U.S. Catholic bishops on Friday voted to craft their first bioethics directives for Catholic health care institutions treating transgender people. The Catholic Church oversees about 1 in 7 U.S. hospital beds.
The U.S. Conference of Catholic Bishops (USCCB) voted unanimously at their annual meeting to authorize their doctrine-crafting body to come up with a proposal. The proposal would be a revision to the Ethical and Religious Directives – or ERDs – that are binding on the vast network of Catholic hospitals, physicians’ systems, surgery centers and urgent care centers.
The section being discussed, which deals with professional-patient relationships, has not been updated since 1994.
The range of views about just what the bishops are about to do was on display at their meeting, where various clerics rose to the microphone and characterized the process as either the start of a fairly open inquiry, or instead as a means to a more specific end.
The Doctrine Committee, which will draft proposed revisions, in March issued a kind of position paper called “The Moral Limits to Technological Manipulation of the Human Body.” The 14-page paper, which uses the word “order” 45 times, says a core tenet of Christianity is that there is a God-crafted natural order, and that “sexually differentiated” male and female bodies are part of it.
Contemporary interventions to alter the body “for what is termed ‘gender dysphoria’ or ‘gender incongruence,'” the paper says, are “not morally justified . . . they do not repair a defect in the body; there is no disorder in the body that needs to be addressed.
“Such interventions, thus, do not respect the fundamental order of the human person as an intrinsic unity of body and soul, with a body that is sexually differentiated. . . . Catholic heath care services must not perform interventions, whether surgical or chemical, that aim to transform the sexual characteristics of a human body into those of the opposite sex.”
However, some experts within Catholic health care said the process that’s starting is somewhat open in some aspects, and that there are many bishops and Catholic health care workers who believe science about gender is still evolving.
Part of this process, they said, could come down to asking: What falls into the bucket of “gender-affirming?”
“The biggest issue is our understanding of human sexuality. Will we into the future continue to see human sexuality as what we call binary, male and female, or are there shades between? What does this mean from a theological perspective is the big question and I don’t know what the answer will be,” said the Rev. Charles Bouchard, the senior director of theology at the Catholic Health Association, which includes most Catholic health entities. “There is a broad cultural trend where people see gender as totally fluid. We don’t buy that, but is there another understanding of human sexuality we’ll come to see?”
Until now, Catholic health organizations have no directives when it comes to trans-specific issues, and a generally conservative approach.
In general, Bouchard said, Catholic health entities don’t initiate, advance or encourage transitioning from one gender to another. They don’t do gender-affirming surgeries that could alter a person’s fertility. And usually they don’t do appearance-altering surgeries like breast augmentation or removal or facial surgeries that help a trans person appear more in line with their gender identity.
Because appearance-altering surgeries are common in society, he said, there are legal pitfalls for Catholic health care institutions if they would do a certain surgery for a man but not a woman, or for a cis person but not a trans person. That could also be true of a surgery like a hysterectomy.
Then there are institutions in a gray area, such as those that result from a merger of a Catholic entity and a non-Catholic one.
However, it’s common, for example, for Catholic health care workers to renew subscriptions for hormones and oversee hormone therapy, and to provide emotional support for families sorting through issues around a trans child.
Some health care advocates are extremely concerned about the revisions to the ERDs, partly because of the huge number of Americans treated in Catholic health facilities and because of the cultural climate and crackdown on gender-affirming care.
“We are preparing to speak out in dismay about this action as being harmful – extremely harmful to thousands of trans people across the country and being based not in science or medicine, which is what people expect when they go to the hospital, but instead in theology,” said Lois Uttley, a longtime adviser on health-care equity and accountability issues. “Many people who work in Catholic hospitals are distraught.”
Uttley and others raised questions about the timing of the bishops’ project, at a time when states dotting the country are passing limits and bans on the health care that trans people can get.
“The bishops are jumping on the bandwagon of attacks on trans health care in the political sphere,” she said.
The role of the doctrine committee, said USCCB spokesman James Rogers, is to update the ERDs to give practical guidance on trans health care. The doctrinal note – which appears to make clear where the bishops are headed – is more of a theological statement. “Some people are getting ahead of the committee on doctrine.”
In late March, after the Doctrine Committee issued the note, a coalition led by Catholic nuns released a letter voicing support for trans, nonbinary and gender-expansive individuals, a document seen as an implicit rebuke to the ethos of the note.
The letter also states that transgender people are “experiencing harm and erasure” in various ways, listing daily discrimination, a groundswell of state-level legislation aimed at LGBTQ+ rights and “harmful rhetoric from some Christian institutions and their leaders, including the Catholic Church,” the Religion News Service reported in March.
RNS reported that the letter was in the works before the note was published, but that the note made it more urgent.
“There’s a sense of urgency in me to say that there are many, many faithful Catholics who know a different way,” Sister Barbara Battista, the congregation justice promoter for the Sisters of Providence, St. Mary-of-the-Woods, told RNS.
Some bishops Friday at the USCCB meeting urged the Doctrine Committee members to consult more broadly.
Cardinal Robert McElroy, bishop of San Diego, said the process needs to distinguish between Catholic teaching on the “importance of maintaining” the difference between male and female and “the existential question of those who are suffering from dysphoria . . . I urge that be the centerpiece and urge consulting very wide and deep within the medical community and with people who are suffering from dysphoria.”
Some previous revisions of the ERD took years of consulting. Doctrine Committee Chair Bishop Daniel Flores told the bishops once the committee comes up with a draft, it will be subject to review and ultimately a vote by all the bishops.
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