Women’s Medical Fund Helps Where Government Fails

Eleanor J. Bader

It's not even 10:00 a.m. at Philadelphia's abortion fund and I'm already overwhelmed. But the counselors are cheerful, eager to do what they can for low-income women who can't afford abortions in southeastern Pennsylvania.

"My name is Danielle," she says, and immediately begins to
sob. "I have three little kids and cannot have another. I cannot. I’m telling
you, I cannot be pregnant or have
this baby."

Danielle then takes a deep, audible breath, lets out another sob,
and slowly resumes talking to the answering machine at the Women’s Medical Fund
in Philadelphia.

I’m on cash assistance and just paid my electric bill so I
don’t have any money for an abortion. I need to come up with $250. Please,
please help me.

Danielle is followed by Taneisha, Josenia, Courtney, Daisy,
Shannon, Monica, Amara – 25 calls total, not including the dozen who’ve hung up
without saying a word.  Each of
them says the same thing: She wants to have an abortion but cannot afford one.

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It’s morning at the Women’s Medical Fund and counselors
taking calls off the voicemail describe this parade of messages as typical.
They seem nonplussed as they prepare to call each woman back, readying
themselves to ask hard questions about personal finances, health, and family
support systems to ascertain whether the Fund can assist them. It’s a daunting
task, made harder by the current economic climate, which leaves the Fund with
less money to dispense.

It’s not even 10:00 a.m. and I’m already overwhelmed. But
the counselors – highly trained college interns and volunteers supervised by a
paid staff of three – are cheerful, eager to do what they can for low-income
women in their five-county catchment area of southeastern Pennsylvania.

The 24-year-old Fund was established in 1985, shortly after
the state cut off Medicaid coverage for abortion. As one of the 102 groups in
the National Network of Abortion Funds, its mission is to offer grants and
loans to women who want to end unwanted pregnancies but lack the means to do so.  Since its founding more than 12,000 Philadelphia-area
teenagers and adult women have been aided and more than $1.6 million – all of it
raised through individual donations and foundation grants – has been disbursed.

Still, like other members of NNAF, WMF staff look forward to
the day when the Hyde Amendment – the hated 32-year-old bill that bans federal Medicaid
coverage for abortion unless the woman was raped, violated by incest, or will
die or face serious health complications if she carries the pregnancy to
term – is overturned. As advocates, they favor expanding Medicaid to include all
reproductive health services for low-income women.

Until then, however, WMF counselors have no choice but to
ask each woman they speak with a litany of personal questions: Was she forced
to have intercourse? Did a family member impregnate her? Was she ever warned
that carrying a pregnancy to term might put her at medical risk? A "yes" on any
of these queries sends both counselor and patient deep into government
bureaucracy. They understand that if Medicaid will pay for the abortion, the
WMF can stretch their increasingly limited dollars a bit further.

"We never have enough money," admits Susan Schewel, WMF’s
Executive Director, "but it has gotten worse. The recession has caused some of
our donors to make cutbacks and our fall fundraising did not go as well as we
had hoped." In fiscal 2008, which ran from July 1, 2007 until June 30, 2008,
the Fund received $100,000 from local foundations; in fiscal 2009 they took in
$60,000. Still, in fiscal 2009, more than $165,000 was distributed. What’s more,
nearly 500 women were assisted in the first four calendar months of this year,
up almost 50 percent since 2008; the average grant: $139.

"The typical WMF caller is in her twenties, has a toddler or
preschooler already, and is on either cash assistance or has a part-time, minimum
wage job. Almost one-third are uninsured and 93 percent live below the federal
poverty guideline for their family size," says Schewel. She continues:

A fair number of the
women work part-time and go to school part-time.  Their lives are really complicated but the one thing they
have in common is that they’re all doing the best they can. In fact that’s my
mantra: Everyone is doing the best she can.

That said, Schewel and WMF’s counselors can’t help but be frustrated
by the fact that privately-run Funds have become an essential component of
reproductive health care, filling gaps left by inadequate government funding.

"Our so-called safety net doesn’t really act as a safety net," Schewel says. "Women can’t live independently even if they access all the benefits
they’re entitled to: Medicaid, cash assistance, food stamps, child support.
Even if she gets everything that’s out there she can’t live alone unless she
has subsidized housing. The low-cost housing shortage in Philly is terrible so
lots of women live with family or friends who are willing to put them up for a
month, or a week, or a year but they’re basically homeless. This crisis is exacerbated
when the women becomes pregnant."

Twenty-seven-year-old Melissa, the mother of a three-year-old,
faced an unplanned pregnancy crisis in mid-May.  "It was a little more than a month before I was set to begin
a nine-month training program to become a phlebotomist," she says. 

When I got the pregnancy results I was
scared and unsure about what to do but knowing that I couldn’t afford an
abortion made it worse. Once I found the Fund they helped me get everything
together and slowly but surely things fell into place. I had already come up
with as much money as I could on my own, and when I called the Fund, the counselor
assured me that they’d help with the difference.

Catherine is in similar straits. Her voice is composed as
she describes her predicament: She is 13.4 weeks pregnant and has an abortion scheduled
for the following week. Then, slowly, in response to the counselor’s questions,
she confides that she is in poor health, listing problems including endometriosis,
chronic Hepatitis C, asthma, and limited mobility.   

Almost as an
afterthought she mentions the horror she lives with: "My ex-husband ran me over
with his car a while back. Five vertebrae were broken and my collarbone and
left leg were shattered."

She can no longer work, she says, and has applied for
Social Security Disability but has not heard back about her eligibility.  In the interim, she and her 11-year-old
son live with her sister and she receives a biweekly welfare grant of $158.
"I’m extremely poor," she mumbles.

As the interview progresses, the counselor learns that
Catherine’s doctor has advised her against completing the pregnancy, warning that
her already fragile health could be worsened by childbirth. Might this allow
her to get Medicaid coverage? The counselor jots down Catherine’s doctor’s name
and number and assures her that she will contact the medical practice to
discuss her probable eligibility for Medicaid-funded surgery. The counselor adds
that she will also fax the doctor an MA-3 form -a Physician’s Certification for
Abortion-to get the ball rolling.

This news makes Catherine euphoric; she sounds as elated as
a lottery winner.

Not so Jaime, who is 6.4 weeks pregnant and says that she
needs $450. That fee, for a general anesthetic, is more than the WMF can
provide and the counselor tells Jaime to call the clinic and ask the price for
local anesthesia. "Not being put to sleep means that the abortion costs less,"
she counsels. "Please call me back with the new price and we’ll take it from
there."   Will she ever hear
back from Jaime? the counselor wonders.

Others requests involve more heartbreak: Incarcerated
husbands and boyfriends; women suicidal because of unwanted pregnancies; honors
students whose contraceptives failed; women unexpectedly laid off from jobs
they thought were secure.

"These women are the experts about their lives," says WMF
director Susan Schewel. "Not me. Not us."

Erica, who received $130 from the Fund in April, says that
she was surprised that WMF staff respected her decision to have an abortion.

I’m 20 and have two kids already, a one-year-old and a four-year-old. This
pregnancy came as a surprise. I thought about having it but was so sick
throughout the day that I was unable to function. It was too much on me. The
total cost of the abortion was $350, but the clinic gave me a discount to $230.
I had $50 already and my job advanced me $50. When the Fund made up the
difference, I got the abortion done.

"Receiving help from the Fund was the best thing that
happened to me in a long time," Erica adds. "I was overwhelmed and happy to get
money when I called."

Steph Herold was a volunteer counselor at the WMF for
several years while she was in college. Now an abortion counselor, she describes
the work of the Fund as extremely important, if limited.  "You have to accept that you are there
to help with one aspect of a woman’s abortion experience, the cost of the
procedure," she said in an email. "Ultimately,
though, you play a critical role in her pursuit of reproductive rights."    

The WMF believes that reproductive choice is essential, but
recognizes that without access, choice is meaningless. By providing direct
financial assistance to low-income women, they equalize the playing field, giving
poor females the same options that have always been available to their better-heeled
peers.

More
information about the Women’s Medical Fund is available at www.womensmedicalfund.org or by
calling 215.564.4070.

The National Network of
Abortion Funds can be reached by calling 617.524.6040.

News Politics

Congresswoman Pushes Intersectionality at Democratic National Convention

Christine Grimaldi

Rep. Bonnie Watson Coleman (D-NJ) charges that reproductive health-care restrictions have a disproportionate impact on the poor, the urban, the rural, and people of color.

The members of Congress who flocked to the Democratic National Convention in Philadelphia this week included a vocal advocate for the intersection of racial and reproductive justice: Rep. Bonnie Watson Coleman (D-NJ).

Watson Coleman’s longstanding work in these areas “represented the intersection of who I am,” she said during a discussion in Philadelphia sponsored by the Center for Reproductive Rights and Cosmopolitan. Reproductive health-care restrictions, she stressed, have a disproportionate effect on the poor, the urban, the rural, and people of color.

“These decisions impact these communities even more so [than others],” she told Rewire in an interview. “We don’t have the alternatives that middle-class, suburban, white women have. And we’d rather they have them.”

Watson Coleman has brought that context to her work in Congress. In less than two years on Capitol Hill, she co-founded the Congressional Caucus on Black Women and Girls and serves on the so-called Select Investigative Panel on Infant Lives, a GOP-led, $1.2 million investigation that she and her fellow Democrats have called an anti-choice “witch hunt.”

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Coleman said she’s largely found support and encouragement among her fellow lawmakers during her first term as a woman of color and outspoken advocate for reproductive rights.

“What I’ve gotten from my Republican colleagues who are so adamantly against a woman’s right to choose—I don’t think it has anything to do with my being a woman or an African American, it has to do with the issue,” she said.

House Republicans have increasingly pushed anti-choice policies in advance of the ongoing August recess and November’s presidential election. The House this month passed the Conscience Protection Act, which would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in such care.

Speaker Paul Ryan (R-WI) lauded passage of the bill and the House’s thus-far unsuccessful effort to prove that Planned Parenthood profited from fetal tissue donations—allegations based on widely discredited videos published by the Center for Medical Progress, an anti-choice front group that has worked closely with GOP legislators to attack funding for Planned Parenthood.

On the other side of the aisle, Watson Coleman joined 118 other House Democrats to co-sponsor the Equal Access to Abortion Coverage in Health Insurance Act (HR 2972). Known as the EACH Woman Act, the legislation would overturn the Hyde Amendment and ensure that every woman has access to insurance coverage of abortion care.

The Hyde Amendment’s restriction of federal funding for abortion care represents a particularly significant barrier for people with low incomes and people of color.

The Democratic Party platform, for the first time, calls for repealing the Hyde Amendment, though the process for undoing a yearly federal appropriations rider remains unclear.

For Watson Coleman, the path forward on getting rid of the Hyde Amendment is clear on at least one point: The next president can’t go it alone.

“The president will have to have a willing Congress,” she said. She called on the electorate to “recognize that this is not a personality contest” and “remove some of those people who have just been obstructionists without having the proper evidence.”

In the meantime, what does a “willing Congress” look like for legislation with anti-choice roadblocks? A majority voting bloc helps, Watson Coleman said. But that’s not everything.

“There are lots of bills that Republicans will vote for if their leadership would simply bring them up,” she said.

Analysis Law and Policy

Do Counselors-in-Training Have the Right to Discriminate Against LGBTQ People?

Greg Lipper

Doctors can't treat their patients with leeches; counselors can't impose their beliefs on patients or harm them using discredited methods. Whatever their views, medical professionals have to treat their clients competently.

Whether they’re bakers, florists, or government clerks, those claiming the right to discriminate against LGBTQ people have repeatedly sought to transform professional services into constitutionally protected religious speech. They have grabbed headlines for refusing, for example, to grant marriage licenses to same-sex couples or to make cakes for same-sex couples’ weddings-all in the name of “religious freedom.”

A bit more quietly, however, a handful of counseling students at public universities have challenged their schools’ nondiscrimination and treatment requirements governing clinical placements. In some cases, they have sought a constitutional right to withhold treatment from LGBTQ clients; in others, they have argued for the right to directly impose their religious and anti-gay views on their clients.

There has been some state legislative maneuvering on this front: Tennessee, for instance, recently enacted a thinly veiled anti-LGBTQ measure that would allow counselors to deny service on account of their “sincerely held principles.” But when it comes to the federal Constitution, providing medical treatment—whether bypass surgery, root canal, or mental-health counseling—isn’t advocacy (religious or otherwise) protected by the First Amendment. Counselors are medical professionals; they are hired to help their clients, no matter their race, religion, or sexual orientation, and no matter the counselors’ beliefs. The government, moreover, may lawfully prevent counselors from harming their clients, and universities in particular have an interest, recognized by the U.S. Supreme Court, in preventing discrimination in school activities and in training their students to work with diverse populations.

The plaintiffs in these cases have nonetheless argued that their schools are unfairly and unconstitutionally targeting them for their religious beliefs. But these students are not being targeted, any more than are business owners who must comply with civil rights laws. Instead, their universities, informed by the rules of the American Counseling Association (ACA)—the leading organization of American professional counselors—merely ask that all students learn to treat diverse populations and to do so in accordance with the standard of care. These plaintiffs, as a result, have yet to win a constitutional right to discriminate against or impose anti-LGBTQ views on actual or prospective clients. But cases persist, and the possibility of conflicting court decisions looms.

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Keeton v. Anderson-Wiley

The first major challenge to university counseling requirements came from Jennifer Keeton, who hoped to receive a master’s degree in school counseling from Augusta State University. As detailed in the 2011 11th Circuit Court of Appeals decision considering her case, Keeton entered her professional training believing that (1) “sexual behavior is the result of personal choice for which individuals are accountable, not inevitable deterministic forces”; (2) “gender is fixed and binary (i.e., male or female), not a social construct or personal choice subject to individual change”; and “homosexuality is a ‘lifestyle,’ not a ‘state of being.'”

It wasn’t those views alone, however, that sunk her educational plans. The problem, rather, was that Keeton wanted to impose her views on her patients. Keeton had told both her classmates and professors about her clinical approach at a university-run clinic, and it wasn’t pretty:

  • She would try to change the sexual orientation of gay clients;
  • If she were counseling a sophomore student in crisis questioning his sexual orientation, she would respond by telling the student that it was not OK to be gay.
  • If a client disclosed that he was gay, she would tell him that his behavior was wrong and try to change it; if she were unsuccessful, she would refer the client to someone who practices “conversion therapy.”

Unsurprisingly, Keeton also told school officials that it would be difficult for her to work with LGBTQ clients.

Keeton’s approach to counseling not only would have flouted the university’s curricular guidelines, but also would have violated the ACA’s Code of Ethics.

Her conduct would have harmed her patients as well. As a school counselor, Keeton would inevitably have to counsel LGBTQ clients: 57 percent of LGBTQ students have sought help from a school professional and 42 percent have sought help from a school counselor. Suicide is the leading cause of death for LGBTQ adolescents; that’s twice or three times the suicide rate afflicting their heterosexual counterparts. And Keeton’s preferred approach to counseling LGBTQ students would harm them: LGBTQ students rejected by trusted authority figures are even more likely to attempt suicide, and anti-gay “conversion therapy” at best doesn’t work and at worst harms patients too.

Seeking to protect the university’s clinical patients and train her to be a licensed mental health professional, university officials asked Keeton to complete a remediation plan before she counseled students in her required clinical practicum. She refused; the university expelled her. In response, the Christian legal group Alliance Defending Freedom sued on her behalf, claiming that the university violated her First Amendment rights to freedom of speech and the free exercise of religion.

The courts disagreed. The trial court ruled against Keeton, and a panel of the U.S. Court of Appeals for the 11th Circuit unanimously upheld the trial court’s ruling. The 11th Circuit explained that Keeton was expelled not because of her religious beliefs, but rather because of her “own statements that she intended to impose her personal religious beliefs on clients and refer clients to conversion therapy, and her own admissions that it would be difficult for her to work with the GLBTQ population and separate her own views from those of the client.” It was Keeton, not the university, who could not separate her personal beliefs from the professional counseling that she provided: “[F]ar from compelling Keeton to profess a belief or change her own beliefs about the morality of homosexuality, [the university] instructs her not to express her personal beliefs regarding the client’s moral values.”

Keeton, in other words, crossed the line between beliefs and conduct. She may believe whatever she likes, but she may not ignore academic and professional requirements designed to protect her clients—especially when serving clients at a university-run clinic.

As the court explained, the First Amendment would not prohibit a medical school from requiring students to perform blood transfusions in their clinical placements, nor would it prohibit a law school from requiring extra ethics training for a student who “expressed an intent to indiscriminately disclose her client’s secrets or violate another of the state bar’s rules.” Doctors can’t treat their patients with leeches; counselors can’t impose their beliefs on patients or harm them using discredited methods. Whatever their views, medical professionals have to treat their clients competently.

Ward v. Polite

The Alliance Defending Freedom’s follow-up case, Ward v. Polite, sought to give counseling students the right to withhold service from LGBTQ patients and also to practice anti-gay “conversion therapy” on those patients. The case’s facts were a bit murkier, and this led the appeals court to send it to trial; as a result, the student ultimately extracted only a modest settlement from the university. But as in Keeton’s case, the court rejected in a 2012 decision the attempt to give counseling students the right to impose their religious views on their clients.

Julea Ward studied counseling at Eastern Michigan University; like Keeton, she was training to be a school counselor. When she reviewed the file for her third client in the required clinical practicum, she realized that he was seeking counseling about a romantic relationship with someone of the same sex. As the Court of Appeals recounted, Ward did not want to counsel the client about this topic, and asked her faculty supervisor “(1) whether she should meet with the client and refer him [to a different counselor] only if it became necessary—only if the counseling session required Ward to affirm the client’s same-sex relationship—or (2) whether the school should reassign the client from the outset.” Although her supervisor reassigned the client, it was the first time in 20 years that one of her students had made such a request. So Ward’s supervisor scheduled a meeting with her.

Then things went off the rails. Ward, explained the court, “reiterated her religious objection to affirming same-sex relationships.” She told university officials that while she had “no problem counseling gay and lesbian clients,” she would counsel them only if “the university did not require her to affirm their sexual orientation.” She also refused to counsel “heterosexual clients about extra-marital sex and adultery in a values-affirming way.” As for the professional rules governing counselors, Ward said, “who’s the [American Counseling Association] to tell me what to do. I answer to a higher power and I’m not selling out God.”

All this led the university to expel Ward, and she sued. She claimed that the university violated her free speech and free exercise rights, and that she had a constitutional right to withhold affirming therapy relating to any same-sex relationships or different-sex relationships outside of marriage. Like Keeton, Ward also argued that the First Amendment prohibited the university from requiring “gay-affirmative therapy” while prohibiting “reparative therapy.” After factual discovery, the trial court dismissed her case.

On appeal before the U.S. Court of Appeals for the Sixth Circuit, Ward eked out a narrow and temporary win: The court held that the case should go to a jury. Because the university did not have a written policy prohibiting referrals, and based on a few troubling faculty statements during Ward’s review, the court ruled that a reasonable jury could potentially find that the university invoked a no-referrals policy “as a pretext for punishing Ward’s religious views and speech.” At the same time, the court recognized that a jury could view the facts less favorably to Ward and rule for the university.

And although the decision appeared to sympathize with Ward’s desire to withhold service from certain types of clients, the court flatly rejected Ward’s sweeping arguments that she had the right to stray from the school curriculum, refuse to counsel LGBTQ clients, or practice anti-gay “conversion therapy.” For one, it said, “Curriculum choices are a form of school speech, giving schools considerable flexibility in designing courses and policies and in enforcing them so long as they amount to reasonable means of furthering legitimate educational ends.” Thus, the problem was “not the adoption of this anti-discrimination policy, the existence of the practicum class or even the values-affirming message the school wants students to understand and practice.” On the contrary, the court emphasized “the [legal] latitude educational institutions—at any level—must have to further legitimate curricular objectives.”

Indeed, the university had good reason to require counseling students—especially those studying to be school counselors—to treat diverse populations. A school counselor who refuses to counsel anyone with regard to nonmarital, nonheterosexual relationships will struggle to find clients: Nearly four in five Americans have had sex by age 21; more than half have done so by the time they turn 18, while only 6 percent of women and 2 percent of men are married by that age.

In any event, withholding service from entire classes of people violates professional ethical rules even for nonschool counselors. Although the ACA permits client referrals in certain circumstances, the agency’s brief in Ward’s case emphasized that counselors may not refuse to treat entire groups. Ward, in sum, “violated the ACA Code of Ethics by refusing to counsel clients who may wish to discuss homosexual relationships, as well as others who fail to comport with her religious teachings, e.g., persons who engage in ‘fornication.'”

But Ward’s approach would have been unethical even if, in theory, she were permitted to withhold service from each and every client seeking counseling related to nonmarital sex (or even marital sex by same-sex couples). Because in many cases, the need for referral would arise well into the counseling relationship. And as the trial court explained, “a client may seek counseling for depression, or issues with their parents, and end up discussing a homosexual relationship.” No matter what the reason, mid-counseling referrals harm clients, and such referrals are even more harmful if they happen because the counselor disapproves of the client.

Fortunately, Ward did not win the sweeping right to harm her clients or otherwise upend professional counseling standards. Rather, the court explained that “the even-handed enforcement of a neutral policy”—such as the ACA’s ethical rules—”is likely to steer clear of the First Amendment’s free-speech and free-exercise protections.” (Full disclosure: I worked on an amicus brief in support of the university when at Americans United.)

Ward’s lawyers pretended that she won the case, but she ended up settling it for relatively little. She received only $75,000; and although the expulsion was removed from her record, she was not reinstated. Without a graduate counseling degree, she cannot become a licensed counselor.

Cash v. Hofherr

The latest anti-gay counseling salvo comes from Andrew Cash, whose April 2016 lawsuit against Missouri State University attempts to rely on yet murkier facts and could wind up, on appeal, in front of the more conservative U.S. Court of Appeals for the Eighth Circuit. In addition to his range of constitutional claims (freedom of speech, free exercise of religion, equal protection of law), he has added a claim under the Missouri Religious Freedom Restoration Act.

The complaint describes Cash as “a Christian with sincerely-held beliefs”—as opposed to insincere ones, apparently—”on issues of morality.” Cash started his graduate counseling program at Missouri State University in September 2007. The program requires a clinical internship, which includes 240 hours of in-person client contact. Cash decided to do his clinical internship at Springfield Marriage and Family Institute, which appeared on the counseling department’s list of approved sites. Far from holding anti-Christian bias, Cash’s instructor agreed that his proposed class presentation on “Christian counseling and its unique approach and value to the Counseling profession” was an “excellent” idea.

But the presentation itself revealed that Cash intended to discriminate against LGBTQ patients. In response to a question during the presentation, the head of the Marriage and Family Institute stated that “he would counsel gay persons as individuals, but not as couples, because of his religious beliefs,” and that he would “refer the couple for counseling to other counselors he knew who did not share his religious views.” Because discrimination on the basis of sexual orientation violates ACA guidelines, the university determined that Cash should not continue counseling at the Marriage and Family Institute and that it would be removed from the approved list of placements. Cash suggested, however, that he should be able to withhold treatment from same-sex couples.

All this took place in 2011. The complaint (both the original and amended versions) evades precisely what happened between 2012 and 2014, when Cash was finally expelled. You get the sense that Cash’s lawyers at the Thomas More Society are trying to yadda-yadda-yadda the most important facts of the case.

In any event, the complaint does acknowledge that when Cash applied for a new internship, he both ignored the university’s instructions that the previous hours were not supposed to count toward his requirement, and appeared to be “still very much defend[ing] his previous internship stating that there was nothing wrong with it”—thus suggesting that he would continue to refuse to counsel same-sex couples. He continued to defend his position in later meetings with school officials; by November 2014, the university removed him from the program.

Yet in challenging this expulsion, Cash’s complaint says that he was merely “expressing his Christian worldview regarding a hypothetical situation concerning whether he would provide counseling services to a gay/homosexual couple.”

That’s more than just a worldview, though. It also reflects his intent to discriminate against a class of people—in a manner that violates his program’s requirements and the ACA guidelines. Whether hypothetically or otherwise, Cash stated and reiterated that he would withhold treatment from same-sex couples. A law student who stated, as part of his clinic, that he would refuse to represent Christian clients would be announcing his intent to violate the rules of professional responsibility, and the law school could and would remove him from the school’s legal clinic. And they could and would do so even if a Christian client had yet to walk in the door.

But maybe this was just a big misunderstanding, and Cash would, in practice, be willing and able to counsel same-sex couples? Not so, said Cash’s lawyer from the Thomas More Society, speaking about the case to Christian news outlet WORLD: “I think Christians have to go on the offensive, or it’s going to be a situation like Sodom and Gomorrah in the Bible, where you aren’t safe to have a guest in your home, with the demands of the gay mob.” Yikes.

Although Cash seems to want a maximalist decision allowing counselors and counseling students to withhold service from LGBTQ couples, it remains to be seen how the case will turn out. The complaint appears to elide two years’ worth of key facts in order to present Cash’s claims as sympathetically as possible; even if the trial court were to rule in favor of the university after more factual development, Cash would have the opportunity to appeal to the U.S. Court of Appeals for the Eighth Circuit, one of the country’s most conservative federal appeals courts.

More generally, we’re still early in the legal battles over attempts to use religious freedom rights as grounds to discriminate; only a few courts across the country have weighed in. So no matter how extreme Cash or his lawyers may seem, it’s too early to count them out.

* * *

The cases brought by Keeton, Ward, and Cash not only attempt to undermine anti-discrimination policies. They also seek to change the nature of the counselor-client relationship. Current norms provide that a counselor is a professional who provides a service to a client. But the plaintiffs in these cases seem to think that counseling a patient is no different than lecturing a passerby in the town square, in that counseling a patient necessarily involves expressing the counselor’s personal and religious beliefs. Courts have thus far rejected these attempts to redefine the counselor-patient relationship, just as they have turned away attempts to challenge bans on “reparative therapy.”

The principles underlying the courts’ decisions protect more than just LGBTQ clients. As the 11th Circuit explained in Keeton, the university trains students to “be competent to work with all populations, and that all students not impose their personal religious values on their clients, whether, for instance, they believe that persons ought to be Christians rather than Muslims, Jews or atheists, or that homosexuality is moral or immoral.” Licensed professionals are supposed to help their clients, not treat them as prospective converts.