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Counting the Cost of Discipleship

Eagerly approaching the end of her Certified Nurse Midwife education, CMDA member Sara Hellwege decided to seek a position where she could minister to medically underserved patients without compromising her life-affirming convictions.

by Jonathan Imbody

“I am sending you out like sheep among wolves. Therefore be as shrewd as snakes and as innocent as doves.”
—Matthew 10:16

Eagerly approaching the end of her Certified Nurse Midwife education, CMDA member Sara Hellwege decided to seek a position where she could minister to medically underserved patients without compromising her life-affirming convictions. So she launched out into her job search, a seemingly simple and safe journey that unfortunately would end in a shipwreck.

“I began sending applications with my peers’ recommendations to prospective practices, pending passing the comprehensive and board examinations,” she recounted. “I applied at Tampa Family Health Centers because I was seeking to work in an area whose patients primarily come from an underserved, low-income, culturally diverse population background. My husband and I contemplated working overseas, and we felt this would be a great position to begin preparing for that role.”

Sara never anticipated the national firestorm that her job search would launch. “After sending an initial inquiry to the practice and some routine dialogue, I received an unexpected email,” she said. “The wording stunned me.”

Due to the fact we are a Title X [federal family planning funds] organization and you are a member of [a pro-life organization], we would be unable to move forward in the interviewing process.1

Sara never anticipated a zero-tolerance, no-diversity policy of outright discrimination: “Pro-life health professionals need not apply.”

“During my previous professional experiences, there had been colleagues who had differed with my view, but we always maintained a respectful dialogue and working relationship,” she said. “I was shocked to learn that having a professional membership listed on a resume could then be brazenly utilized as justification to confidently deny employment. It saddened me to be turned away due to ideological and religious differences.”


Sara could have taken the route of passive acceptance, by ignoring the discrimination and simply keeping her head down, searching for a more sympathetic employer. Instead, she followed the example of the apostle Paul, who appealed to Rome to uphold his legal protections when he was unjustly persecuted for his Christian faith, as recorded in Acts 25:11.

Alliance Defending Freedom (ADF), one of several pro-life groups CMDA works with to provide pro bono legal help to members2 who experience discrimination, agreed to take up Sara’s cause. ADF attorneys filed suit in federal district court in Florida, in addition to filing administrative complaints with the U.S. Department of Health and Human Services (HHS) and the Equal Employment Opportunity Commission (EEOC).

“I wanted to set the tone and a precedent,” Sara explained, “that this type of discrimination is not acceptable. I wanted to help my peers and others in the medical field, hoping that standing firm in my faith would empower others to speak up regarding their experiences regarding discrimination for their faith and convictions. I took my cues from 1 Corinthians 16:13-14: ‘Be on your guard; stand firm in the faith; be men of courage; be strong. Do everything in love.’”


As Sara soon discovered, standing firm in the faith in today’s toxic cultural environment can exact what Nazi-resister and Christian martyr Dietrich Bonhoeffer called the “cost of discipleship.” Her simple plea for freedom of conscience triggered scathing condemnations and even threats of violence from anti-religious, pro-abortion commentators and activists:

  • In a commentary on Sara’s court case, “The religious war on contraception,” Amanda Marcotte from asserted, “Is ‘religious freedom’ about being free to practice your faith, or just a generic cover story for any and all attempts to try to foist your beliefs on others?”3
  • In a follow-up op-ed published in USA Today, Marcotte continued the attempt to tar the victim as the attacker, opining that “a growing crop of fundamentalists are demanding that the religious freedom of patients to make their own decisions about health care should be curtailed, allowing providers to push their own agenda on them.”4
  • Americans United for Separation of Church and State pulled out all stops and labeled the case as an “increasingly aggressive war against access to birth control” borne of a “theology anchored in judgment, punishment and retribution.”5
  • An editorial at Jezebel slung a term at Sara and the “anti-birth control crowd” that is too crude to reprint here.6
  • A commentator at Wonkette attacked Sara in a profanity-laced diatribe as a “wingnut nurse,” concluding, “Sara needs to find a new calling because obviously women’s health care provider ain’t it, and also, she should punch herself in the face.”7

“During the tumultuous time of the legal proceedings,” Sara recalls, “I was quite fortunate to have support of my local CMDA chapter, prayer from those in the national office and encouragement from my church family. That support allowed me to stand firm in my convictions and hope of the gospel.”

Sara offers a gentle response to the harsh allegations against her: “My religious belief to not end the life of an unborn person and working within the Hippocratic Oath does not lead me to isolate a segment of the population from receiving care. I have and will continue to provide respectful, evidence-based, compassionate care to all of my patients, regardless of their religious beliefs, sexual identity or lifestyle choices.”


Sara’s case illustrates that faith-based healthcare professionals do not, and cannot, separate the faith principles motivating them to serve the needy from the faith principles upholding the sanctity of human life.

Polling conducted for CMDA’s Freedom2Care revealed that 92 percent of faith-based physicians said they would be forced to leave medicine if coerced into violating the faith tenets and medical ethics principles that guide their practice of medicine. The poll also found that 39 percent have “experienced pressure from or discrimination by faculty or administrators based on [their] moral, ethical or religious beliefs.”8

Conscience rights impact healthcare professionals as well as the patients they serve. In Freedom2Care’s polling, 88 percent of American adults surveyed said it is important to them that they share a similar set of morals as their doctors, nurses and other healthcare professionals.

Sara explains, “Conscience freedom widely impacts healthcare availability. Currently our nation possesses vast geographic areas with no OB/Gyn coverage, including 38 out of 67 counties in my own state of Alabama. Mounting shortages are not limited to the field of obstetrics and are climbing within nursing and medicine.”


The federal court examining Sara’s case ruled that the federal conscience protection law applicable to the discrimination she experienced does not make clear the right of a victim of discrimination to sue in court (a “private cause of action”).

The U.S. District Court in Florida, Tampa Division found that “whether Hellwege has alleged a private cause of action under either statute presents a novel and complex issue of state law” and accordingly “decline[d] to exercise supplemental jurisdiction over Hellwege’s claims under these statutes.”9

To address this gap, pro-life organizations, including CMDA, are pressuring the U.S. Congress to pass the Conscience Protection Act. The act would give victims of discrimination the right to sue in court. It also would make permanent certain conscience protections that Congress currently needs to pass every year.

Meanwhile, the ship of American civil rights is being turned back in the direction of religious and conscience freedom, with an executive order, a new division to enforce conscience protections and a new rule to protect conscience freedom in healthcare (see sidebar).


Undaunted by losing a court case and weathering a tidal wave of vitriol, Sara is now focused on advancing conscience- and life-affirming principles in the public policy arena, even if that means a career shift to public policy to advance the cause. She summed up her experience and engagement with this issue:

I commend the actions of CMDA on the strides that have been made to protect the healthcare professionals’ conscience freedom on both the state and federal levels. I applaud their actions and service related to educating the public and professionals regarding vital issues such as human trafficking, physician-assisted suicide, embryonic stem cell research and a myriad of other critical issues that have the ability to affect our daily life as clinicians. I encourage us all to prayerfully consider how God may be leading us to work alongside CMDA to defend and advocate on crucial issues for professionals. We can all be fully devoted to the work to which He has called us, whether it be providing exemplary patient care, supporting a colleague through a difficult situation or advocating on behalf of the marginalized. Exodus 1 describes the Hebrew midwives disobeying the commands of Pharaoh by not killing the male Hebrew children, but instead, fearing the Lord and holding fast to the sanctity of life. In turn, God was faithful to provide protection and establish their households. A lesson that I learned from the Hebrew midwives and my experience is that our God is true yesterday, today and forever; He is the one in whom we should place our trust. It is by His grace that He orchestrates the situations which pass before us, and we should be seeking His approval—not that of others. 

Sara’s experience exemplifies what pro-life healthcare professionals can expect to experience in the current era if they choose to remain faithful to their conscience, to life-affirming medical ethics and to their faith in Jesus Christ:

Arm yourself with the wisdom of a serpent.
Clothe yourself with the gentleness of a dove.
Prepare for persecution from the wolves.
Seek protection from governing authorities.
Stand firm in your faith in Christ.

“All men will hate you because of me, but he who stands firm to the end will be saved…So do not be afraid of them. There is nothing concealed that will not be disclosed, or hidden that will not be made known.” 
—Matthew 10:22,26


To learn more and get involved with CMDA’s efforts in public policy on the federal level, visit washington. To learn more about the Conscience Protection Act, visit CMDA’s Freedom2Care legislative action site at To voice your views to your legislators on this and other issues, visit


A series of recent landmark actions at the federal level are poised to protect, enforce and educate others about your rights to believe as you choose and to act according to conscience upon your beliefs.

On May 4, 2017, a “Presidential Executive Order Promoting Free Speech and Religious Liberty” set the groundwork for a series of administrative actions by declaring, “It shall be the policy of the executive branch to vigorously enforce Federal law’s robust protections for religious freedom.” The order asserted the vision of American founders to establish “a nation in which religious voices and views were integral to a vibrant public square, and in which religious people and institutions were free to practice their faith without fear of discrimination or retaliation by the Federal Government.” The order directed federal agencies to “address conscience-based objections to the preventive-care mandate” and “issue guidance interpreting religious liberty protections in Federal law.”

On January 18, 2018, the U.S. Department of Health and Human Services (HHS) held a press event to announce a new Conscience and Religious Freedom Division within the Office for Civil Rights. The new unit will “specialize in enforcement of and compliance with laws that protect conscience and free exercise of religion, and that prohibit coercion and discrimination.” Speakers at that event included Senator James Lankford and Rep. Vicki Hartzler (two people CMDA meets with regularly), as well as CMDA member Sara Hellwege, who recounted her story of discrimination.

At the March for Life on the morning of January 19, 2018, CMDA Vice President for Government Relations Jonathan Imbody spoke with U.S. Department of Health and Human Services’ Acting Secretary Eric Hargan regarding the need for conscience protections in healthcare and education regarding federal conscience laws. Sec. Hargan told him to keep an ear out for some very good imminent news and assured him he would be happier by the end of the day. That afternoon, HHS publicly announced a new proposed rule, “Protecting Statutory Conscience Rights in Healthcare.” The regulation, which builds upon a 2008 rule that was subsequently gutted, is designed to educate the healthcare community about federal conscience laws and to provide for robust enforcement of the laws.

For more information on this topic, visit


1 To read the full memo, visit

2 For a full listing of legal help options, visit www.freedom2care. org/legal-help.

3 Marcotte, A. (2014, July 23). The religious war on contraception. Retrieved March 12, 2018, from

4 Marcotte, A. (2014, July 25). Freedom isn’t forcing religion on others: Column. Retrieved March 12, 2018, from www.usatoday. com/story/opinion/2014/07/25/religious-freedom-women-discrimination-hobby-lobby-exemption-obama-column/12987547/.

5 Boston, R. (2014, July 21). Access Denied: The Religious Right Opens Up A New Front On Its War Against Birth Control. Retrieved April 19, 2018, from 

6 Ryan, E. G. (2014, July 21). Nurse Who Won’t Prescribe Birth Control Sues Clinic For Not Hiring Her. Retrieved March 12, 2018, from 

7 Gray, K. J. (2014, July 27). Wingnut Nurse Sues Family Planning Center For Not Giving Her Job Just Because She Says She Won’t Do Job. Retrieved March 12, 2018, from

8 Polling details available at

9 Hellwege v. Tampa Family Health Centers, Case No. 8:14-cv-1576-T- 33AEP. April 10, 2015 order by Virginia M. Hernandez Covington, District Judge. Accessed online March 12, 2018 at

This Feature Story Appears in:

Summer 2018 Edition of Today’s Christian Doctor