CMDA's The Point

Federal Court Strikes Down Transgender Mandate, Protects Medical Judgment and Conscience

February 4, 2021
Photo: Pixabay

by Jonathan Imbody

A federal court has provided protections for physicians committed to following medical evidence and conscience convictions regarding the transgender and gender-questioning patients for whom they care.

The U.S. District Court for the District of North Dakota struck down an Obama-era rule that would have nixed physicians’ considerations of conscience and medical judgment on transgender procedures and prescriptions. Becket, the legal firm representing the plaintiffs in the case—which is an order of Catholic nuns, a Catholic university and Catholic healthcare organizations—describes the victory in a press release below.

Becket also represents CMDA and a Catholic health entity in a different federal court in a similar case, Franciscan Alliance v. Azar.

The North Dakota decision bodes well for the CMDA / Franciscan Alliance case, which likewise aims at protecting physicians’ freedom to follow medical evidence, make medical judgments based on the evidence and also to follow conscience convictions.

As Becket attorney Luke Goodrich, who represents CMDA and Franciscan Alliance in that case, explains in his Twitter thread below, “This is a victory for common-sense, conscience, and sound medical judgment. And our clients will continue providing outstanding care to transgender patients for everything from cancer to the common cold.”

CMDA’s national polling found that:

  1. Faith-based health professionals need conscience protections to ensure their continued medical practice.
  2. Conscience-driven health professionals care for all patients.
  3. Religious professionals overwhelmingly support a biological—not ideological—definition of sex. 
  4. Religious health professionals face rampant discrimination.
  5. Access for poor and medically under-served patient populations depends on conscience protections.

Becket news release

Court blocks mandate forcing doctors to perform controversial gender transition procedures

Federal court upholds conscience rights for doctors and protects welfare of patients

Washington, January 19, 2021–A federal court in North Dakota just blocked a requirement known as the Transgender Mandate that would force medical professionals and religious hospitals to perform gender transition procedures on their patients—including children—even when the procedures are potentially harmful.

In Religious Sisters of Mercy v. Azar, an order of Catholic nuns, a Catholic university, and Catholic healthcare organizations sued the federal government challenging a provision of the Affordable Care Act that would have forced doctors to perform gender transition procedures even if doing so would violate their religious beliefs and medical judgment.

Becket represented the plaintiffs, arguing that sensitive medical decisions should be kept between patients and their doctors without government interference, and that no one should be required by law to disregard their conscience or their professional medical judgment.

“Now more than ever, Americans are grateful for the sacrifices of our medical professionals who serve on the front lines and use their training and expertise to serve the vulnerable,” said Luke Goodrich, senior counsel at Becket“The court’s decision recognizes our medical heroes’ right to practice medicine in line with their conscience and without politically motivated interference from government bureaucrats.”

In 2016, the federal government issued a mandate, applicable to nearly every doctor in the country, interpreting the Affordable Care Act to require them to perform gender transition procedures on any patient, including children, even if the doctor believed the procedure could harm the patient. 

Doctors who refused to violate their medical judgment would have faced severe consequences, including financial penalties and private lawsuits. Immediately, religious organizations and states sued, challenging the legality of the mandate in multiple courts.

In 2016, a federal court in North Dakota put the rule on hold, and in 2019 another federal court in Texas struck it down.

In June 2020, HHS passed a new rule aimed at walking back the requirement, but other courts have blocked that new rule.

Today’s ruling is the second ruling from a federal court blocking the Transgender Mandate. The ruling protects patients, aligns with current medical research, and ensures doctors aren’t forced to violate their religious beliefs and medical judgment.

“These religious doctors and hospitals provide top-notch medical care to all patients for everything from cancer to the common cold,” said Goodrich. “All they’re asking is that they be allowed to continue serving their patients as they’ve done for decades, without being forced to perform controversial, medically unsupported procedures that are against their religious beliefs and potentially harmful to their patients. The Constitution and federal law require no less.”

Becket Attorney Luke Goodrich’s Twitter thread


Major victory for #ReligiousFreedom: A federal court just struck down the controversial #TransgenderMandate that ordered doctors to perform potentially harmful gender-transition procedures in violation of conscience and medical judgment: Sisters-of-Mercy-Opinion.pdf

The plaintiffs are religious doctors, hospitals, and clinics who joyfully serve ALL patients regardless of sex or gender identity. They routinely provide top-notch care to transgender patients for everything from cancer to the common cold. They also provide millions of dollars in free and low-cost care to the elderly, poor, and underserved rural areas.

But a controversial HHS regulation threatens multimillion-dollar penalties unless they perform gender-transition procedures, even when the procedures violate the doctors’ religious beliefs and medical judgment and could harm patients.

Today’s decision rightly says the mandate violates federal law. This is now the second court to say so. The other court’s decision is currently on appeal at the 5th Circuit.

These religious hospitals and doctors joyfully serve transgender patients. There is ample evidence, however, that certain gender transition procedures can be harmful to patients:

Several federal courts–including the 5th and 1st Circuits–have examined whether there is “consensus in the medical community about the necessity and efficacy of sex reassignment surgery as a treatment for gender dysphoria.”

These circuits have all reached the same conclusion: “There is no medical consensus that sex reassignment surgery is a necessary or even effective treatment for gender dysphoria.” Gibson v. Collier, 920 F.3d 212, 223 (5th Cir. 2019). 16-51148-CV0.pdf (

HHS’s own doctors during the Obama administration agreed: “Based on a thorough review of the clinical evidence…there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for [patients] with gender dysphoria.” Proposed Decision Memo for Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N) (

And a landmark ruling from the British High Court recently said that “puberty blockers” were experimental and that children under 16 likely couldn’t give informed consent to them: A British Court Breaks Gender Fever | Opinion (

In @BECKETlaw‘s case decided today, the doctors and hospitals argued that they shouldn’t be forced to perform procedures that violate their consciences and could harm their patients. The federal court agreed.

Today’s ruling protects patients, aligns with current medical research, and ensures doctors aren’t forced to violate their religious beliefs and medical judgment.

This is a victory for common-sense, conscience, and sound medical judgment. And our clients will continue providing outstanding care to transgender patients for everything from cancer to the common cold.


About Jonathan Imbody

Jonathan previously served as CMDA's Federal Policy Analyst and as CMDA's liaison with the federal government in Washington, D.C. A veteran writer of more than 30 years, Jonathan authored Faith Steps, which encourages and equips Christians to engage in public policy issues. He has published more than 100 commentaries in The Washington Post, USA Today, New York Times, Los Angeles Times, San Francisco Chronicle, Chicago Sun-Times and many other national publications. Jonathan's writing focuses on public policy issues including freedom of faith, conscience and speech; human trafficking; abortion; assisted suicide; stem cell research; the role of faith in health; international health; healthcare policy; sexual risk avoidance and HIV/AIDS. Jonathan received his bachelor's degree in journalism and speech communications from the Pennsylvania State University, a master's degree from Penn State in counseling and education and a certificate in biblical and theological studies from the Alliance Theological Seminary in New York. Jonathan's wife Amy is an author and leads the Redemptive Education movement. They have four children and four grandchildren.

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