By J Conrado, AMSA Gender & Sexuality Advocacy Coordinator and M2 at EVMS, Nikitha Balaji, AMSA Health Policy Gender and Sexuality Coordinator and M1 at CWRU SOM, Elissa Cleland, AMSA Gender & Sexuality Chair and M2 at EVMS, Trevor Lyford, AMSA Health Policy Chair and M2 at EVMS, and Rohini Kousalya Siva, National AMSA President, MD MPH MS
On June 30th, 2023, in 303 Creative LLC v. Elenis, the Supreme Court of the United States (SCOTUS) ruled that Colorado cannot apply anti-discrimination laws against a graphic designer who plans to deny specific services to LGBTQ+ couples on the basis of First Amendment rights and religious beliefs. The American Medical Student Association (AMSA) strongly opposes the majority opinion. As Justice Sotomayor wrote in her dissent, “[a]round the country, there has been backlash to the movement for liberty and equality for gender and sexual minorities. New forms of inclusion have been met with reactionary exclusion. This is heartbreaking.” AMSA stands with Justices Sotomayor, Kagan, and Jackson in dissenting this blatant encouragement of bigotry and discrimination. This case is about much more than wedding websites and “expressive service”–this SCOTUS decision opens the door for more businesses to deny services to historically marginalized groups under the guise of “creative expression” and “religious freedom.”The notion that the First Amendment grants people the freedom to openly discriminate against LGBTQIA+ individuals undermines the very principles upon which our society is built. It fosters an environment where individuals can perpetuate a harmful hierarchy of privilege.
In the midst of a nation-wide battle for gender-affirming care, this ruling is a significant setback to the LGBTQIA+ community. With bills like Senate Bill 1580 in Florida, which allows doctors and insurance companies to deny care to patients based on “medical conscience,” this court ruling will only embolden legislators to further “protect” religious freedom by allowing healthcare professionals to discriminate based on a patient’s sexual orientation and gender identity. It is essential to recognize that professional obligations and responsibilities should supersede personal beliefs when providing services to the public. We as future physicians recognize, understand that we have an ethical duty to prioritize the health and well-being of patients. Refusing life-saving gender affirming care to transgender individuals based on personal beliefs is not only a violation of medical ethics but also a denial of equitable rights to healthcare.
Without hyperbole, denying specific services to LGBTQIA+ individuals is not only a blatant form of discrimination, but also a matter of life and death. The repercussions of this decision will be devastating to LGBTQ+ youth who are already four times as likely to attempt suicide due to stigma and prejudice. Now, the Supreme Court has seemingly given the green light to dehumanize minority groups by deeming this historically bigoted tactic a constitutional right. As future physicians, we fear that not only will this ruling burden a medically vulnerable group with further mental torment, but also gives insurance companies an additional avenue to discriminate against the medically marginalized. Research studies and evidence have demonstrated the profound psychological and physiological impacts of discrimination, which align with sentiment expressed by Congress in the Civil Rights Act of 1964 regarding “deprivation of personal dignity” that accompanies denial of equal access to public establishments. These effects are so substantial that the American Psychological Association deemed them significant enough to file a brief in support of Colorado’s anti-discrimination law.The brief notesthat the absence of protective, inclusive, and anti-discriminatory laws correlate with increased stigma and negative health effects. Pursuant to AMSA’s Preamble, Purposes, and Principles, we at AMSA consistently advocate for the dignity and wellbeing of all people–particularly those in historically marginalized populations. We, as a nation, must do better.
At this critical juncture when over 530 anti-LGBTQIA+ bills have been proposed this year alone, it is imperative that we raise our voices against discriminatory rulings which will indisputably harm the LGBTQIA+ community. We ask our members to take a stand against bigotry and encourage your state legislators to sponsor the Equality Act and advocate for nation-wide anti-discrimination laws, using this email template. When we speak up collectively as future physicians who care deeply about social justice and equity for all, we will be able to advance necessary change rooted in nonmaleficence and beneficence, not hate and prejudice. We as future physicians of the United States of America are committed to upholding the principles of Hippocratic Oath. We firmly believe that every individual, irrespective of their gender, race, sexual orientation, etc. is entitled to equal rights, including equitable access to healthcare.
