Catholic medical professionals across the United States are facing the increasingly common situation of seeing young patients who say they want to transition to the opposite gender.
The current standard of care for these patients in many hospital settings is to affirm their transition, no matter what — and Catholic professionals who don’t want to conform to these standards say that they are at risk of losing their jobs if they don’t.
“Janelle,” a Catholic psychotherapist who is currently working in Pennsylvania with adolescents and requested that her identity be protected, administers an outpatient and inpatient group therapy program. She has seen a sudden increase in the number of transgender youths during the last year.
“I have been doing this for three years,” Janelle said. “About 60-80% of the teens I see are now identifying with another gender. It is overwhelming. On one hand, you want to develop a therapeutic relationship with them, but I have it in my heart that I am not helping them by affirming them.”
Janelle’s hospital system is not religious and has come under pressure to always affirm transgender patients. But the situation has become so chaotic, that some patients are changing their personal pronouns on a daily basis.
“I had one patient who was female and had a boyfriend. She identified with they/them. Other patients I have encountered switch pronouns from day to day,” she said. “In psychotherapy, we always try to affirm our patients, but to keep changing your pronouns — this will only increase your anxiety and depression.”
Janelle has been thinking about speaking to her boss about opting out of affirming transgender patients. But she does not think it will go well.
“I think I would lose my job,” she said.
A Catholic psychiatrist who works at a hospital that treats many young patients with gender dysphoria told the Register she too has disagreements with so-called gender transitioning, from various standpoints. She is alarmed at the medical and psychological consequences that come from hormone blockers and sex-change surgery.
Hospital regulations often prohibit doctors from counseling patients away from transitioning in any way, said the psychiatrist, who spoke on the condition of anonymity out of fear of reprisal. She said in her place of employment, if a doctor does not affirm the patient’s decision to change their gender, he or she can be accused of interfering in the patient’s treatment and reported to the hospital’s administration.
According to Catholic teaching, gender transitioning cannot be reconciled with a proper understanding of human nature, wherein a person’s sex is manifested by the body itself.
“[A] person’s sex is manifested by the body in accordance with how the person has been created, and so it cannot be in conflict with any truer or deeper sexual identity contrary to that bodily sex,” states the National Catholic Bioethics Center on a webpage dedicated to explaining Catholic teaching on transgenderism.
“This is a foundational anthropological point that no medical association or political ideology can overturn,” said the statement, which goes on to explain why Catholic teaching prohibits the nontherapeutic mutilations involved in sex reassignment surgeries as well as the administration of puberty-blocking hormones to children as a means of transitioning.
And the position of Catholic bioethics is that any cooperation with gender transitioning is morally illicit.
“To help this process in any way is to be involved with a moral evil,” said Josef Zalot, staff ethicist at the National Catholic Bioethics Center. “Any psychologist or psychiatrist who finds themselves in this situation can: (1) go along with it, (2) recuse themselves from it by trying to walk away from these patients, or (3) get legal advice.”
But for some medical professionals, depending on where you live, there isn’t always an opportunity to object based on religious beliefs or conscience.
“If you are working in a secular hospital, you very often must go along with it. This is wrong on so many levels. This violates freedom of conscience. And it violates medical practice,” said Zalot.
Catholics at Secular Hospitals
Because gender ideology has evolved so fast into the cultural mainstream of the United States — and particularly within American medicine — many mental health professionals have found themselves blindsided.
“A Catholic mental health professional who I trust very highly estimates that approximately one-third of his colleagues in the U.S. strongly disagree with the so-called ‘affirmative model of care’ (affirming psychotherapy, puberty blockers, cross-sex hormones, and surgical procedures). Unfortunately, they fear repercussions from their professional societies if they speak out, so many do not say anything, at least not publicly. Patients, including children, are being hurt,” said Zalot.
Dr. David Chen, a psychiatrist from Rockville, Maryland, agrees.
“Most insurance companies and hospitals that are not Catholic have adopted this relativistic way of thinking about people — where you can choose your own gender,” said Chen. “Insurance companies and public hospitals in most states have made it so that doctors have to comply.”
The Equality Act, a bill currently being debated in Congress, is another concern. It seeks to amend the Civil Rights Act of 1964 to prohibit discrimination based on sex, sexual orientation and gender identity. Right now, the bill is stalled in Congress. If it passes, it will mean that no one can claim a religious exemption.
“So — for example — a psychiatrist in a public hospital right now might be able to articulate a religious exemption so as not to treat transgender patients. Though, I know a Catholic doctor who did so and was disciplined by her hospital,” said Chen. “What we need are competent attorneys to help these mental health professionals. If the Equality Act passes, then even our phone conversation would not be protected and would be considered a hate crime.”
“The Equality Act is the most in-aptly named law that our Congress has proposed in recent decades,” said Busch. “It ensconces not just protections for and celebrations for different sexual orientations and gender identities across the spectrum. It eliminates any dissent at the federal or state level,” said John Bursch, senior counsel and vice-president of appellate advocacy with the Alliance Defending Freedom.
For Catholics who work in Catholic hospitals, there is often still the capacity to not participate in transitioning/sex-change surgery based on the Catholic medical ethics that govern such institutions.
The NCBC’s guidance is that no “Catholic health care organization should establish policies that positively affirm the choice of any behavioral, hormonal, or surgical gender transitioning of patients, personnel, or other persons served by the organization.” Nor should a Catholic institution require personnel to be involved in gender transitioning procedures.
But the capacity of Catholic institutions to conform with Church teachings, in their policies opposing gender transition procedures, is being challenged. At the federal level, the Religious Freedom Restoration Act (RFRA) generally prevents the federal government from taking actions that violate someone’s deeply held faith.
“The Equality Act wipes out RFRA with respect to LGBT issues,” said Bursch. “Through that, they can compel Catholic hospitals to perform sex-transition surgery. They can apply counseling bans to every therapist in the country. They can force even your local doctor to treat someone as though they are a sex that they are not, even though that would be against their best medical advice.”
Another threat is arising from the White House. So far this year, federal courts twice have blocked a policy supported by the Biden administration, known as the transgender mandate. This mandate would compel religious doctors and hospitals to perform gender transition procedures on their patients, even if the procedures were medically harmful and against the religious beliefs of doctors.
The first federal court ruling to block the transgender mandate was on Jan. 19, in the lawsuit Religious Sisters of Mercy v. Azar in North Dakota. In that case, an order of nuns joined with a Catholic university and Catholic healthcare organizations in their suit against the federal government. On Aug. 10, a federal district court affirmed the earlier ruling and granted a permanent injunction to the plaintiffs against the application of the mandate.
The second federal court ruling to block the transgender mandate was in Texas on Aug. 9, through the lawsuit Franciscan Alliance v. Becerra. This case was brought to court by a religious hospital, an association of over 20,000 healthcare professionals, and nine states.
An earlier successful legal fight against a local transgender law took place in New York City, when Dr. Dovid Schwartz, an orthodox Jewish psychotherapist, decided to fight back against the New York City Council. In 2018, the council passed a law making it illegal for any person to provide services for a fee, seeking to change a person’s sexual orientation or a person’s gender identity to conform to the sex “that was recorded at birth.” The law threatened fines of up to $10,000 for first, second, and subsequent violations. By contrast, counseling to steer a patient towards a gender identity different than his or her physical body was permitted.
Schwartz sued the New York City Council in 2019, asking a federal district court to halt the enforcement of this ordinance. In the face of the lawsuit, the city repealed the counseling ban in July 2020 and settled with Schwartz for $100,000.
An Assortment of Laws
Across the U.S., an assortment of laws regulate what is legal and what is not for mental health professionals, with regard to counseling patients who want to transition to the opposite sex or have already done so. The precise standards depend on where you live and what health care organization you work for.
“Unfortunately, the law isn’t super-developed in this area. That is something we are working hard to change,” said ADF’s John Bursch.
“There is a patchwork of laws. It started with this idea by some government officials to make it clear to everybody that we should embrace and celebrate other types of sexual orientations or anything on the gender spectrum, that we cannot have therapists telling people that the kind of conduct they want to engage in is wrong.”
Bursch referred to a website, run by advocates of sexual reassignment surgery, as the most up-to-date resource documenting such laws.
The problem, Bursch said, is that these new laws demand that mental health professionals counsel in one way only — towards transitioning to the opposite gender — and they do not take into account the rights of free speech of the psychologist/psychiatrist, or their freedom of religion and conscience rights.
“There are two different concepts that immediately come to play here — both with the First Amendment.”
The first issue in play “is the free exercise clause, which says that not only are you free to exercise your religion, but the government can never compel you to do something which violates your religious beliefs contrary to your faith. And it is wrong for these cities and these states to say to counselors: If you want to be a professional counselor you have to violate the Catholic Church’s teachings or whatever your faith-tradition’s teachings are about marriage and human sexuality in order to keep your job,” said Bursch.
The other issue is the violation of the right to free speech.
“The free speech clause in the First Amendment says two different things that are pertinent here: (1) you can’t compel someone to say something and by forcing therapists to speak positively about things with which they disagree — that violates the compelled speech principle (2) the government cannot take sides in speech,” said Bursch.
Need for Protections
Because of the inconsistencies of laws on this issue, religious freedom lawyers want stronger protections at the state and federal level.
“The Equality Act will cause all kinds of mischief, not just in the context of medical professionals. It will affect employment, public accommodations, and just about any other aspect of life that you can imagine — which is why the USCCB has spoken so strongly against the adoption of the Equality Act,” said Bursch.
“President Biden publicly has been a big cheerleader for the Equality Act and urged Congress to pass it — and that is consistent with what his administration has been doing with respect to conscience rights generally,” said Bursch.
Right now, however, the chance of the Equality Act passing the Senate seems low because there is no supermajority to pass it in the face of a filibuster.
For mental health professionals, it is an uneasy time: one where patients are not allowed to hear opposing, legitimate opinions, and where some therapists are being muzzled from expressing their deeply-held beliefs to the patients they have sworn to help.
“The reality is that this ideology will continue until people stand up and fight it,” said Zalot. “We need mental health professionals who are willing to stand up because it is not good medicine.”