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Federal court rules religious healthcare providers can’t be forced to perform abortions or transgender surgeries


“This ruling is a major victory for conscience rights and compassionate medical care in America. Doctors cannot do their jobs and comply with the Hippocratic Oath if the government requires them to perform harmful, irreversible procedures against their conscience and medical expertise.”


In a big win for religious freedom, a federal appeals court has blocked the Health and Human Services mandate that would have required doctors to perform abortions and gender transition surgeries against their religious beliefs.

Quick Facts

After a circuitous court battle, Franciscan Alliance and other Christian healthcare providers may have finally secured protection from Obamacare’s transgender treatment mandates. In 2016, the Obama administration issued guidance that abortions and transgender surgeries were to be included as part of protections against discrimination, known as Section 1557. That began a court battle with Franciscan Alliance, a Catholic hospital, among others. A district court granted protection through a vacatur of the challenged portions of the rule but not a permanent injunction.

In 2021, President Biden signed an executive order declaring that his administration would apply the Supreme Court Bostock ruling prohibiting discrimination against transgender employees to other statutes, including Title IX and the Trump Administration’s Rule 2020, which replaced Obama’s aforementioned rule by, among other things, allowing religious exemptions and “defining sex as male and female according to biology.”

Biden’s order reignited the issue, but in 2021, a district court granted a permanent injunction against both the transgender and the abortion mandate. The administration, however, appealed. On Friday, the Fifth U.S. Circuit Court of Appeals affirmed the lower court’s ruling.

The HHS had argued that Franciscan Alliance’s claim was moot because it was made against the 2016 Rule and not only had those sections been removed, but a new rule, the 2020 Rule, had replaced it. Judge Don R. Willet wrote:

“It is true that a case can become moot if the defendant ceases the allegedly unlawful conduct—including when a challenged statute, executive order, local ordinance, or regulation expires or is repealed. But ‘a defendant cannot automatically moot a case simply by ending its [allegedly] unlawful conduct once sued.’ If that is all it took to moot a case, ‘a defendant could engage in unlawful conduct, stop when sued to have the case declared moot, then pick up where he left off, repeating this cycle until he achieves all his unlawful ends.’”

Willet added that the burden rests with the defendant to demonstrate that the wrongful behavior will not occur again. “HHS has not carried its burden,” the court wrote. “It has become even clearer that Franciscan Alliance’s RFRA claim is not moot. Just months ago, HHS issued the 2022 Notice, which warned covered entities like Franciscan Alliance that refusing to offer gender-reassignment surgeries violates Section 1557.”

Willett added, “HHS has also repeatedly refused to disavow enforcement against Franciscan Alliance. In its brief on appeal, HHS simply says it ‘has not to date evaluated’ whether it will enforce Section 1557 against Franciscan Alliance—in other words, it concedes that it may.”

Joseph Davis, counsel at Becket, the law firm that represented Franciscan Alliance, hailed the ruling, saying,

“This ruling is a major victory for conscience rights and compassionate medical care in America. Doctors cannot do their jobs and comply with the Hippocratic Oath if the government requires them to perform harmful, irreversible procedures against their conscience and medical expertise.”

Davis added, “For years, our clients have provided excellent medical care to all patients who need it. Today’s ruling ensures that these doctors and hospitals may continue to do this critical work in accordance with their conscience and professional medical judgment.”

This mandate has repeatedly been blocked and it’s easy to see why. It is hard to imagine a more egregious violation of religious and personal freedom than forcing a doctor to perform an abortion when they believe it is the murder of a child or forcing them to mutilate otherwise healthy persons for the sake of unproven, unnatural “gender affirming care.” You would think even a government with a thirst for control would be able to readily recognize that if these procedures are to be legal, there should at least be exemptions for doctors who would be performing these procedures contrary to their beliefs.

Yet ours is a government long past simply being a conglomerate of control freaks. It is now teetering dangerously on the precipice of tyranny — if it hasn’t fallen headlong already. They know these procedures are controversial and they know many doctors and hospitals object to them, and yet these fundamentals of medical and religious ethics are of no concern to government officials. Their only concern is that they are a challenge to the left’s vision for the country, and all challenges must be stomped out and all religious dissenters brought to heel in order for them to reach their goal.

The Religious Freedom Restoration Act (RFRA) was passed in 1993 to better protect Americans’ right to the free exercise of their faith, a right which should already have been protected by the Constitution. It passed on a bipartisan basis 97-3, and even then-Sen. Joe Biden voted for it. Yet in less than 30 years, the RFRA has become a key target of the left, which seeks to overrule it at every turn, opting to impose their own beliefs on all Americans. They not only ask but demand that the masses ignore what is plain to them and instead march forward with their desire for a world that thrives on marring the image of God.

Bravo to the courts who upheld the religious rights of doctors and to those who joined the lawsuit. In order to stop rogue agencies, Americans must utilize the legal avenues available to them.

In Exodus chapter 1, Pharaoh ordered that the Hebrew midwives kill every Hebrew boy who was born. In Egypt, Pharaoh was seen as a god and his word was law. Yet verse 17 tells us, “But the midwives feared God, and did not do as the king of Egypt had commanded them, but let the boys live.” Verses 20 and 21 tell of God’s favor to the midwives. “So God was good to the midwives, and the people multiplied, and became very mighty. Because the midwives feared God, He established households for them.”

The midwives probably feared Pharaoh, but they feared God more and so they did not obey Pharaoh. American doctors face a similar situation. The federal (and, in some cases, state) government celebrates abortion and transgender surgery and demands that doctors perform these immoral procedures. It is up to medical professionals to decide whether they will obey the government or their beliefs. Fortunately, there are still healthcare providers who fear God and are willing to stand up and follow His commands, not the government’s.

Ready to dive deeper into the intersection of faith and policy? Head over to our Theology of Politics series page where we’ve published several long-form pieces that will help Christians navigate where their faith should direct them on political issues.

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