Bishops pass new health care directives on gender issues
The bishops of the United States voted Wednesday to approve amendments to the Ethical and Religious Directives for Catholic Health Care Services (ERDs) to explicitly rule out the practice of surgical or hormonal procedures and other medical interventions which “alter the fundamental order of the human body in form or function.”
The directives are a guide issued by the bishops to offer ethical standards in health care, based on Catholic teaching about human dignity. The vote, which passed with the needed two-thirds of the bishops conference membership, incorporated additions to Part Three of the ERDs, which deals with professional-patient relationships, as well as amendments to other parts of the document.
The guide is periodically updated. It is currently in its sixth edition, which was approved by the bishops seven years ago. A seventh edition is to be released in the coming months.
In 2023, the bishops unanimously adopted a proposal to review Part Three, which has not been updated since 1994 and does not currently include guidance on “radical modifications of the human body,” such as surgeries and hormones given for gender dysphoria.
The additions adopted for inclusion into the upcoming seventh edition include citations from various documents, including Pope Francis’ exhortation Amoris Laetitia, which states that “creation is prior to us and must be received as a gift,” and there is a moral duty “to protect our humanity,” which means first of all, “accepting it and respecting it as it was created.”
Recognizing this principle, the ERDs will in future affirm the need to “respect the nature of the human person as a unity of body and soul,” and that 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.”
The adopted changes include specific reference to “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).”
Presenting the changes to the bishops during the USCCB’s fall plenary assembly in Baltimore, Bishop James Massa, chairman of the doctrinal committee, said the changes to the ERDs are a “corrillary” to a 2023 doctrinal note form the USCCB’s committee on doctrine and meant to “address the lacuna” in the current version on the issue of gender-related conditions and interventions.
The doctrinal note, as adopted into the revised ERDs, states that “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.”
Citing both the USCCB doctrinal note and Dignitas Infinita, the 2024 declaration on human dignity from the Vatican Dicastery for the Doctrine of the Faith, the revised text of the ERDs states that “Since the human person is a unity of body and soul, Catholic health care professionals and their patients have the duty and the right to preserve the integrity of the human body.”
The text states, “It can be morally permissible, however, to remove or to suppress the function of one part of the body for the sake of the body” under certain conditions: “There must be no other reasonable means of addressing the pathological condition, the efficacy of the
procedure must be reasonably well assured, and the benefits expected from the procedure must be proportionate to the burdens it imposes, including suffering, cost, and damage to the body.”
Bishop Massa told the bishops that the conference had consulted closely with the Catholic Health Association, the National Catholic Bioethics Center, the Catholic Medical Association, and the Alliance of Catholic Healthcare on “draft after draft” of the new text and received “invaluable feedback” on “every word, every phrase,” and that bishops had been canvassed for their own opinions on the text throughout the month of October.
Massa also told bishops that the Vatican, via the Dicastery for the Doctrine of the Faith, has already formally approved the 2023 doctrinal note, which formed the substance of the changes to the ERDs and had been informally asked for feedback and approval throughout the drafting process.
The ERDs do not, Massa reminded the bishops, have canonical force at a national level and the bishops will have to individually promulgate the updated text in their dioceses once they are issued by the conference.
Prior to the 2023 Spring meeting, the USCCB’s administrative committee authorized the publication of a note from the conference’s doctrine committee on the “moral limits to technological manipulation of the human body.”
The 2023 note said, among other things, that transgender surgeries are immoral because they “do not repair a defect in the body…these interventions are intended to transform the body so as to make it take on as much as possible the form of the opposite sex, contrary to the natural form of the body. They are attempts to alter the fundamental order and finality of the body and to replace it with something else.”
During the 2023 floor discussion, Cardinal Robert McElroy, then of San Diego, now of Washington, DC, made a distinction between “the doctrinal tradition of the Church, particularly on male and female” and the need “to wrestle with the existential question of those who are suffering from dysphoria.”
“I think there’s a fundamental difference between a declaration on doctrine, which was issued, and the formulation of the ERDs,” he said, stressing that the ERDs are not just a recapitulation of teaching but an application of doctrine to “the existential situation of people who are suffering.”
“The ERDs are meant to be a pastoral, medical document to inform and guide the health care ministries,” McElroy said. “I urge therefore that the consultation be very wide and deep, within the medical communities and with people who are suffering from dysphoria also.”
Others, including Cardinal Joseph Tobin, Archbishop Paul Etienne, and Archbishop Shawn McKnight, called for broad consultation on Part Three of the ERDs, including those who suffer from gender dysphoria.
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