U.S. Bishops Will Vote on Hospital Guideline Revisions that Could Ban Gender-Affirming Care

The U.S. Conference of Catholic Bishops will vote at their spring assembly this week on whether to ban gender-affirming care for transgender people at Catholic hospitals.

At the assembly, which begins today and goes through Friday, one of the action items up for a vote is a change to the bishops’ guidelines for Catholic healthcare. According to the National Catholic Reporter:

“If approved, the measure would authorize the bishops’ doctrine committee to begin the process of revising the Religious and Ethical Directives for Catholic Health Care [ERDs], which are described as the ‘authoritative guidance’ for U.S. Catholic health care institutions. The revision would change the directives to align with a doctrinal note the bishops released in March, which focused on what the prelates called the ‘moral limits to technological manipulation of the human body.’ . . .

“The ballot item on which the bishops will vote this week, a copy of which was provided to NCR, says the Committee on Doctrine, led by Bishop Daniel Flores of Brownsville, Texas, intends to make minimal changes to the directives, but ‘is prepared to make those changes necessary for providing clear and useful guidance to Catholic health care services.’

“The item also says that the committee’s ‘immediate concern’ is the directives’ Part III, which addresses the relationship between Catholic medical professionals and their patients. However, the ballot item adds that the committee ‘does not exclude the possibility of proposing minor revisions in other parts’ of the directives.”

The ERDs, last updated in the 1990s, do not address gender-affirming care directly, though NCR noted some existing provisions, such as patients having a “right and duty to preserve their bodily and functional integrity” could be applicable. This reasoning was included in the doctrinal committee’s document released in March, along with the bishops’ other arguments for why Catholic healthcare should not provide gender transition care.

The March document has faced intense criticism from theologians and LGBTQ+ advocates for its many flaws. Bondings 2.0 recently covered a commentary by bioethicist M. Therese Lysaught who argued it “could have been written in the 1950s” given its intellectual, theological, and moral failings, including no consultation with the transgender and nonbinary people who would be most impacted. Asked further by NCR about the U.S. bishops’ efforts to stymie transgender healthcare, Lysaught commented:

“‘[The doctrinal note shows] next to zero knowledge of, experience with, or expertise in transgender persons and the complexities of Catholic health care, even less compassion or Christian virtue.’

“‘As a moral theologian, I think it’s important to note that the Congregation for the Doctrine of the Faith has not yet issued a statement on transgender health care. I would guess that this is due to the fact that the issue is so new and that they are prudently waiting for the scientific and clinical research to advance so that the Church’s moral discernment can be properly informed.'”

Massimo Faggioli, a Villanova University theologian primarily focused on church history about ecclesiology, said the doctrinal note and future revisions do show “a certain amount of caution” compared to previous episcopal documents that were “much more belligerent.” He, too, acknowledged that it is but “one step in what is largely unknown in terms of Catholic doctrine.”

Cory Mitchell, a bioethicist at Loyola University Chicago, emphasized that any future developments need to account for both scientific developments and the experience of trans people. NCR reported:

“[Mitchell] told NCR that most medical professional bodies in the United States see gender-affirming care as evidence-based treatment to mitigate the suffering of people diagnosed with gender dysphoria.

“‘When dealing with a patient population, from an ethical standpoint, if you can mitigate or ameliorate harm or suffering, you do so,’ Mitchell said. ‘That’s the story of the good Samaritan. We don’t pass by on the other side of the road when we can help and continue Jesus’ healing ministry.’

“However the bishops revise the ethical and religious directives, Mitchell said he hopes the process will reflect the ‘culture of encounter’ that Pope Francis has championed so that ‘norm-making does not become hurting, sanctioning, or othering’ transgender people.”

Though the vote to begin revisions to the Ethical and Religious Directives will likely pass, a ban on gender-affirming care at Catholic hospitals is not a given. LGBTQ+ advocates, theologians, bioethicists, healthcare professionals, and pastoral ministers must all push to ensure any ERD revisions account for both modern science and trans people’s experiences. If the bishops’ committe does not consult transgender people and members of the overwhelming majority of health professionals who support trans-affirming healthcare, their comments will not only be intellectualy irresponsible, but it will only serve to cause pain for trans people and division for the entire church.

And, in whatever changes are made, the priority should not be abstract theology, but the very real flourishing of trans and nonbinary patients served by Catholic hospitals.

—Robert Shine (he/him), New Ways Ministry, June 14, 2023