Oct. 1, 2009 -- Guadalupe Benitez was prepared to battle her body -- she has polycystic ovarian syndrome, a condition that makes it difficult to conceive -- in order to have children with her partner, Joanne Clark.
But the couple never imagined that the greatest barrier between them and the family they wanted would be their doctor.
"Right off the bat, [our doctor] mentioned that when it came to insemination, she wouldn't be able to perform it," said Benitez, 37, of Oceanside, Calif. "She had problems with people in same-sex relationships and it was against her religion."
Benitez and Clark, 50, said they were shocked and angry at the doctor's admission but continued to see her at the North Coast Women's Care Medical Group in Encinitas, Calif., because their insurance plan did not offer other clinic options.
The couple says that their doctor assured them another doctor at the clinic would perform the intrauterine insemination (IUI). However, after 11 months of fertility drugs, testing, and an exploratory surgery, all while Benitez and Clark attempted home inseminations to get pregnant, they say every doctor at the clinic declined to perform an IUI for Benitez due to religious reservations.
"We felt dumped," Clark said, adding that she and Benitez were physically and emotionally wrecked and devastated.
No Baby for You, Doctors Say
The couple sued Dr. Douglas Fenton and Dr. Christine Brody at the North Coast Women's Care Medical Group for discrimination in 2001 and settled earlier this month for an undisclosed sum after eight years of litigation.
Although this may not be the first time a patient has been denied medical care for personal reasons, Benitez's case demonstrates the narrow path doctors often walk between providing the best health care services and adhering to their own moral, ethical or religious beliefs.
"In general, religious beliefs or gender orientation should not interfere with the rights of an individual to reproduce," said Dr. Sherman Silber, director of the Infertility Center of St. Louis at St. Luke's Hospital in St. Louis, Mo. "If a doctor doesn't want to care for a patient, the doctor has a right to decide who he or she is and isn't going to take care of. But that conflicts with the discrimination issue."
Converging Law, Medicine and Morals
In fact, Benitez's case illustrates how a host of considerations, including law, medical practice and personal rights converge in a tangled system of checks and balances.
A patient has the right to receive the best care possible from their chosen physician, said Dr. Siva Subramanian, professor of pediatrics and obstetrics at Georgetown University Hospital. But a physician has the right to personal beliefs and morals that may influence what they are willing to do medically.
Subramanian pointed out, however, that a physician's beliefs may conflict with state and federal laws governing medical practice -- laws that a licensed physician has agreed to comply with.
In all cases, a physician should make relevant personal beliefs known to patients during the first meeting, Subramanian said. And in cases where personal beliefs conflict with the law, physicians should be prepared to accept the consequences of standing by their beliefs.
"Ethics and law does not have to see eye to eye," Subramanian said. "But if there is a conflict between the law and whatever the moral or ethical beliefs are, the doctor has got the choice to either abide by the law... or they'll say, 'I understand the law but my ethical, moral and religious beliefs are such that I'm going to stand firm, even if that means I have to go to jail.'"
Legal Issues for Service Providers
But some argue that service providers, particularly those in the medical field, have a duty to avoid such conflict.
"If people choose to go into a particular field of medicine, practice medicine according to the standards of care of that field and in accordance with applicable civil rights laws," said Jennifer Pizer, Benitez's attorney at Lambda Legal, an advocacy group for same-sex rights.
Benitez's case is another example of an issue that clashes repeatedly with some religious or moral beliefs -- doctors who do not perform abortions, for example, or pharmacies that do not stock prophylactics or dispense birth control or Plan B pills for use after unprotected sex.
Illegal Medical Actions
Had Benitez and Clark been turned away from the North Coast Women's Care clinic, Pizer said the doctors would have committed a civil rights violation for denying care based on their opinion that same-sex couples should not be parents.
"It would not have been legal to turn her away at the first visit," Pizer said. "This was compounded and made much worse by the doctors' repeated promises that [Guadalupe] would receive the treatment she needed. It was a long series of broken promises."
In fact, abandoning a patient in the middle of ongoing care is a far more egregious error in the medical community compared to voicing personal reservations about treatment and then referring a patient to another doctor.
"You cannot have somebody you are taking care of and in the middle of it, not give infertility treatment unless you told the patient clearly and specifically before you take them on as a patient that their [treatment] will not go beyond a certain point," Subramanian said. "As long as you've got a license, you have an obligation and that supersedes moral grounds."
Upon settlement, the North Coast Women's Care Medical Group released a joint statement with Benitez and Clark, saying that "the defendants are sincerely sorry that Ms. Benitez and Ms. Clark have felt [treated differently due to sexual orientation], and have never meant to treat Ms. Benitez with disrespect. Defendants want all of their patients, including those who are lesbian and gay, to feel welcome and accepted in their medical practice, and are committed to treating all of their patients with equal dignity and respect in the context of the highest quality medical care."
Since Benitez and Clark sued North Coast Women's Care Medical Group, they have had three children with help from doctors at a different clinic. Pizer said she believes the doctors at the North Coast Women's Care clinic have understood the need to reconcile their religious views with applicable laws as well as their commitment to caring for patients.
"This will provide important guidance for other states when this question arises in other states, which, doubtless it will," Pizer said. "It makes clear that a person engaging in a profession or business has a responsibility to pick a line of work in which that person can follow their own moral precepts and also comply with applicable law."