Advocate Good Shepherd sacrificed Harmonie Perrone’s fertility to protect its doctrinal manual from a patient who asked for the drug she knew would stop her fallopian tube from rupturing.
The facts are not in serious dispute. On an unseasonably warm June day in 2026, Harmonie Perrone, 28, felt the telltale pain of an ectopic pregnancy — a pregnancy lodged outside the uterus, in her remaining fallopian tube. She had been through this twice before. The first ectopic pregnancy had cost her the right tube. The second, caught early, had been resolved with a single dose of methotrexate, the standard-of-care drug the American College of Obstetricians and Gynecologists recommends administering “as soon as possible” to stop the growth of an ectopic mass before the tube ruptures and the patient bleeds to death. The third time, Perrone knew she had hours, not days.
She drove to Advocate Good Shepherd hospital in Barrington, Illinois, a state whose law enshrines reproductive rights and whose Hospital Emergency Service Act explicitly names ectopic pregnancy as an acute medical condition requiring stabilizing care. The hospital performed an ultrasound, identified a mass on her left fallopian tube, and sent her home with an appointment the next day at what turned out to be a med spa. The physician there, Dympna Coll, refused to administer methotrexate. “We have to weigh out the life of the mother and the baby, and there’s a 1% chance that there is a baby in there,” Coll told her, according to Perrone. Perrone invoked her statutory right to abortion in Illinois. Coll replied that Perrone was “not going to bully me into doing this.”
Perrone obtained methotrexate at a second facility more than 24 hours after she first sought care at the emergency department. The dose was given, but the delay from the first visit’s refusal cost her the pharmacological window. Six days later her remaining tube ruptured. She lost her ability to carry a pregnancy without invasive intervention. She is now infertile.
The lawsuit she filed Monday names Advocate Good Shepherd and Coll. It alleges medical malpractice, violations of the Illinois Hospital Emergency Service Act, and a federal claim under the Emergency Medical Treatment and Labor Act — the statute that, since 1986, has required any hospital that accepts Medicare to screen emergency patients and either stabilize their condition or transfer them. The suit will now proceed through the courts. But the legal architecture that produced Perrone’s injury is already in place, and it is not the work of a single hospital or a single doctor. It is the work of a decades-long effort by the conservative legal movement to expand the conscience rights of religiously affiliated health-care providers, and of a Supreme Court that has consistently treated the religious-liberty claims of institutional actors as trumps over the statutory rights of patients in medical emergencies, including federal statute.
Reconstruct the hospital’s position first. Advocate Good Shepherd is part of Advocate Health, a faith-based system operating under the Ethical and Religious Directives for Catholic Health Care Services — the ERDs that align clinical practice with the Church’s magisterial teaching on the inviolability of nascent human life. Under those directives, a surgeon may, in principle, remove a pathologically ruptured tube to save the mother’s life under the principle of double effect — the death of the embryonic tissue is an unintended, albeit foreseen, side effect of a life-saving procedure necessary to arrest catastrophic hemorrhage. But administering methotrexate, which pharmacologically halts the cellular division of the embryo while allowing the body to resorb the pregnancy in situ — the standard of care for an unruptured ectopic pregnancy precisely because it preserves the tube and the patient’s future fertility — is classified as a direct abortion under the ERDs. The doctrinal line: a direct attack on the embryo’s continued existence is impermissible regardless of the medical outcome; waiting for the tube to rupture is permissible because the ensuing surgery is for the catastrophic hemorrhage, not the pregnancy. The physician’s duty to stabilize in the temporal space between presentation and rupture is subordinated to the embryo’s right to continue existing. The hospital’s position, reduced to its working-bar essence, is that the embryo’s life cannot be directly terminated, even at the cost of the mother’s future fertility, and — in the limit case — even at the cost of her life. When pushed, the hospital will argue that sending Perrone home with a next-day appointment to a non-emergency facility was a good-faith effort to route her to a provider whose conscience could perform the termination.
When Coll refused to administer the methotrexate and told Perrone the termination would have to be referred out to a later appointment, she was not exercising medical judgment. She was obeying the ERDs. What Perrone’s lawyers will now have to prove in litigation is that the law required the ERDs to yield.
The audit begins with the statutory text. The Illinois Hospital Emergency Service Act, 210 ILCS 80/1, defines “emergency medical condition” to include “acute symptoms of sufficient severity… such that the absence of immediate medical attention could reasonably be expected to result in… serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.” Ectopic pregnancy is the paradigm case the statute itself identifies. The Act requires a hospital that lacks the capability to stabilize such a condition to “initiate the transfer of the patient to another hospital which has the capability” — not to hand the patient a next-day appointment card and a referral to a strip-mall med spa incapable of providing emergency treatment. The Illinois Health Care Right of Conscience Act, 745 ILCS 70/1 et seq., expressly excludes emergency medical care. The conscience shield does not reach the emergency room.
EMTALA, 42 U.S.C. § 1395dd, imposes a parallel federal obligation on every Medicare-participating hospital to provide “an appropriate medical screening examination” and to stabilize or transfer. The statutory text, the implementing regulations, and the CMS guidance documents are explicit: a woman with an unruptured ectopic pregnancy presenting to an emergency department has an emergency medical condition that requires immediate stabilizing care, or immediate transfer to a facility that can provide it. The Supreme Court has not yet decided a case in which a religiously affiliated hospital’s conscience claim directly collides with a patient’s right to that care under EMTALA or state law. But the trajectory is unmistakable. The same majority that treated a corporation’s religious objection to paying for contraceptive coverage as a legally substantial burden, see Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014), and then extended that reasoning to exempt religious nonprofit employers under the contraception mandate in Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, 591 U.S. 657 (2020), is the majority that will be asked, in whatever litigation reaches it, whether a Catholic hospital can refuse methotrexate to a patient with a rupturing ectopic pregnancy. The framework is now in place: the religious-liberty claim is presumptively of the highest weight; the state’s interest in protecting a particular patient’s physiological integrity is reviewed under strict scrutiny; the hospital’s conscience overrides the statutory duty to stabilize in the name of a religious directive, leaving the patient to absorb the consequence — in Perrone’s case, the permanent loss of her fertility.
This is not a failure of regulation. It is the operational output of a legal structure the conservative legal movement spent decades constructing and the Court’s institutionalists spent a generation pretending was about nuns and contraceptive paperwork. The machinery that determines whose life-saving treatment will be delayed and whose physician will be permitted to weigh embryo against patient is the same machinery that gave us Hobby Lobby, gave us Little Sisters, and will give us, some term soon, a case with fatality figures attached to its religion-clause caption. The opinion in that case does not yet exist. The machinery that will produce it already broke the woman.
The hospital’s refusal to stabilize, followed by the physician’s decision to file a defamation suit against Perrone for describing the refusal, operates as institutional enforcement. The threat of a legal counterattack, combined with the clinical delay itself, chills the population meant to be protected. Perrone’s lawsuit, represented by Amplify Legal and supported by the ACLU of Illinois, will test whether the statutory protections on the books in Illinois can be enforced against a religiously affiliated institution — or whether those protections, like the contraception mandate the Supreme Court has all but erased, are paper guarantees that dissolve on contact with a conscience claim.
We saw the identical mechanics earlier this month in Tennessee, where a Christian fertility doctor aligned his in vitro fertilization practice with his church’s teaching by refusing to discard or fertilize embryos beyond a biblically justified number — the clinical standards governing fertility medicine overridden by religious conviction. In Tennessee, the refusal affects the elective-clinic timeline. At Advocate Good Shepherd, the refusal operates in the emergency department, where the consequence is measured not in family-formation delay but in the irreversible destruction of a woman’s reproductive capacity. The legal architecture is the same. The institutional conscience right now being constructed around medical providers will reach, term by term, whichever procedural posture presents the cleanest vehicle for the final holding — that the religious directive governs the patient’s body, and the statutory obligation to stabilize a medical condition in crisis is a suggestion that yields when the conscience is Catholic.
The hospital let the fallopian tube rupture to satisfy the requirement that the mother’s life be in immediate peril before the embryo could be displaced. The law required it to treat her before she hemorrhaged. The law on the books in Illinois forbade what happened. The law on the ground in Barrington ignored it. The Court, when it is asked to choose between a patient’s right to survive and a Catholic hospital’s right to refuse, has spent a generation signaling which way it will lean. The machinery is built. Perrone’s fertility was the operating cost.