Is the transgender position reconcilable with Catholic Teaching?

I recently submitted this Resource development and analysis to my university. Feedback from my assessor are in italics and brackets:

Part I:

The following Catholic Thought curriculum modules will be addressed in the Resource development and analysis below:

- Virtues and Vices

- Faith and Bioethics.

The Resource will help the audience meet the following learning outcomes (LO):

LO1: Understand the uniqueness of the transgender position

LO2: Articulate key reference points that underpin what the Catholic Church teaches

LO3: Demonstrate sophisticated philosophical and theological knowledge.

The Resource is targeted at transgender people, and Catholics with an interest in the transgender position.

Part II:

The following Resource will show how one may consider teaching the target audience, as described above, on whether the transgender position is reconcilable with Catholic Teaching, in the context of Virtues and Vices, and Faith and Bioethics. This Resource suggests 5 discussion sessions. Relevant resources for the group discussions are available via the footnotes and bibliography of the Resource. The teacher would initiate the discussion by providing the below content, and asking associated questions.

Session 1: Theological Anthropology and Philosophy of the Human Person in the Context of Sex and Gender

There are competing views on the transgender position, including those revolving around Catholic Teaching. The position is not only complex, but is also a contemporary issue that behoves the application of Catholic Teaching. This exercise is important, because according to the Catechism of the Catholic Church (CCC), human persons are expected to lead a virtuous life in order to become like God.[1] In the context of gender, for the human person to be like God, he or she would embrace the maleness and femaleness He created them with, respectively, as per Genesis 1:27.

If this is the telos of the human person, then he or she is moving towards a eudaimonia that resulted from fully embracing the maleness and femaleness of the human person.[2] This is part of the dignity of the human person. Such an embrace could not cross-contaminate dualistically, for example, it would not be virtuous for a male human person to embrace femaleness. This is reinforced in the works of St Thomas Aquinas, that the human person is a composite of body and soul, and that the soul is the substantial form of the body.[3] Therefore it would seem that the transgender position, in practice, would be a vice. (Explain further)

This Session would therefore help participants meet LO2 and LO3.

Session 2: The Transgender Experience of the Human Person

The experiences of human persons of transgender disposition show that their position is more complex than the explanation thus far in this Resource, especially when counselling and psychotherapy has been tried to address gender dysphoria. One such experience during childhood reads as follows on a blog:

“Medicine should be used to alleviate dysphoria, not to disguise a person’s sex, at least that’s been my experience. I base my happiness on not getting distracted by dysphoria, ie getting on with finding meaning in life like everybody else, nor do I care about other people’s opinions or perceptions… I wish I never experienced gender dysphoria (this is what actually makes me very sad). If I didn’t experience it 24/7, I would’ve “be[come] a man” as I was told to do growing up… I have no capacity to ever understand what it means to not have gender dysphoria, ie be cisgender. Ever. I never had that capacity to begin with, and I never will. Transition was a last resort because I wanted to stop being miserable, and stop being so unhappy. If I could’ve avoided transition, I would’ve. Ultimately, no one can give me happiness, only I can.”[4]

This Session would especially help participants meet LO1, if willing transgender participants were encouraged to share their stories.

Session 3: Introduction to Reconciling the Transgender Position with Catholic Teaching

The science of gender dysphoria remains controversial, but it appears that such a disposition arise from biological and environmental factors.[5] Therefore, on the balance of probability, and given that there is no Magisterial teaching on how to respond to gender dysphoria,[6] gender transition to address dysphoria may be considered, according to the CCC, an action where the imputability and responsibility for such an action is diminished by psychological factors.[7]

If the Catholic Church teaches that “biological sex and the socio-cultural role of sex (gender) can be distinguished but not separated”,[8] then men should not wear what would be considered women’s clothes — Deuteronomy 22:5 considers this to be inappropriate. St Thomas Aquinas sheds further light that wearing attire that does not correspond to the wearer’s role or status is less than truthful,[9] especially if it involved sensuous pleasure. However, the exception to the rule is crossdressing out of necessity, such as avoiding the attention of the enemy, or lack of access to clothes.[10] Perhaps crossdressing to alleviate gender dysphoria, rather than to gain sensuous pleasure, constitutes diminished imputability. (Explain further, phrase better)

It is worth noting that crossdressing is not obvious when done by transgender people who have been on hormone therapy long-term, and therefore have developed secondary sex characteristics that is opposite to their biological sex — these people are arguably wearing opposite-sex attire that corresponds to their presented gender. For these people, crossdressing in order to correspond to biological sex may inadvertently attract unwanted enemies who do not take kindly to apparent crossdressing. Either way, the Catholic Church does not have a clear position on crossdressing, especially since Pope Nicholas I at one point wrote that he is not concerned about the virtue (or lack thereof) of the Bulgars’ dress, such as femoralia, for both genders.[11]

This Session would therefore help participants meet all LOs. Any further content would overwhelm the participants, thereby not optimally meeting the LOs. Therefore the next Session is a continuation of Session 3.

Session 4: Reconciling the Transgender Position with Catholic Teaching

Gender dysphoria is usually deeper than dress, and gender dysphoria patients may choose to undergo hormone therapy and/or sex reassignment surgery (SRS), both of which can significantly affect the appearance of a human person’s biological sex. Based on Thomas Aquinas’ thoughts on attire-wearing, he would have likely argued that medical transition that leads to a gender presentation not corresponding to biological sex is less than truthful.[12] But this does not prevent a gender dysphoria patient from both affirming their body-soul composite,[13] and taking practical measures to alleviate gender dysphoria.

As an analogy, relationships between members of a given family are ideally biological, and therefore relational identity that arises from this cannot be chosen. It follows that parental roles and responsibilities are derived from such biological structures.[14] However, some children in some families are adopted children, where the adopting parents are not biologically related to the children they adopt. But for all intents and purposes, these children are considered the children of these parents — that is the point of adoption, where these children’s identity in relation to their adopting parents is not false, and has its own non-biological, but meaningful and authentic reality, as implied by Galatians 4:4–5.

Therefore, adoption identity and transgender identity, both non-comparable, are both social, non-biological types of identity of the human person. These are types of identity that can be adopted without denying the implications of the body-soul composite — these concepts are not in competition with each other. Essentially, adoptive parenthood is modelled on biological parenthood, and a trans woman’s womanhood, for example, is modelled on biological womanhood.

This Session would therefore help participants meet LO1 and LO3, and finalise Session 3.

Session 5: Catholic Bioethics of the Transgender Position

Medical transition to treat gender dysphoria has been compared with liposuction desired by an anorexia nervosa patient,[15] or a body dysmorphic disorder (BDD) surrounding limb amputation.[16] But this analogy is not helpful because such allegedly comparable desires are a desire for a less than healthy body, whereas gender dysphoria is a desire for a healthy, and not necessarily perfect, body of the opposite sex. The endstate of gender dysphoria treatment is the resolution of the dysphoria, whereas BDD may be more of an ongoing dissatisfaction with particular healthy body parts.[17]

Of course, a gender dysphoria patient may also have BDD, and/or other comorbidities, requiring a tailored, not a blanket, approach. This approach could incorporate Catholic Teaching on the principle of double effect. For example, modelling on biological womanhood, as described above, sufficiently to alleviate dysphoria, would be proportionate, that is, a good effect. This is so long as there is no treatment creep that includes ongoing and cosmetic procedures to attain a perceived perfect state of biological womanhood.

There are different types of hormone therapy and SRS, and some of these treatment types could be considered treatment creep depending on the nature of the patient’s dysphoria. The ‘good effect’ types of treatment can cause sterilisation, a bad effect, and tend to be neutral.[18] Sterilisation in this case is regrettable, but is not deliberately a means to a ‘good effect’ end — gender dysphoria does not revolve around sterilisation.

On proportionality and balancing effects, Pope Pius XII’s Principle of Totality is another useful bioethical tool in discerning gender dysphoria treatment, especially SRS. In application, there are three criteria under this principle for justifying SRS:

1. The retention of a gender-indicating organ of the human person is causing serious gender dysphoria

2. The gender dysphoria arising from said organ is unavoidable, except by a related SRS, the efficacy of which is well-assured; and

3. It is reasonable to expect that the positive effect will compensate the negative effect.[19]

To clarify, gender dysphoria comes in different forms. A gender dysphoria patient may be more dysphoric about how they present their gender to society with clothes, than say, their genitalia. Another’s experience may be the other way around, and the third dysphoric experience may include social, genital and other secondary sex characteristics. Therefore, a gender dysphoria patient who is not genitally dysphoric, but is seeking genitalia-related SRS, is likely to not be giving consideration to the principles of double effect and totality, perhaps due to BDD or another condition. This, therefore would go against what the Catholic Church teaches.

Hormone therapy and SRS to the necessary level and no further, has been found to resolvingly alleviate gender dysphoria and reduce the apparent risk of suicidal ideation. According to AusPATH, efficacy is well-assured, because carefully-developed guidelines for medical transition stress the importance of engagement and assessment between doctor and patient, and adherence to the process is associated with low rates of regret and detransition.[20]

This Session would therefore help participants meet all LOs, and bring the 5-part discussion and learning series to an end. It will help participants understand how the transgender position is reconcilable with Catholic Teaching.

(You have made a good presentation of the issue of Church teaching and transgender people. Part I needed to be a little more developed to show what you intended by your resource etc…

I think that it would have been good to also present the Catholic teaching in terms of the gift of the body — that is, creation in the image of God and how this should guide us to see how the disharmony that may be felt between our bodies and souls may be a result of original sin…

Overall, you have the beginning of a very good plan for lessons on this topic but this needs to be developed further in light of Church teaching and theological anthropology. Well done on engaging a very complex topic. (in future please submit your paper double spaced — it makes it easier to read and mark!)

Bibliography

Australian Professional Association for Trans Health. “AusPATH: Public Statement on Gender Affirming Healthcare, including for Trans Youth.” Accessed July 09, 2021. https://auspath.org/gender-affirming-healthcare/.

Bayley, Carol. “Transgender Persons and Catholic Healthcare.” Health Care Ethics USA Winter (2016), https://www.chausa.org/docs/default-source/hceusa/transgender-persons-and-catholic-healthcare.pdf.

Brennan, Tad. Routledge Encyclopedia of Philosophy, sv “Telos.” Taylor and Francis, 2002. https://www.rep.routledge.com/articles/thematic/telos/v-1.

Brugger, E. Christian. “Catholic Hospitals and Sex Reassignment Surgery: A Reply to Bayley and Gremmels.” National Catholic Bioethics Quarterly 16 (2016): 587–597, https://doi.org/10.5840/ncbq201616456.

Catechism of the Catholic Church. 2nd ed. Vatican City: Vatican Press, 1997.

Dana Pham. “Targeting trans women for being women.” Noteworthy — The Journal Blog. June 20, 2020. https://blog.usejournal.com/targeting-trans-women-for-being-women-9565e6a47185.

Gremmels, Becket. “Sex Reassignment Surgery and the Catholic Moral Tradition: Insight from Pope Pius XII on the Principle of Totality.” Accessed July 09, 2021. https://www.chausa.org/publications/health-care-ethics-usa/article/winter-2016/sex-reassignment-surgery-and-the-catholic-moral-tradition-insight-from-pope-pius-xii-on-the-principle-totality.

Internet Medieval Sourcebook. “The Responses of Pope Nicholas I to the Questions of the Bulgars A.D. 866 (Letter 99).” Accessed July 09, 2021. https://sourcebooks.fordham.edu/basis/866nicholas-bulgar.asp.

Jones, David Albert. “Truth in transition? Gender identity and Catholic anthropology.” New Blackfriars: A Review 99, no. 1084 (2018): 756–774, https://doi.org/10.1111/nbfr.12380.

Klima, Gyula. “MAN=BODY+SOUL: Aquinas’s Arithmetic of Human Nature.” Accessed July 09, 2021. https://faculty.fordham.edu/klima/bodysoul.htm.

McHugh, Paul. “Transgender surgery isn’t the solution.” wsj.com, June 12, 2014. https://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120.

National Catholic Bioethics Center. “Brief Statement on Transgenderism.” National Catholic Bioethics Quarterly 16 (2016): 599–603, https://doi.org/10.5840/ncbq201616457.

Tobin, Bernadette. “Gender and Personal Identity: Two Views.” abc.net.au, September 5, 2017. https://www.abc.net.au/religion/gender-and-personal-identity-two-views/10095420.

Zucker, Kenneth J., Lawrence, Anne A. and Kreukels, Baudewijntje P. C. “Gender Dysphoria in Adults.” Annual Review of Clinical Psychology 12 (2016): 217–24, 10.1146/annurev-clinpsy-021815–093034.

Footnotes

[1] Catechism of the Catholic Church, 2nd ed. (Vatican City: Vatican Press, 1997), 44, 367, https://www.vatican.va/archive/ccc_css/archive/catechism/ccc_toc.htm.

[2] Tad Brennan, Routledge Encyclopedia of Philosophy, sv “Telos,” Taylor and Francis, 2002, https://www.rep.routledge.com/articles/thematic/telos/v-1

[3] “MAN=BODY+SOUL: Aquinas’s Arithmetic of Human Nature,” Gyula Klima, accessed July 09, 2021, https://faculty.fordham.edu/klima/bodysoul.htm.

[4] Dana Pham, “Targeting trans women for being women,” Noteworthy — The Journal Blog, June 20, 2020, https://blog.usejournal.com/targeting-trans-women-for-being-women-9565e6a47185.

[5] Kenneth J. Zucker, Anne A. Lawrence and Baudewijntje P. C. Kreukels, “Gender Dysphoria in Adults,” Annual Review of Clinical Psychology 12 (2016): 217–24, 10.1146/annurev-clinpsy-021815–093034.

[6] David Albert Jones, “Truth in transition? Gender identity and Catholic anthropology,” New Blackfriars: A Review 99, no. 1084 (2018): 756–774, https://doi.org/10.1111/nbfr.12380.

[7] Catechism of the Catholic Church, 358.

[8] Bernadette Tobin, “Gender and Personal Identity: Two Views,” abc.net.au, September 5, 2017, https://www.abc.net.au/religion/gender-and-personal-identity-two-views/10095420.

[9] Thomas Aquinas, Summa Theologiae, IIa IIae 169 art. 1 ad 3.

[10] Aquinas, Summa Theologiae, IIa IIae 169 art. 2 ad 3.

[11] “The Responses of Pope Nicholas I to the Questions of the Bulgars A.D. 866 (Letter 99),” Internet Medieval Sourcebook, accessed July 09, 2021, https://sourcebooks.fordham.edu/basis/866nicholas-bulgar.asp.

[12] E. Christian Brugger, “Catholic Hospitals and Sex Reassignment Surgery: A Reply to Bayley and Gremmels,” National Catholic Bioethics Quarterly 16 (2016): 590, https://doi.org/10.5840/ncbq201616456.

[13] National Catholic Bioethics Center, “Brief Statement on Transgenderism,” National Catholic Bioethics Quarterly 16 (2016): 601, https://doi.org/10.5840/ncbq201616457.

[14] Jones, “Truth in transition?” 756–774.

[15] Paul McHugh, “Transgender surgery isn’t the solution,” wsj.com, June 12, 2014, https://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120.

[16] Brugger, “Catholic Hospitals and Sex Reassignment Surgery,” 587–597.

[17] Jones, “Truth in transition?” 756–774.

[18] “Transgender Persons and Catholic Healthcare,” Carol Bayley, Health Care Ethics USA Winter (2016), https://www.chausa.org/docs/default-source/hceusa/transgender-persons-and-catholic-healthcare.pdf.

[19] “Sex Reassignment Surgery and the Catholic Moral Tradition: Insight from Pope Pius XII on the Principle of Totality,” Becket Gremmels, accessed July 09, 2021, https://www.chausa.org/publications/health-care-ethics-usa/article/winter-2016/sex-reassignment-surgery-and-the-catholic-moral-tradition-insight-from-pope-pius-xii-on-the-principle-totality.

[20] “AusPATH: Public Statement on Gender Affirming Healthcare, including for Trans Youth,” Australian Professional Association for Trans Health, accessed July 09, 2021, https://auspath.org/gender-affirming-healthcare/.