U.S. bishops are about to block trans-affirming care at Catholic hospitals

Hormone therapies and gender-affirming surgeries are "injurious to the true flourishing of the human person," the bishops said

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The United States Conference of Catholic Bishops—the USCCB—is on the verge of forbidding Catholic hospitals from providing gender-affirming care for transgender patients, a move that would make an already perilous situation for trans people even worse.

A doctor holds a rosary (image via Shutterstock)

This issue is all the more urgent because Catholic hospitals have rapidly been swallowing up public facilities. Couple that with threats made against public hospitals that provide trans care, and this move would make it that much harder for trans people to attain hormone therapies or surgeries to help make their bodies conform with who they are.

How could this decision have that much impact? To understand why, it helps to understand the power of the USCCB. By and large, and with very few exceptions, they do not allow Catholic hospitals to perform any procedures that violate Catholic doctrine. If the hospitals violate the rules, they could lose their affiliation with the Church which could theoretically be the beginning of the end for many of those places. Even when those hospitals employ doctors and nurses who very much want to help patients, their hands are often tied.

Here’s just a glimpse of those rules:

Directive 45 says “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.” What if a woman has an ectopic pregnancy, where the fertilized egg isn’t implanted in her uterus but gets stuck in the fallopian tube? That’s dangerous. Her life is at risk. A normal hospital could give that woman a drug to induce an abortion… or just remove that fertilized egg through surgery. Catholic hospitals won’t allow either one of those things because it would violate Directive 45.

Directive 48 says “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.” In other words, if the fertilized egg is in the fallopian tube, the USCCB still won’t allow doctors to fix the problem the easy way. In practice, that means doctors may have to remove a woman’s entire fallopian tube to prevent something fatal, reducing her ability to get pregnant in the future, even though it’s totally medically unnecessary, because that’s what the USCCB tells them to do.

Directive 52 targets contraception: “Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning.”

Read anything about Mother Teresa and you will learn how her opposition to birth control put a lot of women from Calcutta in danger. But Catholic hospitals will not dispense it. If a woman who was sexually assaulted says she needs birth control immediately, and a Catholic hospital happens to be the one nearby, it may not help her. Some might, but it’s not guaranteed, and if there’s any chance the victim is already pregnant when the hospital sees her, that help is even less likely. The only form of contraception they will offer, even for married couples who don’t want kids, is Natural Family Planning (NFP), which is based around tracking a woman’s cycle so that she doesn’t have sex when she’s super-fertile. (Because as we all know, everyone only enjoys sex within a window of a few days per month and everyone’s really good at math and keeping track of things.) It’s hardly a reasonable alternative to contraception that is more effective, more often.

Directive 53 says “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” Which means Catholic hospitals won’t perform vasectomies on men, or tubal ligations on women, because those would interfere with natural pregnancies in the future.

That one gets even more messed up. Let’s say you’re a woman who’s giving birth and you’re having a C-section because a vaginal delivery might be too dangerous. (That happens fairly regularly.) Let’s say that the woman decides, “You know what? I’m done having babies after this. No more kids for me. In fact, my health would be at risk if I had another baby, so tie those tubes.” (That also happens fairly regularly.) In fact, the best time to get your tubes tied so you physically cannot get pregnant is when you’re giving birth because the doctor has already made an incision in your abdomen, so tying your tubes is relatively easy. It’s far less risky than having two separate surgeries. Almost a third of women who have C-sections get their tubes tied in the process.  

But doctors at a Catholic hospital won’t do that. They will perform the C-section, sure, but that’s it. They are forbidden from tying a woman’s tubes thanks to Directive 53.

Directive 40 goes after sperm donors: “Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child.” That same religious logic forbids in vitro fertilization because that might involve the destruction of embryos. A couple can’t even use a surrogate mother to give birth to their biological child because that would also be seen as “gravely immoral.”

Basically unless your pregnancy is planned and there are no health issues, a Catholic Hospital may be your worst enemy.

And we haven’t even gotten into end-of-life care.

These Catholic hospitals have an obligation to the Catholic Church, not their patients. The Hippocratic Oath may say “Do no harm,” but the Catholic Church’s oath has a big asterisk next to that phrase that requires checking in with the pope first. And ultimately, the people they hurt the most tend to be low-income people, women, and LGBTQ individuals. People who may not have a choice in how or where they get health care, if they can get it at all. Even if they have insurance, it’s possible their policies require them to go to the Catholic hospital. Meanwhile, these hospitals get roughly $48 billion dollars a year in taxpayer money from the government—through Medicare and Medicaid reimbursements—to keep it all going.

If this were an isolated problem, that would be one thing. But it’s not. Catholic hospitals are taking over the country:

Four of the nation’s 10 largest health systems are now Catholic, according to a 2020 report by the liberal health advocacy organization Community Catalyst. The 10 largest Catholic health systems control 394 short-term, acute-care hospitals, a 50 percent increase over the past two decades. In Alaska, Iowa, South Dakota, Washington and Wisconsin, 40 percent or more of hospital beds are in Catholic facilities.

The same group notes that more than 30% of births in the U.S. now happen in a Catholic hospital. 

In many states, you may have no choice but to go to a Catholic hospital depending on where you live. The Post reports that 1 in 7 hospital beds in the country are now run by a Catholic health care system and some states are worse than others. A 2016 report from MergerWatch found that 46 Catholic hospitals were the “sole community providers of short-term acute hospital care for people living in their geographic regions.” That means people in those areas have no choice but to receive non-comprehensive health care in certain circumstances. (I use the word “care” loosely.)

Making matters worse? Much like evangelical Christian bakers who don’t advertise their bigotry with a sign on the door saying who they will or won’t bake a cake for, Catholic hospitals don’t always advertise the services they won’t do—or even the fact that they are Catholic. Sometimes, these hospitals are named St. Something or Mercy Hospital and there’s a cross in the logo and it’s easy to figure out the connection, even if, like a lot of people, you don’t know what that means.

But sometimes their names are ambiguous on purpose. Like Dignity Health. You wouldn’t necessarily know that’s a religiously affiliated hospital.

In fact, in 2018, the New York Times looked at the websites of 652 Catholic hospitals and found that two-thirds of them didn’t even make it clear they were Catholic. It required at least three clicks from the home page to confirm that. And only 3% of those hospitals listed what procedures they do not perform.

What that means is that you may not know which hospitals are Catholic, and most people will have no idea what procedures are banned until it’s way too late. 

And yet administrators at public hospitals often feel like they have no choice but to be taken over by the Catholic Church. They may be severely underfunded and looking for any lifeline; the Catholic Church has money to toss around. But that partnership comes with the understanding that certain patients won’t get the care they need, even in emergency situations. It’s a Faustian bargain for those administrators.

And now the USCCB has set its sights on trans people.

According to the National Catholic Reporter’s Brian Fraga, when the USCCB meets for its spring assembly this week, trans care will be on the chopping block. My first reaction to hearing that was shock… that they hadn’t done that already. Since when did Catholic hospitals provide that sort of care?! But that’s the wrong way of looking at it. When the policy document was last updated in the "mid-1990s,” the bishops weren’t thinking about trans people at all.

Their omission created the option for trans care to be provided at Catholic hospitals; now they’re trying to correct the mistake of accidentally maybe helping people.

Back in March, the USCCB issued informal guidance on trans patients in a document telling Catholic hospitals which procedures “promote the authentic good of the human person and which are in fact injurious.” (Spoiler: If it helped trans people, it was “injurious.”) That informal guidance may become formal guidelines after this week:

The March 20 doctrinal note argues that gender-affirming medical treatments — which may include hormonal therapies and surgical procedures — are "injurious to the true flourishing of the human person," and says that Catholic health care services must not perform them. The note added that such interventions "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." 

Fraga spoke with ethics experts who rightly pointed out how cruel such policy changes would be, in no small part because they’re being written by people who have no clue what they’re talking about:

But scholars including M. Therese Lysault, a Loyola University Chicago Stritch School of Medicine theologian who studies and has written about bioethics, criticized the document for reflecting "a striking inability to conduct a basic moral analysis." 

Lysault told NCR that the doctrinal note displayed "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."

…

The bishops conference said the doctrinal note was developed "in consultation with numerous parties, including medical ethicists, physicians, psychologists, and moral theologians." But several bioethicists who criticized the document told NCR that it did not reflect the evolving science on gender dysphoria nor the insights and lived experiences of transgender people.

Of course, the USCCB leaders don’t care about any of that. The Vatican has previously said trans people “annihilate the concept of nature.” It doesn’t acknowledge their existence. Denying care to trans people, then, is the ethical move in their minds.

The USCCB’s meeting is scheduled to take place June 14-16 in Florida. Seems appropriate that these cruel actions against trans people will take place in a state known for anti-LGBTQ legislation.

(Portions of this article were published earlier)

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