Federal court blocks Biden transgender surgery mandate, which means doctors of conscience don’t have to do it


A federal appeals court in North Dakota has permanently blocked the federal mandate on doctors and hospitals, a mandate that would force them to perform “gender transition” surgeries and procedures against their conscience. The Biden administration is sure to appeal the decision to the U.S. Supreme Court.

The Eighth Circuit Court of Appeals decision in Sisters of Mercy v. Becerra is the second circuit court to block the federal mandate. In a related case, the the Fifth Circuit ruled similarly this year (Franciscan Alliance v. Becerra.)

The groups wanting to opt out of being forced to perform gender transition surgery include the Religious Sisters of Mercy; Sacred Heart Mercy Health Care Center, (Alma, MI); SMP Health System; University of Mary; Catholic Benefits Association; Diocese of Fargo; Catholic Charities of North Dakota; Catholic Medical Association and the State of North Dakota, which sued the U.S. Department of Health and Human Services the Equal Employment Opportunity Commission.

The hospitals’ case is based on religious freedom. The federal government, through the Affordable Care Act (Obamacare), says no institution that accepts federal payments for services may discriminate based on “gender.” That means that even patients covered by private insurance or are who are paying cash for services cannot be denied gender transition surgery at almost any hospital in America.

In May 2016, the government began implementing a mandate requiring a doctor  to perform gender transition procedures on any patient, including children, even if the doctor believed the procedure could harm the patient. 

The government required virtually all  privateinsurance companies and many employers to cover gender reassignment therapy or face severe penalties and legal action.

Two major insurance plans were exempted from HHS’s mandate — Medicare and Medicaid, plans run by the federal government.

Research shows these so-called “gender reassignment” surgeries have serious consequences, including heart conditions,  increased cancer risk, and loss of bone density. Other studies of children with gender dysphoria show that the vast majority of children with gender dysphoria outgrow their condition. The federal government’s panel of medical experts  concluded  these therapies can be harmful and advised against requiring coverage of them under Medicare and Medicaid. 

In 2020, the government attempted to fix the unlawful rule, but that effort was blocked by other courts.

A court  struck down the mandate in 2016. The federal government appealed to the Eighth Circuit, which heard oral argument on Dec. 15, 2021. A decision was expected in early 2022, but was released on Friday, Dec. 9, 2022, nearly a year later.

“The federal government has no business forcing doctors to violate their consciences or perform controversial procedures that could permanently harm their patients,” said Luke Goodrich, vice president and senior counsel at Becket. “This is a common-sense ruling that protects patients, aligns with best medical practice, and ensures doctors can follow their Hippocratic Oath to ‘do no harm.’”  

“Today’s victory sets an important precedent that religious healthcare professionals are free to practice medicine in accordance with their consciences and experienced professional judgment,” Goodrich said. “The government’s attempt to force doctors to go against their consciences was bad for patients, bad for doctors, and bad for religious liberty.”

The Biden Administration has 45 days to ask the Eighth Circuit to rehear the Religious Sisters of Mercy case, or 90 days to appeal to the U.S. Supreme Court. 

More information can be found at www.transgendermandate.org


  1. I saw a moving interview with a young woman who was lamenting having her breasts removed when she was thirteen. She said that, like people who have lost a leg can still feel their toes, she can still feel her missing breasts. I think every person, especially parents, considering gender transition surgery, should watch the interview.

  2. Yes, how can you force anyone to do something that is against their scruples, and call your movement “freedom “ ? I will reserve my right to do as I wish, not to do service to people that offend me in any way. I don’t have to use religion as a reason, either. Slavery was abolished. We are all free to do as we please, so long as we don’t impinge on someone else’s freedom to do the same. And those so called doctors who do mutilation on minors should be held responsible when they become adults and sue them.

  3. A small step in protecting doctors and at the same time preventing brutal child abuse. If that child still wants the procedures at 18yo, then he/she is free to make that decision.
    Let’s see if we can hang on to this victory.

  4. Now all Dr’s need to declare they refuse to do this and cite the same reason. These sick people need to get help and get a life!
    My Gosh if they spent the same energy on improving their lives instead of becoming a social pariah by choice things would be different.
    A move in the right direction in my opinion. Stop the sickness in its tracks.

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