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QUESTION: As a Christian and a medical professional, what am I to do when seeing patients who are going through methods to transition genders? My work in endocrinology has included procedures that aid transitioning. I may also need to train the patients how to inject themselves with hormonal treatments. I am uncomfortable because I know those transitioning are using their God-given bodies in a sinful way. Am I guilty of complying with sin and/or condoning it, thereby bringing guilt upon myself? I love my Lord. I love my job. Can I keep my current vocation and do it in a God-pleasing way?

ANSWER: We have reached a stage in our culture in which ideology has taken center stage. While the “opinio legis” drives us to look for absolute (black and white) answers to complex problems, the complexity of problems should compel us to step back and carefully consider what is going on, and what we want to accomplish. Few answers can truly be considered black and white.

In this kind of a scenario there are a lot of moving parts that tend to become overwhelming.

The Sin

You appear to have correctly identified the sin – a patient rejecting the biological sexual assignment from God.

Culpability

It is typical, upon identifying a sin, that we want to ascribe guilt based on proximity. What I mean by that is that we wrestle with our own culpability based on someone else’s desire to sin. The counselor who counsels for transition surgery appears to be more culpable than the janitor who cleans the counselor’s office. The surgeon who does the surgery (and profits from it!) seems more culpable than the taxpayer who pays the taxes that built the roads that lead to the surgery center that does the surgery. The parent or friend who has encouraged the patient to engage in this sin seems more culpable than the acquaintance, coworker, or classmate who sensed something was wrong, but couldn’t put a finger on it.

With this line of thinking we can draw a few hard and fast lines depending on proximity. As this applies to abortion, for example, we want to penalize the abortionist, but not the friend who talked the mother into getting the abortion. In the case of your vocation, we would lay a higher level of culpability on the counselor and the surgeon directing the process than others who are required to serve in a “support” capacity to assure safety.

A Bigger Picture for an Unbeliever

I advocate a different perspective that is often lost in such debates.

The patient who does not believe in Jesus as his/her Savior will not instantly become God-pleasing in deciding against transitioning (Hebrews 11:6). The problem for an unbeliever, regardless of sexual inclination, is a busted relationship with God that cannot be resolved by righteous performance in life (Isaiah 64:6; Romans 3:10; Galatians 3:11). The proper solution, of course, is the administration of God’s Word (Romans 10:17). Therein lies a problem which I will address shortly.

A Bigger Picture for a Believer

We also encounter professed Christians who are pursuing some form of gender reassignment. Presumably, the Christian patient should know better, but doesn’t. For that patient, there needs to be an extended conversation about demonstrating allegiance to our Creator and Savior with our lives. Therein lies the same problem as dealing with the unbeliever, so now let’s look at the problem.

The Problem

We are New Testament believers in God, who have changed eternities through Jesus Christ. Our desire to live rightly, and to encourage other believers to live rightly, stems from a desire to demonstrate appreciation for what God did for us in Christ. Any act contrary to the word of God suggests less than genuine appreciation for God’s sacrificial love, and likely suggests a misunderstanding of how we show that appreciation.

The problem, however, is that both enlightenment (for the unbelieving patient) and correction (for the believing patient) require some sort of distinctly Christian communication, and that has become verboten in today’s culture.

Many Bible-believing health care professionals have found themselves not only in what feels like compromised circumstances but are now muted in their expressions of faith. They report that they can no longer wear cross necklaces, lapel pins, or earrings. They have been instructed to avoid all expressions of religious beliefs in their offices, waiting rooms, and examination rooms.

The problem, simply stated, is that we find ourselves muted in these encounters; forbidden by policy to share our faith – or so it would seem.

A Possible Solution

Over the years we tended to become formalistic in the way we thought about witnessing to our faith. I think, for example, about “God’s Great Exchange” which has us walking through a conversation to help a prospect face eternity. I think of when I signed up for my congregation’s evangelism program, and it immediately involved memorizing a few dozen passages. Such approaches, while well-intended, miss the point of how we are to prompt a spiritual discussion.

Peter wrote this way about sharing our faith:

But in your hearts revere Christ as Lord. Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect. (1 Peter 3:15)

Instead of initiating the conversation and massaging its direction to talk about “God’s Great Exchange,” we see here that there is something about the way we live, talk, and act that suggests a confidence and certainty that otherwise evades people.

In other words, if policy prevents a person from initiating the conversation, then wait for it to come from the patient.

Making Things Happen

When Jesus sent the disciples out in a hostile world, he instructed them to be as shrewd as snakes and innocent as doves (Matthew 10:16). What that looks like undoubtedly varied depending on the circumstances and even the personality of the disciple.

I find it interesting that the Greek word used for “shrewd” in Matthew 10:16 is the same word used in Luke 16:8 to describe the “shrewd” servant who juggled the books to earn favor with others. The word suggests performing a responsibility with a sense of self-survival in how to do it. Put simply, doing the work of God with the shrewdness of snakes means we recognize that many circumstances are challenging. Whereas in one circumstance we might get away with shouting out the Gospel with boldness, in another circumstance we hold back, waiting for a better time. It involves a strategic or prudent way of thinking.

Likewise, the “innocence” of doves involves a word that implies genuine “goodness” in the way Scripture defines goodness – namely, a comparable or greater concern for others than for oneself (Matthew 22:39; Philippians 2:3-5).

Put in a practical way: Someone in your circumstance needs to be so concerned about the patient’s relationship with God that you need to muster all of your imaginative resources to display the hope you have through Christ in the way you live your life and perform your job.

To that end I have some suggestions:

I can’t believe I am listing this first, but perhaps a well-placed tattoo might be in order. A cross tattoo or a Bible passage seems like low-hanging fruit here, which may likely not invite much of a conversation and may be required to be covered when meeting with patients. Consider this example I encountered a few years ago:

My wife, Diane, and I were having dinner. Our waitress was either late high school or early college aged. She reached across the table to place something down, and I noticed a peculiar tattoo that ran on the back side of her hand, in the soft area between the knuckles of the thumb and index finger. It was red, indicating it was a very recent tattoo, and it looked like someone’s very shaky or sloppy signature.

That peculiar tattoo prompted me to ask her about it and she explained, and I am trying to recall her words as exactly as I can: “My grandma and I were very, very close. Near the end of her life, she became frail and forgetful. She sent me a card for my birthday and died shortly after that. This tattoo is her signature from that card. I wanted to be reminded of her every time I looked at the back of my hand. I loved her very much and look forward to seeing her in heaven.” It was a terrific example of expressing the hope that she has, and also inviting the conversation, without initiating it.

Not everyone wants tattoos (including me), but other ways to invite conversation is to talk about a busy life tied to meetings at church, or volunteer work done at the church or any volunteer work in which Christian virtues (love, sacrifice, caring, etc.) are on display. Typically, people at this stage of the transitioning process got there in search of hope or stability in their life. To see it displayed in someone else may invite further conversation. A follow-up – over coffee, tea, or ice cream – would afford the early stages of relationship building and talking outside of the clinic.

But Are You Sinning by Aiding in Sin

A centerpiece statement we like to use in Christian bioethical decision-making is that Christian bioethics is the only field of study in which motive is the first determinant of right and wrong. If the nurse is only interested in earning a paycheck or specifically in aiding sin (i.e., “I believe in this cause so I will stand here on the frontline to support it”), then I would say sin is clearly involved.

If, however, she sees herself as a reflection of Christ, who paid taxes to those who committed sins in the way they collected money, and she permitted payment of taxes to a regime that used the money for sinful purposes, and who walked and dined with the prostitutes and tax collectors, all for the cause of reaching the lost, then she should continue.

You certainly can resign from your position and remove yourself from that setting. Many (maybe even “most”) would advise that. Yet, that may also be your mission field. And when those who have the Truth and the message of salvation abandon a field because of its embrace of sin, it leaves the field open to further reinforce the sin.

In the end, those who make the decision for transitional surgery are the ones who first must account for their actions. In some way we all facilitate sin. Sometimes we do so knowingly, but more likely out of a sense of necessity. Most of us support sin absentmindedly. All of this happens in a fallen world where we cannot avoid the tentacles of sin. For the bad judgments we made, the apathy we displayed, and the wrong choices we made, we find forgiveness at the cross. Our prayer is always for a pure heart in our service to God. Even Paul found the effort frustrating because of his lapses. Nevertheless, with the right motivation, you can be a “light in the darkness” for some or one.

I know this is a lot of words. Sorry about that. As I said early on, the challenges today are complex. They invite a lengthy answer.