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Religious Corporations Are Interfering in Doctor-Patient Relationships

Faith-based health facilities are increasingly imposing their biases on the medical decision-making process.

Faith-based health facilities are increasingly imposing their biases on the medical decision-making process.

A faith-based health system’s firing of a doctor who challenged its ban on aid-in-dying could become the latest front in the effort by religious corporations to expand their rights.

Dr. Barbara Morris worked for Centura Health in Colorado, a Catholic and Seventh-day Adventist health system that banned her, on religious grounds, from helping a patient with terminal cancer who was requesting access to lethal medication. In Colorado, where such prescriptions are legal, more than a third of acute-care hospital beds operate under Catholic rules that ban abortion, most forms of contraception, sterilization, in vitro fertilization and aid-in-dying. Nationwide, Catholic hospitals have denied gender-affirming care to transgender patients, pressured people to bury their miscarried fetuses and turned away or delayed care to patients who are miscarrying. The Seventh-day Adventist Church also opposes abortion and aid-in-dying.

Colorado’s aid-in-dying law, passed by voters in 2016, allows religious facilities to ban doctors from prescribing lethal medication when the patient intends to use it “on the facility’s premises.” Morris’s patient, Neil Mahoney, planned to take the medication at home. Transferring Mahoney’s care to another system would require him to start his evaluation over again, likely repeating blood tests, CT scans and biopsies he had already had.

Morris first tried to challenge the policy internally, but a Centura attorney told her that while the ban “conflicts with Colorado law,” it was consistent with the system’s religious beliefs.

Five days after Morris and Mahoney filed a lawsuit against the policy, Centura executives showed up at Morris’s office. They asked for her badge and computer, and handed her a letter accusing her of “[encouraging] a morally unacceptable option.”

“It is our religious judgment that your conduct in relation to Mr. Mahoney violates the religious principles upon which the Hospital operates and warrants the termination of your employment for cause, effective immediately,” the letter read.

Morris was shocked. On October 7, she filed an updated complaint accusing Centura of illegally firing her in retaliation for her lawsuit. “This case is about whether Centura Health … can inject its religious views into the doctor-patient relationship in violation of Colorado law — and whether an employed physician has a right to challenge that interference,” her lawyers wrote.

But legal experts say far more is at stake than that.

“The Centura case, I think, risks the ability of doctors to perform care consistent with public, democratically adopted decisions about reproductive and end-of-life care,” Elizabeth Sepper, a professor at the University of Texas at Austin School of Law, told Truthout. The firing of Morris “stands as a sort of cautionary signal to physicians, and perhaps is meant to tell them that speaking out or getting involved in physician aid-in-dying or in reproductive health is going to lead to your termination of employment.”

Religious corporations like Centura have, in recent years, gained vast new powers to ignore laws. In 2014, the Supreme Court’s Hobby Lobby ruling allowed for-profit corporations to refuse to provide birth control coverage to employees. In 2017, the Supreme Court allowed Catholic hospitals to generally get around the law protecting employee pension funds on the grounds that these funds were “church plans.” This year, the Trump administration proposed a rule to give religiously affiliated federal contractors broad leeway to discriminate against employees who are LGBTQ or disagree with their company’s religious views. These expansions of corporate religious exemptions have come as health systems like Centura have expanded their hold on the health care landscape; at least 1 in 6 acute-care hospital beds nationwide is subject to Catholic rules. In dozens of communities, including in Colorado, Catholic hospitals are the only option in reach. Centura itself is now Colorado’s largest health care system.

In response to Morris’s lawsuit, Centura sought to have the case heard in federal rather than state court, arguing that its right to enforce its policy and fire Morris may be protected by the Constitution and the Civil Rights Act. This month, a federal judge denied that request. But that doesn’t make Centura’s arguments any less chilling, experts said.

“If Centura is right about how the Constitution and the Civil Rights Act work, then it follows that a religious organization could fire employees for noncompliance with any religious rule they put in place,” Sepper said. Such institutions could, in other words, fire someone for being LGBTQ, getting pregnant outside of marriage or getting divorced. (Many states already lack protections for LGBTQ workers and the Trump administration argued before the Supreme Court this month that such workers aren’t protected by federal employment nondiscrimination laws.)

Part of Centura’s argument in the case hinges on an apparent attempt to broaden an existing doctrine that allows religious employers to fire people in ministerial roles.

“What the hospital seems to be arguing here is that every single employee becomes a minister, so [they] could be fired any time that a religious organization says, ‘Hey, you violated our rules,’” Sepper said.

In an interview with Truthout, Jason Spitalnick, an attorney for Morris, dismissed the idea that doctors should be treated like ministers.

“At some point, there has got to be a line between an entity providing ministerial services and one that’s providing services that are ordinarily considered to be secular,” Spitalnick said. “The services that hospitals provide are secular, medical services.”

In a statement, Centura said Morris had “publicly disavowed the values of Centura Health and actively condoned medical aid-in-dying, in violation of Centura’s policy.” Centura’s CEO, Peter Banko, has said that Morris was fired not because of the lawsuit, but because of the values she expressed in filing it. “Had she never said any of that, we wouldn’t be discussing the termination of her employment,” Banko told KUSA in Denver.

In an interview with Truthout, Morris dismissed that argument.

“There’s nowhere in the [employment] contract that says you have to agree with the [Catholic rules], right? It says you’ll abide by them,” she said. “That, to me, is really important. Your employer can get to tell you what to think? That, to me, is totally outrageous.”

Colorado is one of nine states — plus Washington, D.C. — that allow aid-in-dying. Other states, including Washington State, have had trouble ensuring access because of a high concentration of religious facilities.

On another front, disability activists have raised concerns about aid-in-dying laws and their implications for people with disabilities.

“In a society that prizes physical ability and stigmatizes impairments, it’s no surprise that previously able-bodied people may tend to equate disability with loss of dignity,” the disability rights group Not Dead Yet wrote in an online toolkit. “This reflects the prevalent but insulting societal judgment that people who deal with incontinence and other losses in bodily function are lacking dignity. People with disabilities are concerned that these psycho-social disability-related factors have become widely accepted as sufficient justification for assisted suicide.”

Yet even those who oppose the legalization of aid-in-dying per se from a disability justice perspective may still have reason not to hope that Centura executives prevail in their legal battle, due to concerns about the larger ripple effects that this case could have in relation to the fundamental question of whether religious corporations are exempt from the law. Religious entities, including hospitals and schools, have invoked religious exemptions to defend against allegations of mistreatment by disabled patients and to justify firing disabled workers.

“There is always concern over how broad of a brush they can paint with religious exemptions and could that be used to deny other treatments?” Josh Winkler, a member of Atlantis ADAPT, a disability rights group based in Denver, Colorado, told Truthout. While he agrees with the opposition by religious health systems to aid-in-dying, Winkler said he objects to the fact that many would, for example, refuse to perform an abortion, even if someone with a disability needed it for medical reasons.

Ultimately, Morris’s case is not just about aid-in-dying, but about whether a religious corporation can insert itself into that medical decision-making process.

“We have to stand up as a profession and say: We cannot allow this. We cannot allow a corporation to tell us how to care for our patients,” Morris said. “We cannot pretend that these health systems are not big corporations, because they are.”

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