BALTIMORE (OSV News) — The U.S. bishops have approved an updated version of their guiding document on Catholic health care, with substantial revisions that include explicit prohibitions against so-called “gender-affirming care.”.
Proposed updates to the “Ethical and Religious Directives for Catholic Health Care Services,” or ERDs, were overwhelmingly accepted during the Nov. 12 session of the U.S. Conference of Catholic Bishops’ fall 2025 plenary assembly.
The ERDs — developed in consultation with medical professionals and theologians, and regularly reviewed by the U.S. Conference of Catholic Bishops — articulate ethical standards for health care in light of church teaching, and provide authoritative guidance on moral issues encountered by Catholic health care.
Now, the seventh edition of the ERDs — endorsed by 206 bishops, with eight abstaining and seven opposing — incorporates 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.
During a Nov. 11 presentation on the proposed revisions, Auxiliary Bishop James Massa of Brooklyn, New York, chair of the USCCB Committee on Doctrine, explained to the assembly that the sixth edition did not include such guidance, a “lacuna” the committee sought to address.
The USCCB’s 2023 doctrinal document and the ERDs revisions were the fruit of extensive reflection and discernment, with feedback from Catholic physicians, bioethicists and health care organizations, said Bishop Massa during the Nov. 11 presentation.
“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 Nov. 11 presentation, Bishop Massa said he also had “informal consultation” with the Vatican — which had formally reviewed the 2023 doctrinal note — on the ERDs 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 ERDs revisions, individual bishops would then decide to make the ERDs 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.”
