A Catholic religious order that has spent more than 120 years caring for dying cancer patients free of charge is now fighting New York state in court, claiming a gender identity mandate threatens to shutter their ministry or send them to jail.
The Dominican Sisters of Hawthorne filed a lawsuit challenging New York's LGBTQ Long-Term Care Facility Residents' Bill of Rights, a law signed by Gov. Kathy Hochul on Nov. 30, 2023. The sisters run Rosary Hill Home, a 42-bed hospice in Hawthorne, New York, that serves terminally ill patients who cannot afford nursing care. They say the law forces them to choose between their Catholic faith and their freedom.
The statute requires long-term care facilities across New York to accommodate residents' stated gender identity in several specific ways. Staff must use a resident's preferred pronouns. Room assignments must reflect gender identity rather than biological sex. Restroom access must follow the same rule. Facilities must also train staff in gender ideology and publicly post notices of compliance, as Fox News detailed in its coverage of the case.
For the sisters, each of those requirements collides with Catholic teaching on the nature of the human person. Their lawsuit frames the conflict in broad terms.
"The implications are so much greater than whether to utter the words 'he' or 'she.'"
That line, drawn from the nuns' legal filing, captures the order's position that the mandate reaches deep into how they organize daily life at the hospice, from sleeping arrangements to the language used at a dying patient's bedside.
The consequences for noncompliance are not abstract. The Washington Times reported that willful violations of the underlying public health law can bring fines of up to $10,000 and up to one year in prison, or both. Other potential penalties include fines starting at $2,000 per violation and escalating to $5,000, court-ordered compliance, and revocation of the facility's operating license.
Lose the license, and Rosary Hill Home closes. For the terminally ill poor who depend on the hospice, there is no generic backup plan. The sisters provide their care at no cost to patients.
New York's health department has already put the order on notice. The state sent Rosary Hill Home three warning letters about compliance, the New York Post reported. The sisters requested a religious exemption. The state denied it.
Mother Marie Edward, the general superior of the Hawthorne Dominicans, has been direct about what is at stake. She told reporters that the order has never turned patients away based on belief or background.
"We Sisters have taken care of patients from all walks of life, ideologies, and faiths. We treat each patient with dignity and Christian charity."
That history, she said, makes the state's posture all the more bewildering. National Review noted that the Dominican Sisters of Hawthorne have operated Rosary Hill Home for more than a century, serving patients regardless of their faith or ideology. No complaints from residents have been cited in any of the reporting on the dispute.
Mother Marie Edward underscored that point bluntly: "We have never had complaints. We cannot implement New York's mandate without violating our Catholic faith."
The lawsuit argues that the law violates the sisters' constitutional and religious rights. Their legal team has framed the case as a straightforward collision between a state speech and conduct mandate and the First Amendment's protections for religious exercise and free speech. The pattern is familiar. A Christian photographer in Louisville recently won an $800,000 settlement after challenging a local law that would have compelled her to photograph same-sex weddings in violation of her beliefs.
The nuns' case lands in a legal environment where religious liberty claims are stacking up across the country. Courts at every level are grappling with how far government mandates can reach into the operations of faith-based organizations.
In Missouri, a Christian group recently mounted a legal challenge at the Eighth Circuit over state regulation of faith-based ministries, raising similar questions about where regulatory authority ends and religious autonomy begins.
The Supreme Court has shown increasing willingness to hear these disputes. The justices unanimously allowed a Mississippi street preacher's First Amendment challenge to proceed earlier this term, signaling that claims involving religious speech and government penalties remain squarely on the Court's radar.
New York's law applies to all long-term care facilities in the state, not just religious ones. But the Dominican Sisters occupy a unique position. They are not a secular corporation adjusting an HR policy. They are a Catholic religious order whose members have taken vows. Their hospice exists as an expression of their faith. Forcing them to adopt language and housing practices that contradict Church teaching on sex and gender, they argue, strikes at the core of why they exist.
Investigators and courts will need to determine several open questions. No public explanation has emerged from the Hochul administration about why the state denied the sisters' exemption request. Authorities have not publicly confirmed whether any long-term care facility in New York has received a religious accommodation under the law. The state has not detailed how it interprets the law's penalty provisions in practice, or whether it has pursued enforcement actions against any other facility.
Those gaps matter. If New York is applying this mandate uniformly with no religious carve-outs, the constitutional questions sharpen considerably. The Religious Freedom Restoration Act and the Free Exercise Clause both impose limits on how government can burden sincere religious practice, particularly when less restrictive alternatives exist.
The Justice Department's recent review of Biden-era FACE Act prosecutions against pro-life protesters has drawn fresh attention to the broader question of whether government power is being wielded selectively against people of faith. The nuns' case in New York raises a parallel concern from a different angle: not criminal prosecution for protest, but regulatory coercion aimed at a religious ministry's internal operations.
Strip away the legal filings and policy language, and the dispute comes down to a small hospice where nuns care for people who are dying and who have nowhere else to go. Mother Marie Edward described the mission simply.
"It is to provide comfort and skilled care to persons dying of cancer who cannot afford nursing care."
That mission has continued unbroken for over a century. The sisters charge nothing. They accept patients others will not take. And now, as the Daily Mail reported, they face the prospect of fines, injunctions, license revocation, and prison for operating that ministry according to their beliefs.
Mother Marie Edward put the stakes in terms that left little room for ambiguity: "New York's gender ideology mandates not only violate our Catholic values, they threaten our existence with fines, injunctions, license revocation, and even jail time."
The case now moves through the courts. Its outcome will shape how far states can push gender identity mandates into the daily operations of religious institutions that serve the public.
When a state tells nuns who nurse the dying poor that they must speak and act against their faith or face prison, the question is no longer about pronouns. It is about whether religious liberty still means anything when it becomes inconvenient for the government.
