By Colten Maertens-Pizzo

In episode 110 of Bioethics on Air, “Digesting the Doctrinal Note on Gender,” NCBC ethicists Ted Furton and John Brehany join Joe Zalot to discuss the effect on Church teaching in Catholic health care from the Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body released by the US Conference of Catholic Bishop’s (USCCB) Committee on Doctrine. Prior to this note, the USCCB focused its responses on the issues of restroom and locker room policies and pronoun usage in Catholic schools. This seems to be the first time, according to Furton and Brehany, that the bishops are directly addressing issues of Catholic health care specifically. Before delving into the nuances of the doctrinal note, however, Furton and Brehany clarify its limits.

The USCCB comprises Catholic bishops of the United States who regularly meet for all matters of interest and form committees to explore special topics. Although the USCCB Committee on Doctrine does not have the Magisterium’s teaching authority, the bishops themselves do have teaching authority, per their office. The doctrinal note is significant, then, because it comes from a gathering of bishops and functions as “a resource of bishops for bishops” to teach and inform the faithful on moral issues. Despite the broadness of its full title, the doctrinal note primarily focuses on the moral issue of treating gender dysphoria with chemical or surgical techniques, commonly referred to as transitioning.

According to the DSM-5, “Gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.” This can be described more colloquially as someone’s feeling that he or she is the opposite of his or her sex, which brings much internal struggle and suffering that can lead to self-harm or suicide. Furton and Brehany lament the recent changes to its treatment from the traditional way of counseling to the modern push to transition. Beginning in “the Netherlands in the early 2000s … a decision was made that it was more medically appropriate to change the body to match the mind.” They identified two philosophical inconsistencies with this change. First, the medical community wrongly claimed that the discomfort of gender dysphoria is from actually being in the wrong body. Second, the medical community then vilified all critics of this claim.

Public debates have swiftly boiled over these past few years. The heart of the debates is whether a person can be in the wrong body. The doctrinal note astutely responds in the negative: “The soul does not come into existence on its own and somehow happen to be in this body, as if it could just as well be in a different body. … This soul only comes into existence together with this body.” And this body will always be sexed, though the soul is not sexed, since sexual difference arises from the body. However, the soul is always from its beginning the soul of a specific body that is either male or female. As Furton correctly affirms, “You become male or female in the moment of infusion.” He then connects gender to sex when he explains, “You learn how to be male or female over the course of living as a man or woman.”

Body and mind develop essentially alongside each other. Therefore, the mind may never be given unmitigated precedence over the body, as if the mind determined the body. Such subordination violates the fundamental order of the human person. The doctrinal note acknowledges that “because of this order and finality, neither patients nor physicians nor researchers nor any other persons has unlimited rights over the body.” This principle, then, limits the scope of medical interventions for conditions such as gender dysphoria, where patients experience incongruence between their body and sense of self. Transitioning, according to Furton, violates this principle ­because the intervention is “trying to change the body rather than preserve it from some harm.” Brehany adds that we must never forget that “persons are not the absolute masters of themselves.” He is correct. All attempts to mould the body to suit the mind elevate the mind over the body and deny that body and mind develop together.

Admittedly, there were serious questions about the permissibility of chemical or surgical interventions for treating gender dysphoria. In her wisdom, the Church waited for ethicists and theologians to debate their merits. However, the rapid push for transitioning compelled the USCCB to speak definitively, and its position provides Catholic health care services with a sound justification and clear reasoning for refusing to treat gender dysphoria with either chemical or surgical means. As the doctrinal note makes clear, Catholic healthcare services “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.” But it was never gender ideology per se that spurred the USCCB to act now. It was the threat to children that compelled them to speak definitively.

Starting in force in the late 2010s, gender ideology began encouraging chemical transitioning for children. This is the worst possible time to encourage children to question their embodiment, precisely because it is when they need clear guidance for growth in body and mind. As critics have argued for years, studies increasingly indicate that chemical transitioning is anything but reversible. Brehany references an interview with Dr. Susan Bradley, a pioneer in the field of puberty blockers, who had admitted to him, “We were wrong, all along, about puberty blockers. … We had thought they would help to relieve anxiety,” but they did not. Instead, they cement the dysphoria and intensify the disjunction between body and mind. A safer approach would be to return to the counseling formerly used to treat gender dysphoria.

Throughout their interview, Furton and Brehany bemoan the ideological turn that has worsened the state of gender dysphoria in this present age, but perhaps Furton’s response is the most poignant to parents questioning whose advice to follow: “Please protect your children from the ravages of this ideology.” Tragically, it will be difficult for parents to heed his warning because gender ideology remains firmly entrenched in the workings of the medical community. As Brehany explains, “If parents get in the way [of gender affirming care], this is an example of child abuse,” at least according to current policies for child welfare services in the United States. Hopefully, the doctrinal note will provide Catholic parents with the surety of faith and reason to defend their children, despite the unjust consequences that may come.

Colten Maertens-Pizzo works for the Archdiocese of Chicago Catholic School System.