The updated Ethical and Religious Directives for Catholic Health Care Services approved by the United States Conference of Catholic Bishops on Nov. 12 revise language and guidance on providing care, especially to transgender persons.
However, a CHA ethicist says the revisions continue to uphold Catholic health care's commitment to care for all. "The changes reflect already established church teaching," said Nathaniel Hibner, senior director of ethics for CHA.
Hibner thinks those who have not been involved in the revision process, which began in June 2023, will be surprised by the extent of the changes, even though the revisions don't mandate material changes to current clinical practice.
The updates "reaffirm the church's teaching on the dignity of all persons and their right to life from conception to natural death," according to a statement from CHA President and CEO Sr. Mary Haddad, RSM.
CHA ethicists, other staffers and members provided written commentary throughout the revision process, as did other Catholic health care and ethics groups.
This is the seventh revision to the ERDs, which were first written in 1921 as a short set of ethical norms for Catholic hospitals. The USCCB issued the last edition in 2018 and addressed issues surrounding institutional partnerships and Catholic identity.
Regarding care for transgender persons, Hibner said the revisions are consistent with the current position of Catholic health care providers, who do not perform sex reassignment surgeries, elective surgeries, or other procedures to alter or remove sexual organs that are otherwise healthy. A theological note issued by the USCCB's Committee on Doctrine in 2023 addressed many of the issues about transgender care.
The directives encourage Catholic health care providers to offer emotional and psychological support, cognitive behavioral therapy and/or spiritual care for transgender persons and their families.
"Catholic providers will continue to welcome those who seek medical care from us and identify as transgender," Sr. Mary said in her statement. "We will continue to treat these individuals with dignity and respect, which is consistent with Catholic social teaching and our moral obligation to serve everyone, particularly those who are marginalized. Catholic health care will also continue to advocate for the right of everyone to access high-quality health care."
The USCCB revised a directive about procured abortion to reflect language used in an encyclical issued by Pope John Paul II in 1995. Catholic health care providers do not perform direct abortions, and the revised ERDs do not prohibit providers from providing medically indicated care to a woman who is suffering from serious or life-threatening conditions during her pregnancy.
Other language changes include updates to clinical terminology, such as referencing people with a "neurological injury" instead of in a "persistent vegetative state."
CHA will continue to communicate with members about the revisions through webinars, articles and podcasts. CHA will also update its annotated version of the ERDs.
Hibner said the ERDs do not give answers for every scenario: The document is meant to be a succinct guide for health care professionals to understand the immediate concerns or goals when they face ethical issues in care. He noted that ethicists and mission leaders can provide further guidance.
Hibner pointed out that as medicine and science evolve, the document will be updated again.
Hibner said that the document's introductions outline teachings and scripture on topics like human dignity, the common good, justice and free will, and that those lasting values guide what is in the directives.
"We're upholding the beliefs that get outlined in the introductions," he said. "So those beliefs continue, even in this revision."