A federal judge recently ruled against the University of Maryland Medical System in finding that it discriminated against a transgender Baltimore man, Jesse Hammons, by refusing to perform a hysterectomy that was recommended by his physician to treat gender dysphoria. This matter concerns every Marylander — regardless of gender identity. The ruling supports all patients’ access to care and keeps vital medical decisions between patients and doctors, rather than subject to arbitrary institutional policies.
The Hammons case arose at the University of Maryland St. Joseph Medical Center in Towson, which has been operated as a Catholic hospital since 1864. St. Joseph’s was acquired by UMMS in 2012 under an agreement that stipulated that its religious identity would be maintained. At the time, UMMS board member and former state Sen. Francis X. Kelly offered reassurance that, “All of the ethical standards of the church will be upheld. That won’t be a problem at all.” In fact, 10 years later, it has become a big problem, with major legal and ethical issues coming into conflict with the care provided (or denied) by St. Joseph’s.
St. Joseph’s abides by the Ethical and Religious Directives for Catholic Health Care Services. These directives prohibit services like sterilization, infertility treatments, birth control and abortion. The National Catholic Bioethics Center, which audits St. Joseph’s compliance with the directives, holds that gender transitioning “is intrinsically disordered because it cannot conform to the true good of the human person, who is a body-soul union unalterably created male or female.” The center further states that, “Gender transitioning should never be performed, encouraged, or positively affirmed as a good in Catholic health care.”
However, Catholic hospitals vary in how they apply the directives. Hysterectomies are regularly performed at St. Joseph’s, but when the administrative staff learned that the purpose of Hammons’ procedure was to treat gender dysphoria, they canceled it a week before it was scheduled to take place. In 2020, Hammons charged St. Joseph’s with violating the Affordable Care Act, as well as his constitutional rights.
The diagnosis of gender dysphoria, which is recognized by the World Health Organization and the American Psychiatric Association, refers to the stress and impairment experienced by people who identify as a different gender from the one they were assigned at birth. To address the condition, gender-affirming treatments are recommended. When Hammons sought a hysterectomy, it was not for the purpose of sterilization, but rather a recommended treatment, and a medical decision made with his doctor for a diagnosed condition.
But is Hammons’ case discrimination? To determine that, we must ask whether factors other than Hammons’ gender identity were considered. If a woman is diagnosed with uterine fibroids and seeks a hysterectomy as treatment, that procedure will be provided at St. Joseph’s despite the fact that it renders her sterile. If the same patient seeks a hysterectomy to treat a diagnosis of gender dysphoria, that procedure will be denied at St. Joseph’s on the basis of Catholic ethical beliefs that are not shared by the majority of patients and that conflict with standards of modern medical care. Representatives from St. Joseph’s confirmed in the Hammons case that gender dysphoria is the only diagnosis for which they will not provide the recommended treatment of hysterectomy.
Denial of medical care on the basis of transgender identity is discrimination, and Marylanders should be wary of a policy that prohibits their physicians from delivering standard, evidence-based health care.
This issue is broader than one state or one hospital system. In the U.S., one in six hospital beds is part of a Catholic health system. In some states, one-third of total admissions are to Catholic hospitals. As more states enact anti-transgender legislation, it is critical for hospitals, including those in Maryland, to ensure access to care for this vulnerable population.
In March 2022, the U.S. Department of Health and Human Services took a positive step, issuing guidance stating that “Health care providers who believe they are or have been unlawfully restricted from providing health care to a patient on the basis of that patient’s gender identity may file a complaint” with the Office for Civil Rights. This guidance represents progress, as does the federal ruling against UMMS in the Hammons case. Such actions affirm that it is critical for hospitals to provide equitable, just treatment for all patients, regardless of gender identity. Maryland hospitals have an opportunity to lead the way and ensure that all patients have protection from discriminatory practices and respect for decisions they make with their doctors.
Rachel Box (Twitter: @RachelBox5) is a graduate student in bioethics at Albany Medical College, as well as an assistant professor at the Johns Hopkins School of Medicine and director of editorial services within the Department of Orthopaedic Surgery there.