Updated guidelines for U.S. Department of Veterans Affairs (VA) hospitals allow doctors and other care providers to refuse to treat patients based on their marital status and political affiliations.

Prior to the recent change, VA hospital bylaws required all medical staff to treat patients regardless of their race, age, color, sex, religion, national origin, politics, marital status, or disability. But, according to the Guardian, personal characteristics that are not protected by federal nondiscrimination law, such as national origin, politics, and marital status, have been removed. As the outlet notes, while all veterans are still entitled to treatment at VA medical centers, the change allows individual staffers to refuse to treat certain patients.

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The letter called the VA secretary “hypocritical” and slammed him for his “decision to pit veterans against each other.”

Rules around hiring decisions have also been changed to allow discrimination against candidates based on their national origin, sexual orientation, marital status, membership in a labor organization, or political party affiliation.

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According to the Guardian, VA press secretary Peter Kasperowicz said that the new rules, which have already gone into effect at some VA hospitals, were implemented in response to the president’s January 20 executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” The anti-trans order declared that the U.S. government would only recognize two sexes, male and female, based on biology, and instructed all government agencies “to end the Federal funding of gender ideology.”

However, it’s unclear how the order relates to allowing VA hospital staff to discriminate based on marital status and political party affiliation.

While Kasperowicz insisted that “all eligible veterans will always be welcome at VA and will always receive the benefits and services they’ve earned under the law,” he did not dispute that the new guidelines allow VA doctors to discriminate against patients and could result in doctors being fired for their own marital status or political affiliations.  

Veterans interviewed by the Guardian said the new guidelines would likely most impact women, LGBTQ+ veterans, and those who live in rural areas with few doctors.

“It seems on its face an effort to exert political control over the VA medical staff,” Dr. Arthur Caplan, head of the division of medical ethics at New York University’s Grossman School of Medicine, said of the change. The “extremely disturbing and unethical” new guidance could result in doctors questioning patients about their support for Trump or for LGBTQ+ rights. “Those views aren’t relevant to caring for patients. So why would we put anyone at risk of losing care that way?” Caplan said.

Former VA Under Secretary for Health Kenneth Kizer said that the new rules “seem to open the door to discrimination on the basis of anything that is not legally protected.” Kizer said that under the new rules, VA doctors could potentially refuse to treat patients not just for their current or past political activity, but also based on their “personal behavior such as alcohol or marijuana use” or on their “reason for seeking care – including allegations of rape and sexual assault.”

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