In recent years, the market share of Catholic hospitals—which unconscionably restrict healthcare options for all patients in accordance with Catholic dogma, which many patients don’t share—has grown to alarming proportions in the United States. About 1 in 7 U.S. hospital beds are in Catholic systems. And, according to a study published in the Journal of the American Medical Association, as of 2020: “35.3% of US counties, where 38.7% of US women of reproductive age live, have a high Catholic hospital market share.”
The key concern about Catholic hospitals is the restrictions they place on women’s and reproductive healthcare. Predictably, reports of severe harm to women who were denied medical best practices at Catholic hospitals over the last few years have proliferated, along with the growth in Catholic market share. As the Washington Post reports, the U.S. Conference of Catholic Bishops’ ERDs (Ethical and Religious Directives for Catholic Healthcare Services) prohibit “sterilization including vasectomies, postpartum tubal ligations and contraception, as well as abortion.”
Anyone who can get pregnant is at serious risk in a Catholic system, where even the “direct abortion” of an ectopic or otherwise unviable pregnancy is likely to be denied no matter how critical the patient’s condition. And because Catholic systems have bought up smaller secular hospitals and subjected them to the bishops’ ERDs as a condition of the sale, patients may not even know they’re in a Catholic system until it’s too late.
Like reproductive healthcare, queer healthcare can also be dicey in Catholic institutions. And in March, the USCCB’s Committee on Doctrine released a statement against gender-affirming healthcare, complete with concern-trolling about children, that adds fuel to the fire of the vicious attacks on transgender rights and visibility underway in the American public sphere, particularly in Republican-controlled states where the Right’s anti-trans panic has increasingly translated into legal restrictions on trans access to healthcare. Last Friday, the USCCB went further by voting, at its plenary assembly meeting in (appropriately) Orlando, Florida, to greenlight the Committee on Doctrine to amend the ERDs so that they explicitly ban the provision of gender-affirming care in Catholic medical systems.
As Brian Fraga tersely puts it in National Catholic Reporter, “It’s unclear how many Catholic health facilities currently provide gender-confirming medical treatment.” However, he did add that according to his Catholic bioethicist sources, “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.” There has been at least one instance in which a Catholic hospital system’s guidelines did, at one time, recommend that providers refer certain patients with gender dysphoria for gender-affirming surgery. But when right-wing activists brought this fact to the attention of the bishops, they quickly asserted their authority and put the kibosh on the whole thing, forcing the system, SSM Health, to change its guidance.
The key point here is that the bishops found the previous gender-affirming guidance to be out of compliance with their ERDs without having to make any changes to the ERDs, which very clearly state that all care must comply with Catholic teachings (and prohibit what it calls “elective” surgeries on healthy reproductive organs). That they’re moving to do so now, then, when the issue seems to be almost nonexistent within Catholic hospitals in the first place, strongly suggests they’re doing so gratuitously. In short, America’s Catholic bishops have actively chosen to further marginalize transgender Americans when they could have carried on with business as usual or at least acknowledged and condemned the violence and discrimination to which trans people are often subject. Instead, they went along with the moral panic du jour, in which attacking trans people is a popular means of flexing one’s right-wing, dominionist Christian bona fides. The bishops actively chose cruelty.
To be sure, I don’t know definitively what’s “in the heart” of any particular American Catholic bishop. But the bishops’ motives for their current actions are beside the point with respect to the harm done. We all know what the road to hell is paved with. As a transgender American I can state, emphatically, that publicly opposing our right to access gender-affirming healthcare in this critical moment is unequivocally harmful. In fact, there’s no telling exactly how much harm a body as prominent as the USCCB will do by participating in the scapegoating of a vulnerable minority already disproportionately subjected to violence and discrimination. But however grim things get for trans folks going ahead—genocide is not inevitable, but it is a real possibility—history will not look kindly on the Catholic Church for playing a part in taking us down that path.