U.S. Catholic bishops double down on anti-trans policies in new hospital rules

The USCCB’s updated health directives ban gender-affirming care and ignore medical experts, leaving trans patients with even fewer options

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When the U.S. Conference of Catholic Bishops (USCCB) gathered this month “to spend time in prayer and fraternal dialogue,” they made sure to spend some time detailing how they could make the lives of transgender people even worse.

Specifically, they codified a plan forbidding Catholic hospitals from performing any kind of gender-affirming care.

A doctor holds a rosary (image via Shutterstock)

They based their decisions on two documents.

One was some informal guidance they offered to hospitals in 2023. They said gender-affirming care did not “respect the fundamental order of the human person as an intrinsic unity of body and soul, with a body that is sexually differentiated.” They also added that any kind of care “must respect the fundamental order of the human body.”

That was foreshadowing. But a memo isn’t the same as a hard-and-fast rule.

In 2024, the Vatican chimed in with even more forceful language. In a document ironically called “Infinite Dignity“ (Dignitas Infinita), the Catholic Church called the acknowledgement of trans identities “grave violations of human dignity.” (All this from an organized crime syndicate best known for harboring predators and covering up child sexual abuse.)

It’s not like the document was horrible the whole way through. It condemned war and torture and the death penalty, for example, and urged people to help the poor and those with disabilities. That’s nice. But then it began railing against abortion rights and surrogacy and death with dignity and trans people.

In fact, Sections 55-60 were all about trans people. The document never actually used the T-word. Instead, it said that people who subscribed to “gender theory” were merely making a “personal self-determination,” as if being trans was a choice (not true). It also claimed that sexual difference was the “greatest possible difference that exists between living beings” (not true and in denial of any sort of gender spectrum. It said that gender-affirming operations risked threatening a person’s “unique dignity” (not true and in fact completely backwards).

By their logic, having an appendectomy or getting LASIK was also a violation of God’s perfect design because you’re altering what you were born with.

It was everything you’ve come to expect from a group of elderly men who have never had (heterosexual) sex, much less understand the nuances of sex and gender, but pretend to be experts anyway. That said, it’s not like this was surprising. According to the Catechism of the Catholic Church (i.e. The Rulebook), homosexual acts are considered “intrinsically disordered” and the Vatican says trans identities seek to “annihilate the concept of nature.“

But that document created a different kind of problem for Catholic hospitals in the U.S. because their rulebook—and yes, they have their own rulebook—didn’t say any of this.

The last time the Catholic hospital rulebook was updated was in 2018. Importantly, that book, officially called “Ethical and Religious Directives for Catholic Health Care Services” (Sixth Edition), didn’t have any rules concerning gender-affirming care. That’s why those recent documents were a big deal.

It’s also why the USCCB felt obligated to adopt the Seventh Edition of the rulebook last week. And this one most definitely has sections about health care for transgender people. The passages in sections 28 and 29 are brand new additions to the book:

28. Since “creation is prior to us and must be received as a gift,” we have a duty “to protect our humanity,” which means first of all, “accepting it and respecting it as it was created.” In order to respect the nature of the human person as a unity of body and soul, Catholic health care services must not provide or permit medical interventions, whether surgical, hormonal, or genetic, that aim not to restore but rather to alter the fundamental order of the human body in its form or function. This includes, for example, some forms of genetic engineering whose purpose is not medical treatment, as well as interventions that aim to transform sexual characteristics of a human body into those of the opposite sex (or to nullify sexual characteristics of a human body).

29. In accord with the mission of Catholic health care, which includes serving those who are vulnerable, Catholic health care services and providers “must employ all appropriate resources to mitigate the suffering of those who experience gender incongruence or gender dysphoria” and to provide for the full range of their health care needs, employing only those means that respect the fundamental order of the human body.

The words that the bishops wrote in their memo years ago have now been codified.

In short, Catholic hospitals cannot perform any kind of care for trans people since it would be altering the “fundamental order” of their body. Sure, doctors should “mitigate the suffering” of trans people, but they’re forbidden from doing the most important thing they can do to mitigate that suffering.

When the 2023 memo suggesting these changes was released, theologians and bioethicists condemned them with harsh words:

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.

It looks like the bishops ignored those concerns from people who know what they’re talking about. Because acknowledging compassion and decency and actual science would violate the religious dogma these people live by, and their priority is to tradition, not human decency.

Even some Catholics are disturbed by what the bishops just did:

“Catholic teaching upholds the invaluable dignity of every human life, and for many trans people, gender-affirming care is what makes life livable,” said Michael Sennett, a trans man who is active in his Massachusetts parish.

Sennett serves on the board of New Ways Ministry, which advocates for LGBTQ+ inclusion in the Catholic Church. In 2024, the group arranged a meeting with Pope Francis to discuss the need for gender-affirming care.

New Ways Ministry’s executive director, Francis DeBernardo, said that for many transgender Catholics he knows, “the transition process was not just a biological necessity, but a spiritual imperative. That if they were going to be living as authentic people in the way that they believe God made them, then transition becomes a necessary thing.”

DeBernardo also said the Ethical and Religious Directives “are neither ethical nor religious.”

You can questions why these people remain in a club that doesn’t want them as members, but they make a fair point: Many trans people will tell you that transitioning is vital to living their authentic lives. To be denied that opportunity, at least at Catholic hospitals, means that the Catholic Church would rather have them live a lie (and be miserable) than give them the kind of care that would allow many of them to feel whole.

And all this comes at a time when the Republican-led federal government is doing everything in its power to shut down rural hospitals, limit health care options in general, and urge state legislatures to pass their own anti-trans laws.

The reason all this matters is because the USCCB, with very few exceptions, does 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.

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 a 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. And this isn’t an isolated problem. 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 noted that more than 30% of births in the U.S. now happen in a Catholic hospital.

Interestingly enough, despite these new restrictions, there are still ways trans people can get what they need even at Catholic hospitals... provided they have doctors who know how to get around the rules.

That does not always mean patients can’t get help. Some doctors find workarounds for their patients — and it’s been an open secret in Catholic hospitals for some time, said Debra B. Stulberg, chair of family medicine at the University of Chicago, [a] secular institution. She has researched the church’s health care policies as they relate to reproductive health care and gender-affirming care.

“People who want hormonal contraception — the clinicians are advised that you can’t provide these medicines for the purpose of contraception,” Stulberg said. “But if the patient has really painful periods or really bad acne, you can prescribe it for other reasons.”

For trans people, the loopholes may include referring them to secular clinics or framing hormone therapy as treatment for some unrelated condition.

In the meantime, the new guidance for Catholic hospitals should be a signal to everyone that there’s no moderating faith-based extremism. It doesn’t matter if the pope’s tone is gentle, or the Vatican’s document includes other sensible statements, or a few high-ranking individuals call for LGBTQ inclusion in the Church. The organization insists it will never change on the most basic, common-sense moral issues of our time, and they’ve planted their flag on the wrong side of them. A handful of U.S. bishops believe they know more about medical care than doctors, theologians, and experts in transgender health. (It’s telling they never specify which “medical professionals and theologians” they consulted when crafting their rules.)

Unless more practicing Catholics reject the Church for good, none of that will ever change.

(Portions of this article were published earlier)

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