NEW YORK – A recent decision by the Biden administration to allow a deadline for appeal to pass in effect preserves a federal ruling that the government cannot mandate religious doctors and hospitals to provide gender-transition care against their religious beliefs.

The Biden administration had until June 20 to appeal the federal ruling from December, which permanently protected religious doctors and hospitals from gender-transition care mandates the federal government added to the Affordable Care Act in 2016. It elected not to do so.

The development comes about a week after the U.S. bishops voted to revise their Ethical and Religious Directives for Catholic Health Care Services, specifically to address if Catholic health care providers can provide gender-affirming care. Ahead of the vote, among other things, multiple bishops noted the need to look into potential legal ramifications of any revisions.

In a statement, a spokesperson for the United States Conference of Catholic Bishops told Crux that the Biden administration’s decision “doesn’t impact the work of the doctrine committee,” which is responsible for making the revisions.

“The [Ethical and Religious Directives] place the timeless teaching of the Church into the contemporary health care setting and are an expression of Christ’s desire for the good of every person,” the spokesperson said. “We remain attentive to the need for the government to respect and uphold conscience protections for medical professionals and healthcare institutions.”

The case at hand is Sisters of Mercy vs. Becerra. The plaintiffs in the case were the Sisters of Mercy, a Catholic religious order based in Alma, Michigan, some of whose members serve as licensed healthcare professionals, as well as a handful of other Catholic health care providers and organizations.

The defendants, meanwhile, were HHS Secretary Xavier Becerra, HHS itself, and other government personnel and departments. The Sisters of Mercy filed the lawsuit in 2016 against then HHS Secretary Sylvia Burwell.

Their lawsuit pertained to 2016 amendments to section 1557 under Title IX of the Affordable Care Act, which stipulated that it was unlawful for any health program or activity that receives federal financial assistance to deny transition-related care.

The rule omitted religious exemptions. HHS argued that a religious exemption “could result in a denial or delay in the provision of health care to individuals and in discouraging individuals from seeking necessary care, with serious, and in some cases, life threatening results.”

A lower court struck down the rule in January, 2021, in essence because it violated the plaintiffs’ religious freedom. The Biden administration appealed the decision in December of that year, and on December 9, 2022, a federal appeals court affirmed the lower court decision, which the Biden administration elected not to appeal by the June 20 deadline.

HHS did not respond to a Crux request for comment on its decision not to appeal.

On the Biden administration’s decision not to appeal, Luke Goodrich, vice president and senior counsel at the Becket Fund for Religious Liberty, who represented the plaintiffs, emphasized the importance of doctors not being forced to act against their consciences.

“After multiple defeats in court, the federal government has thrown in the towel on its controversial, medically unsupported transgender mandate,” Goodrich said in a statement. “Doctors take a solemn oath to ‘do no harm,’ and they can’t keep that oath if the federal government is forcing them to perform harmful, irreversible procedures against their consciences and medical expertise.”

This is the second time the Biden administration chose not to appeal a federal court ruling against the gender-transition care mandate. In the previous case, Franciscan Alliance v. Becerra, a federal court issued a similar ruling on August 26, 2022, that the mandate violated the plaintiffs’ religious freedoms.

Goodrich noted that the decisions in both cases being put to bed is a win for religious doctors.

“These religious doctors and hospitals provide vital care to patients in need, including millions of dollars in free and low-cost care to the elderly, poor, and underserved,” Goodrich said. “This is a win for patients, conscience, and common sense.”

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