an increase in violations of existing federal “conscience” laws was false, noting that some of the arguments employed by the government “cannot be taken seriously.”
Nursing assistants – Photo: Truckee Meadows Community College, via Wikimedia.
Reproductive health advocates and civil liberties defenders praised the court’s decision.
“Today’s decision is an important victory against the Trump Administration’s cruel and unlawful attempts to roll back critical patient protections,” Alexa Kolbi-Molinas, a senior staff attorney with the Reproductive Freedom Project at the ACLU, said in a statement. “Everyone is entitled to their religious beliefs, but religious beliefs do not include a license to discriminate, to deny essential care, or to cause harm to others.”
“By empowering providers to put religious beliefs ahead of quality of care, this rule is a direct threat to public health, particularly for vulnerable populations,” Lisa David, the president and CEO of Public Health Solutions, said in a statement. “Everyone should have the power to make their own reproductive care decisions and have access to a full spectrum of health care services.”
Several other lawsuits were filed challenging the rule, including one from a coalition of 23 cities and states, led by New York Attorney General Letitia James, and another brought by Planned Parenthood Federation of America, the National Women’s Law Center, and Democracy Forward.
Related: LGBTQ advocates alarmed at Trump’s religious exemption for health care workers
In a case out of California where a judge recently heard oral arguments, a lawsuit brought by the Center for Reproductive Rights, Lambda Legal, and Santa Clara County on behalf of a coalition of civil rights and medical providers argued that the rule seeks to intimidate facilities into dropping reproductive services over the fear that they’ll lose federal funding if they are accused of violating a religious employee’s beliefs.
A similar case out of Baltimore, schedule for a hearing on Nov. 14, argues that the rule negatively impacts the Baltimore City Health Department’s ability to ensure that vulnerable and marginalized populations can seek medical care without fear of discrimination, which could lead patients to delay or avoid treatment, potentially threatening their health.
“Personal views do not give people the right to withhold critical health care or endanger others’ lives,” Donna Lieberman, the executive director of the New York Civil Liberties Union, said in a statement. “Patients should be able to trust that they’re getting the health care they need, regardless of religion or politics. This is a win in the Trump administration’s continued attack on women and LGBTQ people.”
Lambda Legal Senior Attorney Jamie Gliksberg said the legal organization was “thrilled” with the court’s ruling on Wednesday.
“In his decision to completely eliminate the Denial of Care Rule, Judge Paul A. Engelmayer has likely saved countless lives,” Gliksberg noted. “Courts across the country are seeing the Denial of Care Rule for what it is, an egregious violation of the civil rights of and a direct attack on the lives of women, LGBT people, religious minorities and many others. The Denial of Care Rule was deeply rooted in animus against some of our most marginalized and vulnerable communities, and that has no place in our society.”
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