BALTIMORE (OSV News) ─ As they gathered for their annual fall meeting in Baltimore, the nation's bishops considered possible revisions to their guiding document on Catholic health care ─ with protocols on the issue of gender dysphoria being "especially relevant in our day," said the bishops' doctrinal committee chair.
Proposed updates to the "Ethical and Religious Directives for Catholic Health Care Services," or ERD, were presented during the Nov. 11 session of the U.S. Conference of Catholic Bishops' Fall 2025 Plenary Assembly.
Currently in its sixth edition, with a seventh edition up for a Nov. 12 vote at the USCCB meeting, the ERD ─ developed in consultation with medical professionals and theologians, and regularly reviewed by the U.S. Conference of Catholic Bishops ─ articulates ethical standards for health care in light of church teaching, and provides authoritative guidance on moral issues encountered by Catholic health care.
Auxiliary Bishop James Massa of Brooklyn, chair of the USCCB Committee on Doctrine, noted in his presentation that the bulk of the proposed revisions will examine how to incorporate into the document guidance issued in 2023 by the USCCB's Committee on Doctrine, which prohibited surgical or chemical interventions seeking to exchange or simulate the sex characteristics of a patient's body for those of the opposite sex.
"The current edition of the ERDs does not offer any explicit guidance regarding the morality of certain chemical and surgical interventions that are commonly offered for the treatment of gender dysphoria," explained Bishop Massa, adding that the doctrine committee sought to "address that lacuna" with the proposed revisions.
The 2023 guidance and the proposed ERD revisions were the fruit of extensive reflection and discernment, with feedback from Catholic physicians, bioethicists and health care organizations, said Bishop Massa.
"Every phrase, every word of the ERDs received scrutiny by multiple experts from different perspectives," he said. "We incorporated insights from all the consulting parties."
In addition, the proposed revisions of the ERD build on "Dignitas Infinita," the 2024 declaration on human dignity published by the Vatican's Dicastery for the Doctrine of the Faith.
That document recounts the biblical and magisterial basis for the Catholic Church's understanding of human dignity as inherent, since it ultimately flows from the human person's creation "in the image and likeness of God" and redemption in Christ.
The declaration addressed "some grave violations of human dignity that are particularly relevant," specifically poverty, war, threats to migrants, human trafficking, sexual abuse, violence against women, abortion, surrogacy, euthanasia and assisted suicide, the marginalization of people with disabilities, gender theory, sex change interventions and digital violence -- a list that was not "exhaustive," said the text.
While deploring violence and discrimination against those struggling with their gender and sexual identity, "Dignitas Infinita" reaffirmed church teaching on gender, describing sexual difference as "the greatest possible difference that exists between living beings," which in humans "becomes the source of that miracle that never ceases to surprise us: the arrival of new human beings in the world."
In his presentation, Bishop Massa said he also had "informal consultation" with the Vatican ─ which had formally reviewed the 2023 doctrinal note ─ on the ERD revisions.
"They did make a couple of recommendations that we include references to some of the more recent papal documents," he said. "We have a longer quote from 'Dignitas Infinita,' and also something on artificial intelligence."
Bishop Massa also said that upon USCCB approval of the ERD revisions, individual bishops would then decide to make the ERD document a particular law in their dioceses, or at least treat it as such without formally promulgating the text.
Speaking to OSV News ahead of the USCCB plenary, Bishop Massa observed that the directives are an "important resource" for developing pastoral letters and guidelines ─ one that is "very helpful to those who continue the essential work of making our anthropology and our Catholic moral teaching accessible to our people, to the faithful."
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Gina Christian is a multimedia reporter for OSV News. Follow her on X @GinaJesseReina.
