Tag Archives: John A. Di Camillo

Dysphoria and disorder: a tale of two disturbances

If a friend is debilitated by significant anxiety, stress, low self-esteem, and depression, we naturally want to help alleviate this dangerous dysphoria (profound state of unease, anxiety or dissatisfaction). But first we need to find out why our friend is unhappy. Dysphoria is usually a symptom of an underlying problem: tension at home, traumatic experience, sense of meaninglessness, chemical imbalance, pathogen, or other factor(s). It could also result from a combination of factors, which may be more or less severe and more or less persistent. We might say that dysphoria results from disorder: problematic symptoms arise from something that is out of its properly ordered state.

John A. Di Camillo, PH.D., BE.L.,

None of this suggests that our friend is at fault for causing the underlying disorder. It is likely that he or she has been victimized in some way, perhaps even by happenstance. There is nearly always some contributing cause outside a person’s own will or desires. So “disorder” is not a term that ascribes culpability to the person, but an objective identification of a problem. If we want to help our friend we need to know the underlying disorder.

When diagnosing mental health issues, psychologists and psychiatrists in the U.S. refer to a volume created and updated by the American Psychiatric Association (APA) called the Diagnostic and Statistical Manual of Mental Health Disorders, now in its fifth edition (DSM- 5). The World Health Organization maintains a comprehensive International Classification of Diseases (ICD). Health care providers and insurance companies in the United States currently make use of its tenth revision (ICD- 10) for diagnostic coding, and the DSM-5 classifications identify which ICD-10 codes to use for billing.

So let’s consider gender dysphoria, which is a lasting discrepancy between experienced gender and assigned gender. It is not mere gender nonconformity. The diagnostic term “gender dysphoria” was formally introduced in the DSM-5 only in 2013. In the previous edition of the DSM, the term was “gender identity disorder.” Why the change?

According to the APA, the rationale for the change was twofold. First, it aimed to remove any implication that the patient is “disordered.” Nonetheless, other mental health diagnoses with the term “disorder” remained unchanged, and the DSM-5 still uses the term “mental disorders” in its title. Second, it aimed to retain a diagnostic term without compromising the first aim. In fact, following the rationale of eliminating “disordered” connotations, the complete removal of gender identity disorder had been proposed; but a psychiatric diagnosis was still needed to enable access to and insurance coverage for “gender transitioning” counseling, hormonal interventions, and surgeries.

So the term “gender dysphoria” purposefully mutes the disorder and emphasizes the distress that results. The psychiatric problem is no longer lack of identification with one’s bodily sex, but rather the unhappiness associated with it. “Treatment” can therefore mean eliminating the dysphoria—not the underlying identification issue—by reinforcing the perceived gender through “gender-affirming” counseling, hormones, surgery, or all of these. Affirm the conviction and change the body to make the person feel better.

Masking the problem of an identity disorder by focusing on the consequence of dysphoria gravely undermines the possibility of authentic healing for vulnerable persons experiencing gender confusion. It reflects a fundamental misunderstanding of what it means to be a human person, who is a unity of body and soul. Maleness or femaleness is found in the unified, embodied person. There is no “inner self” that can be a distinct source of personal identity over and against bodily sex; rather, the convictions or desires of the mind might be at odds with the person’s embodied sexual identity. In fact, the DSM- 5 lists six criteria that can be invoked for a gender dysphoria diagnosis, five of which reference a “desire” or “conviction.”

Focusing on the dysphoria while attempting to deny the disorder demands reinforcing the disorder and mutilating the body to meet an imagined version of the “self” at odds with the person’s body-soul reality. This cannot bring authentic joy and fulfillment. The pastoral constitution Gaudium et spes of the Second Vatican Council reminds us that “man is not allowed to despise his bodily life, rather he is obliged to regard his body as good and honorable since God has created it and will raise it up on the last day.” Let us bear in mind the need to love and understand people experiencing gender identity confusion, while also helping them to understand and love their male or female bodies as beautiful manifestations of their authentic selves.

JOHN A. DI CAMILLO, PH.D., BE.L., is a staff ethicist at The National Catholic Bioethics Center in Philadelphia. He earned his bioethics doctorate and licentiate degrees at the Pontifical Athenaeum Regina Apostolorum in Rome.


Transgender tyranny and the defense of freedom

The Declaration of Independence begins with an appeal to the authority of “the Laws of Nature and of Nature’s God” — laws at once deeper and higher than those of the king, not subject to personal desires, and which no human law could contradict or modify.

John A. Di Camillo

John A. Di Camillo

This natural moral law enabled the Founders to assert their monumental claims “that all men are created equal, that they are endowed by their Creator with certain unalienable rights.” The right of liberty flowed from the natural moral law, authored by God, and could be asserted over and against human tyranny.

Now, 240 years later, liberty and equality have become twisted so as to undermine the natural law. On May 13, for example, the federal government issued a “Dear Colleague Letter on Transgender Students,” providing guidance on the interpretation and application of Title IX of the Education Amendments of 1972. The letter establishes, contrary to well-established science, that one’s “sex” is freeform, entirely up to one’s own “internal sense of gender.”

Schools must affirm whatever gender an individual “intends to assert,” with no need for a medical diagnosis or other evidence, on pain of fines, judicial action, or discontinuation of federal funding. On these grounds, boys simply claiming to be girls could enter girls’ bathrooms and changing facilities or play on girls’ sports teams.

On the same day, the government issued its final rule on Section 1557 of the Affordable Care Act, requiring any recipient of federal funding — such as physicians, hospitals and insurers — to provide or pay for chemical and surgical “gender transition” procedures. It gives people who have “transitioned” the same health care rights as people born in that gender. Violators may face action from the U.S. Department of Justice, civil action or the loss of federal funding.

These government interventions radically undermine two types of freedom: the authentic personal freedom of persons experiencing gender confusion or diagnosable dysphoria, and the freedom of religion and conscience of everyone else.

First, the freedom of a gender-confused person is subverted when society affirms a misconception of his or her identity. It traps the person in the slavery of a fantasy and makes it more difficult to accept reality, which is needed for integral healing. Increasing the availability of “reassignment” further restricts freedom: Knowledge of ready access to hormones and surgery distracts from and reinforces the underlying problem, offering an appealing but superficial “solution.” It makes the person less inclined to work at understanding and resolving the mistaken perception of having the wrong biological sex. It’s like affirming an anorexic woman’s perception that she is overweight, providing her with easy access to liposuction, and calling it “treatment.”

We cannot lose sight of reality. In a statement titled “Gender Ideology Harms Children,” the American College of Pediatricians recalls that sex is “an objective biological binary trait,” while gender describes an awareness of oneself as male or female. The former cannot be changed, while the latter is subject to influences that may clarify or confound one’s self-understanding. Believing oneself to be of a different sex than one’s biological sex is “at best, a sign of confused thinking,” and as many as 88% of girls and 98% of boys with such confusion accept their biological sex after puberty. Given this, and considering that suicide rates are 20 times higher in adults who have undergone “reassignment,” the College decries as child abuse “conditioning children into believing … impersonation of the opposite sex is normal and healthful.” A person is not freed by reinforcing self-misunderstanding.

Second, the freedom of conscience of all other persons is trampled by state demands that they become actors in others’ fantasies. The prevailing cultural and media narrative, reinforced by some clinicians who adopt a “gender affirmation” approach, and now by the coercive power of the federal government, would have others treat the confused person in accordance with his or her objectively distorted self-perception. The new guidance and regulations apply to entities that receive federal funding such as schools and hospitals, but this is only a first step toward imposing such standards on our entire society.

For the sake of the authentic freedom of persons experiencing gender confusion or diagnosable dysphoria, and for the freedom of all people in our great nation to live in truth, follow their consciences, and exercise religious liberty, we must pray and work to defend our freedoms against the tyrannical falsehood of gender ideology. In celebrating our independence this July, let us recall the laws of nature and of nature’s God as the source of all claims of liberty.

JOHN A. DI CAMILLO, BE.L., is a staff ethicist at the National Catholic Bioethics Center.


Four popes, two saints, one Church

JOHN DI CAMILLO: Catholic organizations must journey and profess with the cross . . .

John A. Di Camillo

John A. Di Camillo

Popes John XXIII and John Paul II were declared saints on April 27. Pope Francis presided and Emeritus Pope Benedict XVI attended. The canonization comes at a time of danger to religious liberty in our pluralistic and increasingly secularized country, with economic strains and laws that threaten the Catholic identity of health care ministries.

The words of these four pontiffs, from the Second Vatican Council to today, call on us to uphold the integrity of Catholic identity and mission and the natural moral law when collaborating with others.

In his encyclical Mater et Magistra (1961), John XXIII spoke clearly: “In their economic and social activities, Catholics often come into contact with others who do not share their view of life. In such circumstances, they must, of course, bear themselves as Catholics and do nothing to compromise religion and morality. Yet at the same time they should show themselves animated by a spirit of understanding and unselfishness, ready to cooperate loyally in achieving objects which are good in themselves, or can be turned to good” (#239).

He repeated this in his encyclical Pacem in Terris (1963). Make no mistake: We are called to be in the world, cooperating for the achievement of good while avoiding the commission of evil.

A life of activity in the world should not be a capitulation to evil, even when the latter is enshrined in civil law. In his encyclical Evangelium Vitae (1995), John Paul II wrote plainly about the dangers of a democracy “idolized to the point of making it a substitute for morality.” Citing Saints Thomas Aquinas and Augustine, he acknowledged the rightful role of civil law, including its limits: “Every law made by man can be called a law insofar as it derives from the natural law. But if it is somehow opposed to the natural law, then it is not really a law but rather a corruption of the law” (#72). There is no moral obligation to obey an unjust law; it must be opposed.

John Paul also wrote frankly about the intrinsic evils of direct abortion and euthanasia, and he addressed the cooperation with evil that may arise. He noted that “to refuse to take part in committing an injustice is not only a moral duty; it is also a basic human right” (#74). Nevertheless, we can legitimately work to limit evils in ways that might seem wrong at first blush. For example, Catholics may vote for a law that restricts abortion even if the law does not outlaw abortion. Collaboration with others to achieve good aims, even if it contributes to an evil indirectly, could be licit. However, direct participation in an evil or directly willing an evil “can never be justified either by invoking respect for the freedom of others or by appealing to the fact that civil law permits it” (#74).

In his 2005 encyclical Deus Caritas Est, Benedict XVI applied this concept of collaboration that preserves Christian integrity to the charitable works of the Church, which include her organized ministries: “It is very important that the Church’s charitable activity maintains all of its splendor and does not become just another form of social assistance” (#31). The Body of Christ cannot be reduced to state-defined “charities” and man-made measures.

Speaking last year to the cardinal electors in the first homily after his election, Pope Francis chose the same theme. Catholics and Church ministries must profess Jesus Christ crucified. If we do not, “we profess the worldliness of the devil.” We should beware of idolatrizing government standards, industry norms, professional standards, or any other human construct that might presume to supplant or subvert the Church’s mission — or to suppress the exercise of Catholic religious and moral precepts. Catholic organizations must journey, build, and profess with the cross, or they are worldly: “We may become a charitable NGO, but not the Church, the Bride of the Lord,” he said.

Aware of the challenges to religious liberty in our nation, let us heed the calls of John, John Paul, Benedict, and Francis to witness and profess Christ’s teachings in their integrity as we go about our work in the world. In a time of many needs and opportunities for collaboration, may we contemplate John’s words in Pacem in Terris: “Catholics who, in order to achieve some external good, collaborate with unbelievers or with those who through error lack the fullness of faith in Christ, may possibly provide the occasion or even the incentive for their conversion to the truth” (#158).

Our collaborative activities should not convert the Church to the world. May they always be occasions and incentives for the conversion of the world to Christ.

JOHN A. DI CAMILLO is a staff ethicist at the National Catholic Bioethics Center in Philadelphia.

Veiling the corporate instrument

John A. Di Camillo writes that sound ethics requires recognition of religious freedom . . .

John Di Camillo

John Di Camillo

The for-profit firm Domino’s Farms and its owner, Tom Monaghan, successfully obtained an order of injunction to protect them temporarily from the government’s unjust “preventive services” mandate, which requires that employers provide medical insurance for surgical sterilizations, contraceptives and abortion-inducing drugs.

The court order on March 14, 2013, invoked common sense: A business organization, regardless of whether it is considered a “person,” can be an extension of the beliefs, rights, and mission of its owners. A business entity is an instrument of individuals, regardless of whether it is for-profit, non-profit, or religiously affiliated.

This is clear when thinking about an organization’s identity and how it “acts.” It typically has a constitution or articles of incorporation, a mission statement, bylaws or protocols providing additional details on how its mission is to be accomplished. The acts of individuals with control over the company (owners, shareholders, corporate members, boards of directors, etc.) determine how the company acts. The individuals act on behalf of the company, and the company acts through the decisions of the individuals. For example, while “the company” is considered the employer of any employees, it’s clear that individuals make hiring and firing decisions.

In this light, consider the government’s response to requests for religious and conscience exemptions to the mandate. Despite a feeble nod to the religious liberty of some non-profit religious organizations with an exceedingly narrow religious exemption and a feigned “accommodation,” the government unabashedly claims that a for-profit organization can be compelled to do what its owners consider evil without violating the religious freedom of the owners.

The implication is that the organization is sufficiently distinct from its owners that there is no religious freedom conflict at all. This denies that an organization is an instrument of individuals. An organization, so the government seems to claim, creates a “moral responsibility shield” around its owners. The owner is not morally responsible for the company’s actions — there is only legal liability for the company’s illegal actions. Since the company’s existence depends on civil and contract law, there is no wrongdoing so long as the company obeys duly established procedures and statutes.

This legalistic reasoning has been recognized as faulty by U.S. courts in cases in which corporations are invoked as a liability shield to protect owners (and their money) when they act immorally. Of course, interpreting the civil law in this manner requires an appeal to morality that goes beyond the letter of the law: A criminal may be obeying all proper statutory protocol but for purposes that conflict with the spirit of the law, in other words, for immoral purposes. The owner may integrate his or her personal funds with those of the company to set up Ponzi schemes, hide assets, or otherwise “cheat the system.”

Courts have intervened in such cases to “pierce the corporate veil,” as it is termed in legal language, so that the individual is punishable for crimes or liable for debts that the letter of the corporate law might not otherwise indicate. The reasoning invoked is that the company has become indistinguishable from the individual running it. Just as an inert instrument such as a pen cannot be invoked to protect the moral agent from responsibility for written libel, so a company cannot be invoked to shield the individual from legal liability for criminal actions accomplished through the company.

How does this reality square with the government’s reasoning about for-profit companies and the preventive services mandate? Rather than piercing the corporate veil to rightly assign legal penalties for an individual’s immoral actions, it seems the government is veiling the corporate instrument to achieve its own immoral aims, quashing the religious liberty and conscience rights of individual owners. It is hiding the reality that business organizations are instruments of individuals so that it can dismiss the moral claims of those individuals.

It seems far too convenient and dangerous to pierce the corporate veil when an individual violates the moral law and claims the legal structure of a corporation as a shield, but then to veil the corporate instrument when the government wishes to impose immoral actions without interference from individual conscience and religious freedom rights.

On the one hand, government courts rightly pierce the corporate veil, transcending the strict letter of the law when an individual is acting immorally under the presumptive protection of the legal fiction of a business entity. Yet on the other hand, the government presumes to veil the corporate instrument, considering the organization to be a distinct agent held liable only to legal regulations — however immoral — in order to shut down conscience and religious freedom claims brought by individuals. Sound ethics and law require proper recognition of the moral conscience and religious freedom of every individual.

JOHN A. DI CAMILLO is a staff ethicist at the National Catholic Bioethics Center in Philadelphia.

Value-driven service and spending

John Di Camillo writes that we have the obligation to avoid compromising our faith and values . . .

John Di Camillo

The Riverbend Bed & Breakfast in Canada denied a double bed to homosexual couples and offered them separate rooms, citing their objection to abetting immoral sexual practices. It was sued for discrimination. Courts could not grasp the distinction between sexual orientation and practice. The business was fined and had to close.

Jim and Mary O’Reilly, Roman Catholic owners of the Wildflower Inn in Vermont, were sued after their events manager inaccurately informed a lesbian couple that the inn would not host receptions for homosexual marriages. To comply with anti-discrimination laws, the inn’s actual practice was to disclose the owners’ opposition to same-sex marriage but not to deny service. Nonetheless, under the settlement, the O’Reillys must pay $30,000.

Many argue that business owners’ and consumers’ beliefs and values should have no impact on economic decisions because engaging in commercial activity entails a tacit prohibition on manifesting religious belief or moral values. Yet this position constitutes implicit acceptance of the belief in a moral exemption for commercial activity and the value of material goods over spiritual goods.

In his encyclical letter Caritas in Veritate, Pope Benedict XVI instead reaffirms that economic activity “needs to be directed towards the pursuit of the common good” and therefore “must be structured and  governed in an ethical manner.” This is because “the economy needs [person-centered] ethics in order to function correctly.” We must acknowledge and participate in commerce as Christian witnesses, responding to Paul’s call “to live sober, upright, and godly lives in this world” (Titus 2:12) while ever mindful of his warning not to be conformed to this world (see Rom 12:2).

The social responsibility of businesses entails stewardship of resources, respect for employees and consumers, and promotion of the common good through policies, services and products. Benedict’s encyclical confirms that the consumer likewise “has a specific social responsibility, which goes hand-in-hand with the social responsibility of the enterprise,” because “purchasing is always a moral — and not simply [an] economic — act.” In a free market system, the array of choices means I might purchase a comparable quality product at a comparable price from a different vendor; and if, with minimal inconvenience, I can patronize the one that better promotes human dignity, then I am morally impelled to do so.

The practical impact of purchasing decisions on the behavior of a large enterprise is negligible if taken alone. However,  as the Holy Father notes in Caritas in Veritate, “global interconnectedness has led to the emergence of a new political power, that of consumers and their associations.” Consumers working together can acquire the clout of an investor and challenge injustices in business — this is the power of a boycott. Life Decisions International, which researches and publishes The Boycott List, claims that 287 corporations have withdrawn funding from Planned Parenthood as a result of the coordinated efforts of pro-family people, causing estimated losses of over $40 million.

Alternatively, consumers can actively favor businesses. Chick-fil-A Appreciation Day was a resounding success on Aug. 1. Over 650,000 confirmed RSVPs, showing strong support for the company’s CEO, Dan Cathy, who had affirmed the natural and biblical understanding of marriage. The company confirmed that it generated record sales that day, reflecting the constructive witness of consumers to good values while integrating multiple facets of human activity.

Given the relevance of morality to economic activity, is there an obligation to boycott every business that supports evil or to refuse every client who may abuse a service? An absolute yes or no would be reassuring but inaccurate. The clear imperative is never to do evil that good may come (as Paul tells us in his letter to the Romans), but cases of foreseen evil following from otherwise good or indifferent actions are more nebulous. The principle of material cooperation with evil provides helpful guidance but requires case-specific assessments about the moral distance of causal associations, the moral gravity of the evil, proportionate reasons, and other factors. Careful discretion and prayer must guide these practical judgments.

When it comes to business services and spending, we cannot participate in every good cause or prevent all possible evils. Yet each of us has the obligation to avoid compromising our faith and values, to object to unjust impositions of the civil law, to avoid misrepresentation and scandal, and to work ceaselessly to turn ourselves, our habits, our families, our work, our businesses, and our communities more toward the respect of a fruitful culture of life, recognizing and pruning away what is harmful as best we can.

John A. Di Camillo is a staff ethicist at the National Catholic Bioethics Center in Philadelphia.