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Archbishop Timothy P. Broglio of the Archdiocese for the Military Services, USA, who is president of the U.S. Conference of Catholic Bishops, speaks June 15, 2023, during the USCCB's spring plenary assembly in Orlando, Fla. (OSV News photo/Bob Roller)

The U.S. bishops voted on Friday to begin a process that could lead to rules formally banning Catholic hospitals from offering medical procedures and therapies sometimes collectively described as gender-affirming care.

Meeting in Orlando for their spring meeting, the U.S. Conference of Catholic Bishops overwhelmingly decided via a voice vote to begin a process of revising the Ethical and Religious Directives, guidelines that draw from theology and church teaching and regulate the roughly 2,200 Catholic hospitals and health care facilities in the United States.

While most Catholic hospitals already refrain from offering transgender surgeries and hormonal interventions, the vote means that the bishops will move to formalize such bans by incorporating guidance from a document released by the U.S.C.C.B.’s doctrine committee in March. In the “Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body,” the bishops addressed both hormone therapies and surgical procedures related to gender.

The section of the directives that the bishops voted to revise has not been updated since 1994.

While most Catholic hospitals already refrain from offering transgender surgeries and hormonal interventions, the vote means that the bishops will move to formalize such bans.

“At that time,” the proposal the bishops approved on Friday states, “it was not envisioned that it might be necessary to include specific guidance concerning radical modifications of the human body, such as are frequently advocated today for the treatment of the condition commonly known as gender dysphoria or gender incongruence.”

The vote begins a process that could take months, or even longer, before any changes are made to the directives. But the eventual language is likely to come from the March document, which states unequivocally that certain medical procedures related to gender, such as hormone therapy and elective hysterectomies, cannot be offered in Catholic health care settings.

“These technological interventions are not morally justified either as attempts to repair a defect in the body or as attempts to sacrifice a part of the body for the sake of the whole,” the document states. Such interventions, the 14-page document continues, are “attempts to alter the fundamental order and finality of the body and to replace it with something else.” Thus, the bishops conclude, such interventions are not morally permissible.

“Catholic health 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 or take part in the development of such procedures,” the document says.

A handful of bishops took to the floor ahead of the vote and urged the committee to broaden its consultations ahead of any proposed revisions, including meeting with people who identify as transgender.

“These technological interventions are not morally justified either as attempts to repair a defect in the body or as attempts to sacrifice a part of the body for the sake of the whole,” the document states.

Cardinal Robert McElroy, the bishop of San Diego, said that one of the main questions in any revisions to the directives related to transgender patients must be “How do we help people who are wrestling with dysphoria?”

The archbishop of Newark, Cardinal Joseph Tobin, urged the committee to consult a wide range of experts during the drafting process, “including people who are from the trans community.”

Calling the proposed revisions “a delicate matter,” Archbishop Paul D. Etienne of Seattle said such consultations were “absolutely necessary” and should also include physicians and hospital administrators.

Some bishops said that the drafting committee should look at the legal impact of any revisions, particularly at how federal health care guidelines could impact Catholic hospitals, while others, including Bishop Michael Olson, who heads the Diocese of Fort Worth and who serves on the doctrine committee, said that a broader pastoral document about gender dysphoria could be helpful after the directives are updated.

The head of the Catholic Health Association, which represents hundreds of Catholic hospitals and other health care facilities, said that she hopes the revision process will “engage in broad consultation with patients suffering from gender dysphoria and providers who care for them to ensure the health of the whole person.”

“Through this effort, I hope we can reach an outcome which reflects a deeper clinical, theological, and pastoral understanding of caring for transgender individuals,” Mary Haddad, R.S.M., said in a statement. “Establishing trust with marginalized patients is vital to their health and well-being, and it is our hope that the ERD revision will communicate this pastorally and clearly.”

In recent years, Catholic health systems have come under increased scrutiny because of the church’s teaching on abortion and sterilization. When it comes to Catholic hospitals, reproductive and other church teachings are laid out in the Ethical and Religious Directives, which set out ideals for Catholic health care as well as certain prohibitions.

“Does objecting to performing gender transition procedures—but welcoming patients who identify as transgender—constitute discrimination?” Cardinals Dolan and Cupich wrote. “Of course not.”

The guidelines also “lay out the positive claims that we make as Catholic health care ministries, about who we want to be,” Michael Rozier, S.J., an assistant professor of health management and policy at St. Louis University, told America. “The parts that get the most attention are the elements of the E.R.D.s that prohibit certain actions, but those certainly aren’t the entirety of them.”

Some Catholic health care leaders sought to assure transgender patients that they would still be welcome at church-affiliated hospitals following the publication of the memo in March.

Sister Haddad said in March that the document would not affect how Catholic hospitals treat transgender patients, even if certain procedures and therapies are not allowed.

“Catholic health care providers will continue to respect the dignity of our transgender patients and provide them with the same quality care we provide to all our patients,” she said in a statement. “We recognize that the well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology in caring for our patients.”

Mary Rice Hasson, a senior fellow at the Ethics and Public Policy Center, told Our Sunday Visitor, “People need to hear the truth: we are created only male or female.”

Writing inAmerica last September, in response to proposed federal health care policy changes related to transgender health care interventions, Cardinal Blase Cupich of Chicago and Cardinal Timothy Dolan of New York said that Catholic hospitals are welcoming to all.

“Does objecting to performing gender transition procedures—but welcoming patients who identify as transgender—constitute discrimination?” the cardinals wrote. “Of course not.”

The March document was praised by those who say transgender care has moved too quickly, especially when it comes to children, but criticized by others who said that the bishops failed to take into account the lived experiences of transgender people.

Mary Rice Hasson, a senior fellow at the Ethics and Public Policy Center, told Our Sunday Visitor, “People need to hear the truth: we are created only male or female.”

“Even within some Catholic circles there is a lot of confusion about whether medical interventions are morally licit,” Ms. Hasson said. “The USCCB Doctrine Committee is clear: These interventions are not morally licit.”

Others said the document did not explore difficult medical and moral questions.

M. Therese Lysaught, a bioethicist at Loyola University Chicago, wrote at the National Catholic Reporter, “the doctrinal note and its prohibitions provide no real guidance to Catholic health care professionals who will continue to face practical questions as they accompany real persons.”

This article has been updated with a statement from the Catholic Health Association.

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