For anyone interested in medicine beginning in the late 1970s, the book The House of God, by Dr. Stephen Bergman (aka Samuel Shem, MD,) was often recommended (or reviled) by those who were in the field as a sort of rite of passage to provide some idea of what a career in medicine might be like (before the Libby Zion case) with the caveat that it was fiction.  Four decades later, the book still provokes questions and discussions for many.

On June 30, 2014, the United States Supreme Court weighed in on the subject of God and health care, although this time it was not fiction at all.  In a 5-4 decision in the Burwell v. Hobby Lobby Stores, Inc., “as applied to closely held corporations, the regulations promulgated by the Department of Health and Human Services requiring employers to provide their female employees with no-cost access to contraception violate the Religious Freedom Restoration Act.”  The main issue brought by the Hobby Lobby owners (and the owners of Conestoga Wood Specialties Corp.) was that four specific types of contraception would terminate a pregnancy, and therefore, as employers, under the Affordable Care Act, having to provide healthcare coverage to their employees for these contraception options would violate their religious beliefs.

In the dissenting opinion, it was felt that the Supreme Court’s majority decision made a mistake in determining that the Religious Freedom Restoration Act applied to for-profit corporations.  Possibly more important than this issue was the feeling that the contraception coverage provided by the Affordable Care Act improves overall public health and women’s well-being.  As stated by Justice Ruth Bader Ginsberg, “the mandated contraception coverage enables women to avoid the health problems unintended pregnancies may visit on them and their children.”  See the articles in The Washington Post and on MSNBC.

So, are we sure that the events of the last day of June were nonfiction?  Within a few short days, on July 3, 2014, in a 6-3 decision (all male in the majority) the Supreme Court held that Wheaton College, a religious college in Illinois, does NOT have to fill out forms, based on religious grounds as required by the Affordable Care Act, to be exempt from the same contraceptive coverage issue ruled upon in the Hobby Lobby case.  “Wheaton and some religious employers claim that the form HHS requires them to fill out and sign (EBSA Form 700) substantially burdens their religious belief because it directly facilitates the provision of contraceptive coverage to which they object.”  In this surprise decision, the female justices were united in their concern about the Wheaton decision, stating that the most recent ruling “evinces disregard for even the newest of this court’s precedents and undermines confidence in this institution.”

Medicine.  Religion.  Courts.  What would The Fat Man say? Perhaps a review of the Laws of The House of God will help us find the way.  Rule #8 may apply this month.


Stuart J. Glassman, MD

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GOMER: Get Out of My Emergency Room. Classic.