Transgender Healthcare and the Catholic Moral Vision

Today’s post is from guest blogger Jacob Kohlhaas, an associate professor of moral theology at Loras College, Dubuque, Iowa. Professor Kohlhaas has written on theology of family topics for U.S. Catholic and America, is the author of Beyond Biology: Rethinking Parenthood in the Catholic Tradition, and is co-editor of the forthcoming volume Catholic Family Teaching: Commentaries and Interpretations (Georgetown University Press, 2024).

The U.S. Conference of Catholic Bishops’ (USCCB) recent clarification on morally impermissible medical interventions for transgender persons has generated media attention including responses from moral theologians Daniel Horan and Craig Ford, and church observer Michael Sean Winters. I am no better equipped than these peers to address the full range of concerns the document raises, but I would like to offer a specific reflection on how the document echoes recent tradition and why that is a problem.

I bring only two unique qualifications to this discussion. First, the USCCB’s clarification displays a surprisingly deep reliance on seventy-year old statements of Pope Pius XII and I am probably one of few active theologians who can honestly count Pius XII as a substantial influence in my theological work. Second, I will be undergoing hip replacement surgery later this summer, which seems to raise some interesting distinctions about how different types of “pelvic issues” are thought about in the Catholic Church.

Both of these qualifications require caveats: First, Pius XII’s legacy is complex and problematic; however, I find his moral vision helpful in adding perspective to issues tied to our own historical moment. Second, I am not suggesting hip replacement and gender-affirming surgery are basically similar, I simply want to call attention to how the Catholic moral vision shrinks dramatically when different body parts are under examination.

The Catholic moral tradition places value on the natural integrity of the body as well as the supernatural destiny of the human person. This means that significant bodily interventions require moral justifications, but also that these justifications are not necessarily constrained to physical function. We are, after all, part of a tradition that believes both that God took on a human body in the person of Jesus Christ, and that Jesus revealed God’s profound love for us through willingly sacrificing his life for our sake. As such, decisions about how we use our bodies, and when and how we can alter or sacrifice them in whole or in part, are necessarily complex.

In my case, there is no clear standard for differentiating when a hip joint has gone from serviceable to defunct. Replacement may be unavoidable, but the timing is a judgement call based on factors including lifestyle and preferences. My decision was to move fairly aggressively, in large part because I am relatively young (41) and see many benefits to returning to nearly normal levels of mobility quickly. So far, no one seems particularly shocked by the choice.

No one has lectured me on the natural purpose of my body. No one has offered to help me discern objective criteria for assessing if my joint is simply problematic but functional versus truly harmful to the integrity of my body. No one has suggested that my spiritual or psychological well-being and the way I envision living a healthy life are somehow the real problems that need to be corrected. Finally, no one has denied the possibility that God might create hips that just don’t quite fit and require serious intervention for a small portion of people born with such a condition.

When it comes to this type of surgery, it seems the “principle of totality” is easily and widely accepted. This principle basically recognizes that while individual parts have their own purpose, they should not dictate the good of the whole. After all, I’m not just a hip, I’m not just a body, I am irreducibly a person.

But something odd happens when we move from talk about hips to other body parts that fall along the midline. The USCCB’s recent clarification exemplifies how the stakes seem to heighten and the moral scope seems to narrow when genitals or other physical markers of sexual difference enter the picture. Consequently, when sex and gender appear to be at stake, the moral vision slides from respect for the person who is a body to concern about the integrity of body as a precondition being a person. In doing so, the principle of totality no longer includes social, psychological, and spiritual well-being (as in my example of timing a hip replacement) but is instead limited to the body’s anatomy alone.

The USCCB’s guidelines place significant emphasis on bodily integrity but at consequential moments appears to forget that persons are more than the sum of their body parts. The guidelines state that when justifying intentional removal or alteration of a functional body part, such a serious decision must be made “truly as a last resort that is necessary for the welfare of the body, there being no other options for securing the welfare of the body as a whole” (#12 italics added). Where did the person go? So much of the Christian tradition rests on the idea that the person lives for goods well beyond the physical integrity of their body, and yet, when genitals are at stake, anatomical bodily integrity itself is offered as the standard for moral discernment.

Interestingly, the document seems to fall into this position through its own tendency to prefer simple proof-texting to broader contextual assessment. The Catholic moral tradition is characterized by a long history of giving unique emphasis and peculiar reasoning to moral questions having to do with sexuality and gender. In this respect, the document is quite faithful to a problematic legacy. My bigger concern, though, is that the popes being selectively quoted also offer examples of thinking that could have led to a very different document. In other words, the drafters of this document faced a range of interpretive possibilities when considering how to receive the tradition in light of the present concern. They chose to favor a particular narrow line of thinking evidently tailored to reaffirm a predetermined conclusion.

Pius XII was deeply interested in the medical advancements of his era. Although he employed a moral methodology that was very much in keeping with the recent tradition preceding him, he occasionally came to surprising conclusions, including narrowly justifying certain bodily interventions considered purely cosmetic. More importantly, despite sharing in many of the preoccupations of the moral tradition around human sexuality, Pius XII reliably thought of the human person in terms of supernatural goods, noting that the riches of the faith are paramount and offer a corrective to excessive naturalism or reductive moralism.

Decades later, John Paul II attempted to synthesize the consistency of traditional moral theology with the new orientation of the Vatican II church. This crystalized in the “personalistic norm” which condemns the reduction of persons to objects and positively affirms, “The person is the kind of good towards which the only proper and adequate attitude is love.”

Transgender health care presents the Catholic moral tradition with questions that are very complex. Two of the most significant popes cited in the clarification consistently reminded us that the person is far more than their body alone. Even as the USCCB has chosen to follow a narrow tradition that inconsistently places the good of persons behind the functionality of their body parts, the moral tradition itself continues to offer many more expansive interpretive possibilities.

–Jacob Kohlhaas, April 10, 2023