New treatment plan

Virginia native Scott Armistead, his wife, and their three boys boarded a plane for Pakistan in 1999. For the next 16 years, Armistead practiced family medicine at a village mission hospital just north of Islamabad, the country’s capital. The family grew accustomed to the risks of living under an Islamic government with blasphemy laws that criminalized derogatory remarks about Islam and it’s central figure, Muhammad.

Those years abroad changed Armistead. And during that time, the United States changed, too. In 2015, Armistead reentered an academic medical landscape strangely reminiscent of the Islamic authoritarianism he’d left behind.

The new reigning anthropology separated the body from the person inside it, exalting the will and emotions over physical reality.

That perspective had already crept into Virginia Commonwealth University School of Medicine when Armistead began teaching second-year medical students at a clinic for uninsured patients. But in October 2020, the school embraced it fully by declaring the clinic—and Armistead’s family medicine practice—to be “gender affirming.” Its goal was eventually to distribute cross-sex hormones and refer patients for transgender surgeries.

When Armistead raised concerns, the medical director emphasized that the change was a priority of the school’s family medicine department. End of discussion.

For decades, protections for healthcare professionals who refuse to perform medical procedures that violate their consciences enjoyed a certain degree of bipartisan support. Not anymore.

Federal mandates clearly forbid forcing medical workers to violate their consciences. But medical schools, hospitals, and state agencies often do just that. Those healthcare workers must rely on the federal government to open an investigation and, if necessary, revoke federal funding from the violating institution. That only works when a sympathetic president occupies the White House.

President Joe Biden’s White House was anything but sympathetic. Four years of Biden’s radical pro-abortion and pro-transgender administration shattered any remaining confidence in the federal government’s commitment to defending medical workers.

Christian healthcare professionals and legal experts are cautiously hopeful that Health and Human Services officials under the new Trump administration will once again champion these protections. But some Christian doctors warn this new era won’t last. They argue establishing a medical professional’s right to sue under federal and state conscience laws is essential for navigating a medical landscape that increasingly clashes with their Hippocratic pledge to do no harm.

FEDERAL CONSCIENCE PROTECTIONS for healthcare workers date back to the 1970s. They were deemed essential in the wake of the sexual revolution and rapidly shifting ideas about pregnancy and personhood—and the role of the American physician.

The U.S. Supreme Court declared most state restrictions on abortion unconstitutional in January 1973. That June, Congress passed the Church Amendments, prohibiting entities and individuals that receive federal grants, contracts, or loans from compelling healthcare workers to assist or perform abortions or sterilizations.

Conscience protections are “always geared around a procedure or a treatment,” said Jeffrey Barrows, senior vice president of bioethics and public policy at the Christian Medical & Dental Associations (CMDA). “We’re not talking about not seeing certain patients.” But he noted that’s still a common—and unwarranted—criticism of conscience protection laws. Altogether, at least two dozen federal laws safeguard healthcare professionals, medical students, and physician training programs from discrimination based on their refusal to provide or pay for procedures they find religiously or morally objectionable.

While previous Democratic administrations took a more hands-off approach to enforcing conscience protection laws, Biden administration officials were downright hostile, Barrows said. “[For] the last four years, you could yell and scream … and the Biden administration could care less about this.”

For example, the Biden administration gutted a Trump-era Department of Health and Human Services rule published in 2019 that clarified and strengthened HHS enforcement mechanisms for policing conscience violations. Biden’s HHS Secretary Xavier Becerra also disbanded the Conscience and Religious Freedom Division, an office dedicated solely to enforcing conscience protection laws. Roger Severino, who led a team of over 250 staff as head of the HHS Office of Civil Rights during Trump’s first term, established the division in 2018.

Severino pointed to one example of the Biden administration’s open hostility to conscience rights: HHS under Trump opened a case to investigate claims that the University of Vermont Medical Center deliberately scheduled a nurse to assist in an abortion, even though she had made her objections to the procedure known. The center refused to find another nurse to help, and even told the nurse the procedure didn’t involve an abortion. It was the kind of textbook conscience violation Severino refers to as a “slam dunk case.”

Becerra dropped it.

Severino, who now serves as vice president of domestic policy at the Heritage Foundation, said this decision previewed Biden’s unprecedented politicization of the department in the name of advancing abortion and gender ideology—what he called the administration’s “twin guiding stars.”

Shortly after the U.S. Supreme Court overturned Roe v. Wade in 2022, the Biden administration directed HHS to focus on protecting and expanding access to abortion. HHS officials then issued new guidance clarifying that the Emergency Medical Treatment and Labor Act (EMTALA)—which requires emergency rooms to provide basic stabilizing care to patients whether or not they can afford it—included providing abortion, even in states restricting the procedure.

The federal government took the state of Idaho to court, arguing its pro-life laws interfered with the new HHS guidelines. Nowhere in the lawsuit did the administration mention right-of-conscience exemptions.

Texas general surgeon Eithan Haim was another one of the Biden administration’s healthcare casualties. Haim attracted the ire of the Department of Justice when he publicly revealed that Texas Children’s Hospital continued to perform sex-change procedures on children after announcing it had halted the practice. Biden’s DOJ claimed Haim violated HIPAA, the patient privacy law, and charged him with four felonies—carrying the possibility of a decade behind bars.

Though the Biden administration’s animosity toward medical religious objections reached new heights, CMDA’s Jeffrey Barrows noted “there’s been a gradual eroding of respect for conscience freedoms” for decades. Part of that stems from a broader shift in how American culture understands the role of the physician and other healthcare workers.

Doctors today are likened to public utilities, not individual people entitled to their own ideas of what they are and are not willing to do for a patient. Rachel Morrison, an attorney and fellow at the Ethics and Public Policy Center, attributes the shift to the growing prominence of what she calls the “provider consumeristic model,” which often exalts patient autonomy at the expense of a doctor’s expertise.

Treating medical workers as “vending machines,” as Morrison puts it, leaves little room for respecting their value as moral beings.

Scott Armistead Photo by Roy M. Burroughs / Genesis

ARMISTEAD FIRST SMELLED TROUBLE in 2019 when VCU’s clinic introduced a form directing patients to choose from a laundry list of sexual orientations as well as describe their sexual preferences and habits—all before their first visit.

Not only did Armistead disagree with the anthropological assumptions behind the form, he worried it would embarrass and disgust some of his patients, many of whom were South Asian or Middle Eastern refugees who relied on their children to translate. School administrators allowed Armistead to forgo using the form with his patients, but kept it in place for the clinic as a whole.

Shortly after, a group of VCU students affiliated with the Christian Medical & Dental Associations approached Armistead with concerns about a new school policy requiring students to ask standardized patients about their preferred pronouns and provide their own during introductions. Standardized patients are individuals from the community who are paid to act as patients during training scenarios. Armistead approached administrators with another co-worker, and together they argued the policy change wasn’t culturally competent and disrespected the students’ convictions. Administrators told them individual preceptors like Armistead could discuss the change with their students.

But one year later, the school declared the clinic to be “gender affirming” and repudiated Armistead’s request to discuss the clinic’s new priorities.

That fall, the Christian students told Armistead the school would dock their grades if they refused to ask for the standardized patients’ pronouns. The students asked to meet with school administrators but were turned down, so Armistead helped seven of them craft a written response.

“This disintegration of the person represents a philosophical perspective on what it means to be human which we do not share,” the students wrote. “To force us into a language with this assumed disintegrated understanding of what it means to be human seems disrespectful to us.”

Medical school administrators sent their own written response—to the entire student body. In it, they likened the Christian students’ concerns to historical racism: “At one time it was not standard practice to see black and white students in the same practice.”

Scott Armistead Photo by Roy M. Burroughs / Genesis

SO FAR, THE TRUMP ADMINISTRATION has shown strong signs that HHS officials will once again defend—rather than sabotage—healthcare workers’ rights of conscience. Trump’s DOJ dropped all charges against Texas surgeon Eithan Haim. The president also rescinded a Biden-era executive order permitting hospitals not to comply with state-level investigations into gender transition clinics and indicated HHS would strengthen protections for whistleblowers. In March, the administration dropped the federal government’s lawsuit claiming Idaho’s abortion ban violates the Emergency Treatment and Medical Labor Act.

“It would be wonderful to see all the policies of the first Trump administration restored,” Roger Severino said. He’s hopeful that will include relaunching the Conscience and Religious Freedom Division.

Still, doctors and legal experts argue a renewed commitment to enforcing the laws on the books isn’t enough.

Federal conscience protection laws don’t provide for private right of action, which allows individual healthcare workers to take a hospital or another entity to court. In order to fight back themselves, healthcare workers must sue under state religious discrimination laws or make a First Amendment case in federal court. But that’s a lengthy—and costly—process.

Without a private right of action, conscience protections are little more than “words on a page,” argued Greg Chafuen, senior counsel for Alliance Defending Freedom’s Center for Public Policy. Sen. James Lankford, a Republican from Oklahoma, introduced the Conscience Protection Act in 2021 and 2024. The bill would create the long-hoped-for private right to action, but it’s unlikely to garner the bipartisan support it needs to make it to Trump’s desk. So Chafuen, along with doctors at the Christian Medical & Dental Associations, is targeting state legislatures instead.

So far, at least 20 states have considered a version of the Medical Ethics Defense Act. The measure affirms conscience as a “fundamental and inalienable right” that was “central to the founding of the United States” and permits medical practitioners or institutions to take their opponents to court if the act is violated. Tennessee Gov. Bill Lee signed the MED Act into law in April.

But a similar bill faces choppier waters in New Hampshire. The Granite State, along with New Mexico and Vermont, has no existing conscience protection laws for medical workers, institutions, or payers, according to Americans United for Life. Mary Pearson, a family medicine doctor and CMDA’s representative for the state, said New Hampshire’s lack of protections is pushing healthcare workers out.

Pearson befriended a young pediatrician who told her community hospital she would not prescribe sex-change hormones and puberty blockers. The hospital put her on leave and referred her for an interview with a psychiatrist on the New Hampshire Board of Medicine to assess whether she was still mentally capable of caring for patients. She left the state in 2023 after settling a religious discrimination case with the hospital outside of court.

The pediatrician, who signed a nondisclosure agreement when she settled with the hospital, chose not to go public with her story.

“A lot of people are really intimidated by the liberal atmosphere here. A lot of people leave,” Pearson said. “And that’s really sad in a state where our motto is ‘Live free or die.’”

In 2019, a national survey of Christian healthcare workers found 91% of respondents would rather quit their jobs than violate their conscience.

ONE AFTERNOON, WHILE PREPARING a new batch of students for standardized patient interviews, Scott Armistead began a discussion about the anthropological assumptions underlying why the students were being taught to introduce themselves using their pronouns. When a student pushed back against his concerns, Armistead answered her politely and invited the students to his home if they wanted to discuss the issue further.

The semester continued smoothly until, a couple of months later, Armistead received a letter of reprimand from school administrators. It accused him of “open resistance” to the clinic’s transgender policies. “You have asserted that individuals are born with a gender, and if they don’t believe they are that gender, they are ‘broken’ and need to be healed,” administrators wrote, adding that Armistead had also violated the school’s religious discrimination policy by inviting his staff to join him in prayer each morning.

Administrators put Armistead on a six-month probation, forbade him from working with students (though he could continue seeing patients), and forced him to complete diversity and inclusion training. His nurse warned him administrators were watching him “like a hawk.” “I got the feeling that they were trying to find reasons for getting rid of me,” he said.

School officials cited “clinical near misses”—medical errors that had the potential to cause harm but didn’t—when they finally removed Armistead from his position. That’s a common feature of religious liberty cases, said Ian Huyett, a lawyer with a New Hampshire–based religious liberty advocacy organization called Cornerstone. The meticulous record-keeping unique to the medical field makes it that much easier to dig up a minor grievance.

Armistead and a group of students appeared before Virginia’s General Assembly in late January and spoke in support of their state’s version of the Medical Ethics Defense Act, introduced in December 2023. The bill died in the House Health and Human Services Committee.

But Armistead said the fight’s not over.

“Because there is a crisis going on,” he said.