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The National Catholic Bioethics Center
Joint NCBC Letter to Congress on the Equality Act
May 2019
© 2020 by The National Catholic Bioethics Center

For a PDF version of this document with links, click here.

Dear Chairman Nadler and Ranking Member Collins of the Judiciary Committee of U.S. House of Representatives:

We are writing on behalf of the countless medical professionals—physicians, nurses, and other health care workers—who are deeply concerned about a mounting threat to our conscience rights and the integrity of the medical profession.

The Equality Act (H.R. 5) elevates “sexual orientation” and “gender identity” as protected categories in the federal Civil Rights Act. It also expands the definition of public accommodations to include any “establishment that provides health care.” This bill would effectively mandate that all health care professionals and providers perform and pay for controversial transition-affirming therapies against their best medical judgment. The bill includes no conscience protections and explicitly removes recourse to the Religious Freedom Protection Act (RFRA) for citizens affected by this burdensome mandate.

Medical professionals must be free to exercise their best medical judgment when it comes to the treatment of our patients. There is no consensus within the medical community about how to best care for individuals who struggle with gender dysphoria (i.e. “significant distress or impairment” arising from the “incongruence between one’s experienced/expressed gender and assigned gender”). In fact, many of these treatments remain highly controversial, especially given the accompanying medical risks.

So-called sex-reassignment therapies have not been shown to reduce the extraordinarily high rate of suicide attempts among people who identify as transgender: 41 percent, compared with 4.6 percent of the general population). As pointed out by the Obama Centers for Medicare and Medicaid, the most thorough study of outcomes for sex-reassigned people, a 30 year longitudinal study from Sweden, found a nineteen-times-greater likelihood for death by suicide.

These studies do not even begin to address the experimental therapies being conducted on gender dysphoric children. Studies show that 80 to 95 percent of children who experience a discordant gender identity come to identify with their bodily sex after puberty. Yet transgender activists advise drastic hormonal and surgical interventions for gender dysphoric children: social transition as young as 4, puberty blocking drugs as young as 9, cross-sex hormones as young as 14, and surgery as young as 18.6 These medical interventions come with serious health consequences.

Puberty blocking drugs are non-FDA approved to permanently delay natural puberty and must be prescribed off-label by doctors. Side effects include “disfiguring acne, high blood pressure, weight gain, abnormal glucose tolerance, breast cancer, liver disease, thrombosis, and cardiovascular disease”—and, of course, sterility.

Moreover, blocking therapies are non-reversible. As Drs. Hruz, Mayer, and McHugh note in a study for The New Atlantis, “If a child does not develop certain characteristics at age 12 because of a medical intervention, then his or her developing those characteristics at age 18 is not a ‘reversal,’ since the sequence of development has already been disrupted.”

The medical community must take these numbers seriously and exercise caution when it comes to the treatment of gender dysphoria. Yet the Equality Act would leverage federal authority to silence the debate within the medical community regarding these controversial therapies.

There are already efforts at the state level to suppress any difference of opinion when it comes to these drastic therapies. Catholic hospitals in New Jersey and California were sued when they declined to perform hysterectomies on otherwise healthy females who wished to become male. A third Catholic hospital in Washington settled out of court with the ACLU after they sued the hospital for declining to perform a double mastectomy on a sixteen-year-old girl. These lawsuits are a direct attack on the autonomy and integrity of the medical profession.

Human sexuality is not a disease and should not be treated as such. Moreover, it is not standard medical practice to intervene in the natural, healthy sexual development of children nor to unnecessarily remove healthy organs in adults. We believe that the best therapies for gender dysphoria will seek to make patients comfortable in their own bodies, rather than take unnecessary medical risks to attempt the impossible and make their bodies reflect their feelings.

Medical professionals must remain free to exercise their best medical judgment when it comes to their patients. A federal gender identity health care mandate like the Equality Act would have disastrous consequences.

We urge you to oppose the Equality Act in order to protect the integrity of the medical profession and allow us to serve our patients freely and in good conscience.



Donna J. Harrison, MD
Executive Director
American Association of Pro-Life Obstetricians and Gynecologists

Michelle Cretella, MD
Executive Director
American College of Pediatricians

Greg F. Burke, MD, FACP
Co-Chairman, Ethics Committee
Catholic Medical Association

David Stevens, MD, MA (Ethics) CEO
Christian Medical Association

Diana Ruzicka, RN, MSN, CNS-BC
National Association of Catholic Nurses, U.S.A.

Dr. Marie T. Hilliard, MS, MA, JCL, PhD, RN
Senior Fellow
The National Catholic Bioethics Center

Phillip L. Stiver, MD
Physicians Resource Council of Focus on the Family