The Power Worshippers

by Katherine Stewart

  Pastor Grosshans of Winter Garden, Florida, can count still more blessings from the powers that be. His son Joshua is a lawyer and he is married to a fellow lawyer, Jamie R. Grosshans. A graduate of Thomas Edison State College of New Jersey and the University of Mississippi School of Law, Mrs. Grosshans appears to have a thriving career. She clerked for the Civil Rights Division of the Department of Justice in Washington, D.C., and the United States Attorney’s Office for the Northern District of Mississippi. She has served on the board of directors for the Central Florida Christian Legal Society and, according to a biography accompanying an article she wrote for a publication of the Christian Legal Society, “frequently provides pro bono representation for crisis pregnancy centers.”42

  Jamie Grosshans, not surprisingly, is an officer in the Central Florida Federalist Society. A look further back at her career shows that she was a Blackstone Fellow with the Alliance Defending Freedom. In short, she is a beneficiary of the vast support system for young conservative legal minds created and managed through the legal advocacy groups of the Christian right. In 2018 the grooming paid off when she was appointed by Governor Rick Scott as a judge with the Fifth District Court of Appeal.43 According to the Orlando Sentinel, she is among eleven candidates for nomination to the Florida Supreme Court.44

  Jamie Grosshans’s climb up the right flank of the Florida judiciary mirrors the judicial takeover now occurring in the federal government, too. With Leonard Leo’s assistance, by March 2019, eighty-six Trump nominees had been confirmed since Inauguration Day: two to the Supreme Court, thirty-one to courts of appeals, and fifty-three to district and specialty courts. Trump also nominated fifty-eight individuals to the federal courts. At that time there were 170 current and known future vacancies, giving Trump an opportunity to leave his mark on nearly 20 percent of the federal judiciary.

  Among the many sordid legacies that the Trump/Pence administration will leave behind, perhaps the most damaging over the long term may well be the infiltration of America’s judicial system with the progeny of the Federalist Society, the Alliance Defending Freedom, and their allies.

  This is why Joseph Richardson keeps up his campaign, year after year, for what seems like symbolic representation in gatherings of local managers and lawmakers in Winter Garden, Florida. The symbol represents something far more profound, and more meaningful, than a twenty-second invocation. It is really about deciding what kind of nation the United States will become. Are we a nation in which one brand of religion enjoys a place of privilege? Are we a nation of laws—except in cases where the law offends the feelings of those who subscribe to our preferred religion? Will we recognize the equal dignity of all of our citizens? Or are we the kind of society that heaps contempt upon those groups that our national religion happens to despise?

  CHAPTER 11

  Controlling Bodies: What “Religious Liberty” Looks Like from the Stretcher

  Over the past decade, Christian nationalists have managed to convince many Americans that religious liberty is something that has to do with homophobic wedding cake bakers and florists. It’s all about symbolic acts and offenses that cause harm only in the mind, or so many are led to conclude. We really don’t get what the movement has in mind for us.

  What today’s Christian nationalists call “religious liberty” is in reality a form of religious privilege—for their kind of religion. But privilege is never free. It always comes at the expense of other people’s rights. And the rights that are at stake here are not just about buying cakes and flowers.

  The “religious liberty” of Christian nationalists can cost you your dignity, your health, your job, and even your life. I should know. I came close to paying for the “religious liberty” of others with my life. But before I share my experience, I want to tell the stories of those who have paid a much higher price.

  Some years ago a medical doctor whom I’ll call Dr. Reynolds worked at an HIV clinic at Yale New Haven Hospital, formerly the Hospital of Saint Raphael, a Catholic entity. At present, an estimated one in six hospital beds in the United States is now in a Catholic-run medical facility. Like all Catholic health care facilities, including hospitals, clinics, and affiliated providers, Saint Raphael was governed by a set of Ethical and Religious Directives (ERDs), a numbered set of rules that reaffirm Catholic teachings as they relate to health care. The ERDs, which act as guidelines for all Catholic health care facilities and impose limitations on the types of services and procedures they are able to deliver, are laid down by the Vatican and codified by the United States Conference of Catholic Bishops.1 They are the work of clergymen, not doctors. All employees of Catholic-affiliated hospitals and health care facilities must follow the directives as a condition of their employment. Many contractors and suppliers are also bound to the ERDs.

  A condition of Yale New Haven Hospital’s acquisition of Saint Raphael was that the ERDs must remain in place. So even though the HIV clinic at Yale New Haven Hospital was not a Catholic institution, it was compelled, as a term of the acquisition, to observe the ERDs. Such conditions are commonplace.

  The ERDs are very clear on the subject of contraception. Directive 52 spells it out: “Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teachings on responsible parenthood and in methods of natural family planning.”2

  For Dr. Reynolds, Directive 52 presented a problem: some HIV medications, such as Efavirenz, which decreases the amount of HIV in the blood, are known to cause severe fetal malformities and other complications in pregnancy. Yet Dr. Reynolds was not allowed to prescribe medication for the explicit purpose of preventing pregnancy. “We still do not hand out condoms,” she said. “We don’t prescribe birth control.”

  Dr. Reynolds recalls an experience with one patient, a young woman with HIV, who she wished to put on Efavirenz. “It’s a very potent antiviral medication, and has this very severe side effect of teratogenicity, which means it can cause severe harm to a developing fetus,” Dr. Reynolds says. “She said she wasn’t in a relationship and wasn’t sexually active. I gave her the medication and told her, ‘You shouldn’t get pregnant if you’re taking this.’ ” Because of the ERDs, Dr. Reynolds says, “I did not have the option of giving her birth control. I can do that by referring her out. But I could not prescribe birth control pills to prevent her from becoming pregnant on this med. She ended up getting pregnant and had a baby without a brain.”

  It is not terribly surprising, given Catholic doctrine on the topic, that the ERDs prohibit abortion. Directive 45 states, “Abortion (that is the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.” What many prospective patients don’t know is that, as a consequence of this prohibition, many Catholic hospitals either ban outright or are reluctant to perform a number of miscarriage-related procedures that the Church chooses to characterize as abortion.

  Mindy Swank of Illinois was one of those who found that out the hard way. Married and thrilled to be expecting her second child, she was at home one day when her water broke prematurely at twenty weeks. Through testing, she learned that the fetus had no chance of survival. But Swank was being treated at a Catholic hospital. The doctors at the hospital would not perform an abortion while there was still a fetal heartbeat—even though continuing the pregnancy put her health and life at risk. Mindy suffered through two weeks of emotional anguish as she waited for her body to complete the miscarriage on its own. Then one morning she woke up bleeding. She and her husband hurried to a different nearby hospital to ask them to treat her, but that hospital, too, adhered to Catholic “directives” and refused to induce labor. Over the next five weeks, desperate to ob
tain the medical care she needed, Mindy returned to that hospital multiple times and was consistently turned away. Nobody told her that she could get the abortion she needed at a non-Catholic hospital, and she continued to struggle with the emotional and physical strain. Then, at twenty-seven weeks, she began to hemorrhage. The hospital finally induced labor, and the baby died shortly after delivery.3

  Tamesha Means, a Michigan mother of two, also found out the hard way. She was eighteen weeks pregnant when her water broke. With a rupture of membranes that early, the pregnancy was doomed. Means made her way to the nearest hospital, which happened to be a Catholic facility operated by Mercy Health Partners. An examination confirmed what she already suspected: the pregnancy was not viable. An “abortion,” or termination, would have been the safest course of action, but instead, the hospital staff sent her home.

  The next morning, bleeding and in pain, Means returned to the hospital. By now she was showing signs of infection, yet again she was turned away. As the pain intensified, she returned a third time. And yet again the hospital staff attempted to send her home. But as an administrator was filling out the discharge paperwork, Means began to deliver the products of the miscarriage, and only then did the hospital provide the medical care she needed.

  The women who are harmed the most by these restrictions are often left incapable of telling their own stories. Dr. David Eisenberg, who was completing a residency at an Illinois hospital, recalls “the sickest patient I ever cared for during my residency.” A young woman experiencing a miscarriage had sought care at a different hospital, which was a Catholic facility. Although her membranes had ruptured, the hospital denied steps to hasten the completion of the miscarriage. Ten days later the young woman transferred hospitals and fell under Dr. Eisenberg’s care. By this point, Eisenberg recalls, she had a fever of 106 degrees and was “dying of sepsis.” She survived, Eisenberg says, but suffered a cognitive injury as well as an acute kidney injury requiring dialysis. The woman spent nearly two weeks in the hospital, after which she was transferred to a long-term care facility.

  “To this day I have never seen someone so sick—because we would never wait that long before evacuating the uterus” in a non-Catholic health care setting, says Eisenberg.

  There is no official count of the number of pregnant women who have turned to Catholic hospitals and clinics when something goes wrong, only to be denied the medical care they need. And it is not easy to find women willing to publicize the most intimate details of traumatic experiences in order to “prove” to the world what should not have to be proven: that pregnancy carries significant risk of complications, and hospitals and medical professionals in a modern society ought to allow best practices, rather than religious dogma, to guide their protocols of care. It’s also partly because patients do not necessarily know when they are being denied treatment on “ethical and religious” grounds. Hospitals are not required to explain why they are denying service or to inform their patients about other options for treatment. Evidently, the Ethical and Religious Directives do not prohibit the practice of deceiving patients.

  Despite the challenges in collecting information, a 2016 report by the American Civil Liberties Union (for which I served as an investigator), titled “Health Care Denied: Patients and Physicians Speak Out About Catholic Hospitals and the Threat to Women’s Health and Lives,” detailed the ways in which women experiencing pregnancy complications, miscarriage included, frequently do not receive the kinds of medical care from Catholic facilities that other, non-Catholic hospitals routinely deliver.

  A 2018 report by the Public Rights/Private Conscience Project, in conjunction with Public Health Solutions, explored the particular danger this arrangement poses to women of color.4 “Pregnant women of color are more likely than their white counterparts to receive reproductive health care dictated by bishops rather than medical doctors,” the authors wrote in the report, “Bearing Faith: The Limits of Catholic Health Care for Women of Color.” Perhaps these facts go some way to explaining the alarming trends in maternal health, particularly among women of color. America’s maternal mortality rate is the highest among nations in the developed world, and it is rising sharply, up over 26 percent between 2000 and 2014.5 Black women are three to four times as likely as white women to die of pregnancy complications. This report finds that “in many states women of color disproportionately receive reproductive health care restricted by ERDs” and suggests that the consequent dangers “should be evaluated against the backdrop of vastly inferior health care delivered to women of color across the board.”6

  Many medical professionals privately express their frustration with the situation—but they, too, can be reluctant to go public with their stories. “Tricia,” a thirty-one-year-old mother of three who works as an emergency medicine nurse at a Catholic hospital in northwest Indiana, also agreed to speak with me provided I use a pseudonym. (“All the medical facilities in this area are Catholic, so if I get fired, where am I going to work?” she says.) According to Tricia, the emergency room at her hospital periodically turns away women experiencing miscarriages. “I only work one day a week there,” she says, “but it happens a few times a year when I’m on duty, so I know it must happen more often than the times I’ve seen it.”

  Tricia recalls a nineteen-year-old woman who came to the emergency room seeking medical treatment for an ongoing miscarriage. Turned away twice, she developed complications. “She came in with a fever a few days later and they sent her home again. I don’t think she was actively bleeding all that much, but the baby was already dead and she wasn’t passing it on her own,” says Tricia. “They said, ‘It’s just spotting and it will get worse, so let’s just wait and see what happens.’ They didn’t even offer her methotrexate [a chemotherapy drug that will cause a woman to expel the products of a miscarriage]. They waited until her blood pressure was low and she was septic, and then they did the D&C.

  “It was a lot to put her through,” says Tricia. “She had to go through all that needless trauma—emotional, physical, and financial.”

  For Tricia, the denial of care at Catholic hospitals is also personal. Prior to the scheduled cesarean birth of her third child, Tricia decided, along with her husband, that their family was complete. The safest time for a woman to undergo a tubal ligation after childbirth is at the time of delivery. But the ERDs also prohibit “sterilization.”

  “So for me to get a tubal ligation,” says Tricia, “I would have had to wait until after recovery from childbirth, then go out of network and find another doctor who doesn’t know me or my medical history, travel to a non-Catholic hospital and have an unnecessary subsequent surgery, with all the expense, risk, and inconvenience.

  “There is no other situation in which doctors and the hospital will decline to treat a patient who presents with a medical complication,” she says, her voice rising in frustration. “Like if someone shows up with appendicitis, they won’t decline to treat them and just say instead, ‘Oh, you should go home; let’s just wait and see what happens.’ ”

  The power of imposing this kind of “religious liberty” on pregnant women isn’t just for hospitals. Pharmacists, too, can now enjoy the privilege. Nicole Arteaga, a first-grade teacher in Peoria, Arizona, found that out during an unexpectedly traumatic visit to her local Walgreens.

  In June of 2018, Arteaga was pleased to discover that she was pregnant with her second child. But at the ten-week mark, her doctor delivered devastating news: The fetus had no heartbeat and the pregnancy was failing. At the doctor’s suggestion, Arteaga decided to take misoprostol, a drug that antiabortion activists call an “abortifacient,” rather than undergo a needless, invasive, and expensive surgery.

  When she went to her local Walgreens to pick up the medication, however, the pharmacist refused to fill the prescription on the grounds of his own “ethical beliefs.”

  “I stood at the mercy of this pharmacist explaining my situation in front of my 7-year-old, and five customers standing behind on
ly to be denied because of his ethical beliefs,” she wrote on her Facebook page. “I left Walgreens in tears, ashamed and feeling humiliated by a man who knows nothing of my struggles but feels it is his right to deny medication prescribed to me by my doctor.”7

  According to today’s Christian nationalists, this type of “religious refusal” is a shining example of “religious liberty” in action. It isn’t.

  Arteaga was eventually able to fill her prescription at another pharmacy. So the defenders of this form of privilege will say that no real damage was done. But this is quite false. The humiliation that Arteaga experienced was precisely the point of this bullying exercise in religious privilege. The pharmacist took advantage of an opportunity to announce, in public, that the United States government authorizes him to single out individuals who offend a certain narrowly defined set of religious beliefs, to discriminate against them, and to humiliate them.

  The Ethical and Religious Directives of the Catholic Church aren’t entirely focused on the reproductive lives of women. They also aim to control the ways that people spend their last days of life. John—the name has been changed—did not know this until it was too late.

  In 2014, John was dying of brain cancer. He was residing in a hospice in Snohomish County, thirty-five minutes north of Seattle.8 His condition was terminal, and he knew it. He likely faced complete incapacity and dementia. More than that, he knew that he almost certainly faced a painful end.

  John asked his physician and the staff repeatedly for information on medically assisted death. In 2008, voters in the state of Washington had approved of a statewide “Death with Dignity” initiative that made it legal for physicians to provide aid in dying for people with terminal illnesses and fewer than six months to live. Exit polls showed that 49 percent of Protestants, 47 percent of Catholics, and 79 percent of those who claimed “no religion” voted in favor. John must have known something about the initiative, and now he wanted help.