Two questions emerge about religious freedom from Kloosterman v Metropolitan Hospital

As evidenced by Kloosterman v Metropolitan Hospital, a recent case from Michigan, a serious issue involving religious freedom concerns the conscience rights of health care providers. Disputes arise when medical professionals are unable to comply with policies such as those mandating their participation in gender “reassignment surgery” and prescribing related drug therapy because doing so violates their religious beliefs.

Litigation began after officials at a public hospital fired Valerie Kloosterman, a physician assistant with an unblemished seventeen-year record, would not refer patients for gender “transitioning” drugs and procedures or to use pronouns corresponding to their gender identities rather than their biological sexes.

Valerie Kloosterman is a “‘a devout Christian,’ [who] ‘believes that one’s sex is ordained by God, that one should love and care for the body that God gave him or her, and that one should not attempt to erase or to alter his or her sex, especially through drugs or surgical means.’” Although Kloosterman “received nothing but positive reviews and accolades from her superiors, her colleagues, and her patients,” her status “changed in 2021 shortly after [her employer] Metropolitan Hospital culminated its affiliation with the University of Michigan Health System, rebranded itself University of Michigan Health-West, and then fired” her.

Officials dismissed Ms. Kloosterman in refusing her request for an accommodation excusing her from a mandatory diversity training module due to her religious beliefs. Yet, these same officials accommodated others who objected to prescribing controlled substances, such as opioids or diet pills.

On August 24, 2021, officials conducted a meeting with Ms. Kloosterman at which they “‘denigrated her religious beliefs, called her ‘evil’ and a ‘liar,’ mockingly told her that she could not take the Bible or her religious beliefs to work with her, and [falsely] blamed her for gender dysphoria-related suicides.” Officials fired Ms. Kloosterman due to her belief “that it would be dishonest and sinful to violate her conscience and oath by knowingly facilitating a drug or procedure that—in her independent medical judgment—will bring to a patient more harm than benefit”

Officials did not even allow Ms. Kloosterman to finish her daily charts, collect her belongings, or to say goodbye to co-workers and patients.

Late, on October 11, 2022, First Liberty Institute, “the largest legal organization in the nation dedicated exclusively to defending religious liberty for all Americans” filed suit on Ms. Kloosterman’s behalf against the hospital and various officials. Focusing on the federal issues here, Ms. Kloosterman alleged that the defendants violated her First and Fourteenth Amendment Rights to the Free Exercise of Religion and Freedom of Speech, respectively, as well as to Equal Protection plus Title VII of the Civil Rights Act of 1964.

On October 9, 2023, Jane Beckering, a federal trial court judge appointed by President Biden, largely rejected the defendants’ motions to dismiss Ms. Kloosterman’s claims. Recognizing Ms. Kloosterman’s “exemplary” record whose “vibrant faith informs how she does her work as a medical professional,” the judge ruled that officials violated her Free Exercise rights by demonstrating “hostility toward the sincere religious beliefs that motivated her objection to the training module.”

In her analysis, the judge relied in part on Kennedy v. Bremerton School District, wherein the Supreme Court upheld the rights of a high school football coach in Washington to pray silently on the field after games on the basis that “official expressions of hostility” violate the First Amendment’s Free Exercise Clause.

The court next allowed Ms. Kloosterman’s equal protection and Title VII claims to proceed. As noted, the court found that because officials accommodated the preference of some providers who objected to drug dispensations, she plausibly stated a claim that they violated her Title VII rights by impermissibly subjecting her to disparate treatment in rejecting her request.

At the same time, the court dismissed Ms. Kloosterman’s First Amendment free speech claim. The judge explained that based on Supreme Court precedent, because Ms. Kloosterman spoke in her official capacity as a public employee, rather than a private citizen, in questioning the hospital’s policy, her speech was unprotected. The court also rejected Ms. Kloosterman’s request for an injunction that would have returned her to her job as lacking merit.

As with many legal disputes, Ms. Kloosterman’s case presents two legitimate, competing interests. On the one hand are the rights of health care professionals to follow their consciences by being excused from participating in non-life threatening medical procedures that violate their religious beliefs, particularly if others are ready, willing, and able to provide the desired services.

Conversely, public officials have the duty to ensure patient access to medical procedures and medications. Kloosterman is thus a salient example of the challenges that arise in attempting to protect the religious freedom rights of health care providers while ensuring that patients receive needed services. How the courts balance these competing interests is likely to have a profound impact on the religious freedom rights of health care professionals and all Americans.

At the heart of the issue, two questions emerge about religious freedom. First, while patients certainly have the right to access needed medical services, conflict emerges over whether public officials can obligate medical professionals to participate in non-emergency procedures that violate their religious beliefs and consciences. Moreover, it is important to emphasize that Ms. Kloosterman did not seek to deny all care to patients.

While Ms. Kloosterman sought an accommodation to avoid complying with hospital policies that violated her conscience, there is no evidence in the record that she objected to others providing the services and gender “transition” drugs to which she objected.

As to this initial question, it is important to reiterate that the First Amendment guarantees Americans the right to the free exercise of religion without unnecessary governmental interference. In addition, as the court acknowledged, the far-reaching Title VII affords people of faith the right to reasonable accommodations such as not being obligated to participate in medical procedures including reassignment surgery, dispensing drugs, or using pronouns that violate their consciences.

Consequently, insofar as the officials in Kloosterman sought to mandate diversity training, perhaps these same administrators should be required to complete professional development sessions designed to better inform them of the rights of employees to religious accommodations in lieu of having to try to compel them to violate their consciences.

The second question concerns why—absent emergency, life-threatening circumstances—public officials would want to require health care professionals to violate their consciences. In other words, what did hospital officials think they could accomplish by attempting to force Ms. Kloosterman to ignore her religious beliefs and values? Especially when the desired services and medications are readily available from others who were apparently capable of providing the needed care?

In firing Mrs. Kloosterman hospital officials demonstrated a contemptible lack of respect as they denigrating her religious beliefs. As with so many aspects of life, because respect is supposed to be mutual, those who wish to receive it must offer it in return, something officials failed to do, especially where it would have been easy enough for them to have accommodated Ms. Kloosterman’s request for a religious exemption consistent with Title VII. Further, had officials treated Ms. Kloosterman’s request like those of other employees, they could have avoided this unnecessary, and likely costly, litigation.

Hospital officials in Kloosterman ignored basic, cherished American legal principles relating to religious freedom. In fact, the draconian approach the officials adopted in attempting to force Ms. Kloosterman to violate her religious beliefs flew in the face, language, and history, if not the spirit, of the First Amendment. Litigation surrounding the conscience rights of medical professionals thereby bears close watching because the fate of religious freedom, not just for health care providers, but for all, arguably hangs in the balance.