Ban on Gender-Affirming Care Compromises U.S. Bishops’ Authority
Nik Rodewald
Today’s guest contributor is Nik Rodewald (he/him), a queer Catholic pursuing a PhD in theology and ethics at Loyola University Chicago. His research centers on the connection between queer understandings of time and Catholic sacramental theology.
In the first chapter of the Gospel of Mark, Jesus causes a scene in the Capernaum synagogue. The Gospel does not tell us exactly what Jesus said that day, but it does tell us how this Galilean preacher was received: “they were astounded at his teaching, for he taught them as one having authority, and not as their scribes” (1:22).
As if this authority needed further testimony, Jesus casts out an unclean spirit with his words: “Be silent, and come out of him!” (1:25). What those gathered at the synagogue felt in their hearts—that something about this man’s teaching spoke to the truth of their lives in a way that their leaders’ words could not—was confirmed by visible peace brought to a man caught in the tumult of spiritual and physical distress.
The scene of Jesus in the Capernaum synagogue testifies to the important truth that spiritual authority can be recognized by the restless heart searching for God and confirmed by words that are, for us, an ever-present help in times of distress.
On November 12, 2025, the U.S. Catholic bishops voted overwhelmingly (206 in favor, 8 opposed, and 7 abstaining) to approve the Seventh Edition of their Ethical and Religious Directives for Catholic Healthcare, which mandates that Catholic healthcare institutions cannot provide gender-affirming care to patients or refer them to institutions that would provide this care. By the standards of authority Jesus sets in Mark 1, the bishops’ approval of the revised healthcare directives compromises their moral and spiritual authority on three levels.
First, by ignoring the experience of grace among transgender people, the bishops deny visible signs of spiritual peace in today’s world. Transgender theologian Justin Sabia-Tanis, for example, describes his own gender transition as a “holy invitation” and a “collaboration between God and humanity in co-creating what our bodies are and what they will become.”
Sabia-Tanis recounts how his transition brought him to new self-awareness: “I have learned many things about my body that I did not know before I transitioned, like the fact that my beard grew in red, like the Irish ancestors that are part of my genetic heritage, or that my muscles and fat can regroup themselves to make my hips, my face, my waist all look different than they were before.”
Sabia-Tanis’s story reveals that gender transition can be a grace-filled time of vulnerability. Against the abstract accusations of “gender ideology” that portray transition as an attempt to “play God,” transgender Christians like Sabia-Tanis reveal that transition, supported by gender-affirming care, can be a source of vulnerability and self-emptying, allowing God to re-form one’s body into a sign of grace and peace in the world.
Secondly, the bishops’ directives compromise authority by effectively denying Vatican II’s teaching on conscience. During the Second Vatican Council, the Catholic Church adopted a two-fold teaching on religious liberty and conscience. The dignity of the human person in their search for God grounds a right to freedom from religious coercion. In the world (though not necessarily within the confines of the Church), no person can be either coerced into acting against, nor restrained from acting in accordance with, their conscience.
In a U.S. landscape where Catholic hospitals fill critical gaps within a patchy healthcare system, Catholic hospitals are often the only provider patients can access. As such, Catholic hospitals provide a public good. If accessing gender-affirming care forms a vital part of one’s search for God, as Sabia-Tanis’s experience demonstrates, then withholding gender-affirming care in Catholic hospitals becomes both a denial of a public good and a violation of conscience within Vatican II’s framework.
The USCCB’s prohibition restrains individual doctors who feel obligated to provide care from following their conscience, just as it restrains patients who discern that gender-affirming care is a necessary part of their quest for God. As such, the new ethical directives compromise the bishops’ spiritual authority because they compromise the truth that the Church tradition, through Vatican II, has discerned concerning conscience rights and human dignity.
Finally, the bishops’ authority is compromised by their failure to witness to the Christian tradition’s belief in a unity of body and soul. In the 2023 Doctrinal Note that provides the theological foundation for the recent directive, the bishops argue that “manipulation of the human body” is only permitted for two reasons: repairing bodily “defects” or sacrificing a part of the body for the sake of the whole. Because gender-affirming care does not address the healthy physiological functioning of the body, the argument goes, it cannot be permitted.
The bishops’ argument reduces a person’s health and flourishing to physiological function, ignoring the deep connections between mental, physical, and spiritual well-being, in the face of a growing body of scientific research that associates gender-affirming care with improved mental health outcomes and significant decreases in substance abuse and suicidality rates.
Affirming that human beings are a unity of both body and soul should lead church leaders to affirm that, sometimes, medical interventions like gender-affirming care are essential for the flourishing of the whole person. By denying this truth and reducing well-being to physiological function, the new directives compromise the bishops’ authority by damaging the credibility of their witness to the unity of body and soul.
The new healthcare directives compromise the U.S. bishops’ moral and spiritual authority. Our queer and trans siblings deserve better. They deserve bishops whose teachings, like Jesus’s, resonate deep within the human heart and provide sure comfort in times of distress.
–Nik Rodenwald, November 19, 2025
Editor’s Note: For New Ways Ministry’s response to the new set of Ethical and Religious Directives, click here.
Nik,
Thanks for this thoughtful and enlightening commentary on the recent Catholic bishops’ statement.
Last night on the PBS News Hour, Amna Nawaz interviewed Bishop Mark Seitz about both the bishops’ statement on immigration and their statement on transgender people.
Bishop Seitz spoke eloquently about the need for humane policies and treatment of immigrants and others swept up in ICE raids in this country. He is the bishop of El Paso, Texas, and I am sure his knowledge and experience of what is going on, and of some of the people affected, is first hand.
But when she asked him about the Catholic bishops’ statement on treatment for transgender people, and asked him about the statement being at odds with the years of study by medical professionals, and the statement being at odds with differing policies of other religious groups that interpret the same holy book as the bishops, and why they see things differently than the bishops, he fudged and said there have always been different interpretations. He said the Church respects and supports transgender people and wants to walk with them. But the Church must do what it thinks are best for them and opposes what it thinks will harm them. He didn’t address the medical studies and didn’t speak of listening to and learning from transgender people.
I was left with the feeling that he had just undercut the fine and humane things he had said about immigrants by talking about transgender people as though they were little children who needed to be instructed by their parent bishops who knew what was best for them. And he completely omitted addressing the years of study by medical professionals.
Unfortunately, this attitude is not only disrespectful of science and the experience of real fellow humans, but it is also contrary to the very notion and process of synodality. It is apparent that the bishops who voted for this statement haven’t learned anything about the varieties of gender identity experienced by human beings. And it is apparent their knowledge of real people, history, and medical science and practice in this area is woefully inadequate.
Hopefully the number of bishops who opposed the statement will grow as synodality spreads deeper roots and more and more bishops listen and learn.