The 8th Circuit Court of Appeals is expected to hear arguments Wednesday over whether a Health and Human Services mandate can force religious-based hospitals to perform sex-reassignment procedures that could cause "harm" to patients, plaintiffs say.

Earlier this year, President Joe Biden's administration restored federal protections for gay and transgender people, allowing them to sue for "sex discrimination" in healthcare. The Religious Sisters of Mercy, along with other faith-based hospitals and medical providers, argue its facilities "routinely provide top-notch care to transgender patients," contending the HHS mandate should not force it to provide potentially "harmful" procedures such as sex-reassignment surgery for minors.

"Those fighting the mandate are Catholic doctors, hospitals, and clinics who joyfully serve all patients regardless of sex or gender identity," according to a statement from Becket Fund for Religious Liberty, which served as legal counsel for the plaintiffs.

Despite two lower federal courts striking down the mandate as a violation of the Religious Freedom Restoration Act, the Biden administration appealed two previous cases.


In 2016, the Obama administration issued a rule imposing mandates, with threats of severe financial penalties, for doctors to provide gender-transition treatment to patients, including minors, even against a doctor’s belief the treatment would be harmful. Former President Donald Trump's administration altered the rules in 2020 to comply with the RFRA and court rulings, but this was blocked by other courts.

Biden's administration has relied on the 2020 Bostock v. Clayton County case, applying the Bostock ruling to Section 1557 and other statutes. Other federal agencies followed suit.

"The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation," said HHS Secretary Xavier Becerra, named as a defendant in the trial, in a May statement.

On Jan. 21, a district court for the District of North Dakota Eastern Division struck down the mandate.


"The decision to undergo gender reassignment therapy is a difficult and deeply personal one, and it is especially complicated and sensitive in the case of children," Becket wrote in a press release. "It is a healthcare decision that should be left between a family and their doctor, and not decided by politicians and government bureaucrats. "