The Power Worshippers

by Katherine Stewart

  But the hospice in which he was a patient was affiliated with Providence Health & Services, a large Catholic health care network, which necessarily adheres to the Ethical and Religious Directives. The ERDs prohibit not just aid in dying but certain palliative treatments. Directive 61 states: “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.”9

  Providence has a specific policy that prohibits referrals in connection with or even discussions with patients of the Death with Dignity Act. In keeping with company policy, John’s physician and staff declined to answer his repeated pleas for information. The nurses who cared directly for John believed that they would be fired if they tried.

  Somehow, John managed to get a gun into the hospice. On the last day of his life, he climbed into a bathtub, put the barrel in his mouth, and shot himself to death. We know of the story only because the nurses were so traumatized—and so angry at their employer for having compelled them to deny John the information that might have changed the outcome—that one filed a complaint with the state’s department of health.

  Mary Beth Walker, a spokesperson for Providence, called the death “tragic” but provided little information about the details of the event. She maintained that Providence “absolutely respects that patients have a right to ask” about the Death with Dignity Act. But she did not clarify whether the organization felt any obligation to answer their questions. The organization’s policy statements, which the spokesperson forwarded to the press, stipulated that its staff and its contractors will not “participate in any way in assisted suicide.” The department of health found no wrongdoing and concluded that facilities are not required to provide patients with information about the Death with Dignity Act.

  The assertiveness of the Catholic hospital system in imposing its religious requirements on patients comes at a time of massive expansion.10 Over the past decade the hospital system in the United States as a whole has been undergoing a process of consolidation and concentration, and Catholic hospitals are at the forefront of the charge. Behind the general trends are complex shifts in government policy. All hospitals are to some degree creatures of government, brought into being through regulatory systems and a huge flow of public money through entitlement programs such as Medicare and Medicaid as well as tax subsidies, land use agreements, and other governmental interventions.

  As the consolidation of the industry advances, Catholic providers benefit from structural advantages that stem directly from their religious character. By virtue of their religious status, for instance, the Catholic operations have considerably more leeway to underfund pension plans.11 Following the recent merger wave, over 16 percent of hospital beds in the United States are now in Catholic-run medical facilities. In some states the number exceeds 40 percent.12

  The Catholic control over hospitals actually gives the Church an even wider reach over the rest of the medical system. Catholic hospitals seek to impose their ethical and religious directives on some of their business partners, too. According to Directive 72, “The Catholic party in a collaborative arrangement has the responsibility to assess periodically whether the binding agreement is being observed and implemented in a way that is consistent with the natural moral law, Catholic teaching, and canon law.” In today’s interconnected health market, this “ethical and religious” umbrella covers an expanding network of physicians, pharmacists, and specialist providers.

  In Washington State, the consolidation of the industry has proceeded at a particularly vigorous pace. Three of the state’s largest health care systems in the area—PeaceHealth, Providence Health & Services, and CHI Franciscan Health—are Catholic entities, and they are expanding throughout the Northwest. Over 30 percent of all hospitals in the region now have a Catholic affiliation.

  Because bishops and other religious authorities vary in their involvement with hospital protocol, some hospitals and clinics are more persnickety about adhering to the ERDs than others. At some facilities, administrators and doctors manage to create wiggle room that allows them to deliver some of the services that are technically prohibited. For instance, they may prescribe hormonal birth control if it is deemed a “medical necessity” unrelated to the prevention of pregnancy. Conversations between doctors and their patients are protected by confidentiality laws, and hospital administrators may not probe too deeply. At some Catholic facilities, medical professionals refer women in need of birth control or other forms of reproductive care to unaffiliated outside providers—such as a local Planned Parenthood.

  But these concessions—or “workarounds,” as they are sometimes referred to—sound more generous than they are. Forcing women to go through the side door to access essential forms of health care imposes logistical and financial burdens. It sends a clear message that they are unworthy of best-practices medical treatment and that female sexuality and reproductive health deserves to be shrouded in secrecy and shame.

  In January 2018, the Trump administration established the Conscience and Religious Freedom Division in the Health and Human Services Office for Civil Rights. From the name of the new unit, an alien visitor might have supposed that the purpose of the office was to guarantee the rights of patients to receive equal care and respect, without regard to their religion or other matters of conscience. But the actual mission of the office is to make it easier for health care professionals to deprive patients of lawful, medically indicated services on the basis of their own religious beliefs.13 Under the leadership of Roger Severino, a trial attorney with a history of right-wing legal activism and opposition to LGBT rights, the office was clearly intended to answer to the needs of avowedly religious people who do not wish to care for women in need of certain reproductive health services or LGBT Americans. Then on May 2, 2019, a “National Day of Prayer,” President Trump proudly announced that the office had issued a rule on “Protecting Statutory Conscience Rights in Health Care,” which allows health care providers, including physicians, nursing staff, participants in training programs—even X-ray technicians and schedulers—to refuse to serve or treat patients if it happens to offend their “religious beliefs or moral convictions.”

  It was just the latest example of the Trump administration privileging the “consciences” of certain groups at the expense of others. By now the Department of Labor had issued guidelines for federal contractors that said it’s quite all right to violate antidiscrimination law against certain groups as long as they can claim they do so on account of their sincerely held religious beliefs.14 In July 2018, then-Attorney General Jeff Sessions followed up with his own Religious Liberty Task Force, highlighting the Trump/Pence administration’s true priorities.15

  The biggest future gains for the Christian nationalist version of religious liberty, however, are likely to come from the Supreme Court. During the now-forgotten part of his Senate testimony, before questions about temperament and alleged past sexual aggressions consumed the proceedings, Judge Brett Kavanaugh signaled his concurrence with the theory of “religious liberty” animating the Trump administration. The two senators from Texas, Ted Cruz and John Cornyn, both praised Kavanaugh as a jurist who would uphold “religious liberty”—and all sides understood what this really meant: Kavanaugh’s record confirms that he will uphold the religious privileges of conservative Christians at the expense of other people’s rights.

  In the case of the Priests for Life v. United States Department of Health and Human Services, Kavanaugh took the view that the requirement that nuns fill out a one-page form that would have exempted them from providing contraception coverage to their employees imposed a “substantial burden” on their organization’s free exercise of religion. Clearly he keenly felt the nuns’ anguish about sharing a government with women who can exercise control over their reproductive health.

  But in Garza v. Hargan, he thought it was no real burden at all for a minor-aged girl, eighteen weeks pregnant and in federal custody, to be denied access to t
he abortion she desperately wanted. In that same decision—thankfully slapped down within days by the full bench of the court on which he sat—Kavanaugh characterized abortion as a “momentous life decision” and referred contemptuously to abortion rights—established in Roe v. Wade and other cases as constitutional in their foundation—as “abortion on demand.” The very phrase, of course, was a dog whistle to the antiabortion movement.

  Thus he offered a precise rendering of how “religious liberty” works in Christian nationalist circles today. You maximize the moral anguish of those whose “values” you share and protect their “rights” wherever possible. And you minimize the suffering of those who don’t belong to the group and treat their rights as merely selfish demands.

  Kavanaugh’s record also showed that he would be happy to empower corporations to pursue the same vision of “religious liberty.” He endorsed the Hobby Lobby decision, which allowed that corporation to use its religious beliefs to deny birth control coverage to its employees, regardless of their beliefs. In Kavanaugh’s America, supported by the alliance of the Trump/Pence administration and the Christian nationalist movement, our schools, our corporations, and our government will work together to empower the partisans of one variety of religion and disempower the rest.

  In the last days of December 2003, I was thirteen weeks pregnant and filled with joy at the prospect of having a second child. Then one afternoon I began to bleed heavily. After soaking a facecloth and then a hand towel in my own blood, I understood it was time to go to the emergency room. Leaving my toddler at home with my husband, I was loaded on to a stretcher and taken by ambulance to the nearest hospital. We were living in downtown Manhattan at the time, and so the ambulance took me to St. Vincent’s Hospital, a Catholic facility in the West Village that has since been shuttered.

  By the time I arrived, my blood pressure was running dangerously low and I felt that I was passing in and out of consciousness. I know now that what I needed then was a D&C, an abortion procedure to remove tissue from the uterus, and I needed it immediately to stanch the bleeding. But hours passed and I was left to hemorrhage alone. On several occasions hospital attendants came by to change my blood-soaked sheets, but no one would touch me. It didn’t make any sense. When I pointed out to a passing ER doctor on duty what must have been obvious—that I was bleeding out—and begged her to conduct a basic examination, she balled up her fists, scrunched her face, and walked away. At some point I started shaking uncontrollably; I was going into shock. I later learned that I lost nearly 40 percent of my blood. Only then did the hospital provide me with the abortion that saved my life.

  When I was transported home, via stretcher, my two-year-old didn’t recognize me. “Who’s that lady?” she asked my mother, who had flown in expecting the worst. It took weeks to recover from the loss of blood. It took much longer to stop reliving the experience in my head. I later inquired with the medical provider in order to review their records of the episode. I was able to confirm the amount of time that elapsed and the total loss of blood but found no explanation for the delay in treatment. In retrospect, given what I now know about the Ethical and Religious Directives, my best guess is that the hospital was willing to gamble with my life for the sake of preserving a child that was at that point nothing more than a fiction of their imagination.

  CHAPTER 12

  The Global Holy War Comes of Age

  At a crowded outdoor café in Verona, Italy, on day two of the 2019 World Congress of Families, I find myself sitting one table away from Dominik Tarczyński, the far-right Polish politician. He is wearing a bright red MAGA hat and he is engaged in a lively conversation with Ed Martin, erstwhile CNN commentator and president of the Eagle Forum Education & Legal Defense Fund, a tax-exempt “pro-family” organization founded by Phyllis Schlafly.

  The following day I catch Martin’s talk at the conference, which brings together ultraconservative religious and political leaders from around the world. Resting beside him on the podium I see a red cap. This one reads “Make Europe Great Again.”

  Under President Trump, the United States has become a flashing red beacon of hope for a new, global, religious, right-wing populist movement. It calls itself a “global conservative movement” and claims that it seeks to “defend the natural family.” But it’s really about taking down modern democracy and replacing it with authoritarian, faith-based ethno-states. You could call it a kind of global holy war.

  The Christian nationalist movement within the United States, which has been my subject in this book, is in reality just one piece of this increasingly interconnected, globe-spanning movement. This global holy war has nuances specific to different countries. But the striking thing about it is its consistency in tone and substance around the world.

  The global holy war now defines itself against a single common, worldwide enemy: global liberalism. In one of the opening speeches at the World Congress of Families, I hear American radio host Steve Turley describe the common foe as “the anti-cultural processes of globalization and its secular aristocracy.” The new movement, “this resistance, this religious renewal,” Turley adds, “is as global as globalism itself.”

  Global liberalism, as the warriors see it, is a hydra. It has “multiple faces,” says Ignacio Arsuaga, the founder and president of the ultraconservative Christian activist group CitizenGO, which is headquartered in Madrid and promotes culture war campaigns in dozens of countries. Taking his turn at the podium in Verona, Arsuaga goes on to name a hit list that will be familiar to anyone who has followed America’s Christian nationalist movement: “radical feminists,” “the abortion industry,” and “the LGBT totalitarians.”

  In one of the breakout sessions at the congress, Alexey Komov, a Russian activist who has special interests in America’s religious-right homeschooling movement1 and Christian film industry,2 adds biologists to the targets: “The scientific worldview, the Darwin theory, it’s the same organizations, the same people who promote LGBT, gender rights … it goes in one package.” He nods. “Gays and Darwin, somehow they are connected.”

  In Verona the new holy warriors reserve some of their greatest animus for migrants. Speakers at the congress warn repeatedly of a “demographic winter” and complain that “soon we will be extinct!” “What happens when our countries are overrun—it’s happening in America—is that our families are destroyed,” says Ed Martin. Perhaps the most celebrated speaker at the event is Deputy Prime Minister Matteo Salvini, a far-right politician who has made thinly veiled references to Italy’s late fascist dictator Benito Mussolini, and who rose to power with rhetorical assaults on Italy’s 5 million immigrants.

  Like Christian nationalists in the U.S., the global holy warriors appear to enjoy nothing so much as tales of their own persecution. Here, of course, they are not speaking of the substantial, often violent persecution of Christians in countries in which they are actually targeted, such as Afghanistan, Somalia, Eritrea, and Sudan, but of an imagined martyrdom in Europe and the United States. Chairman of this year’s World Congress of Families, Antonio Brandi, characterizes the struggle as nothing less than “a fight between good and evil.”

  Having long recognized the utility of an attack on truth itself, speaker after speaker pillories “fake news.” “It doesn’t matter if 10,000 articles tell lies about us, we walk in the footsteps of heroes,” says Brian Brown, president of the International Organization for the Family, the sponsor of World Congress of Families.

  The global holy war has an unmistakably theocratic vision for the future. “I think this collaboration, cooperation, this synergy between the church and the state in Russia, is the key to the defense of traditional family values,” Komov says.

  “Hungary has declared its commitment to the revitalization of Christian civilization,” America’s Steve Turley adds approvingly. “All the while Poland has formally declared Jesus Christ as Lord and King over their nation.”

  In his remarks, Ed Martin, who coauthored a book with the late Ph
yllis Schlafly and right-wing media personality Brett M. Decker titled The Conservative Case for Trump, offers “three key points” to summarize his vision: “Brexit, the borders, and the Bible.” Martin adds, “The Donald Trump administration has been a blessing on America like we’ve never seen.”

  For a time traveler who may have missed out on the past two and half years, surely the most surprising feature of the new global holy war is the special status accorded to the United States under President Trump. “Donald Trump managed to score a historical victory against the entire U.S. mass media and mainstream political establishment, marking a turning point in the march against the global liberalism,” says Levan Vasadze, a Georgian religious nationalist who doubles as a private equity investor with interests in Russia.

  It would seem that President Trump supports Europe’s new holy warriors unreservedly. In his talk in Verona, Martin quoted Trump’s words on his visit to Warsaw in July 2016: “ ‘Just as Poland could not be broken, I declare today for the world to hear that the West will never, ever be broken. Our values will prevail. Our people will thrive. And our civilization will triumph. So, together, let us all fight like the Poles—for family, for freedom, for country, and for God.’ ”

  The bonds between the holy warriors and the Trump team are personal. At the Verona café outside the congress venue, I overhear Ed Martin urge his Polish fellow MAGA cap wearer Tarczyński to invite “Donald Jr.” to an event. Then he coaches the Polish leader as he crafts a pair of tweets, instructing him to tag #realDonaldTrump. Martin also advises Tarczyński to tag Gateway Pundit, a conspiracy theory website that smeared survivors of the Marjory Stoneman Douglas High School shooting, alleging they were “heavily coached” crisis actors. He also recommends Jack Posobiec, famous for peddling the fraudulent Pizzagate myth. Tarczyński dutifully tags both.