As medical students, we are taught that patient-centered care, health equity, and accessibility are the foundational pillars of our future profession. The Queen’s MD Program explicitly aims to train physicians who are prepared to champion the needs of equity-deserving groups, while promising a community where equity, diversity, and inclusion are embedded in everything we do.
Yet, as a second-year medical student spending more time within the walls of our local healthcare system, I have quickly learned about a hidden curriculum — a set of unspoken forces and administrative constraints that dictate what type of healthcare is accessible, who is allowed to receive it, and who is allowed to speak about it.
Here in Kingston, we have three operational hospitals, but two of them — Hotel Dieu Hospital (HDH) and Providence Care Hospital (PCH) — are Catholic-affiliated organizations. Despite being publicly funded, these institutions are legally permitted to limit access to essential forms of healthcare that do not align with Catholic religious principles.
While these limitations are often seen as historic anomalies, their modern applications actively undermine patient autonomy and health equity. Catholic affiliated hospitals utilize their religious principles to selectively and disproportionately affect transgender patients. These Catholic ethical guidelines, while initially appearing to affect only a marginalized community, in reality complicate hospital logistics, which compromises medical access for the broader Kingston community.
The most problematic aspect of these Catholic guidelines is not that the surgeries are technically complex or unavailable, but that the restriction is based purely on the identity and medical motivation of the patient.
The gynecologic portion of gender-affirming surgery for individuals assigned female at birth typically involves a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. This is an OHIP-funded, medically necessary intervention that yields documented, significant improvements in quality of life, body image, and mental health for trans patients.
These exact operations are performed routinely every single week at HDH for indications such as abnormal uterine bleeding, fibroids, and early-stage cancers. Yet, they are explicitly prohibited if the indication is gender affirmation. This manifests as an unwritten administrative rule: if a surgeon writes “fibroids” on an HDH operating room referral form, the surgery proceeds without issue; if “gender-affirmation” is written, the surgery is silently flagged and canceled.
A parallel injustice occurs with reproductive care. Procedures like bilateral salpingectomies and intrauterine device (IUD) insertions are routinely blocked at HDH if performed for the purpose of contraception, despite being freely permitted for cancer prevention or other non-contraceptive indications. These practices directly mirrors institutional mandates outlined in the Catholic Health Alliance of Canada’s Health Ethics Guide.
This is a clear contradiction of the Canadian Human Rights Act of 1985, which mandates that all individuals should have an equal opportunity to have their needs accommodated without being hindered by discriminatory practices based on gender identity or expression. By offering identical anatomical procedures for cisgender indications while banning them for transgender indications, Kingston Health Sciences Centre (KHSC) is passing moral judgment on the worthiness of a patient’s medical needs.
Transgender individuals are already among the most vulnerable in our society, facing disproportionate rates of discrimination and violence. Denying them equal access to a medically necessary procedure at a publicly funded facility only perpetuates this systemic violence.
A common misconception is that faith-based medical restrictions only impact patients seeking niche or highly specific religious-confronting care. In reality, institutional religious mandates disrupt the efficiency of the entire municipal health infrastructure.
In Kingston, HDH holds roughly 60 percent of the city’s gynecological operating room space. Because general gynecology is allocated six times more operating room time at HDH compared to the secular Kingston General Hospital (KGH), routine operations are designed to be cleared through HDH. However, because HDH restricts procedures tied to contraception and gender-affirmation, these routine operations are forced onto KGH’s operating tables.
KGH’s limited operating room space is traditionally reserved for complex, highly comorbid patients and cancer cases. When straightforward, day-surgery procedures are systematically offloaded onto KGH due to religious policies at HDH, it creates an artificial bottleneck. Patients requiring complex gynecological surgeries, who are already facing extensive wait times, are forced to wait even longer as KGH absorbs the routine surgeries turned away by HDH.
Faith-based restrictions do not exist in a vacuum; they strain secular institutions and compromise systemic care for every resident in communities where catholic hospitals are dominant healthcare providers.
Unfortunately, Kingston’s struggles are part of a broader, systemic issue across Canada where the 2013 Catholic Health Alliance of Canada’s Health Ethics Guide continues to cast an ambiguous, unwritten shadow over public hospital policy. The consequences of these institutional barriers are perhaps most visible, and tragic, in end-of-life care.
Because PCH operates under Catholic principles, it completely bars Medical Assistance in Dying (MAID) on its premises. Terminally ill, fragile patients must be heavily sedated and transferred via ambulance to KGH simply to exercise their legal right to a dignified death — a logistical hurdle that causes immense, documented distress to families and providers alike.
This institutional obstruction is finally facing legal action. In the British Columbia Supreme Court, a landmark lawsuit brought by the family of 34-year-old Samantha O’Neill, alongside Dying With Dignity Canada, is challenging the right of publicly funded, faith-based hospitals like Vancouver’s St. Paul’s Hospital to enforce “forced transfers” for MAID. O’Neill, suffering from stage four cervical cancer, endured a traumatic and agonizing transfer in her final hours due to institutional religious policies.
Her family’s Charter challenge argues that public funds should demand public compliance with federal healthcare rights. A success in this B.C. trial is expected to create a legal domino effect, emboldening Ontario physicians and patients to challenge these archaic regulations.
KHSC’s website proudly states: “We treat each person with respect and dignity… by caring for the whole person, when and where they need it most.” Yet, the current reality of surgical access for contraception and gender-affirming care stands in stark opposition to the organization’s professed values. Institutional religious restrictions on gender-affirming and reproductive care directly discriminate against transgender patients while creating systemic bottlenecks that compromise healthcare access for everyone.
As medical trainees, we are entering a profession with a historically troubled legacy regarding the mistreatment of marginalized groups, particularly patients of colour and queer individuals. Frontline physicians speaking out on these injustices often operate under a professional spotlight, taking turns in their advocacy to shield themselves from administrative backlash or professional consequences from the hospitals they are employed at.
This leaves medical students and trainees with a unique responsibility. Because we sit outside the administrative hierarchy, we have the distinct freedom to name these injustices loudly.
Advocacy around this issue stands on the foundational work of Dr. Chris Vicenza and Dr. Emma Denison. Hospital administrators often rely on the short memory of medical training, expecting advocacy to fade as leaders move on in their careers to new institutions. As a second-year medical student inheriting this torch, I wish to not let these systemic injustices be forgotten.
I hope that by highlighting this issue during Pride Month, we can reflect on which members of the 2SLGBTQIA+ community KHSC, and subsequently Queen’s University, deem acceptable to celebrate as they promote their allyship this June.
Zi Han (Henry) Li is a second-year medical student.
Tags
Catholic schools, Catholicism, hospitals, KHSC
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