An LGBT Medical Rating System: A response to Washington’s latest decision

By Lynnea Urania Stuart


It’s like another bowl of the seven last plagues, but instead of being poured out by God, it’s poured out by a double-tongued White House.  This week’s executive decision to create a “Division of Conscience and Religious Freedom” within the Department of Health and Human Services (HHS) reads like a carte blanche license to refuse medical services to LGBT peoples and to women who either seek or have ever had an abortion.

It reeks of a world without grace or forgiveness, a green light for religionists to pass medical judgments against demographics with whom they may not happen to like or agree.  It’s not just a problematic decision in terms of the well being for all Americans.  It’s problematic for religion and spiritualities as well, whether Evangelical, Catholic, or any other tradition, Abrahamic or non-Abrahamic.

It forces an issue regarding conscience.  While there is precedent in New York that one who opposes abortion on religious and ethical grounds should not be compelled to provide the service and allow another employee to be assigned without disciplinary action,1 it’s clearly a step backwards for many who must decide whether medical ministry should only be provided to those whom they can consider to be potentially acceptable church converts.  In other words, will one’s medical ministry coincide with the words of Y’shua, “Freely ye have received; freely give?” 2 Or will that coincide with a contemporary consensus that says, “Repent according to the decisions of our denomination and ye shall receive a flu shot, else ye shall die?”

The onus is now upon the religious more than ever.  For us who may or may not be members of anti-transgender religious bodies, perhaps we need a system by which we can rate medical practitioners as to whether they are willing to help transpeople or not and to what degree.



On January 16, 2018, Politico warned that a new “division” within the office in charge of civil rights at HHS charged with oversight and enforcement of “religious freedom” protections for health care workers.  How extreme would this enforcement be?  HHS would have the ability to punish health care organizations who won’t allow employees to deny medical treatment based on “moral objections” to anyone who is gay, lesbian, bisexual, transgender, or may have made a medical choice that disagrees with that employee.3

What remains to be seen in terms of how draconian this may turn out to be is whether any employee, however low in rank, could force an entire organization into refusal to treat.

Thursday, January 18,  Roger Severino, Director of the Office for Civil Rights at HHS declared, “Never forget that religious freedom is a primary freedom, that it is a civil right that deserves enforcement and respect,” 4

But, we must ask, does this apply to “religious freedom” pertaining to all religions, or only those who are deemed “acceptable” to the Evangelical-Catholic Alliance and ruled by Dominionists?  Would this require enforcement of a Hindu choosing to deny treatment to those who eat beef?  Would this require enforcement of a Jehovah’s Witness choosing to deny treatment that involves blood transfusions?

Certainly not.  The parachurch organizations that pushed for this rule don’t care for those outside their alliance.  They only care about forcing people into their churches.  This rule is clearly an establishment of a certain genre of religions by government intervention.

It’s easy to see how this approach to “discrimination” as defined by judgmental religionists can lead to the kind of religious warfare early American colonists had desired to leave behind in Europe.  It’s also easy to see how the American Civil Liberties Union would be very interested in test cases.  In fact the ACLU reportedly tweeted:

Religious liberty doesn’t include a right to be exempt from laws protecting our health or barring discrimination.  It doesn’t mean a right to refuse to transport a patient in need because she had an abortion.  It doesn’t mean refusing care to a patient because she is transgender.”5

Severino’s idea of a “primary freedom” being a civil right deserving of “enforcement” is far different from allowing an employee to simply not take part in a treatment the employee considers in conflict with his religious practice or moral sense.

It makes sense that Roger Severino would take such a radical position.  Donald Trump appointed him in 2017 from the Evangelical parachurch organization, The Heritage FoundationIn 2016, he had written a report critical of the transgender protections of the Obama administration.6

Not all medical practitioners are on board.  In fact, there is ample belief that the new rule would impose a destructive effect upon  medical ethics and practice.  Ben Brown, a Doctor of Gynecology and Obstetrics and a fellow with Physicians for Reproductive Health referred to oaths taken by medical professionals including the Hippocratic Oath.  He reportedly said, “Imposing their values on a patient is not in consort with our professional job as doctors.”7

It’s clear that, apart from those who have had an abortion, transpeople specifically are in the crosshairs.  Organizations like The Heritage Foundation that ostensibly oppose transpeople already understand that transpeople require elevated levels of medical treatment.  Their clear objective is to deny any prospect of transition, and if one has transitioned or is transitioning, deny life-sustaining care.  In plain terms, Dominionists really do want us to die one way or another.  Imposing upon medical practitioners in this way amounts to an attempt at mass murder of all who do not enter so-called “conversion therapy,” which for us would be a fate worse than death.

An Alt-Right publication presented the move as “open season on faggots,” and expressed “hope” that this is a “prelude to much greater things to come.” 8 What are these “greater things” specifically, concentration camps?  Do these “greater things” include a license to kill in the manner of the “Shoot the Gays Initiative,” also known as the “Sodomite Suppression Act,” that then California Attorney General Kamala Harris succeeded in keeping off the ballot?9



Our own response would necessarily require change to what we had done all along prior to the Affordable Care Act upon which many transpeople have relied for treatment.  Many of us, especially younger people, have not known a time in which transition was done entirely in secret and how facing rejection in families and at work had been events even more dangerous than they have been in recent years in which transgenderism had gained greater acceptance.

In many cases, that greater acceptance will not have changed.  While we used to label medical and psychiatric practitioners as well as other businesses as “gender friendly” or “not gender friendly,” we need to look at how institutions thought of as “gender friendly” might have crusaders in their ranks attempting to enforce denial of medical treatment.  We also need to consider whether a medical office or hospital may have had litigation brought against them, the outcomes, and whether they continue to resist.

Such a system might look something like this for institutions in the future:

  1. Gender friendly institutions
  2. Institutions who are not gender friendly
  3. Gender friendly institutions constrained by individuals not gender friendly
  4. Gender friendly institutions constrained by government action or litigation
  5. Gender friendly institutions who are gender friendly and are resisting government action or litigation
  6. Gender friendly institutions who have succeeded in their resistance.

A similar approach might apply to individual practitioners:

  1. Gender friendly practitioners who are gender friendly
  2. Practitioners who are not gender friendly
  3. Gender friendly practitioners constrained by others in their office not gender friendly
  4. Gender friendly practitioners facing government action , litigation, or institutional discipline for allowing treatment
  5. Gender friendly practitioners resisting government action, litigation, or institutional discipline for allowing treatment
  6. Gender friendly practitioners who have succeeded in their resistance.

Such a rating system would also have to be kept off the open Web for the protection of individual practitioners and institutions given a decaying climate of religio-political intolerance.  This would have to be kept strictly a word-of-mouth designation under advisement of local transpeople.

Please understand.  These are only measures to consider as a possibility for the future.  We haven’t yet come to the point of litigation or government interference.  We haven’t come to the point in which a practitioner may be prosecuted ex post facto for having ever treated a transperson, though there are some who would desire exactly that.

It also means that the often schismatic trans community will have to stand together in cooperation like it has failed to do for decades.  It means a demand of greater respect for one another than what has been the norm among business entities and transgender organizations that rule over their clientele in a cultlike manner.  Internal infighting could become deadly for others, figuratively speaking at first, literally if certain factions in American society have their way.

It also means that religionists must come to terms with the damage they often do in their practice.  No greater damage has been sustained by religion and no greater damage has been imposed upon religionists than the exploitation of religion to inflict harm upon others.  The very entities that seek to withhold life-sustaining care upon transpeople destroy their own ethic of mercy.  While they may speak to the damage a woman may have sustained in herself due to abortion, the same do very little to nurture children brought to term, replacing an awe of innocence with an imposition of guilt through a doctrine of “original sin,” and teaching those children to become twice the children of hell as themselves.  We may well praise the unborn more than the living.

In like manner, whether they realize it or not, the pogroms sought by religionists against LGBT peoples do much the same damage to themselves.  One cannot claim “unconditional love” while nurturing and teaching hatreds tantamount to murder.  The greater damage isn’t to transpeople, a minority of minorities.  The greater damage is to themselves.

And here is where reform really happens.  We who transitioned, on the most part, have already made our peace with our consciences concerning who we are.  Religionists, however, often remain more conflicted than us.  Our people will survive one way or another just like we have since prehistory, simply because we can do nothing else as a people.  In the meantime we must protect one another and those who help us as well.



Featured Image:  The logo for the Department of Health and Human Services superimposed upon a Protestant church whose aura has been diminished.  (Wikimedia Commons)


  1. Tom Callahan. “Backing the Right of Nurses Not to Assist in Abortions” New York Times (January 4, 1988, accessed January 18, 2018)
  2. Matthew 10:8
  3. Dan Diamond and Jennifer Habercorn. “Trump to overhaul HHS office, shield health workers with moral objections” Politico (January 16, 2018, accessed January 18, 2018)
  4. Alison Kodjak. “Trump Admin Will Protect Health Workers Who Refuse Services On Religious Grounds” NPR (January 18, 2018, accessed January 18, 2018)
  5. Twitter (7:58 AM – Jan 17, 2018, accessed January 18, 2018)
  6. Zack Ford. “Trump administration’s new ‘religious freedom’ rule will encourage discrimination in health care” Think Progress (updated January 18, 2018, accessed January 18, 2018)
  7. Juliet Eilperinand Ariana Eunjung Cha . “New HHS civil rights division to shield health workers with moral or religious objections” Washington Post (January 17, 2018, accessed January 18, 2018)
  8. Nick Duffy. “Nazis are thrilled that Trump has ‘declared open season on faggots’” Pink News (January 17, 2018, accessed January 18, 2018)
  9. Anita Chabria. “California ‘Kill the Gays’ ballot blocked” The Guardian (June 23, 2015, accessed January 18, 2018)
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