Catholic Medical Association members wrote a majority of Florida Medicaid’s anti-trans expert reports. Last year, CMA declared a faith-based commitment against approving of any transition care.

The Catholic Medical Association (CMA) is a right-wing advocacy group claiming a membership of about 2,500 Catholic doctors and other healthcare professionals in the United States (Declaration of Mario Dickerson, 4 November 2021). Previously, CMA described being gay as “preventable and treatable” (“Homosexuality & Hope”, 2009), opposed bans of anti-gay conversion therapy, opposed legal marriage equality, claimed abortion is “not healthcare”, denied abortion could ever be medically necessary, promoted “abortion pill reversal”, argued for Catholic religious exemptions to COVID-19 vaccine mandates, and opposed medical transition treatments.

Since April 2022, Florida healthcare agencies have made ongoing efforts against transition care, with the involvement of “experts” from anti-trans groups like the Society for Evidence-Based Gender Medicine (SEGM), Genspect, and the American College of Pediatricians (ACPeds) hate group. However, the CMA and its related groups are an even more extensive source of influence in the Florida anti-trans process and in wider political, legal, and religious action against gender-affirming care in the US healthcare system:

• In April 2022, the Florida Department of Health’s “Treatment of Gender Dysphoria” guidelines cited a “systematic review” by CMA member Paul W. Hruz in the CMA’s journal The Linacre Quarterly; his article was not a systematic review. Three of the five expert reports against transition treatment provided to Florida AHCA/Medicaid were by CMA members: Attachment E by Quentin L. Van Meter (also the president of ACPeds), Attachment F by Deacon Patrick W. Lappert, and Attachment G by G. Kevin Donovan. Additionally, CMA member Patrick Hunter was appointed by Governor Ron DeSantis to the Florida Board of Medicine in June 2022 as AHCA advanced its exclusion of transition care from Medicaid.
• In August 2021, CMA and ACPeds filed a lawsuit against the US Department of Health and Human Services (American College of Pediatricians et al. v. Becerra et al., 2021) in which their respective leaders, executive director Mario Dickerson and president Quentin L. Van Meter, used identical language claiming their members would not endorse any standards of care supporting transition. Dickerson of the CMA filed his declaration on November 4, citing various Catholic doctrinal statements from the Vatican and the Diocese of Arlington, while Van Meter of ACPeds filed his declaration five days later and omitted any reference to Catholic beliefs. Michelle Cretella, former president of ACPeds, is also a member of CMA, and ACPeds may serve largely as a secular front for CMA.
• Because this is an absolute faith-based commitment by CMA and its members, Florida AHCA/Medicaid’s choice of CMA members to contribute three of five expert reports was a guarantee that a majority would not approve of our transition care in any way. These CMA members made no efforts to recuse themselves from this process or to disclose their prior commitment that they would ultimately always find against transition treatment regardless of the process. This effort led to the advancement of a rulemaking process against transition care by the Florida Board of Medicine by a 14-1 vote on August 5, and Medicaid’s exclusion of coverage for transition care starting on August 21.
• CMA and its “allied organization” the National Catholic Bioethics Center (NCBC) operate a credentialing pipeline with the University of Mary’s “master’s in bioethics” program, inviting professionals from any field (“including professionals and specialists from centers for biomedical and biological research, universities, and government institutions involved in shaping public policy”) to attend brief seminars and complete online modules to receive a “certification in healthcare ethics” for $3,450. This can be converted to an MS in bioethics following additional courses at University of Mary. Patrick Hunter of the Florida Board of Medicine has no experience working with trans youth or adults, and received an MS in bioethics from the University of Mary in 2020. He now testifies that he holds an “advanced degree in bioethics” (Declaration of Patrick Hunter, 1 May 2022, in Eknes-Tucker v. Ivey), while other recipients of this degree clarify it is a “master’s degree in Catholic bioethics from the University of Mary in North Dakota, in association with the National Catholic Bioethics Center” (Jane Doe 1 in Doe et al. v. Board of Regents of the University of Colorado et al.).
• The importance of developing a stable of anti-trans experts with the credentials to testify as expert witnesses was discussed by CMA members Hruz, Van Meter, and Lappert at a 2017 meeting hosted by the anti-LGBT Alliance Defending Freedom (ADF) (Deposition of Paul W. Hruz, 29 September 2021, and deposition of Patrick Lappert, 30 September 2021, in Kadel v. Folwell). Lappert, too, has no experience diagnosing or treating gender dysphoria and did not begin offering anti-trans expert testimony until after this meeting.
• The NCBC has developed extensive theological arguments for why social and medical transition are “always morally evil” and “never morally permissible”, and facilitating anyone’s transition is “cooperation with evil” (Furton et al., 2021). Even if transitioning were found to be unambiguously beneficial to trans people, NCBC contends it is still always unacceptable because it is contrary to their interpretation of Catholic teaching; the NCBC has argued against Catholic healthcare organizations that do find transitioning to be morally permissible under Catholic belief (Harrison, pp. 56-57, 68-69 in Furton et al. 2021). Their staff work with Catholic Church dioceses to enforce anti-trans policies in Catholic hospitals and facilities via “Catholic identity” contracts and agreements, including regular audits conducted by an NCBC “survey team” as part of an “ethics review” (Deposition of Gail P. Cunningham, 14 April 2022, and deposition of Father Louis Asobi, 11 April 2022, in Hammons v. University of Maryland Medical System et al.). The NCBC issues reports about Catholic healthcare facilities to local bishops and other Catholic leaders, and Catholic hospitals appear to use spreadsheets to track “gender transition diagnoses” for auditing.
• NCBC policy for hospitals mandates misgendering and deadnaming even trans patients who have had a legal name change, as well as routinely discontinuing HRT for trans patients admitted to any Catholic facility to avoid cooperating with “evil” (NCBC, “Transgender Issues in Catholic Health Care”, February 2017). Because 1 in 6 US hospital beds are in Catholic hospitals, this is an ongoing threat to the health of any trans person who may have a medical emergency near such a facility.

Catholic Church doctrine on trans people and transitioning, explained and enforced by the Catholic Medical Association and the National Catholic Bioethics Center, provides a clear roadmap for banning all forms of gender affirmation at all ages in any state that allows these groups to take control of trans healthcare. This is an unchanging position based on a religious belief and a faith commitment, and all members of the CMA and NCBC can be presumed to hold an absolute opposition to gender-affirming care regardless of evidence.

In the 2021 case American College of Pediatricians and Catholic Medical Association et al. v. Becerra et al., CMA and ACPeds filed suit against the US Department of Health and Human Services for interpreting the Affordable Care Act’s section 1557 prohibition of sex discrimination as also applying to discrimination based on gender identity. The complaint reads in part:

102. Plaintiffs have medical, ethical, or religious objections to the following activities and speech that the gender identity mandate requires of them:

a. Prescribing puberty blockers off-label from the FDA-approved indication to treat gender dysphoria and initiate or further transition in adults and children;

b. Prescribing hormone therapies off-label from the FDA-approved indication to treat gender dysphoria in all adults and children;

c. Providing other continuing interventions to further gender transitions ongoing in both adults and minors;

d. Performing hysterectomies or mastectomies on healthy women who believe themselves to be men;

e. Removing the non-diseased ovaries of healthy women who believe themselves to be men;

f. Removing the testicles of healthy men who believe themselves to be women;

g. Performing a process called “de-gloving” to remove the skin of a man’s penis and use it to create a faux vaginal opening;

h. Remove vaginal tissue from women to facilitate the creation of a faux or cosmetic penis;

i. Performing or participating in any combination of the above mutilating cosmetic procedures to place a patient somewhere along the socially constructed gender identity spectrum;

j. Offering to perform, provide, or prescribe any and all such interventions, procedures, services, or drugs;

k. Referring patients for any and all such interventions, procedures, services, or drugs;

l. Ending or modifying their policies, procedures, and practices of not offering to perform or prescribe these procedures, drugs, and interventions;

m. Saying in their professional opinions that these gender intervention procedures are the standard of care, are safe, are beneficial, are not experimental, or should otherwise be recommended;

n. Treating patients according to gender identity and not sex;

o. Expressing views on gender interventions that they do not share;

p. Saying that sex or gender is nonbinary or on a spectrum;

q. Using language affirming any self-professed gender identity;

r. Using patients’ preferred pronouns according to gender identity, rather than using no pronouns or using pronouns based on biological sex;

s. Creating medical records and coding patients and services according to gender identity not biological sex;

t. Providing the government assurances of compliance, providing compliance reports, and posting notices of compliance in prominent physical locations, if the 2016 Rule’s interpretation of the term sex governs these documents;

u. Refraining from expressing their medical, ethical, or religious views, options, and opinions to patients when those views disagree with gender identity theory or transitions;

v. Allowing patients to access single-sex programs and facilities, such as mental health therapy groups, breastfeeding support groups, post-partum support groups, educational sessions, changing areas, restrooms, communal showers, and other single-sex programs and spaces, by gender identity and not by biological sex; and

w. paying for or providing insurance coverage for any or all objectionable procedures, drugs, interventions, or speech.

103. Plaintiffs do not have policies or practices for engaging in these objectionable practices, and they object to changing their current policies or to implementing different policies, as the gender identity mandate would require of them for these objectionable practices.

CMA executive director Mario Dickerson repeated this list exactly in paragraph 69 of his 4 November 2021 declaration with the exception of item (w), including “Saying in their professional opinions that these gender intervention procedures are the standard of care, are safe, are beneficial, are not experimental, or should otherwise be recommended” in section 69(m) and calling these “the objectionable practices”. He states that offering a favorable opinion of transition care would be against the teaching of the Catholic Church:

70. The objectionable practices violate the teachings of the Church, and our organization’s members cannot carry them out in good conscience.

Throughout his declaration, Dickerson cites the Bible and various Catholic Church authorities as the basis of the CMA’s objections to any transition care, describing their beliefs as “Christian anthropology”:

27. CMA and its members sincerely believe that sex is a biological, immutable characteristic.

28. CMA and its members believe that the norm for human design is to be conceived either male or female.

29. They respect the dignity of the human person as an embodied true male or female.

…

33. These beliefs reflect scientific reality, as well as thousands of years of Christian anthropology, with its roots in the narrative of human origins that appears in the Book of Genesis, when “God created man in his own image . . . male and female he created them.” Gen. 1:27.

34. The Catholic Church teaches that men and women are created in two sexes with corresponding identities. (2) [2: See, e.g., Catechism § 2333, 2393; Pope Francis, Encyclical letter Laudato Si’ ¶ 155 (2015), https://www.vatican.va/content/francesco/en/encyclicals/ documents/papa-francesco_20150524_encicli ca-laudato-si.html.]

Dickerson quotes the Catholic Catechism and describes transition care as “against the moral law”. He goes on to say the use of puberty blockers for trans youth is “religiously objectionable for CMA members to support”:

35. The Catholic Church thus opposes invasive and drastic medical interventions promoted by modern gender ideology. “Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law.” Catechism § 2297.

…

37. The Catholic Church’s most extensive statement today exclusively on gender identity is Male and Female He Created Them: Towards a Path of Dialogue on the Question of Gender Theory in Education. (3) [3: Congregation for Catholic Education, Male and Female He Created Them: Towards a Path of Dialogue on the Question of Gender Theory in Education (2019), http://www.educatio.va/content/dam/cec/Documenti/19_0997_INGLESE.pdf.] The Church calls for love and respect for all people.

38. In this guide it outlines both theological and scientific truths about the human person, including that there are two sexes created by God and found in nature, that one cannot separate one’s sex from one’s gender, and that there are biological and unchangeable differences between men and women. Ignoring these truths does not address or help persons who are suffering.

…

46. Science shows that arresting puberty as a gender identity intervention is scientifically dangerous to children. Arresting puberty past its natural onset is therefore ethically, scientifically, and religiously objectionable for CMA members to support.

He also cites the Hruz article in the Catholic Medical Association’s journal that was referenced by the Florida Department of Health in April 2022:

41. One representative article outlining and illustrating CMA members’ concerns with invasive gender interventions was published in a scholarly format in CMA’s quarterly journal by Paul W. Hruz, M.D., PhD at the Washington University School of Medicine.

Dickerson explains that CMA views being transgender or transitioning as always “mistaken”, citing Bishop Michael Burbidge of the Arlington Diocese:

48. These scientific facts are reflected in Christian anthropology, which is ground in biological and medical reality. As one bishop explained in a recent pastoral letter, “We know from biology that a person’s sex is genetically determined at conception and present in every cell of the body. Because the body tells us about ourselves, our biological sex does in fact indicate our inalienable identity as male or female. Thus, so-called transitioning’ might change a person’s appearance and physical traits (hormones, breasts, genitalia, etc.) but does not in fact change the truth of the person’s identity as male or female, a truth reflected in every cell of the body.” “Indeed, no amount of masculinizing’ or ‘feminizing’ hormones or surgery can make a man into a woman, or a woman into a man.” (6) [6: Most Rev. Michael F. Burbidge, Bishop of Arlington, A Catechesis on the Human Person and Gender Ideology, https://www.arlingtondiocese.org/bishop/public-messages/2021/a-catechesis-on-the-human-person-and-gender-ideology/. Of course, at the same time, every “disciple of Christ desires to love all people and to seek their good actively. Denigration or bullying of any person, including those struggling with gender dysphoria, is to be rejected as completely incompatible with the Gospel.” Id.] As a result, the “claim to ‘be transgender’ or the desire to seek ‘transition’ rests on a mistaken view of the human person, rejects the body as a gift from God, and leads to grave harm. To affirm someone in an identity at odds with biological sex or to affirm a person’s desired ‘transition’ is to mislead that person. It involves speaking and interacting with that person in an untruthful manner.” Id.

He states that CMA officially will not support any form of medical transition, and that the views of ACPeds on these “objectionable practices” are identical to those of CMA:

50. In accord with these scientific and religious understandings, CMA and its members believe that healthcare that provides gender-transition procedures and interventions is neither healthful nor caring; it is experimental and dangerous.

51. For CMA and its members, gender-transition procedures and interventions can be harmful, particularly to children, and medical science does not support the provision of such procedures or interventions.

52. CMA and its members thus believe providing or referring patients for the provision of gender identity interventions violates their core beliefs and their oath to “do no harm.”

53. CMA thus opposes pubertal suppression of minors, as well as hormone administration or other surgical interventions for purposes of “choosing” a gender or sex, and it objects to engaging in speech affirming these gender interventions.

54. CMA has adopted an official resolution stating, “the Catholic Medical Association does not support the use of any hormones, hormone blocking agents or surgery in all human persons for the treatment of Gender Dysphoria.”

…

130. Our members’ sincerely held religious beliefs prohibit them providing, offering, facilitating, or referring for gender transition interventions and also from engaging in or facilitating the objectionable practices.

…

138. CMA’s members are healthcare providers who object on grounds of science and medical ethics, as well as on religious grounds, to providing, offering, participating in, referring for, or paying for the objectionable practices.

…

147. CMA’s members share the non-religious medical and ethical positions described by ACPeds, and they also have overlapping religious objections to engaging in the objectionable practices.

These religious objections to endorsing any gender affirmation or transition, or approving of it as a standard of care, were stated as early as 2017 in a suit brought by the Catholic Medical Association and its related group, the Catholic Benefits Association (Amended and Verified Complaint, 28 March 2017, in Religious Sisters of Mercy et al. v. Azar).

15. Plaintiff Catholic Benefits Association is a Catholic membership ministry that exists to unite and serve Catholic employers who wish to live out their faith in ministry, business, and the workplace. The CBA works and advocates for religious freedom of Catholic employers, including their right to offer healthcare services and provide employee health benefits consistent with Catholic values. The ACTS Mandate thus not only injures CBA members, it also injures the CBA itself by rendering its mission effectively illegal.

16. The Catholic Medical Association is a national, physician-led community of healthcare professionals. Its mission is to inform, organize, and inspire its members, in steadfast fidelity to the teachings of the Catholic Church, to uphold the principles of the Catholic faith in the science and practice of medicine. Its mission includes defending its members’ right to follow their conscience and Catholic teaching in their professional work. As with the CBA, the ACTS Mandate injures CMA members and the CMA itself.

…

290. The 1557 Rule would prohibit CBA members from expressing their professional opinions that gender transition procedures are not the best standard of care or are experimental.

291. The 1557 Rule would also require CBA members to amend their written policies to expressly endorse gender transition procedures, even if such revisions do not reflect the medical judgment, values, or beliefs of CBA members. Id. at 31455. The 1557 Rule would also require CBA members to use gender-transition affirming language in all situations, regardless of circumstance. Id. at 31406.

292. Performing (or referring for) gender transition procedures is also contrary to the religious and conscientious beliefs of CBA members, and their beliefs prohibit them from conducting, participating in, or referring for such procedures.

293. The 1557 Rule would compel CBA members to conduct, participate in, refer for, or otherwise facilitate gender transition procedures.

294. The 1557 Rule would prohibit CBA members from expressing their religious views that gender transition procedures are not the best standard of care or are experimental.

…

301. CBA members’ sincere religious and conscientious beliefs prohibit them from facilitating or participating in gender transition procedures.

302. CBA members’ medical judgment is that it is harmful and unethical to encourage a patient to undergo gender transition procedures.

Their suit explains that a majority of the CBA’s board is comprised of archbishops of the Catholic Church, and calls transitioning “intrinsically evil”, citing an article referring to trans women as “she-males” in the journal of the National Catholic Bioethics Center:

45. The Most Reverend William E. Lori, Archbishop of Baltimore, is chairman of the CBA’s board of directors.

46. Seven of the CBA’s directors are Catholic archbishops. They are Most Rev. Gregory M. Aymond of New Orleans, Most Rev. Charles J. Chaput, O.F.M. Cap. of Philadelphia, Most Rev. Paul S. Coakley of Oklahoma City, Most Rev. Bernard A. Hebda of Saint Paul and Minneapolis, Most Rev. William E. Lori of Baltimore, Most Rev. Joseph F. Naumann of Kansas City, Kansas, and Most Rev. J. Peter Sartain of Seattle. Four of its directors are Catholic lay persons, including: Helen Alvaré, Beth Elfrey, Ed Hanway, and Carolyn Woo. Three-fourths of its directors are required to be Catholic. See Ex. B, Second Amended and Restated Bylaws of The Catholic Benefits Association (“CBA Bylaws) art. 5.2.

47. All of the CBA’s officers are Catholic.

…

79. Sexual reassignment surgery requires the destruction of healthy sexual and reproductive organs. (3) [3: Richard P. Fitzgibbons, M.D., et al., The Psychopathology of “Sex Reassignment” Surgery: Assessing its Medical, Psychological and Ethical Appropriateness, National Catholic Bioethics Quarterly 97, 100 (Spring 2009), available at www.ncbcenter.org/document.doc?id=581.]

80. The Catholic Church teaches that intentionally removing healthy organs that identify as a person as male or female is a type of amputation or mutilation that is intrinsically evil.

…

90. Consistent with the Ethics Committee’s guidance, Plaintiffs and all CBA members believe they must adhere to the above teachings as matters of religious faith and doctrine. Consequently, CBA members believe that gender transition procedures, sterilization, and abortion are contrary to the Catholic faith. CBA members further believe, as part of their faith, that they must not provide, pay for, or directly or indirectly facilitate access to such services and, therefore, that they must not perform gender transition services or abortions and must not include coverage for such procedures in their group health plans.

The CMA-allied NCBC now recommends that Catholic hospitals join the Catholic Benefits Association to obtain the protection of an injunction against applying ACA section 1557 to the CBA (Josef D. Zalot, “Catholic Health Care and Gender Identity”, p. 96 in Furton et al. 2021):

Second, Catholic health care should seek sound legal advice and consider membership in organizations committed to upholding the legal rights of Catholic institutions. One such organization is the Catholic Benefits Association (CBA). The CBA has gained permanent injunctive relief for all its members against (1) the Obama administration’s contraception and sterilization coverage mandate, and (2) the HHS regulation interpreting section 1557 of the Affordable Care Act (2010) to mandate insurance coverage for gender-transitioning hormones and surgeries. CBA membership is a viable option for Catholic health care institutions seeking legal protections and support against unjust government mandates.

In these suits, CMA members and associated groups portrayed their objection to the gender identity nondiscrimination provision of the ACA as limited to their own private practice of medicine. This is itself an issue: it would permit the large swathes of the US healthcare system that are under religious control to discriminate against patients because they are transgender. These significant carveouts for religious belief in medicine leave trans people at a significant likelihood of facing anti-trans discrimination in the normal course of accessing healthcare in this country, an obstacle which cis patients will not face. Moreover, these facilities accept Medicare and Medicaid funding through the government from cis and trans taxpayers alike, and then use this public funding to discriminate against trans members of the public seeking to access care on an equal basis.

However, the latest actions by CMA and the DeSantis administration extend these anti-trans religious beliefs beyond the realm of the members’ own private practices. These members have made a stated religious commitment against saying that transition care should be recommended; they have declared that the use of puberty blockers for trans youth is “religiously objectionable” to them and oppose any medical transition as a matter of official policy; because of their “sincerely held religious beliefs”, they will refuse “engaging in or facilitating” these “objectionable practices”. Further writings by the NCBC show that this objection stands regardless of evidence and is based on theological principles – CMA members subscribe to an interpretation of Catholicism that would consider transitioning to be unacceptable even if all evidence found it to be beneficial to trans people (Hruz, pp. 3, 17, and Zalot, pp. 86, 88–89 in Furton et al. 2021).

When state health agencies select CMA members to serve in any capacity evaluating transition care, it will already be known to those agencies that the CMA is guaranteed to find any gender affirmation to be unsafe, unhelpful, and not recommended. Their faith commitment means that any scientific or medical evidence that comes to light during this process, no matter how overwhelming or persuasively in favor of transition, will be completely irrelevant to this guaranteed outcome. Notably, CMA members Van Meter, Lappert, Donovan, and Hunter made no effort to recuse themselves from this process despite their preexisting commitment to finding a specified outcome. This places their private religious beliefs far outside of their individual medical practice, and their faith now intrudes into civil secular government, imposing itself on the private lives of all citizens regardless of our own personal beliefs. Trans people, our cis allies, and all citizens with an interest in secular public health policymaking are thus placed in a position where it does not matter what we say in our defense – evidence in medicine has been made disposable, replaced by a state-selected anti-trans religious belief system. This is the nature of the anti-trans process now taking place in Florida under the DeSantis administration. ■