Catholic organizations and medical professionals won’t be forced to perform gender-transition surgeries or provide insurance coverage for them after the Biden administration declined to defend the challenged “transgender mandate” federal rules with an appeal to the U.S. Supreme Court.

Becket, a religious-liberty-focused legal group, served as legal counsel for a coalition of Catholic organizations that represented hospitals, doctors and clinics in the case known as Sisters of Mercy v. Becerra.

In January 2021, a federal district court ruled that the intrusion on the Catholic plaintiffs’ free exercise of religion was sufficient to show “irreparable harm.” A three-judge panel of the U.S. 8th Circuit Court of Appeals in a Dec. 9, 2022, decision sided with the lower court’s ruling. The Biden administration had appealed the lower court’s ruling but did not ask the Supreme Court to hear a challenge to the appellate ruling by the June 20 deadline.

“After multiple defeats in court, the federal government has thrown in the towel on its controversial, medically unsupported transgender mandate,” Luke Goodrich, vice president and senior counsel at the Becket legal group, said June 21. “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 conscience and medical expertise.”

The ruling ends a long legal battle related to a similar rule issued under the Obama administration in 2016.

The Biden administration’s Department of Health and Human Services issued the contested rule in January 2021. It revised Section 1557 health-care rules under the 2010 Affordable Care Act to add “sexual orientation and gender identity” and “reproductive health care services,” including “pregnancy termination,” to existing “protections against discrimination on the basis of sex.” The rule also reversed Trump-era conscience protections that sought to allow medical professionals to opt out of performing procedures against their beliefs.

The rule changes meant that Catholic doctors would be forced to perform purported sex-change operations and that Catholic organizations would be forced to cover the procedures in their health-insurance plans.

The Catholic plaintiffs filed the legal challenge to the Biden administration’s mandate. The Catholic groups argued the mandate violated their religious freedom and their conscientious objections protected by federal law.

Plaintiffs included the Religious Sisters of Mercy and their health system and hospitals joined by the Catholic Benefits Association, the Catholic Medical Association, the University of Mary, the Diocese of Fargo, and Catholic Charities of North Dakota. They were also joined by the state of North Dakota.

Goodrich said the Catholic 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.”

“This is a win for patients, conscience, and common sense,” he said in a statement.

The U.S. Catholic Conference of Bishops condemned the federal rule in a July 2022 statement. The bishops objected to requiring health-care workers “to perform life-altering surgeries to remove perfectly healthy body parts.”

The bishops characterized the rule as “a violation of religious freedom and bad medicine.”

The mandate was challenged in another federal lawsuit, Franciscan Alliance v. Becerra, which resulted in the 5th Circuit Court of Appeals striking down the mandate in an August 2022 decision. The deadline to appeal that decision passed last November. In that case, religious medical groups, including Franciscan Alliance, Christian Medical and Dental Society, and Specialty Physicians of Illinois, had challenged the mandate.