US bishops will review health care guidelines to address 'gender interventions'

(OSV News) -- During its 2025 fall plenary assembly, which will take place Nov. 10-13 in Baltimore, the U.S. Conference of Catholic Bishops will consider possible revisions to its "Ethical and Religious Directives for Catholic Health Care Services," or ERD, document.

Now in its sixth edition, the ERD document -- developed in consultation with medical professionals and theologians, and regularly reviewed by the USCCB -- articulates ethical standards for health care in light of church teaching, and provides authoritative guidance on moral issues encountered by Catholic health care.

OSV News spoke with Auxiliary Bishop James Massa of Brooklyn, chair of the USCCB Committee on Doctrine, regarding the proposed revisions, which will focus on several sections of the ERD.

In particular, the upcoming ERD discussions will examine how to incorporate into the document guidance issued in 2023 by the USCCB's Committee on Doctrine, which prohibited surgical or chemical interventions seeking to exchange or simulate the sex characteristics of a patient's body for those of the opposite sex.

Bishop Massa noted that any revisions to the ERD text would require a two-thirds majority vote. In addition, he said, individual bishops would then need to decide to make the ERD document a particular law in their respective dioceses, or at least treat it as such without formally promulgating the text.

This interview has been edited for length and clarity.

OSV News: Which sections of the ERD will be the focus of your upcoming discussions?

Bishop Massa: There are six sections of the ERD (the social responsibility of Catholic health care services, the pastoral and spiritual responsibility of Catholic health care, the professional-patient relationship, issues in care for the beginning of life, issues in care for the seriously ill and dying, and collaborative arrangements with other health care organizations and providers).

It's that third section, the professional-patient relationship -- the gist of which is fostering a relationship based on respect, justice and compassion -- where we have new material in response to the emergence of "gender care" taking place across health care. Our hospitals are facing decisions about what interventions can or should be performed within our own Catholic facilities, so we responded to that.

Now, we also have some changes in the first section on social responsibility, just some tweaking of the language.

We also have changes in the fourth section addressing issues related to the beginning of life -- procreation, conception, etc. -- from a Catholic perspective, and also in the fifth section on end of life care. Obviously, we exclude being involved in euthanasia and assisted suicide in any way, as that is catching on now around the country.

OSV News: Especially regarding the emergence of "gender care," the central issue seems to come down to anthropology -- the often vast differences between how the Catholic faith and other systems of thought and belief understand the nature of a human being, the body, the spirit. How do you articulate the Catholic perspective in the medical setting, given such challenges?

Bishop Massa: Medicine is all about the care of the body, but there are the deeper philosophical issues that are at play today. One can trace in the development of modern philosophy this sort of modern, maybe even postmodern, understanding of the body as simply an expression of the spirit in the human being, or the expression of the soul, which can be manipulated in order to satisfy the way in which the person understands him or herself. The point (to that thinking) is that we can change our gender.

But it's not as if the body is some appendage to the real me, which is the spirit or the soul inside the person. No -- the person is body and soul.

In "Dignitas Infinita" (the declaration on human dignity issued by the Vatican's Dicastery for the Doctrine of the Faith in April 2024), both paragraphs 59 and 60 are important to note, because they state that all attempts to obscure reference to the ineliminable or unchangeable sexual difference between man and woman -- that's to be rejected. We can't have that.

Now, it's (also) a recognition that people are affected by various kinds of disorders of sexual development. They may exhibit behaviors -- or even, in some cases, (conditions) from birth, such as intersex children, for example; it's a very, very rare phenomenon, but it happens. That has to be addressed, and intervention can be made, based on a sound medical judgment, to give the person the sexuality, the genitalia, of either a male person or a female person.

But this idea that we can change our gender at will because it better corresponds to our desires -- that's really a false notion of what it means to be a human being.

OSV News: Both anecdotal and, more recently, scientific data indicate a steep rise over the past decade in the number of those, particularly younger people, who identify themselves as transgender. What do you think is behind this increase?

Bishop Massa: There are many who have written about human self-understanding in this cultural moment ... some very astute commentators on the culture who look deeply at the various trends, and the trends are quite alarming on this issue of identifying as transgender.

Just in the course of nine years, 2014-2023, there is, looking at 18 to 24-year-olds, a 422% increase in self-identifying as transgender (according to collaborative research by scholars at San Diego State University, Widener University and the University of Minnesota Medical School). It's roughly 3% of that young adult population, ages 18-24.

Where does this come from? What has changed in the culture? (Canadian philosopher) Charles Taylor uses the term "expressive individualism," meaning there's this need to kind of stand out, to express my individuality, which has to be set aside from the way other people express themselves. There's a constant need to be heard and listened to.

There's this eclipse of belief in God, the secularization that is well underway and that is really shaping the attitude of important institutions in society -- our schools, our universities, our businesses, commerce. It's all about what we produce, what we make by ourselves or of ourselves.

This idea that we are self-creating beings is sort of the modernist heresy that really lies, I think, at the root of this opposition to a Christian, Catholic, biblical perspective on what it means to be human.

The alternative is to say, "No, you are a gift. Life is a gift." The gift of life has to be retrieved as a  fundamental value -- the awareness of the givenness of our bodies, that we are our bodies and we are gifted into the world as embodied souls, as whole persons, composed of body and soul.

You cannot be fully human without a body. Even the souls separated from the body in death are awaiting the resurrection of the body, as we say in the Creed, because that's what it means to be fully human.

I think retrieving the consciousness of that reality of the body is one of the enormous core tasks of evangelization in our time.

I heard one pastor say that when you meet a person experiencing gender dysphoria, you really have to practice the art of listening to the dysphoria. And you find there are deeper layers of disconnection, family relationships, family dynamics, particular wounds in the person's background, etc.

All that has to be listened to and understood with compassion. There's a real opportunity for the church to be a compassionate presence to people who are experiencing gender dysphoria.

OSV News: And in that regard, the ERD text is also situated within an array of resources to help the church be that compassionate presence. Talk about some of those particular resources.

Bishop Massa: We have some excellent examples of pastoral letters written by bishops of our conference. And we now have a couple of years' worth of publishing of guidelines for parishes and Catholic education entities, and also guidance for pastors and sacramental ministers when decisions have to be made about sponsors for confirmation, baptism, etc.

So there are already, in many ways, examples of the teaching embedded in these ERDs. They have already been applied pastorally through these statements and letters that are coming from bishops at the local levels.

But the ERD text remains an important resource for writing those documents. It's the latest articulation of what is permissible, what is recommended, in Catholic health care across our Catholic health care landscape.

So this is, I think, going to be very helpful to those who continue the essential work of making our anthropology and our Catholic moral teaching accessible to our people, to the faithful.

OSV News: How does the ERD document help Catholic health care workers amid current challenges to their faith in health care environments?

Bishop Massa: In all of these religious freedom cases that end up before the court, the consistency of Catholic teaching across the nation, across a particular region of the church, is very important. And this is one of the compelling reasons why we continue to renew the ERDs. Now we're presenting the seventh edition.

The landscape changes. There are forces in the culture, in the society, that are very hostile to the church's positions on moral issues. This is much more pronounced today than it was in the past.

Also, the technology is changing, and new problems are presenting themselves.

For example, there seemed to be something of a consensus, back when the ERDs were drafted in the early 1970s, on clinical death. What was clinical death? Brain death. But now there are all kinds of debates about when that happens, do you apply neurological criteria, etc. So there's still this very fluid discussion among ethicists and bioethicists about what constitutes clinical death.

The changes that are happening within the profession of medicine present challenges and the need for constant revision of the documents. We have to be responsive to those realities.

Having the ERDs as the standard for the diocese, the particular churches -- to use the technical term -- in the U.S., is of great help for individuals who, in conscience, refuse to perform certain procedures and to offer certain therapies.

Institutions will also face challenges, particularly at the state level. Our federal protections are more robust, and we feel that our hospitals and our institutions are protected from federal litigation against Catholic hospitals and other health care agencies.