U.S. Catholic bishops on Wednesday voted to formalize a prohibition on gender-affirming medical interventions at Catholic hospitals, approving revisions to the church’s Ethical and Religious Directives that guide Catholic health care institutions nationwide. The vote, taken at the bishops’ plenary assembly in Baltimore, makes official a process the church has been pursuing for several years.
The revised directives apply to the thousands of Catholic hospitals and health providers in the United States. According to the Catholic Health Association, more than one in seven patients in the U.S. receive care daily at Catholic hospitals, and in some communities these institutions are the only medical centers available.
Medical groups outside the church broadly support gender-affirming care for transgender patients, which can include psychological, hormonal and surgical treatments. Many Catholic health systems had already taken a conservative approach and generally did not offer such care; the new directives now codify that position. Individual bishops will decide how to implement the directives in their own dioceses.
During public discussion of the revisions, Bishop Robert Barron of the Winona‑Rochester, Minnesota, diocese said, “With regard to the gender ideology, I think it’s very important the church makes a strong statement here.” The updated directives also incorporate prior Vatican guidance issued in 2024 and a 2023 U.S. bishops’ doctrinal note, “Moral Limits to the Technological Manipulation of the Human Body,” which states: “Catholic health care services must not perform interventions, whether surgical or chemical, that aim to transform the sexual characteristics of a human body into those of the opposite sex, or take part in the development of such procedures.”
The Catholic Health Association, while acknowledging the new language, thanked the bishops for incorporating much of the association’s feedback and emphasized that Catholic providers will continue to welcome transgender patients and treat them “with dignity and respect,” citing Catholic social teaching and a moral obligation to serve marginalized people.
Responses within the broader religious and Catholic communities were mixed. The Catholic Church is not monolithic on transgender issues: some parishes and priests welcome trans Catholics, while others oppose gender-affirming care. Michael Sennett, a trans man active in his Massachusetts parish, said Catholic teaching affirms human dignity and that for many trans people “gender-affirming care is what makes life livable.” Sennett serves on the board of New Ways Ministry, an advocacy group that arranged a 2024 meeting with Pope Francis about the need for gender-affirming care. Francis DeBernardo, New Ways Ministry’s executive director, said many transgender Catholics view transition as not only a medical necessity but a “spiritual imperative” to live authentically.
On the same day, leaders of several progressive religious denominations issued a public statement supporting transgender, intersex and nonbinary people amid a national context of legal and political restrictions. The statement was signed by the heads of organizations including the Unitarian Universalist Association, the Episcopal Church, the Union for Reform Judaism and the Presbyterian Church (U.S.A.), and affirmed that many people of faith “do affirm the full spectrum of gender.”
Separately, as the conference drew to a close, U.S. bishops overwhelmingly approved a rare “special message” on immigration. The pastoral statement expressed concern about a climate of fear and anxiety among immigrants, criticized vilification of migrants, and raised alarm about conditions in detention centers and limited access to pastoral care. Archbishop Paul Coakley of Oklahoma City, newly elected president of the conference, said he supported the message both for the good of immigrants and to encourage a balanced, meaningful path to immigration reform. Chicago Cardinal Blase Cupich urged stronger language opposing mass deportations; the final text states that U.S. bishops “oppose the indiscriminate mass deportation of people.”