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Ever since Bruce Jenner transitioned to Caitlyn, the small but loud transgender movement as a collective whole has lobbied for its rights — however bizarre and outrageous — first via Hollywood and then public high schools.

Now as evidence of both its staying power and persuasiveness, the movement is thrusting itself in the center of medical debates — or rather, medicine — questioning science and creating a cacophonous relationship among law, medicine, insurance companies and transgender patients.

Transgender man sues hospital for hysterectomy

Recently, Jionni Conforti, a transgender man (i.e., a woman who believes she is a man), filed a lawsuit against St. Joseph’s, a Catholic hospital, because it refused to allow its doctors to perform a hysterectomy. In the suit, Conforti alleges the hospital violated anti-bias laws (i.e., Obamacare’s nondiscrimination rule).

According to the suit, Conforti has been taking “gender confirming” hormone therapy (notice the subtle but essential language shift from gender “dysphoria” to gender identity to gender “confirming”) since 2014. That same year, Conforti underwent a double mastectomy to “help Jionni align himself with his true sex, consistent with his gender identity.”

The complaint explains:

After completing his double mastectomy, Jionni discussed further gender confirmation surgery with Dr. Tang. Jionni also discovered that there was a possible link between the hormone therapy he was receiving and certain reproductive system cancers. In addition, Jionni’s family has a history of cancer. Due to these concerns, and in consultation with Dr. Tang, Jionni decided to continue with his gender confirmation by seeking to undergo a total hysterectomy

So Conforti thought there may be a link to the hormone therapy and cancer and, with support of a doctor, decided a hysterectomy was necessary. When the hospital refused, based on the grounds that the hysterectomy was needed to complete “gender reassignment,” Conforti sued, claiming discrimination.

Strangely, there’s no further mention of “health” or “cancer” in the suit — almost as if that wasn’t really the reason for the surgery, rather a façade and everyone — including the hospital, Conforti, and attorneys — knows it.

The result? Conforti worries, “It would severely impede his ability to live as his true self in accordance with his gender identity.”

The Conforti case highlights several conflicting issues for doctors and insurance companies. As a religious hospital, St. Joseph not only abides by ethical obligations (primum non nocere, “first do no harm”), but also religious obligations. This acts as a double-defense: The removal of healthy organs seems, as my colleague, attorney Leslie Loftis, put it, “unconscionable.”

Furthermore, the double standard that a transgender man can ask for a hysterectomy to help “confirm” his identity, yet a hospital should perform it despite objections based on religious, ethical, or both grounds is becoming absurd in its visibility, asinine in its flagrance. The gross intermingling of religious and ethical objections doesn’t end there.

Conforti’s insurance company agreed to cover the procedure if Conforti secured referrals from two medical professionals. One was a therapist, the other, his primary care physician, Dr. Ian Tang, who joined Apicha Community Health Center a few years ago, a practice, which specializes in the LGBTQI community and treating those with HIV/AIDS.

I can hardly get my insurance company to cover basic procedures my children need, but it seems as though as long as a transgender person can acquire the right referral from the right people, an insurance company will at least attempt to cover the procedure.

Recent court ruling

This is not an isolated incident, and one court has already ruled on something similar. Last May, the Health and Human Services Department implemented a mandate, which would have required doctors perform gender transition procedures on children —  even if they think it would be harmful — and forced “all private insurance companies and many employers to cover gender transition procedures or face severe penalties and legal action.” It applied to almost nearly every doctor in the U.S. and would have cost health care providers and taxpayers approximately $1 billion. Hardly anyone even knew it existed. (Did you?)

However, a Catholic hospital system, several states, and an association of nearly 18,000 doctors challenged this regulation and on New Year’s Eve, a Texas court struck down this harmful mandate. In a press release, Lori Windham, senior counsel at Becket Law, which filed a lawsuit against the regulation commented,

This is a common-sense ruling: The government has no business forcing private doctors to perform procedures on children that the government itself recognizes can be harmful and exempts its own doctors from performing. Today’s ruling ensures that doctors’ best medical judgment will not be replaced with political agendas and bureaucratic interference.

Looking forward

While the Texas ruling is certainly a victory for families who want bureaucrats to stay out of their children’s lives and for insurance companies who wish to err on the side of ethical treatment, it’s unclear how it will affect cases like that of Jionni Conforti. Other lawsuits will undoubtedly follow against doctors and hospitals nationwide, who merely wish to observe tenets of religion, medicine, or both with their consciences fully intact.

Doctors practice medicine — they don’t create fiction.

The fact that Conforti’s insurance company was willing to cover a hysterectomy, wherein all three parties (patient, therapist, and doctor) made the case he needed it for his gender to be fully “confirmed,” remains either a blatant misuse of coverage or attempt to follow the HHS mandate. Either way it’s ludicrous.

Top that off with the fact that Conforti is actually suing a hospital because he wants a doctor to remove his female organs (since he decided two years ago he wanted to live as a man) seems not only medically unsound and ethically irresponsible, but also Orwellian in its eccentricity.

Doctors practice medicine — they don’t create fiction. Religious-affiliated hospitals operate via their own codes and values vis-à-vis religious expression. They don’t exist to submit to the will of a person who wants to change his entire identity.

It was one thing for Bruce Jenner to display his transition within the glimmer and glitz of Hollywood (how Kardashian was that?), but as my colleagues and I predicted, this would pave the way for a small but boisterous and pushy crowd to make its way into the mainstream, despite being anything but conventional.

Indeed, as last year we witnessed Obama make a decree for all high schools to allow transgender students to use the bathroom of their choosing, this year we see the new battlefield: medicine and insurance companies. That kind of target is medically unsound, ethically unwise, and legally — hopefully — impossible. This is one battle the medical community cannot lose.

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Nicole Russell is a freelance writer whose work has appeared in The Atlantic, The Federalist, The American Spectator, Reason, National Review Online, and Parents magazine. She was the 2010 recipient of the American Spectator’s Young Journalist award. She lives in Northern Virginia with her husband and four children.