In January a US federal court in Maryland ruled in favor of a woman who identifies as transgender and who felt that her rights had been violated because a Catholic hospital would not perform a hysterectomy—removal of her uterus. But there is much hidden in the judge’s presentation and reasoning in Hammons v. University of Maryland Medical System Corporation. There is plenty of public misrepresentation of the hospital’s mission and contractual obligation to follow the Ethical and Religious Directives for Catholic Health Services (ERDs) developed by the US Conference of Catholic Bishops. There is also some serious misunderstanding of the ERDs themselves.

Per the American Civil Liberties Union (ACLU), whose lawyers represented the plaintiff, “Jesse Hammons was denied a commonly performed medical procedure at the University of Maryland St. Joseph Medical Center because he is transgender. The taxpayer-owned hospital claims that providing Hammons with medical care would be a violation of their religious beliefs.” To an unsuspecting public, such statements give the appearance of being rationally unimpeachable, yet their authors intend radically partisan (or false) definitions for some of the generic terms used. For example, hysterectomies for sex reassignment are not quite common, nor did the hospital refuse medical care.

A similar process entered into the judge’s ruling. Supposedly, “with the exception of procedures sought by transgender patients to treat gender dysphoria, St. Joseph will perform any hysterectomy ‘so long as it is consistent with the standard of care for a given diagnosis’” (Hammons v. University of Maryland Medical System Corporation). This is hardly a proper or even a careful interpretation of the content of the ERDs that guide the hospital’s decisions. The ERDs are based on moral and rational principles that transcend most particular diagnoses. By ignoring those principles, the judge failed to respect the true basis of the hospital’s decision not to perform a sterilizing surgery on Jesse Hammons.

The relevant principle is the one that distinguishes between direct and indirect sterilization. The difference lies in the purpose of the act, which, for direct sterilization in a woman, is causing the biological impossibility of bearing children by removing a healthy uterus or ligating the fallopian tubes. The reasoning behind a moral prohibition against such contraception should be familiar to Catholics. As stated in the Catechism of the Catholic Church, “Fecundity is a good, a gift and an end of marriage. By giving life, spouses participate in God’s fatherhood” (n. 2398); direct sterilization is opposed in purpose, and also in consequence, to such goodness, to marriage, to dignified treatment of one’s body, and to joyful cooperation with God’s providence. The prohibition against direct sterilization concerns some of the highest moral tenets of the Catholic faith, including the sanctity of human life, body, and marriage. If a hospital is to respect the Catholic understanding of loving and reverent action in the world, the ERDs’ guideline prohibiting direct sterilization is a clear expression of that mission.

Nowhere does the ERDs’ prohibition of direct sterilization include any statement of refusal to provide true medical care to a transgender person—or to anyone in any category. Nowhere does this prohibition include indirect sterilization, which is intended to remove a diseased organ for the health and bodily integrity of the patient: “The functional integrity of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available” (dir. 29; see also dir. 53).

The judge, however, seems to have been swayed by the plaintiff’s singular focus on her own perceived interests, thereby interpreting the hospital’s intentions as flatly opposed to those interests. That is why the judge could make such a statement as “St. Joseph prohibits medical personnel from performing hysterectomies on all individuals, regardless of sex, who do not have a medical need for that surgery—i.e., individuals who seek a hysterectomy solely for the purpose of elective sterilization. However, Mr. Hammons did have a medical need for his requested hysterectomy; he was not seeking a hysterectomy for the purpose of elective sterilization.” Note that the term “elective sterilization” is not equivalent to “direct sterilization,” for the emphasis in the former term is on whether the functional goal of the surgery is to prevent pregnancy, in comparison to other personal or societal goals such as Hammons’s desire to change the physical manifestation of her felt gender (reassign her sexual identity). With the direct-indirect sterilization distinction, the emphasis is on whether a diseased organ needs to be treated or removed for the integral health of the patient; if there is not such a purpose, the sterilization is direct. Even though the judge interpreted Hammons’s hysterectomy as nonelective, it was still direct, according to the ERDs.

Did the judge misunderstand the ERDs, or did she willfully misinterpret them? Did the hospital’s attorneys represent the higher principles in the ERDs in a manner that would educate the judge about the nature of its Catholic mission? The ruling mentions that the hospital claims it policy is “facially neutral” but does not elaborate; was this a reference to the direct-indirect distinction in the ERDs? Should the hospital’s attorneys have referred also to the primary sources of the ERDs, such as the statement in the Catechism that “except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law” (n. 2297)? These are questions that the attorneys of Catholic hospitals will need to investigate.

What is clear is that organizations like the ACLU will not relent in a one-sided, aggressive interpretation of such religious freedom cases according to the desires of specific minorities. According to the ACLU, the issue is simple and even more succinctly put: “The government has no business operating a religious hospital, much less do they have the right to deny transgender patients care they routinely provide to cisgender patients.” Religious, and especially Catholic, hospitals are targets in the contemporary US legal environment. We will need to argue clearly, simply, and with reference to the highest moral principles in order to mount a successful defense.

 Christopher M. Reilly lives in the Washington, DC, region. He is a candidate for a doctor of theology degree and holds master’s degrees in public affairs, philosophy, and theology.