California Supreme Court: no religious exemption for providing medical care to LGBT patients

by on August 19, 2008  •  In Health, Religion, Reproductive rights

Sometimes a case grabs attention less because of how it changes the law than because the parties or the context seem saturated with symbolic or cultural resonance. North_Coast_Women's_Medical Care Group_v_San Diego Superior_Court falls into that second category.

In this case, the California Supreme Court ruled yesterday that doctors have no religious liberty right to deny treatment because of a patient's sexual orientation.  The case arose when Guadalupe Benitez sought fertility treatment. The physician whom they consulted told Benitez and her partner that she would not, for religious reasons, perform intrauterine insemination (IUI) on Benitez. Instead, what ensued was a year of treatment using medication, with Benitez continuing attempts to self-inseminate at home. When it became clear that this was not working, and during a period when the initial physician was away, Benitez sought IUI from another doctor at the same clinic, who informed her that he, too, had religious objections to treating her. She was referred to a third doctor, outside of that practice, who eventually performed successful IVF.

The importance of the case comes from the defendants' claim that they had a First Amendment right not to treat Benitez, thus trumping her rights under a California statute that prohibits sexual orientation discrimination. Under federal law, the doctors had little chance because the state needs to show only a rational basis for a neutral law of general applicability, in order to defeat the claim for an exemption based on religious belief. The more interesting religious liberty claim was under state law, because the standard of review question had not been decided.

On that point, the court held that even under the most searching review, the physicians had no viable religious liberty claim because the state's interest in preventing discrimination based on sexual orientation rose to the level of compelling. This holding as to the importance of the public's interest in  ending sex/o discrimination conceptually rounds out the same court's ruling in the Marriage Cases, 43 Cal. 4th 757, that such discrimination is inherently suspect. As in that case, the primary precedential value is for state law, binding for California and potentially persuasive precedent for other states.

Does this decision extinguish all possibilities for doctors to assert religious objections to providing care? No – the court said that doctors in such situations had two options.  First, they could decline to perform a specific procedure, an act not forbidden by the anti-discrimination law, so long as they decline to perform it for all patients. Second, they could avoid a personal conflict "by ensuring that every patient requiring IUI receives full and equal access to that medical procedure through a North Coast [medical group] physician lacking the defendants' religious objections."

The second option requires that doctors genuinely prioritize the needs of patients, including patients who live different lives and hold different values than the doctors treating them. Its effect would be to insure that a medical practice opens for business only when it is sufficiently staffed to provide care to every category of patient, not just the ones the doctors feel are "deserving" of it.  The last time I checked, that was called ethics.


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