At their Baltimore meeting, U.S. Catholic bishops voted overwhelmingly to ban gender-affirming medical interventions at Catholic hospitals by revising the Ethical and Religious Directives that guide Catholic health care institutions. The change formalizes a multi-year effort by church leaders to set policy on transgender health care and gives individual bishops authority to implement the directives as binding in their dioceses.
Catholic hospitals provide care to a significant share of Americans — the Catholic Health Association says more than one in seven patients in the U.S. are treated each day at Catholic facilities, and in some areas they are the only local medical centers. Major medical organizations generally support gender-affirming care for transgender patients, while most Catholic health systems have historically taken a more conservative stance and limited such services. The new directives will make that prohibition explicit for Catholic providers.
Bishop Robert Barron framed the revisions as a necessary statement on what he called “gender ideology” during public discussion. At the same time, the Catholic Health Association thanked bishops for incorporating much of its feedback and emphasized that Catholic providers will continue to welcome and treat transgender patients with dignity and respect, in keeping with Catholic social teaching and a commitment to serve marginalized people.
The updated directives draw on earlier Vatican and U.S. bishops documents from 2024 and 2023. A 2023 doctrinal note, Moral Limits to the Technological Manipulation of the Human Body, said Catholic health services must not perform surgical or chemical interventions intended to change a person’s sexual characteristics to those of the opposite sex, nor participate in developing such procedures.
The church remains divided in practice and pastoral approach. Some parishes and priests welcome and support transgender Catholics, while others do not. Advocates argue gender-affirming care can be life-changing: Michael Sennett, a trans man active in his Massachusetts parish and a board member of New Ways Ministry, said transition has been essential for many people. New Ways Ministry organized a 2024 meeting with Pope Francis to press for access to such care; its executive director, Francis DeBernardo, described transition for some Catholics as both a biological necessity and a spiritual imperative to live authentically.
On the same day the bishops debated gender identity, leaders of several progressive religious bodies issued a public statement affirming transgender, intersex, and nonbinary people and noting that many faith communities continue to embrace the full spectrum of gender at a time when some state and federal policies have restricted rights. Ten signers included heads of the Unitarian Universalist Association, the Episcopal Church, the Union for Reform Judaism, and the Presbyterian Church (U.S.A.).
Separately, the bishops also approved a rare special pastoral message on immigration before adjourning their conference in Baltimore. The statement expressed concern about fear among immigrant communities, conditions in detention centers, gaps in pastoral care, and the broader vilification of immigrants. Conference president Archbishop Paul Coakley urged a balanced approach and called on lawmakers to pursue meaningful reform. Chicago Cardinal Blase Cupich successfully pushed for stronger language opposing mass deportation; the final text now says U.S. Catholic bishops oppose the indiscriminate mass deportation of people.