This legislation is part of a wave of religious-freedom bills that have been introduced and passed in the past year or so, almost all inspired by objections to homosexuality and same-sex marriage. Some of these measures are just for show—pastors could never be legally compelled to perform a gay-marriage ceremony in the way some bills have suggested, for example. But some represent a relatively novel approach to religious-freedom legislation: They offer legal cover to people of faith who don’t want to provide certain goods or services to LGBT people, especially when doing so might seem like a tacit endorsement of their relationships and sex lives.

Medical exemptions, though, deserve to be considered in a category of their own. Doctors and therapists interact with people at their most vulnerable, and their training and expertise gives them incredible power over patients. The advice they provide—or refuse to provide—to an LGBT patient could influence the treatment that person seeks. It could make that person less likely to seek primary care or identify themselves as LGBT to other doctors, which can lead to the “failure to screen, diagnose, or treat important medical problems,” according to the American Medical Association. The medical community has a problem: What should hospitals, private practices, and medical associations do about doctors and therapists who say it’s against their beliefs to provide care to LGBT patients?

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Paul Church is an evangelical Christian who attends services at a Congregationalist church in Massachusetts. He’s a urologist—a surgical specialty focusing on pelvic, urinary-tract, and male reproductive disorders—and has been practicing as a staff doctor and affiliate of various Boston hospitals for nearly three decades. He even had a joint appointment as an assistant clinical professor at Harvard Medical School. After coming into conflict with staff over statements he made about homosexuality, he lost his privileges at two area hospitals, effectively ending his ability to perform surgeries.

As Church tells it, the fight started when he circulated comments on the hospital’s internal-communications network—a kind of company intranet. “I was taken aback that a hospital was engaging in, especially, promotions for the gay-pride parade,” he said. “All sorts of sordid, vulgar things go on in it.” Church claims that a number of doctors employed by or affiliated with the hospital objected to its open support of Pride and other LGBT cultural events. “I took up a letter-writing campaign to the leadership, and I was taken aback that they accused me of harboring some kind of discrimination,” he said.

A spokesperson from one of the hospitals, Beth Israel, wouldn’t confirm why Church’s privileges were revoked, but she did point me to the hospital’s harassment policy, which prohibits “verbal or physical conduct that denigrates, belittles, or shows hostility or aversion to an individual” because of, among other things, that person’s “sex, sexual orientation, [or] gender identity.”