VATICAN CITY — The prefect of the Dicastery for the Doctrine of the Faith, who recently appeared to some observers to support “sex change” surgery in especially difficult cases, has not responded to questions aimed at clarifying his comments.

Addressing via video link a theological conference in Germany in February, Cardinal Victor Fernández upheld the Church’s opposition to such surgery and gender ideology, but said, “We do not want to be cruel and say that we do not understand the conditioning of people and the deep suffering that exists in some cases of ‘dysphoria’ that manifests itself even from childhood.”

Noting “exceptional situations” of “severe gender dysphoria that can lead to unbearable suffering or even suicide,” he said these “must be evaluated with great care.” 

Some observers took his comments to be a contradiction of the DDF’s 2024 declaration Dignitas Infinita (Infinite Dignity). That document, which underlined the inherent and inalienable dignity of every person created in the image and likeness of God, was absolute in its rejection of “sex change” surgery, saying that “as a rule,” it “risks threatening the unique dignity the person has received from the moment of conception.” 

It adds, “This is not to exclude the possibility that a person with genital abnormalities that are already evident at birth or that develop later may choose to receive the assistance of healthcare professionals to resolve these abnormalities. However, in this case, such a medical procedure would not constitute a sex change in the sense intended here.” 

In his address to the Catholic Theological Faculty of the University of Cologne, Germany, Cardinal Fernández said he took “as a rule” to mean that the document did “not exclude the possibility that there are cases outside the norm, such as severe dysphoria, which can lead to an unbearable existence or even suicide” and so need to be very carefully assessed.  

He added that gender ideology, which often influences decisions to undertake genital surgery, “includes the denial of reality given as a gift, with the idea that sexual bodily identity can be the object of a radical change, always subject to the desires and claims of freedom of each individual, in the same way as the claim of omnipotence that lies behind gender ideologies.”

Cardinal Fernández’s address — primarily a defense of Dignitas Infinita against theologians and philosophers who criticized its use of the phrase “infinite dignity” — has been made available on the Vatican website as an official DDF document, but only in Italian and German.

The Register asked Cardinal Fernandez via email on April 2 and April 10 if he could clarify whether he believed “sex change” surgery was morally permissible in cases of severe dysphoria, what he meant exactly by “evaluate” such cases, and why his talk is not readily accessible on the Vatican website and only in Italian and German. 

The cardinal had not responded by the time of publication.

Responses to Address

Writing in the Italian-language Catholic daily La Nuova Bussola Quotidiana, Tommaso Scandroglio — an associate professor of moral philosophy who teaches at Schola Palantina, an online university focused on Western and Christian tradition — asserted that Dignitas Infinita permits such surgeries only when they are “aimed at confirming sexual identity, that is, when they are therapeutic, modifying the reproductive system in order to bring it into line with genetic data, which is the primary reference for understanding which sex a person belongs to.” 

“This explains why Dignitas Infinita uses the phrase ‘as a rule,’” he said. “It wants to affirm that in the majority of cases (as a rule) such interventions are to be condemned, except for those that are therapeutic in nature.”

But according to Scandroglio, Cardinal Fernández’s remarks imply that such interventions —  even when they “contradict sexual identity” — could be considered “licit” in cases of severe dysphoria involving “serious risks for the person.” In his view, the cardinal stops short of treating sex “change” as absolutely wrong, as Dignitas Infinita does, and instead suggests it may be “morally acceptable when the dysphoria is severe.”

Yet such surgical interventions are “intrinsically evil acts,” and “remain so regardless of the conditions that motivate them,” Scandroglio said. He warned that if the cardinal accepts the principle of saying “yes” to sex reassignment, “logical consistency will take us from borderline cases to common cases, from the exceptional to the normal.”

Edward Feser, professor of philosophy at Pasadena City College in California, said that to him, “it is not clear” what the cardinal means regarding what Dignitas Infinita “does not exclude” in such “exceptional situations.”

He sees at least two possible interpretations, the first being that while such surgery is not permissible because it tends to be motivated by the omnipotence of gender ideology that the cardinal mentioned, it could, in theory, be permissible “if such an ideology is not in view.”

“If that is what the cardinal is saying, then the remark cannot be reconciled with orthodoxy,” Feser told the Register. “A person’s sex simply cannot be changed, and he simply cannot be said to be in the wrong body or the like. The specifics of the ideology that might motivate a person to get such an operation are irrelevant.”

A second interpretation, he said, is that Cardinal Fernández is referring to dysphoria that is “not purely psychological but has a physiological aspect,” as Dignitas Infinita also states when it mentions abnormalities from birth, or what Scandroglio describes as “therapeutic in nature.” 

“While the cardinal’s later remarks do not make reference to this passage, it may be that that is the sort of case he has in mind as an ‘exceptional situation’ in which surgery is ‘not excluded,’” Feser said. “If this is what he means, then his later remarks are orthodox, but it would be good for him explicitly to confirm that,” he concluded.

Accepting the Truth

John Grabowski, director of moral theology and ethics at The Catholic University of America’s School of Theology and Religious Studies, read the cardinal’s ambiguous comments as an “unfortunate retreat from the relative clarity of Dignitas Infinita.” He said he understood the “desire to be charitable and pastoral in dealing with people, but charity has to be grounded in truth — both revealed truth on which Church teaching is based and the truth of reason available through science. 

“This misguided effort at compassion fails on both scores,” he said.

The term “sex change,” used in Dignitas Infinita and in the cardinal’s address, is a “misnomer,” he said, because changing that reality is a “theological and ontological impossibility.” He stressed that such surgery is “misguided” and that “the threat of possible suicide is something of a red herring in this regard.” 

Grabowski pointed out that “the most reliable, long-term studies we have” show that the suicide rate is “markedly higher” for people who undergo such medical transitioning (19 times higher than the population as a whole, according to a 2011 study). They are also “left scarred, infertile, permanently medicalized, and facing a whole new set of physical problems and challenges,” he said, with many finding themselves “dealing with the same psychological issues” that drove them to seek such surgery in the first place. 

Gender dysphoria, Grabowski asserted, is better understood as a form of “body dysmorphic disorder in which a person has a mistaken perception of their own body.” Anorexia is also in this family of disorders, he pointed out, “but we don't treat anorexia through chemical and surgical interventions which reinforce the misperception, for example, liposuction and appetite suppressants.” 

Instead, he said, “We offer psychological care to help them accept the truth and goodness of their bodies as they are. This is a better treatment model for caring for people struggling with the pain of gender dysphoria.”

Grabowski added, “I think that the cardinal would do well to reconsider his comments on this point.” 

Feser said the cardinal’s unclear comments draw attention to “a major problem” in connection with these matters, which is that “the rhetoric of human dignity too often eclipses considerations of what is simply the truth about human nature and the natural law that is grounded in it. 

“We need to start with the latter and then go on to give an account of human dignity, rather than starting with human dignity and then supposing that we can deduce from it what human nature and the demands of natural law amount to,” he said.

Feser said, “When the rhetoric of dignity is not first grounded in this way in a clearly worked out philosophical anthropology and ethics, it becomes vague and subjective and various doctrinally dubious conclusions can be drawn from it.”