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These two areas of gender activism require clarity and forthrightness from our bishops…

These two areas of gender activism require clarity and forthrightness from our bishops…
(Image: Piotr Łaskawski/

At their June 2023 gathering, the United States bishops voted to revisit a section of Ethical and Religious Directives for Catholic Health Care Services, the latest edition of which was published in 2016.

The bishops will review Part III of the document, which offers directives on patients’ rights, the responsibilities of health care professionals and specific areas of potential concern. Not included in the present version are issues related to purported treatments and remedies for gender dysphoria. Bishop Daniel Flores of Brownsville, the head of the committee on doctrine, proposed -and the bishops voted to approve—the incorporation of a doctrinal note issued in March of 2023 that addresses these matters:

These interventions differ in the magnitude of the changes brought about in the body. They are alike, however, in that they all have the same basic purpose: that of transforming sex characteristics of the body into those of the opposite sex.

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. Bodiliness is a fundamental aspect of human existence, and so is the sexual differentiation of the body. 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. They must employ all appropriate resources to mitigate the suffering of those who struggle with gender incongruence, but the means used must respect the fundamental order of the human body. Only by using morally appropriate means do healthcare providers show full respect for the dignity of each human person. (Doctrinal Note, 17-18)

A few bishops pushed back during the discussion on the vote, suggesting that this material should not be incorporated into the directives until there was “broad consultation,” not only with Catholic health care institutions, but with members of the “trans community” as the bishops work out the pastoral implications of doctrine.

The apparent movement among the bishops to incorporate the very clear and uncompromising words of the doctrinal note into the directives is heartening. Nonetheless, there remain potential problems. As those who have followed this issue over the past few years can attest, the pressure against reality is intense, both outside the Church and inside—as, for example, we see this week in the Archdiocese of Portland—and is not weakening.

The bishops’ words so far—both as a group and as individuals—have been strong and reality-based. There are, however, two areas of potential weakness.


What, exactly, these procedures are supposed to help or treat might seem clear. But looking closely reveals—not surprisingly—confusion about definitions, a confusion that is partly due to the fact that these definitions are ever-changing.

A diagnosis of “gender dysphoria” may seem like a sensible, if challenging reality. Certainly, there are individuals who suffer from such a disconnect between body and sense of sexual identity.

But it is essential to realize that the energy of gender activism is quickly moving away from centering any sense of “gender dysphoria” as a reason for medical intervention, and in some cases, from giving any legitimacy to gender dysphoria as a diagnosis at all. What is quickly coming to the fore in the demands of these activists is a complete collapse of any essentiality of sex or gender—complete fluidity to be expressed in any way one pleases, no gatekeeping allowed.

This is the stated goal of gender activism at this moment: incorporation of gender self-identification into policy and law. That is—you are what you decide you are (he/she/they) and that identification has no necessary relationship to your body. This self-definition is fluid, can change as often as you feel it should, and you have a right to be treated in accordance with this self-identification.

In short, the landscape that health care institutions are facing—and in many cases fostering—has little to do with treatment of disorders, and much more to do with enabling desires.

Now, to be sure, these desires are coming from a disordered, dysphoric place, but the provision of the interventions is increasingly framed as a right due, simply because an individual is seeking it.

It’s a nightmare, it’s anti-reality, and Catholic healthcare should have no part of it—and be explicit in adding a critique of the entire deceptive framework to its reasoning why.

Further, while the bishops and other pastoral ministers might assume they are simply being compassionate in accepting individuals’ self-descriptions as “trans,” it is worth asking—is this correct? Is there even such a thing as “trans?”

To question “trans” as a category is not, by the way, “genocide.” It’s not an assertion that “trans people don’t exist.” That argument is nothing but emotional manipulation. To say that “trans” is a definition of a group of human beings is to say, even implicitly, that it is possible to be born in the “wrong” body—and that is simply not true. It is not even helpful as a description of people who believe they were born in the wrong body and are seeking modifications to repair that.

As presently used, “trans” is an umbrella term used, for example, to group young women seeking, for one reason or another—personal trauma, mental illness, reaction against expectations—to reject their female identity, along with men who get a sexual charge out of seeing themselves as women, as well as effeminate males—and it doesn’t take much to see how ridiculous it is to group all of those (and more) under a single “identity” with specific rights to be delineated.

To be very blunt about it, a young woman requesting to have her healthy breasts amputated and a middle-aged man asking to have implants inserted in his chest are not suffering from the same problem with the same root causes.

Further, to treat them as if they are works, in the end, to mask other problems that merit distinct, particular treatments.


The bishops’ statements so far have indicated, as I said, that they will hold the line. I’m afraid, however, that even more forthrightness on the specifics of these procedures will be required in order to help the general public—and perhaps even large swathes of the Catholic public—to understand why they are problematic, to say the least.

As the discussions about these interventions over the past years have shown, proponents will do their best to hide the grotesque and anti-human aspects of these procedures, and to hide them with a cloak of purported compassion.

Sound familiar? It should, because we’ve been here before. We’ve been trained to think, not of unborn children or tiny, defenseless, voiceless human beings, but of fetuses (accurate, but dehumanizing in intent), products of conception and simply “pregnancies.” The issue has been aggressively and successfully framed as one essentially about women and “health care”—not curettes scraping out small humans from their mother’s wombs.

None of that is pleasant to think or talk about, much less picture. This isn’t either. But as we’ve seen, the obfuscation and compassion-cloaking works. The only way to fight it is to be brutally honest.

(Fair warning: this is rough and explicit. More detailed explanations are widely available, but this article at the Claremont Institute’s American Mind is an excellent—and of course, disturbing—summary.)

So, should Catholic hospitals perform procedures in which:

  • Young women’s—even teens’—healthy breasts are amputated?
  • Women have the interior walls of their vaginas excised and allowed to scar shut?
  • Females are put on a course of testosterone (which must be taken the rest of their lives) and as a (desired) result experience enlargement of the clitoris (to mimic a penis) and often (not desired), uterine problems which will require hysterectomy and might result in a greater risk of cancer?
  • Females have skin and tissue from forearm, thigh or abdomen excised and grafted onto their bodies to mimic a penis? And then their urethras lengthened and stretched to extend through that tube of skin?
  • Males get breast implants?
  • Males have healthy testicles removed (orchiectomy)?
  • Males have wounds created in their bodies then lined with skin from their inverted penises—or digestive tracts—in an attempt to mimic a vagina? A wound that then must be dilated with an instrument several times a day for months, and less often but still regularly for the rest of their lives?
  • Children are given medications that were developed to treat prostate cancer in order to halt puberty?
  • Children who have been given puberty blockers are given cross-sex hormones?

In the end, this is about some very basic questions:

  • Is it possible to change sex? If not, is it ethical to perform procedures on people that “affirm” their desire to do so?
  • The question of the “sickness” or “condition” these procedures are said to treat. Is this a single, actual condition or a label for a number of very different issues that call for recognition and discrete treatment?
  • Should Catholic hospitals be amputating healthy breasts, sewing up healthy vaginas, attaching tubes fashioned from forearm or thigh skin and tissue to women’s abdomens, running urethras through those tubes or clitorises, amputating healthy male genitalia, and inverting penises to line cavities in men’s pelvic areas?
  • Should Catholic health care providers be providing off-label medications to physically healthy children and adolescents in an attempt to halt puberty—a multifaceted stage that involves all systems of the body as well as brain development?

Laying all of this out in such a frank manner is not “scare-mongering.” It’s not “alarmist.” It’s simply about the actual procedures, plainly seen, and no guilt-inducing deflections allowed.

It might even be—wait for it—compassionate.

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