Chevalier de la charité

One factor that has been consistently noted in responses to nearly every anti-trans diocesan policy or statement is that there is little evidence that transgender people were ever consulted in the development of such policies and statements. Instead, their own experiences, stories, struggles, joys and needs are dismissed and ignored.

We need to remember that when we talk about transgender persons we are talking about real people. The issue is not about some abstraction or « culture war » battle to win like some social-media debate. The issue is about the actual lives and deaths, experience of violence and healing of human beings who have inherent dignity and value.

When bishops and other church leaders, nonexpert pundits and church observers treat the serious issues related to LGBTQ persons generally and trans folks in particular as some kind of « culture war » horse race, they actively contribute to the dehumanization and erasure of real people who have real joys and hopes, griefs and anxieties, which ought also be the joys and hopes, griefs and anxieties of said church leaders and commentators (Gaudium et Spes).

In honor of Pride Month and in an effort to listen to more to the stories of trans folks as told by them, I decided to read two recent memoirs by trans authors this month. The first is by Elliot Page, the Oscar-nominated actor and transgender man, whose book is titled Pageboy: A Memoir. The second is by Danica Roem, the Virginia state delegate and transgender woman, whose book is titled Burn the Page: A True Story of Torching Doubts, Blazing Trails, and Igniting Change.

Both books are engaging and moving, interesting and at times heartbreaking, a blend of both humorous and serious anecdotes and experiences. But what I most appreciated is that they were an opportunity to hear directly from the authors themselves as they told their own stories about what it means to each of them to be a trans person today.

Nobody was speaking for them, nobody was spinning a narrative in support of some other agenda. Each of these authors were able to speak their truth and share their life journey.

In the introduction to her book, Roem emphasizes this point as the primary inspiration for writing her memoir. « The facts of your life are what they are. The question is: Are you going to tell your own story about them, or are you going to let other people do that for you? I wrestled with that premise when setting out to write this book. »

Indeed, too many other people, including transphobic and hateful people, are attempting to tell false stories about trans folks to stir up fear, win political capital, to feel superior or simply to be mean. But it doesn’t take much effort to hear the brave stories of transgender people as told by them.

What you find right away is that while their journeys of gender affirmation may be different from their cisgender peers, the rest of their lives are strikingly similar to anybody else’s.

Roem, who spent more than a decade as a newspaper reporter in her home region of Northern Virginia after graduating from college (St. Bonaventure University, which is also my alma mater — while I was in the class ahead of her, our time did overlap), details her lifelong struggle with coming to terms with her true self and responding to her gender dysphoria. 

While her treatment and gender-affirming care are a part of her story, they are not the whole story. After all, she is currently a three-term elected statewide politician whose primary political platform was focused on local issues like traffic management and regional development.

With great humor and the writing skills of a graduate of the Jandoli School of Communication at St. Bonaventure (Go Bonnies!), Roem invites us into her journey, including the highs and lows of her Catholic school education, the heartbreaking story of her father’s death by suicide when she was a small child, her love of heavy metal music and the community of metal fans she embraced and who embraced her, and the very relatable professional struggles of an older millennial who had to regularly work two jobs just to make ends meet after college.

She is a whole person, a talented person, a lovable person, a skilled writer, an effective state representative, an advocate for the LGBTQ community and someone who also happens to be a trans woman. Hearing her tell her story allows one to see her reality, which is something you do not get when another, especially a bad-faith actor, attempts to tell her story for her.

Likewise, Page’s story reveals another compelling queer narrative that unveils both the fear, harm and suffering he has experienced as well as the joys, hopes and affirmation that comes with embracing his full identity. 

As he writes in his author’s note, « I hope that in speaking my truth I have added yet another speck to dispel the constant misinformation around queer and trans lives. If you haven’t already, I urge you to seek out many other vast and varying narratives from LGBTQ+ writers, activists, and individuals. »

I second Page’s encouragement to seek out other stories. His and Roem’s are but two of many stories, and it is important to acknowledge that those of a nationally recognized state politician and a famous Hollywood actor are not representative of most trans people. In fact, most do not have the platforms, resources or eventual support that both Page and Roem have. And that is exactly why these two people have felt compelled to share their stories in such a public way.

While it’s also important not to reduce the complex and multifaceted realities of any individual person, let alone community, into some metonym for tragedy, it is necessary for us to acknowledge the disproportionate discrimination and violence transgender people experience in our society and church.

Page puts it this way near the end of his book: « The world tells us that we aren’t trans but mentally ill. That I’m too ashamed to be a lesbian, that I mutilate my body, that I will always be a woman, comparing my body to Nazi experiments. It is not trans people who suffer from a sickness, but the society that fosters such hate. »

And like some people in our society in general, too many ecclesial and pastoral leaders are keen to foster such hate in our church as well. 

As Christians, we believe in a God who became human like us, who walked on this earth like us, who had joys, hopes, griefs and anxieties like us, and who used stories to tell us about who God is and who we are called to be. Christianity is inherently a narrative religion, which begins with the Word becoming flesh.

During this LGBTQ Pride Month, we would do well to recall this narrative origin and grounding of our faith and attentively listen to the revelations with a lower-case « r » that our transgender siblings are offering us as they relay their own stories. 

If you are a cisgender person who doesn’t know any out trans people, who has only heard the false stories told by others, then picking up Roem’s or Page’s or some other trans person’s book might be a good place to begin hearing the fully human, fully complex, fully authentic stories of some of our trans siblings.

At that moment in Mass, Trejo said, « our new neighbors showed me what it means to them to be able to contribute to our community. »

Sacramento ACT, a collaboration of religious congregations in the region, is among a multitude of faith-based groups partnering with city, county and state agencies to assist the asylum-seekers who were picked up in El Paso, Texas, and flown on taxpayer-funded private jets to Sacramento. A 16-person group was dropped off in front of the Sacramento diocesan pastoral center June 2; the second group, of 20 individuals, arrived June 5 and was met at the airport by local officials and advocates who’d learned of their arrival. 

The Associated Press reported that at least some of the asylum-seekers were recruited from El Paso’s Sacred Heart Church, a Jesuit parish that is located just blocks from Mexico and serves as a refuge to migrants. 

As of June 13, four of the asylum-seekers had been picked up by family members or friends, but the rest remain in the care of local Sacramento agencies. Catholic nonprofits, including Catholic Charities of Sacramento, are offering key support to the travelers, who are in their 20s and 30s, while Catholic leaders and immigration advocates have forcefully denounced the relocations.

« It’s un-American, unethical, it may be illegal, and it’s undermining our work at the border, » said Dylan Corbett, executive director of the El Paso-based Hope Border Institute, a Catholic organization helping immigrants. 

« Every day, we work with immigrants, those on the border, and these are people who are usually at the most vulnerable point in their lives, » Corbett told NCR. « To exploit that for political gain is vile and crass. »

The travelers met with California Gov. Gavin Newsom June 3 and recounted some of the traumas they’d experienced during their journeys, such as seeing migrants lynched for not paying smugglers. One woman said she was threatened with rape.

El Paso Bishop Mark Seitz, chairman of the U.S. bishops’ migration committee, told AP that if « you’re seeking to help a person who needs to get to a certain destination where they have a sponsor, where they have a job or something like that, that is a commendable act. »

But if migrants are being moved « simply in order to use them to make a political point, that is reprehensible, » said the bishop.

In an essay for America magazine, Sacramento Bishop Jaime Soto described how the migrants « stood dazed and unaware of where they had been shuttled » after being left at the pastoral center.

« When I visited with them the following Monday, the sense of geographic and emotional vertigo was still on their faces, » he wrote.

Florida officials contend the migrants’ relocation was voluntary and the men and women — originally from Colombia, Venezuela and Guatemala — provided written and verbal consent that they wanted to travel to the state. 

Officials also released a video they say shows the migrants signing waivers and thanking officials for their safety. No agencies working directly with the migrants have confirmed the identity of the individuals in the video.

Sacramento nonprofit heads and Catholic leaders contend the migrants were deceptively lured with promises of jobs.

« Using human beings as political pawns is inexcusable, » Kathleen Domingo, executive director of the California Catholic Conference, said in a statement. 

Most migrants seek refuge in the United States to escape « the human travesties in their own countries, » she said. « Moving them from one side of the country to the other and, in some cases, away from the places they need to be to continue their immigration proceedings, is akin to trafficking. »

The flights exacerbated ongoing verbal volleying between Newsom, a Democrat, and his Florida counterpart, DeSantis, a Republican presidential candidate who is Catholic. In his early campaigning, DeSantis has highlighted his migrant flight program that included sending nearly 50 migrants from Texas to Martha’s Vineyard in Massachusetts last year. 

Like fellow Republican Gov. Greg Abbott of Texas, DeSantis has made a point of moving migrants to Democrat-leaning states.

California officials said they will investigate whether travelers were misled, and in a June 5 tweet, Newsom called DeSantis a « small, pathetic man » and indicated the state might consider kidnapping charges.

Alecia Collins with Florida’s Division of Emergency Management shared a statement with multiple news outlets June 6: « From left-leaning mayors in El Paso, Texas, and Denver, Colorado, the relocation of those illegally crossing the United States border is not new, » she said. « But suddenly, when Florida sends illegal aliens to a sanctuary city, it’s false imprisonment and kidnapping.”

Some Democratic administrations, including those in El Paso, Arizona and Denver, have at different times bussed migrants to various locations, sometimes to their final destinations.

Miriam Sammartino is director of Catholic Charities and Social Concerns for the Sacramento Diocese. She recalled the Friday afternoon the asylum-seekers showed up at the pastoral center.

« We have an intercom system, and the front desk staff was told that someone was in need, » Sammartino said. « The migrants then unloaded from the van and the person driving the van just drove off. » 

« I was in complete shock, » said Sammartino, who sprang into action, reaching out to community partners for assistance. Within two hours, she’d helped find an initial hotel room for the first group of migrants. St. Vincent de Paul supplied clothing. 

« They basically came with the clothes on their backs, » said Denise O’Brien, executive director of the Sacramento diocesan council of St. Vincent de Paul. The agency provided pants and shirts, undergarments and sweaters. 

All the asylum-seekers have a lot of questions about what happened and what will happen next, said Sammartino. « The first group expressed that they did not know where they were going or where they landed, » and the second group had the « exact same experience. »

Anna Gallagher, executive director of the Maryland-based Catholic Legal Immigration Network, was in California to meet with Soto, board chair of the network, when the migrants arrived, and she accompanied him to visit and pray with the young adults.

« It was moving to see how grateful they were to be welcomed into a faith community, how grateful they were to be in a safe place, and how very, very hard their journeys were, seeing things people shouldn’t have to see, » Gallagher told NCR in an interview June 8. « They have a desire to live in dignity and to work. »

Soto, in his recent essay, said the realities of their painful journey and the « shambled immigration system that tangle them with us loom large. »

« These are greater than the ideas that many harbor about our unexpected neighbors, » said the bishop. « Their arrival in the River City is a sober reality from which we cannot turn away. The ideas that keep us apart cannot ignore the hunger, hope and determination that has placed the reality of one continent, one humanity in our hands. »

Gallagher, who has practiced immigration and refugee law for more than three decades, said that even if the migrants signed waivers, transporting them to California was not an act of compassion but a political maneuver.  

« These men and women had just arrived after experiencing cruel conditions and danger during their journey, including physical and psychological distress, » she said. « They’ve had no time to recuperate and recover. Then they are asked to sign documents they likely don’t understand and might not be in their language. This is wrong. » 

The legal process for asylum-seekers is « very complicated, » said Gallagher. Relocating them to a different city that’s possibly farther from where they must make a court appearance makes it even more difficult — if not impossible — to adequately present a claim for protection, she said. 

The migrants reported that they’d been issued formal notices to appear, meaning on a certain date they will need to show up in immigration court in a specific city. Gallagher said several migrants told her they have court appearances as early as next month. 

If an individual misses a court hearing, an immigration judge may immediately order their deportation, explained Gallagher. Migrants can request a change of venue by filing a formal request but need legal assistance to help them through the process, she said.

« And the migrants don’t speak English, don’t read and write in English, and many of the immigration legal service nonprofits that can assist them are overbooked and overwhelmed, » said Gallagher.

Over the past month, however, fewer new immigrants have been remaining in the country. Despite predictions of a potential surge of migrants after the end of Title 42 — a policy that allowed U.S. authorities to send migrants quickly back over the border without the chance to request asylum — nearly 40,000 asylum-seekers deemed ineligible have been deported, and migrant encounters at the U.S.-Mexico border are down by more than 70%, reported the Department of Homeland Security June 6. 

Speaking from El Paso, Corbett said migration is not something people should be afraid of, calling it an « invitation to solidarity. »

But to exploit migrants « with misinformation or for political gain in a moment of vulnerability, » he said, « that’s an immoral slap in the face of human dignity. »

« What pains me the most is that of all the positions of power and authority in the church, the commission appointees need to be the most scrupulously vetted and completely above reproach, » Clohessy told NCR.

Clohessy isn’t alone in voicing his anger at the priest’s alleged misdealings. Three days after the report was published, Pope Francis went off script when speaking to a gathering of the Vatican’s missionary fundraisers to warn of the risk of corruption among their ranks.

« If spirituality is lacking and it’s only a matter of entrepreneurship, corruption comes in immediately, » the pope said June 3. « And we have seen that even today: In the newspapers, you see so many stories of alleged corruption in the name of the missionary nature of the church. »

Around the Vatican, including among those inside that meeting, it was widely understood that the pope’s remarks were in reference to Small. NCR has since confirmed that the pope directly referred to the Associated Press article in a meeting with Spanish journalists earlier that same day.

Small, who has strongly defended his financial dealings, did not respond to NCR’s request for comment.

« The church’s response in the past has been slow and not really centered on the care of survivors, » said Jesuit Fr. Gerald McGlone, who leads the « Towards a Global Culture of Safeguarding » project at Georgetown University.

« There are multiple issues of trust here that really have to be addressed quickly, » McGlone said of the commission.

A loss of millions

When the British-born Small was appointed to serve as acting secretary of the Vatican’s abuse commission in June 2021, he arrived in Rome with little experience in child protection, but a background in fundraising and advising the U.S. bishops on foreign policy.

The commission was founded in 2014 with a mandate to counsel the pope on child abuse prevention and accountability measures, but has suffered a series of setbacks, including a number of high-profile resignations of its members who believed the Vatican was resisting implementing necessary reforms.

Small’s appointment marked the beginning of a new era. Under his leadership, the commission added 10 new members and reappointed 10 existing members last September.

In March of this year, abuse survivors and former commission members alike were shocked when Jesuit Fr. Hans Zollner — a psychologist long considered one of the church’s leading authorities on combating abuse — resigned as one of the commission’s founding members and cited, among other grievances, concerns about financial transparency and the commission’s leadership.

Two months later, the Associated Press report was published, questioning how Small was able to transfer millions of dollars from the coffers of the U.S. branch of the Pontifical Mission Societies into a nonprofit, Missio Corp., and its private equity fund, MISIF LLC, both of which were created and managed by Small.

While the transfers were legal and approved by Small’s board, they have forced the Pontifical Mission Societies’ U.S. branch to write off a financial loss of more than $10 million and overhaul its staff and board in order to strengthen accountability measures. 

Matthew Manion, director of the Center for Church Management at Villanova University in Pennsylvania, said that it appears that the initial decisions by Small followed standard practice at the time and that he hoped and expected the board did « their due diligence before approving such a significant transaction. » 

But Manion also said that the fact that Small was unwilling to cooperate with his former employer, the Pontifical Mission Societies, in its legal review of the transactions, as was reported by the Associated Press, raises concerns. 

« While these transactions may be perfectly legitimate, the fact that the leader of a major church organization could not just call up his predecessor to get any questions answered is concerning, » he told NCR via email. « And if it is true that a senior church official responsible for the Protection of Minors was not willing to speak to lawyers doing an investigation of his prior employer, the optics are not good for a church that already struggles with credibility issues. »

In his assessment of the case, Nicholas Cafardi, a canon lawyer and former chair of the U.S. bishops’ National Review Board, said that given the fact that Small is a religious order priest, he would have needed the approval of his provincial superior for the creation of the new entities of the nonprofit and the private equity fund.

Under canon law, he said, « anything that involves administration of goods, he needs permission for. »

Neither the general secretariat of the Missionary Oblates of Mary Immaculate in Rome nor the Washington, D.C., provincialate responded to NCR’s request for comment on whether Small sought and received approval for the creation of these entities.

Calls for investigation

In the days since the Associated Press report was published and Francis’ impromptu follow-up comments, former commission members and noted abuse experts have called for a serious review of the commission’s current leadership.

Krysten Winter-Green, a former commission member, characterized the report on Small’s past financial dealings as « troublesome » and said they merited further investigation.

Since the founding of the commission in 2014, Boston’s Cardinal Sean O’Malley — a top adviser to Francis — has served as its president. While O’Malley regularly travels to Rome, the day-to-day management of the commission falls to Small, who is based in Rome.

Terence McKiernan, co-director of the abuse tracking website BishopAccountability.org, said that this arrangement means it’s all the more important that the commission’s secretary be both qualified and credible. 

O’Malley, through a spokesperson, declined NCR’s request for comment.

McKiernan told NCR, « Zollner left [the commission] highlighting concerns about financial accountability, so it seems quite inappropriate to have as the No. 2 there someone who is … clearly not enamored with financial accountability. »

While McKiernan noted that some might claim that Small’s financial investment work, as the priest himself claimed, is savvy, inventive or forward-looking — and even provides skills that could benefit the commission — « it’s clear that transparency and accountability weren’t at the top of his list, » McKiernan said.

Along with his concerns about Small effectively having two jobs, McKiernan also questioned whether there might be a conflict of interest between Small’s work with Missio Invest, which provides low-interest loans to church-run operations in Africa, and the commission’s role in auditing child protection policies, especially in the developing world, where guidelines for reporting are often murky.

« He’s handing money with one hand and holding the magnifying glass with the other, » said McKiernan. « I kind of doubt that’s going to go well. »

Former commission member Winter-Green told NCR via email, « The slightest intimation of misuse of church funds is cause for serious concern, as is the potential for conflict of interest and same should most certainly prompt investigation. »

« To ensure a lack of bias, such an investigation would best be conducted by entities outside the Vatican arena, » she continued. « Given the seriousness of the matter one might expect that the official and any members or staff who are complicit, be relieved of responsibility until such time as this matter is officially resolved and made public. »

Winter-Green, who holds a doctorate in pastoral psychology and three master’s degrees, in theology, human development and social work, is only the latest of at least four other former commission members who have publicly expressed concerns about the current status of the commission, including Irish abuse survivor Marie Collins, Baroness Sheila Hollins of the Royal College of Psychiatrists in the United Kingdom, Franciscan Missionaries of the Divine Motherhood Sr. Jane Bertelsen, and Zollner.

Given the commission’s recent fundraising efforts to significantly expand its programming, Winter-Green said financial transparency from the commission and its staff members is essential.

« It is somewhat of an oxymoron that financial management of the PCPM [Pontifical Commission for the Protection of Minors] rests with an individual under suspicion of the mishandling of funds, » she said.

Kathleen McChesney, a former FBI executive assistant and the first person to lead the U.S. bishops’ Office of Child and Youth Protection, told NCR that if this was a clerical abuse case, the individual in question would be asked to step aside and be placed on administrative leave until an inquiry is done. This also ensures that the individual in question is given due process.

« If I was his boss, I would want to know what happened and what this is all about, » she said of Small. « You want to make sure you have the right person in there administratively or ethically. Maybe he should step aside until an inquiry is done. »

Demand for new leadership

While Small has been on the job for less than two years, his brief tenure hasn’t stopped him from getting noticed around the Vatican — sometimes leading to questions about his seriousness and suitability for his role.

Last October, Small hosted a movie night inside the Vatican for its police force and Swiss Guards, treating attendees to beer and popcorn and a chance to meet one of the film’s stars, Russell Crowe. Small had also taken time off his work to film a cameo role in the film as a neighborhood priest, and an informational poster circulated around the Vatican with Small in costume included the Vatican’s abuse commission’s email address for attendees to RSVP for the movie night.

In recent weeks, a Facebook screen capture has circulated among both Vatican officials and abuse survivors from a Dec. 25, 2022, post by Small of him holding a 3-month-old dog, describing himself as « feeling blissful in Vatican City » and with the text « Merry Christmas from me and Mancia. She’s 3 months old. Keeping the minors safe! »

Incidents such as these have led to concerns about Small’s judgment. Survivors were especially outraged by what they viewed as the inappropriateness of the social media post as seeming to joke about the issue of child protection.

« Any scandal makes it more difficult for abuse survivors to speak up, » Clohessy told NCR of the growing question surrounding Small’s leadership. « When they see a controversy around someone like Fr. Small, I can almost hear the sighs, the shoulder shrugs and the feeling of ‘What’s the use in coming forward?’ « 

« It is utterly tragic that the one church entity that is most in need of transparency and accountability and has arguably promised transparency and accountability isn’t practicing it, » he continued. « It cripples the commission’s work and demoralizes its well-meaning members and undercuts its whole purpose. »

« To have the one church institution that’s supposed to fix decades of secrecy, inaction, callousness and recklessness to be plagued with the very same flaw, it feels like all of this could have likely been prevented either by those who promoted Small, by Small himself and certainly by the pope, » he added.

McGlone, who is himself a clergy abuse survivor and served as the associate director for protection of minors for the Conference of Major Superiors of Men, concurred.

« Obviously everyone is innocent until proven guilty, but even the appearance of impropriety is a problem in this office, » he said.

« The deeper concern that’s always been expressed about Small being in this position is that he’s not had any experience in child protection and has let people in Rome know that on a regular basis, » the Jesuit priest added.

McKiernan also agreed with that assessment: « The commission has remedial work to do, » he said. « Small does not seem the person to participate in that effort. »

And for survivors and advocates like McGlone, change can’t come soon enough.

« Every day that this is in the newspapers, every day that we’re dealing with this, this is like acid in the wound to survivors, » he said. « That’s the bottom line right now. This is the last thing survivors need to hear and see. »

The ballot item on which the bishops will vote this week, a copy of which was provided to NCR, says the Committee on Doctrine, led by Bishop Daniel Flores of Brownsville, Texas, intends to make minimal changes to the directives, but « is prepared to make those changes necessary for providing clear and useful guidance to Catholic health care services. »

The item also says that the committee’s « immediate concern » is the directives’ Part III, which addresses the relationship between Catholic medical professionals and their patients. However, the ballot item adds that the committee « does not exclude the possibility of proposing minor revisions in other parts » of the directives.

More than 1 in 7 patients in the U.S. is cared for in a Catholic hospital, according to the Catholic Health Association, which is comprised of more than 600 hospitals and 1,600 long-term care and other health facilities. Catholic-affiliated health facilities make up the largest group of nonprofit health care providers in the nation, the association says on its website. 

It’s unclear how many Catholic health facilities currently provide gender-confirming medical treatment.

Opinions among Catholic theologians, bioethicists and LGBTQ advocates have been split about the controversial doctrinal note. Some observers, including Massimo Faggioli, a theologian and church historian at Villanova University, said the document’s language reflected a cautious approach in an area of moral theology and doctrine that is not yet fully developed.

« There is a certain amount of caution [in the document] that I think should be appreciated, because in past times we had other documents from other bishops that were much more belligerent, » said Faggioli, who described the document as « one step in what is largely unknown in terms of Catholic doctrine. »

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. »

Lysault added: « As a moral theologian, I think it’s important to note that the Congregation for the Doctrine of the Faith has not yet issued a statement on transgender health care. I would guess that this is due to the fact that the issue is so new and that they are prudently waiting for the scientific and clinical research to advance so that the Church’s moral discernment can be properly informed. » 

The bishops’ health care directives, last revised in the mid-1990s, do not specifically address questions of gender-affirming care for patients who identify as transgender or who are diagnosed with gender dysphoria. 

When the directives were last updated, the doctrine committee says in the upcoming ballot action item, « it was not envisioned that it might be necessary to include specific guidance concerning radical modifications of the human body, such as are frequently advocated today for the treatment of the condition commonly known as gender dysphoria or gender incongruence. »

The section that the doctrine committee is looking to amend makes a reference, in Directive 29, to patients having the « right and duty to preserve their bodily and functional integrity. » Directive 33 mentions therapeutic procedures in the context of whether their benefits would be proportional to the likelihood of harm or undesirable side effects.

In the introduction to Part III, the bishops say patients in Catholic health care facilities must accept the facility’s « public commitment to the Church’s understanding of and witness to the dignity of the human person. » The introduction also says that the medical professional’s relationship with the patient cannot be separated from « the Catholic identity of the health care institution. » 

Several Catholic bioethicists, including some who declined to be identified on the record because of the sensitivity of the topic, told NCR that issues of gender-affirming care in Catholic health settings most often deal with whether the institution should address the patient by their preferred name, or to continue providing the patient with previously  prescribed hormonal treatment while in their care.

The March 20 doctrinal note argues that gender-affirming medical treatments — which may include hormonal therapies and surgical procedures — are « injurious to the true flourishing of the human person, » and says that Catholic health care services must not perform them. The note added that such interventions « 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. » 

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.

John Brehany, executive vice president and director of institutional relations for the National Catholic Bioethics Center, told NCR he thought the March 20 document was « pretty well done. »

Brehany said he hopes the bishops will consult his group, a Philadelphia-based nonprofit that advises church leaders on bioethical issues from a more conservative doctrinal perspective, as they prepare to revise the ethical and religious directives. « My hope would be that [the bishops] bring some clarity to a very important and complex issue, » he said. 

Cory Mitchell, a professor of bioethics at Loyola University Chicago Stritch School of Medicine, told NCR that most medical professional bodies in the United States see gender-affirming care as evidence-based treatment to mitigate the suffering of people diagnosed with gender dysphoria.

« When dealing with a patient population, from an ethical standpoint, if you can mitigate or ameliorate harm or suffering, you do so, » Mitchell said. « That’s the story of the good Samaritan. We don’t pass by on the other side of the road when we can help and continue Jesus’ healing ministry. »

However the bishops revise the ethical and religious directives, Mitchell said he hopes the process will reflect the « culture of encounter » that Pope Francis has championed so that « norm-making does not become hurting, sanctioning, or othering » transgender people.