Gays and lesbians won a civil rights victory in California on Monday when the state’s Supreme Court ruled, in a case brought by Lambda Legal Defense Fund, that a doctor could not refuse to treat a lesbian woman for infertility based on the doctor’s religious beliefs. The ruling, North Coast Women’s Care Medical Group Inc. v. San Diego County, was based on California’s Unruh Civil Rights Act, which protects individuals from discrimination “in all business establishments of every kind whatsoever.”
Guadalupe Benitez began visiting the clinic when she discovered she had polycystic ovarian syndrome, a disorder that impaired her fertility. Benitez’s doctor treated her other symptoms of PCOS for over a year, but the doctor and a colleague at the clinic refused to perform intrauterine insertion, more commonly known as artificial insemination, in order to help Benitez become pregnant.
The doctors denied her this treatment on the grounds that their own religious beliefs dictated opposition to childbearing outside of heterosexual marriage. The court decided that clinics and medical practices qualified as business establishments and that the clinic in question violated Benitez’s rights by denying her care simply because she is lesbian.
The question at the heart of the case is fundamental to the practice of medicine and to people’s access to health care: Under what circumstances may a medical provider’s right of conscience impede the right of a patient to receive treatment? The Court ruled that, under the Unruh Act, a doctor may decide which medical services she will or will not offer; however, a doctor cannot decide what type of patient she will serve. If religious beliefs prevent a doctor from providing a certain treatment, those limitations must apply to everyone rather than, for instance, to gays and lesbians alone.
Regardless of one’s views on fertility treatments and the numerous ethical and legal questions they raise, it seems clear that if services are offered, they should be made available to all. The ruling fairly balances the interests involved and provides a bright line on which doctors and patients can rely.
Yet the case naturally was limited to its facts and major questions remain as to the ability of health care providers to refuse care based on moral codes and how those decisions affect access to quality, affordable health care. The balance of rights becomes murkier when only one category of people need a certain type of medical service—for instance, women who need birth control or transgendered people who need sex reassignment hormones and surgery. In those cases, a wholesale denial of a service is more problematic.
Pharmacists are increasingly invoking a right of conscience in order to refuse filling prescriptions to which they object. And it was recently revealed that the Department of Health and Human Services is considering a new regulation that would allow a wide variety of health care professionals to refuse to provide patients with access to, counseling about, and referrals for abortion and certain forms of contraception if they have a moral (religious or otherwise) objection to doing so. Where, then, does the right of conscience end and the right to treatment begin?
Many questions remain to be resolved when patient and provider rights are perceived to conflict. But the Benitez ruling is a positive step forward and should be celebrated for its strong stance against discrimination and for equal access to medical care.
Jessica Arons is the Director of the Women’s Health & Rights Program at the Center for American Progress. Stephanie Gross is a Domestic Policy Intern with the Center for American Progress.
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Director, Women's Health & Rights Program