Religious Freedom in an Emergency Department

I worked as a staff nurse in a pediatric emergency department from the time I graduated nursing school through when I received my master’s degree in nursing, in total between 6-7 years. I started at age twenty-two.

I enjoyed being twenty-two. I lived in a left wing land with Obama soon to be entering office and even though I attended school in very conservative upstate New York I never really internalized the level of conservatism that abounds in most of the country. I was working in an inner city hospital in the Northeast happily back in my liberal bubble.

The Emergency department was a hodgepodge of characters. Attendings, residents, nurses, techs, EMTs, police, security, administration, social workers, psychiatrists, surgeons, pharmacists…you name it and we had them at some point working in the emergency department. At that age and in that geographical area I basically assumed every one was pro-choice, pro-LGBT rights, and pro-healthcare for all.

I was wrong.

One day I was taking care of a patient who was raped. She was young (children’s hospital being under 18), and scared, and traumatized. The physician spoke to her mom and her about all the options available to her. Rape kit, medications, etc. One of the options was the morning after pill which prevents pregnancy from occurring. The mom and the patient wanted to discuss it and they agreed to certain things but initially did not want the morning after pill. No one pushed it, as that’s not our role.

Later, after all the tests and interviews and near time for discharge the mom approached me and said they decided she would take the morning after pill. I said sure, and went to the desk where the physicians were sitting. The Attending and the resident were sitting next to each other making my life easier. I told them the patient changed her mind and wanted the morning after pill.

The Attending looked awkward and said, “Okay, but I can’t order it,” and he looked at the resident, and she looked awkward and said, “Yeah I can’t order it either,” I stared at both of them like they had two heads and genuinely asked, “Is there something wrong with your computers?” They both shook their heads and avoided eye contact with me. I stood there staring at both of them and said, “Well some one has to order it because this kid was raped and she doesn’t want to get pregnant. So what’s the freaking problem?”

It still had not penetrated my head that they couldn’t order it because their religious beliefs prevented them from ordering it. I literally was still thinking there was a technical issue and for some reason the system was not allowing them to order it. I know it sounds so stupid, but I was young and naive and hopelessly liberal.

Another Attending overheard our exchange and likely heard my statement, and saw me standing there with my hands on my hips glaring at the computers and the doctors, and quietly said, “I’ll do it.”

That’s when I got it.

I remember walking away silently to the medication room. Later I was with the Attending who ordered it and I asked what would have happened if it was night shift and they were the only two doctors in the ED? He told me they would have ordered it. But I wasn’t so sure. I’m still not. I’m thinking if it was night shift and they were the only ones in the ED I’d be trekking up to the ICU and finding one of their Attendings to place the freaking order.

This happened eleven years ago. I still remember it vividly. For many reasons.

For starters I never envisioned patient care being affected by some one’s religious beliefs. I remember we had a travel nurse from North Carolina. She told me they don’t even offer it to rape victims where she worked down south. I thought that was shitty. Still do.

If birth control is against your religious belief I would hope that murder, rape, pedophilia, burglary, tax evasion, etc. are also against your religious beliefs. Do physicians regularly screen their patients for committing tax fraud? Because let’s be real, everyone in America who owns a business probably has kept cash for themselves and not reported it as income. Do you not treat them because they are stealing and committing tax evasion? Do you not treat men who’ve committed rape when they arrive in the ED for a heart attack? Do you not treat the man who arrives in the ED after having a heart attack while he is screwing a prostitute who also arrives with him, but quickly exits when she hears the wife is on the way (Yes that’s happened)? Why is it that you can pick and choose what religious beliefs you follow at work and which you don’t?

You shouldn’t, hence why religious beliefs should not affect the delivery of healthcare.

Here’s one that will totally trip you up- would you refuse to treat a pregnant transgender man who wants to have the baby? What about all that pro-life chatter? Or does pro-life mean you’re only going to treat the lives that matter to you? 

The Health and Human Services Department recently formed a committee to explore religious freedom within healthcare. Per LamdaLegal article the aim of the committee is to protect from consequences health care providers who refuse services to patients due to religious beliefs. It makes me sick that in the United States we have one of the highest Maternal mortality rates in the Western world, but no we aren’t going to form a committee to save women’s lives during childbirth.

In 2009 a study out of Harvard wrote that about 45,000 deaths in one year were attributed to people not having health insurance. But we are focused on decreasing access to care instead of increasing it. Psychiatric hospitals are losing funding, states are shutting down facilities, families with severely autistic individuals have no long term plans for placement. The United States has one of the highest infant mortality rates in the Western world. But we can’t focus on that. Our current administration is instead focusing on restricting care.

But I digress. My patient got her medication preventing pregnancy. Thanks to an Attending who was not conflicted about ordering it.

My heart aches for the number of people within the LGBT community, who if this committee actually makes progress, will hesitate to receive healthcare services because they are fearful of being refused services.

Religious freedom is a beautiful component to American society and the foundation on which our country was built. But religious beliefs do not belong in healthcare delivery. Science, education, and clinical experience should be the basis of medical decision making.



“You mean the sperm donor?” “Yes the biological dad.”

I am going to preface this blog post with the statement that I love my pediatrician group. They are very smart and very professional and I’ve met all of the doctors in the large group practice over the past two years. Twin boys in daycare catch just about everything and then we also have the physicals. We spend a lot of time at our pediatrician’s office. A lot.

At their two year physical we were asked for health history (and not for the first time) we were asked for information about their “biological dad” also stated as “bio father” throughout the dialogue. The first time it was asked my wife and I both kind of stopped and stared and then the dialogue went something like this….

I said, “You mean the sperm donor?”

“Yes, the bio father.”

“You mean the sperm donor?”

“Yes their biological dad.”

“You mean the sperm donor?”

“Yes, do you know any of the history of their biological father?”

“You mean the sperm donor?”

This all was said in less than thirty seconds. Then I said we don’t know much and we all moved on. I think by now you can see where I’m going with this.

Something about the term Dad or Father being placed into my children’s vocabulary when it really has no place there at all pissed me off. It also made me feel vulnerable and protective. Was this person messing with me? Were they being deliberately obtuse or worse deliberately hurtful? Or were they, as I suspect and my wife concurs, just not educated on caring for a two mom family?

My sons are two. They don’t know yet what a dad is. But at some point they will. I don’t want the anonymous sperm donor placed as a father figure in their lives. Because he’s not. We don’t know anything about him except his height, eye color, and age at the time that he donated the sperm. The boys have the option of contacting him when they turn eighteen. And that will be their choice. But I hope at that time it is not out of some longing for a father they never had.

When caring for a two-mom or two-dad or whatever kind of family is presenting in a healthcare provider’s office it would be polite if you ask how they refer to one another. Because there are some two-mom families who do know their sperm donor and do refer to him as the “biological Dad” or whatever. But that’s not my family.

Wherever we take the boys for healthcare we are going to face these vocabulary issues. We are going to have to answer potentially rude (intentionally or unintentionally) questions and we are going to have to do this all in front of our sons. We have to model behavior and vocabulary for them. Because I can’t freak out on every health care provider or secretary who makes assumptions. But I don’t want to sit back and not address the issue.

After that exchange in the pediatrician’s office I thought about my response. I was caught off guard, even though it’s happened there before, so I needed to think of my response next time. I need to overtly say, “We don’t refer to him as the dad or father, the sperm donor is our preferred term. Thanks.” Set the boundary in the moment instead of engaging in this back and forth with some one who thinks sperm donor is synonymous with biological dad. It’s not.

I also contacted their office and gave the feedback that perhaps with diverse families they could ask about preferred names and terms.

Entering a healthcare provider’s office is scary and vulnerable for any one. Add in that we are a minority with our young sons with our own narrative and it makes me instantly defensive mostly because I want my son’s protected and I want the people caring for them not to care for them differently because they have two mom’s.

Dad is a protected term to me. It depicts an individual who has a vested interest in a child’s development. I have a Dad. I know what it’s like. He was and is a good Dad. The boy’s don’t have a dad. They have a sperm donor. They also have two Mom’s. If I donated my eggs and never met the resulting child I would not expect to be referred to as the Mom. I would be the egg donor. The child would hopefully have either a Mom or Dad or two of each. But I would not have a vested interest in that egg’s development into a child, therefore would not presume to be named a parent.

The moral here is if you work in healthcare and care for diverse families, just ask how they want their roles to be referred to or defined as. It makes life for us much easier.


It’s not a phase.

I was asked by a friend recently to give a lecture to students studying psychiatry about treating LGBTQ youth. I decided I wanted to make a list of “Do’s and Don’ts” as part of the presentation. I started asking my clients their experiences with healthcare providers: the good, the bad, and the ugly.

I took away a few things from these discussions. I did not have one client on my caseload who had not in some way experienced discrimination in the form of micro aggression from healthcare providers. I also did not have one client who was absolutely horrified by their experience. They all relayed to me stories very easily and with flat affects about these awful experiences. They only became somewhat upset about it when I reflected to them how terribly they had been treated in those moments. Overall they had a calm acceptance of how they had been treated and discriminated against.

All of these clients who had been shamed, questioned, and put down by healthcare providers who they were supposed to be able to trust, were under the age of twenty-two.

Some of these clients I knew for awhile. These small moments of discrimination had never been shared before I asked. Thank God I asked. Why hadn’t I asked before? I had asked all of them at some point about discrimination they faced. But I never specifically asked about that discrimination being within healthcare.

Micro-aggression is an amazing term. It captures the daily put-downs and small discriminatory acts that cause the break down of people’s souls.

In the “What not to say” list one of my clients said to tell people “Never ask if it’s a phase.”

It’s not a phase.

By the time a person comes out to a healthcare provider they know it’s not a phase. They’ve likely been tortured by thoughts and feelings for years and over time developed language of their own to name themselves as gay or lesbian or queer or transgender or whatever.

It has never crossed my mind to ask clients if this is a phase. Because even if their sexual attraction or gender identity changes and develops over time I would not demean their narrative down to a “phase”. It’s not the role of any healthcare provider to question a person’s self-definition in a demeaning manner.

Healthcare providers are in a unique position. We are a necessity for people because our human bodies are fragile so every one in the LGBTQ community will have at least one experience in their lifetime with some sort of provider. If an individual presents for mental health services they didn’t just decide to come in for services. They have been thinking and thinking and picking up to call and hanging up and canceling the intake, and rescheduling, so when they finally make it through the door to be asked if it’s a phase just made that entire struggle worthless. They walked through the door looking for a safe space and instead found more ignorance and intolerance.

Microaggression is defined as “a statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority.” per Google Dictionary.

It’s calling your transgender son “her, she” or “daughter” for the thousandth time even though they’ve been out as a male for a year. It’s a question of the validity of your belief that you identify as gay or lesbian or bisexual. It’s an assumption that because you’re a gay male you have HIV or you’re a slut or you want to be my bestie and go to the mall with me. It’s the assumption that your lesbian daughter’s girlfriend made your daughter this way. It’s the displacement of blame for something that should not be seen as a problem in the first place. It’s outing your child to people they are not ready to be out to. It’s seeing headlines in the news every day of transgender people being murdered and reading the comments from people who feel this was an act of justice. It’s living next to neighbors who you’re not sure are LGBTQ friendly. It’s being on edge everywhere you go and in every interaction you have with every person in a 24 hour period.

It’s so many little things that happen daily in the lives of LGBTQ youths that scrape away their self worth that leads to the high rates of depression and the high suicide rate.

Suicide rate is such a pretty term for young people killing themselves.

This is a message to all my fellow healthcare providers in whatever capacity you interact with LGBTQ individuals do it with compassion and validation because kids are dying. Don’t let your own beliefs interfere with the implicit oath you take by working in healthcare that you will provide quality care to all individuals. All providers should be safe spaces for all minorities.

Don’t ask if it’s a phase. It’s not.

Don’t tell them their sexual orientation or gender identity isn’t important to the care you are providing. It is.

Do ask if they feel depressed. Do ask if they have thoughts about dying.

Don’t screw up the potentially one and only contact with healthcare a person has before they die because of ignorance and hate.