According to the Catechism of the Catholic Church, “Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law” (2297). These therapeutic reasons can include amputating damaged tissue like gangrenous limbs or even healthy tissue if it serves the needs of the body as a whole.
Concerning the latter justification, Pope Pius XII said, “[B]y virtue of the principle of totality, by virtue of his right to use the services of his organism as a whole, the patient can allow individual parts to be destroyed or mutilated when and to the extent necessary for the good of his being as a whole.”
Can this be applied to operations aimed at changing a person’s physical sex?
Beckett Gremmels, a system director of ethics at CHRISTUS Health in Texas, thinks so. He believes that sex-reassignment surgery (SRS) could, in theory, be justified in light of the principle of totality. According to Gremmels, “SRS could be justified from a Catholic moral perspective. For the first criterion, the continued presence and normal functioning of the various body parts involved contributes to and exacerbates another illness, namely gender identity disorder, which was recently renamed gender dysphoria.”
This first criterion comes from three principles Pope Pius XII gave to justify destroying healthy organs in order to save the body as a whole. The pope used the example of removing healthy testicles in order to prevent the hormones they produce from increasing the spread of prostate cancer. Other Catholic moralists have argued that female reproductive organs with a high propensity for developing ovarian cancer could be removed before the cancer is detected. Even though these procedures result in both the destruction of organs and sterilization, they are moral because they meet the following three criteria:
- The retention or function of a particular organ within the whole organism is causing serious damage or constitutes a threat to it;
- The damage or threat cannot be avoided, or even notably diminished, except by a mutilation in question and whose efficacy is well-assured; and
- It is reasonable to expect that the negative effect will be compensated for by the positive effect.
Gremmels believes that the presence of genitalia that causes someone gender dysphoria, or the feeling of being “trapped in the wrong body,” can cause serious enough psychological damage to justify their removal and replacement with organs meant to look like those of the other sex.
Gremmels does not endorse SRS as a means to actually help people undergo a “sex change,” but simply as a means to alleviate the stress a patient may be feeling from gender dysphoria. He does not believe that SRS has so far been shown to be effective at treating gender dysphoria, but is open to the possibility that empirical research may prove this to be the case in the future. If it were, he says, it could be a moral form of treating people with sexual identity issues.
But when it comes to SRS that cause sterility, Gremmels erroneously considers this sterility to be an undesired byproduct—similar to how removal of the testes in order prevent the exacerbation of prostate cancer also causes sterility. He writes, “Unlike a tubal ligation to prevent problems with a future pregnancy [in which sterility is a goal, not a byproduct], sterility does not prevent the spread of prostate cancer but the accompanying lack of hormones does.”
The analogy breaks down, however, because in SRS sterility is a goal of the procedure and not a mere byproduct of it.
The very purpose of the procedure is to remove natural, functioning sex organs and replace them with non-functioning simulacrums. The procedure’s actual end is not the transformation of the patient into a fertile member of the opposite sex but the mutilation of the patient into a sterile person who thinks he or she is a member of the opposite sex. If, after the procedure, natural fertility still remained through normal sexual relations, many transgender patients would view the SRS as a failure, which shows that sterility is not an unintended effect of this procedure: thus making the procedure immoral.
Gremmels’s argument is on par with claiming that a woman with post-partum depression who experiences dysphoria at the prospect of becoming pregnant again could be licitly given a tubal ligation because the presence of her reproductive organs exacerbates her post-partum depression. But a tubal ligation would not be a means of treating the woman’s depression. It would instead be a means of allowing her depression to cause her body further harm.
Likewise, the removal of healthy sex organs does not treat a sexual identity problem—it is an amplification of the sexual identity problem.
John Brehany of the National Catholic Bioethics Center notes that Pope Pius XII even states in so many words that it is illicit to destroy human capacities in order to relieve psychic burdens. Brehany writes, “A ‘cure’ for psychic distress that not only significantly mutilates a healthy human body but also attempts to remake a constitutive dimension of personal identity would not respect the immanent teleology and hierarchy of values in an embodied human person.”
Even SRS that do not cause sterility, like augmentation mammoplasties for biological males or elective mastectomies for women, should not be recommended because they do not restore healthy functioning to the body. They are only done to reduce the dysphoria of a patient suffering from a psychological disorder.
Finally, we must remember that men and women exist as different, complementary kinds of human beings for whom different medical treatments are required for them to reach their proper ends. Men don’t need to see a gynecologist and women don’t need to worry about getting testicular cancer. But what is true both for men and for women is that we should not lie to them or assist them in lying to others.
It is as impossible to change a person’s sex as it is impossible to change a person’s ancestry, for both are written into our very being. According to ethicists E. Christan Brugger and J. Francis Stafford:
[T]o counsel, perform or accept for oneself any surgery believing or asserting that what’s happening is that a person is changing (“reassigning”) his biological sex would always be contrary to the truth and therefore always impermissible. In other words, to participate in SRS following the assumptions about sex and gender held today by secular culture would be intrinsically evil [emphasis in the original].
Given this multitude of factors, coupled with the fact that transgender ideology does not reflect an accurate view of the human person, ethical healthcare providers should not support the practice that surgically altering someone’s body under the guise of “sex-reassignment surgery” in order to treat a disordered sense of sexual identity. Instead, they should offer appropriate counseling and mental health alternatives as well as compassionate, pastoral care for anyone who suffers from an identity disorder.