A Catholic non-profit hospital system based in Indiana, founded by the Sisters of St. Francis of Perpetual Adoration, faced a federal mandate that it must perform gender reassignment surgeries or risk losing millions in federal funding. Thankfully, in 2021, this faith-based hospital system won a federal court decision against the mandate.
In 2016, the United States Department of Health and Human Services (HHS) tried to force the Franciscan Alliance hospital system, a Roman Catholic non-profit that operates 12 hospitals in the midwestern U.S, to perform procedures contrary to the religious tenets they had always operated by. Franciscan Alliance along with the Christian Medical and Dental Society filed suit in August of 2016 under the Religious Freedom Restoration Act (RFRA) and the Administrative Procedure Act (APA).
HHS bullied Franciscan Alliance, in an attempt to force their hospitals to perform gender transition services, as well as provide their employees with insurance coverage for these same objectionable procedures. Franciscan operates under the United States Conference of Catholic Bishops directives that set forth how to ethically treat all who seek their care. Because of this, they do not perform gender-reassignment surgeries, abortions, or sterilizations.
HHS used Section 1557 of the Affordable Care Act (ACA), which prohibits “discrimination” in health care, to justify its actions, completely ignoring RFRA’s protection of religious freedom and misinterpreting the meaning of “sex” to be inclusive of “gender identity” in violation of the APA. HHS essentially argued that because Franciscan is willing to provide hysterectomies for non-transgender persons, such as those with uterine cancer, refusal to perform the same procedure for a transgender person with a perfectly healthy uterus is indicative of discrimination.
While the district court ultimately ruled in Franciscan’s favor, recognizing HHS violated its rights under the RFRA, the appropriate remedy was not granted as it had been in similar RFRA cases. Franciscan sought to permanently ensure HHS could not construe Section 1557 of the ACA to require agencies or individuals to provide medical services contrary to their religious beliefs. This request was essentially dismissed. The district court’s refusal to provide proper relief to Franciscan Alliance is appalling, particularly in light of disputes over the meaning of “sex in federal law caused by the recent Bostock v. Clayton County case. It is not the place of the government to tell religious institutions that their faith is wrong. It is imperative that courts take this threat to religious freedom seriously.