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NewsUSCCB 2023ERDs

Bishops approve ERD review, after ‘broad consultation’ concerns

The U.S. bishops on Friday voted to move forward with reviewing and updating their directives for Catholic health care services, after several bishops emphasized that the process should include a “broad consultation,” including the voices of the transgender community.

Bishop Daniel Flores addresses the USCCB plenary assembly June 16, 2023.


The proposal to review Part Three of the Ethical and Religious Directives for Catholic Health Care Services passed unanimously on a voice vote on the final day of the USCCB’s plenary assembly in Orlando.

The Ethical and Religious Directives for Catholic Health Care Services (ERDs) is a guide released by the bishops to offer ethical standards in health care, based on Catholic teaching about human dignity.

The guide is periodically updated. It is currently in its sixth edition, which was approved by the bishops five years ago.

Bishop Daniel Flores, head of the bishops’ doctrine committee, explained that part three of the document, dealing with professional-patient relationships, has not been updated since 1994. It does not include guidance on “radical modifications of the human body,” such as surgeries and hormones given for gender dysphoria, he said.

In March, the USCCB’s administrative committee authorized the publication of a doctrinal note from the conference’s doctrine committee on “moral limits to technological manipulation of the human body.”

The note said, among other things, that transgender surgeries are immoral because they “do not repair a defect in the body…these interventions are intended to transform the body so as to make it take on as much as possible the form of the opposite sex, contrary to the natural form of the body. They are attempts to alter the fundamental order and finality of the body and to replace it with something else.”

Flores introduced a proposal to incorporate the doctrinal note into the ERDs. The revision would involve the doctrine committee consulting bishops, moral theologians, doctors and other experts to create a draft that would be subject to review, discussion, and vote by the bishops.

When Flores asked if there were any questions, several bishops came forward to emphasize that they believe there should be a “broad consultation” on the issue, including the voices of people who identify as transgender.

Cardinal Robert McElroy of San Diego made a distinction between “the doctrinal tradition of the Church, particularly on male and female” and the need “to wrestle with the existential question of those who are suffering from dysphoria.”

“I think there’s a fundamental difference between a declaration on doctrine, which was issued, and the formulation of the ERDs,” he said.

He stressed that the ERDs are not just a statement of doctrine but an application of doctrine to “the existential situation of people who are suffering.”

“The ERDs are meant to be a pastoral, medical document to inform and guide the health care ministries,” he said.

“I urge therefore that the consultation be very wide and deep, within the medical communities and with people who are suffering from dysphoria also,” he said.

Cardinal Joseph Tobin emphasized the need to listen to people and to present things in a way that is understandable to people in the language of the ERDs.

“I would like to also encourage a broad consultation, including people who are from the trans community,” he said.

Bishop Shawn McKnight of Jefferson City also called for a “wide consultation, especially with the various Catholic health care systems.”

Auxiliary Bishop Robert Casey of Chicago, speaking on behalf of Cardinal Blase Cupich, who had to leave the meeting early, asked that the consultation include dioceses with a significant Catholic health care presence.

Archbishop Paul Etienne of Seattle also called for a “broader consultation,” saying that policy makers, physicians, and CEOs of health care systems should all be able to weigh in on the discussion.

Bishop Michael Olson of Fort Worth, who is a member of the doctrine committee that released the note on technological manipulation of the human body in March, emphasized that there had been extensive consultation leading up to the development of that note.

“Part of the process that we had in the doctrinal note was listening not only to members who identify themselves as part of the trans community, but those practitioners, theologians, ethicists, family members as well,” he said.

“And what became clear in this process as we compiled and formed the doctrinal note is that there is still a lack of clarity between what is authentic gender dysphoria and then also the gender ideology that in part is preying upon these people and enhancing their suffering, increasing their suffering,” he continued.

“So I’m hoping that the development and the process of the ERDs will help us to bring greater clarity between these two phenomena, of gender dysphoria and also gender ideology. So then hopefully we can write a broader pastoral document after the completion of the ERDs.”

After fielding questions and comments, the bishops held a voice vote on the proposal. The vote passed unanimously, with no abstentions or votes in opposition.

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