President Trump’s “new rules” on conscience protections for health care workers cast a wider net and open the door to sanctioned discrimination. Moreover, they mark another alarming indication of a backward trajectory in the United States under his leadership.

At the heart of this issue is the premise that health care providers are being forced to provide services that clash with their religious beliefs. Therefore, the provider faces discrimination from their employer. Our country’s foundation was predicated on the protection of religious freedom. It should remain at the heart of our moral compass. However, the direction significantly changed course since 2016, and the arrow skewed toward conservative extremist perspectives. Adverse climate change is real, and we are not just talking nature.

To be clear, these protections existed before Trump took office. Health and Human Services and its conservative cohort, however, have focused efforts on promoting the new Conscience and Religious Freedom Division since the January 2018 launch. Strangely, its purpose seems redundant, since these services were already in place through the Office for Civil Rights. The creation of this pointed division needs to be justified by numbers that demonstrate need. Note that the numbers were consistent until 2018 when the new division found traction with its publicity campaign and birthed a bubble. 

Stretching the scope of conscience protections is cause for worry. The new rules allow any tangential personnel to claim discrimination — puzzling permission, especially when you consider the health and life-altering ramifications to patients. Without carefully articulated language, effectual education of appropriate staff and rigorous monitoring, we risk undermining some of the most vulnerable among us.

Let’s count the ways that this discrimination could have an impact on just one profile: mine. I am a female. Thus far, my medical history includes both birth control and infertility treatments. I am also a lesbian who came out as an adult and struggled with fear of being tried in the reactionary court of public opinion. Here is just one example of how that played out in my healthcare: During an annual visit to my OB-GYN, I shared my sexual orientation with the nurse who prepped me for the exam. She noted this on my chart. Unfortunately, the doctor missed the update. Our friendly banter was usual and comfortable at the start of my exam. The doctor also addressed the required topics of sexual activity and contraception. My answer surprised him. The nurse was in the room. I am sure that all three of us were the same shade of crimson. The moments that followed were nerve-wracking. However brief, they felt eternal. I lay there, in an already vulnerable state, now wondering what happens next. Would the quality and candor of the visit change? Would I be subjected to curtness or radio silence from a doctor who was ordinarily pleasant and talkative? He apologized immediately and reassured my anxious mind. The atmosphere was unchanged. Our visit, other than that blip, was consistent with past visits.

Under these conscience protections, professionals such as pharmacists, clinical staff, and physicians could have refused treatments in the past and could continue to do so through varying phases of my life. I can only imagine how this may have played out in an anti-LGBTQ setting. Luckily, I live in liberal Massachusetts, where I feel, mostly, safe from discrimination and harm. Regrettably, you will not hear an echo of my confidence nationwide.

Health care providers and professionals dedicate their lives to improving and saving the lives of others. As such, they should regard personal religious beliefs as separate from that oath when it comes to medical obligation. The alternative treads in risky gray territory. Let’s take the case of gender reassignment. One may argue that this is neither medically necessary or denial of a lifesaving procedure. To the contrary, denial of hormones or medical procedures by the respective health care personnel may place a person into not only physical but psychological crisis, diminishing mental health burdens an individual who is likely managing critical stress levels or possible depression and anxiety. You don’t need to search far and wide to find evidence of devastating, sometimes life-ending, repercussions.

Furthermore, these protections perpetuate the financial disparity in the United States. In broadest terms, liberal states and a high cost of living tend to go hand in hand. Residents here are apt to have access to a network of health care providers who will not refuse treatment. However, those residing in more conservative sections of the country are more likely to be confronted with a refusal of care. In rural areas, patients may have access to only a single facility within a reasonable radius. In any case, no matter the location, refusal to provide services may require additional resources such as travel, extra time off from work, or out of network costs. Let’s not discount the time and energy it takes to research and advocate for yourself or your loved ones. All in all, this adds up to an unattainable price tag for low-income persons or families.

Consider an unfortunate tangent: First responders are sworn to protect everyone. Could we be teetering in a direction that would allow EMTs to refuse a call or have biased reactions from police officers? What’s more, how are these religious beliefs established and documented? In other words, is protection afforded merely by way of a personal decree at the moment? Where do these “protections” begin and end?

Admittedly, it’s an extreme tangent. However, it isn’t far-fetched. Extreme climates aren’t built overnight. It takes years of patience and intelligent manipulation. It is countless, small backward steps — a calculated maneuver, followed by a period of anger from those opposed. What follows is a defeat or, worse, apathy. Deceivingly so, these incidents seem isolated. However, it is within this perilous pattern, over long periods, that we become the unbecoming: a complacent society that is blind or powerless to discrimination and its underbelly, hate. Perplexed, we look back and think, “How did we get here?” In fact, the blueprints are all too legible.

President Trump’s new rules on conscious protections are markings on the prejudiced blueprint. It is not a surprise that conscience complaints filed by providers sharply increased since the start of his term. Enhance your perspective to see the large-scale view and mind the contradictions. This president doesn’t value all human life as equal. He appeals to pro-lifers with such rules, but in his next breath, he regards the lives of adults and children as inferior when it comes to immigration. Are people less human because they weren’t born in the U.S.? The latest stamp demeans the value of female and LGBTQ populations. Are people less human because they are transgender?

Fundamentally, treatment or service does not and should not denote endorsement; just as acts of kindness do not imply agreement with all behavior of the recipients. This broadened scope will undoubtedly bring some knowledgeable or naïve professional and support staff to abuse the system. The actual protections are quite narrow and offer the resources needed to medical professionals. Therefore, it is critical to remain aware and vigilant. The next election is around the corner. Your voices matter. Your time is an asset. Volunteer. Donate. Write. Listen. Reach out to leaders. Vote. Whatever you do, don’t quit. If you haven’t yet found your voice, now is the time. Arm yourself with an education, and don’t be afraid to share your opinion. Most importantly, remain fearless and relentless in your pursuit and demonstration of kindness and tolerance.

Dawn McGrath is a resident of Salem and a member of the Human Rights Campaign.