And again, departing from the coasts of Tyre and Sidon, he came unto the sea of Galilee, through the midst of the coasts of Decapolis. And they bring unto him one that was deaf, and had an impediment in his speech; and they beseech him to put his hand upon him.

And he took him aside from the multitude, and put his fingers into his ears, and he spit, and touched his tongue; And looking up to heaven, he sighed, and saith unto him, Ephphatha, that is, Be opened.

And straightway his ears were opened, and the string of his tongue was loosed, and he spake plain.

And he charged them that they should tell no man: but the more he charged them, so much the more a great deal they published it; And were beyond measure astonished, saying, He hath done all things well: he maketh both the deaf to hear, and the dumb to speak.

Mark 7

By now you have probably heard the news that BYU[1] has prohibited providers at its speech therapy clinic from providing gender-affirming speech therapy to transgender patients on the basis that providing such therapy does not align with LDS Church policy. Shortly after BYU’s actions were made public, the American Speech-Language-Hearing Association (“ASHA”)–the national organization that accredits speech pathology programs and certifies speech-language pathologists (SLPs)–released a statement indicating that BYU’s decision was both contrary to ASHA’s code of ethics and a violation of health privacy laws.  

I’m not an expert on rules governing publicly-funded, private religious universities like BYU and how they intersect with the First Amendment, and I am also not familiar with state or federal civil rights protections for transgender individuals. So I’m not going to address the legality of BYU’s actions. I am also not at all an expert on or spokeswoman for the trans community, it is an area that I am still learning about, and I welcome any direction to responses and articles from that community.** I don’t want to take away from that. But I do want to put out some thoughts on what I think is, and is not, at issue in this decision and hear from our community here about it.

What’s Not At Issue 

Non-Gender Affirming Care. My current understanding (as reported in the Trib article) is that BYU is not denying services to all transgender clients. If, for example, a trans woman was seeking treatment for a cleft palate or stutter, she would not be denied treatment. If, however, she was seeking treatment to change the pitch or tone of her voice, she would be. This means that BYU will frame the issue not as denying care on the basis of gender identity (i.e., it is not denying care because a patient is transgender) but as declining to provide treatments where those treatments conflict with Church policy (based on religious freedom). I imagine they’ve done this carefully to avoid legal problems: they aren’t discriminating on the basis of gender identity, they are just declining to provide certain kinds of treatments.   

I still think what BYU is doing is awful, and I’m not trying to defend it, and I’ll get to that. But I think it’s important to clearly understand what BYU is and is not doing right now so that we don’t give people strawmen arguments to throw down. If, however, this situation changes, I think that’s a significant change. 

Individual Religious Freedom. For those crying “religious freedom”, I’ll say this: BYU’s decision is not about a person’s ability to freely practice his or her religion.  From what I understand, none of the SLPs were being forced to provide gender-affirming speech therapy to transgender patients against their will or in contradiction to their own religious beliefs.  In fact, what I’ve read suggests that they are very upset about the decision and would prefer to continue providing such services. 

This decision is also not about a church’s ability to determine criteria for its own membership or proclaim its own beliefs. I do not believe the transgender patients were BYU students and so this is not about BYU enforcing its honor code against its own student population. It is about BYU deciding that clinics open to the public will deny medical services to the public if it deems those medical services to be inconsistent with its sponsoring religious institution’s policy, and asking a school medical clinic to go against the applicable standard of care and to violate the relevant professional organization’s code of ethics.  

So, whether or not BYU’s behavior here is protected by the First Amendment or shielded by religious exemptions, I don’t find the religious freedom issue here to be particularly compelling in light of the many other interests that BYU is trampling with this decision. 

The Commandments.  I’m not aware of a commandment that says Thou Shalt Not Help Someone Change Their Voice. BYU cites the Handbook as the basis for this decision, because the handbook states that Church “leaders counsel against social transitioning,” which they define as including “changing dress or grooming, or changing a name or pronouns, to present oneself as other than his or her biological sex at birth.” It doesn’t mention vocal therapy, but presumably this is the basis for BYU’s decision.  Well, the handbook also “discourages” tubal ligations and vasectomies, so I guess I didn’t realize that “counsel” and “discouragement” rose to the level of a commandment so critical that it requires this kind of decision.  People who have transitioned can be baptized with First Presidency approval.

BYU also contends that “gender is eternal”; while I won’t get into it here, many have convincingly argued that this does not mean that everyone’s biological sex matches their eternal gender. The handbook conveniently defines “gender” as “biological sex at birth”, which is literally not what “gender” means.  It also ignores that there are many variations in biological sex that can present at birth.  Blaire Ostler’s Queer Mormon Theology is a great read for more on this topic.  

The handbook also reminds us that “transgender individuals face complex challenges. Members and nonmembers who identify as transgender—and their family and friends—should be treated with sensitivity, kindness, compassion, and an abundance of Christlike love.” I know which provision I’d prioritize if I were in charge, but I’m not.   

What Is At Issue

The Trans Community’s Access to Medical Care.  One thing I think is critical to understand at the outset is that this kind of treatment is considered medical treatment for transitioning individuals.  I’ve seen a few inapt analogies online like “this is like someone trying to change an accent,” but that is not what is at issue here. I’m stealing this from a Facebook discussion I was part of, where someone explained (in response to a commenter characterizing these services as “elective”) that:

“I don’t know that any of us who haven’t been through it can begin to comprehend the dysphoria a transgender person experiences. Medical interventions that might seem inconsequential or unnecessary to you can in fact be lifesaving, which would therefore make them necessary. It can be difficult to see this when so often people portray gender dysphoria and transgender individuals as simply having a ‘tendency’ or a preference, rather than their gender identity being something genuinely inherent. Speech therapy services can be vital for a trans individual, whatever degree of transitioning they have chosen. Aside from all the benefits this can offer to the emotional and mental distress of someone experiencing gender dysphoria, there is also a safety component to consider. A female-presenting individual who speaks with a deep, masculine voice could be subject to bullying and violence from a transphobic antagonist. Same for a male-presenting individual who speaks with a higher, feminine voice.”

The Salt Lake Tribute article linked above also describes discrimination that transitioned individuals whose voice does not match their gender identity can face and the way this is considered medical care because, if individuals attempt to change the pitch of their voice without assistance, they may end up damaging their vocal cords.  

Other Students and Community Members Seeking Medical and Other Care. I hate “slippery slope” arguments, but I have to wonder where this particular line of reasoning will end. There are already issues with DMBA (the insurance provider for Church employees, including BYU faculty and students) refusing to provide coverage for birth control. What other medical treatment might be considered “condoning” things that are against Church policy? If an unmarried student goes for treatment for VD but does not commit to abstaining from sex, is the medical clinic to refuse treatment because otherwise they would be “condoning” premarital sex? If a student goes for treatment for drug or alcohol related health problems but likewise does not abstain–but will die without treatment–will the clinic refuse to continue “enabling” the drug use?   

And what about other services such as mental health services?  BYU’s comprehensive health clinic currently states that its services are provided “without regard to … sexual orientation … gender identity” and a variety of other protected classes consistent with federal law and, presumably, applicable professional standards.  Well, that’s great that they don’t discriminate on the basis of sexual orientation.  But what if a gay student goes for counseling for anxiety and the clear best thing for that student to do is to stop attending Church?  Or what if the student is dating members of the same sex?  Are the counselors in that clinic going to be constrained in the advice and care they can provide if what is in the students best mental health interest does not align with Church policy?  

How about other Church welfare services.  If my gay child and her wife are living in my household, will I be barred from visiting the bishop’s storehouse lest they eat some of the Church’s food?  

There is no good place to draw the line.  That is because no line should be drawn when it comes to love and service.  

BYU’S Accreditation & Reputation.  One thing this decision is demonstrating is that Jeffrey Holland wasn’t kidding when he said the University was willing to sacrifice accreditation in furtherance of its discriminatory objectives. I already mentioned above that ASHA is investigating this, and BYU is up for accreditation soon. 

This is a serious concern for students and faculty members currently in the SLP program and even people who have already graduated from the program, who may face difficulties finding employment.  I also wonder about other programs at BYU that are accredited by organizations with non-discriminatory codes of ethics and standards of care.  I’ve long thought that BYU’s social work and related programs are in jeopardy, and although they aren’t directly related to this decision, I think this brings them a step closer to the brink.  

Even if the school does not lose accreditation, this therapy is part of a well-rounded education and many have expressed concerns that employers will not want to hire them if they come from a program that does not offer the full range of training (let alone that chooses to cut training for discriminatory reasons in violation of ASHA’s code of ethics and standard of care).  I’ve spoken to many BYU grads in fields that serve LGBTQ+ populations who are concerned about the impact that BYU’s actions are having on their employment prospects. 

I don’t think this is unfounded: the very day that Holland gave his speech I had drafted an email to a former colleague encouraging them to recruit from BYU. Then the speech hit, and I hit “delete.” I knew that this employer would not want to recruit from an anti-LGBTQ university, and I also knew I didn’t want to ask them to.  I’ve also interviewed candidates from BYU who clearly were not comfortable in diverse environments and were turned down for that reason. While this is most acute in certain programs, I think it is a problem university-wide.

BYU’s “Enter to Learn, Go Forth to Serve” will ring a bit hollow if the programs it currently has that are actually oriented at helping marginalized communities–like those with speech and hearing impairments, or in need of a social worker–are cut.  

Privacy Rights.  ASHA’s statement also raised this issue, and I think it is a serious one.  HIPAA is a federal privacy law that protects medical information, and FERPA is a federal privacy law that protects student information.  As ASHA explains on its website, “It is never acceptable to disclose an individual’s LGBTQIA+ status, medical and surgical history, or sex assigned at birth to colleagues or those not directly involved in that individual’s care. According to the ASHA Code of Ethics, Principle of Ethics I, Rule P, we are to protect the confidentiality of our clients’/students unless ‘doing so is necessary to protect the welfare of the person or of the community, is legally authorized, or is otherwise required by law.’ Confidentiality is guarded by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), FERPA, and individual state laws.”

No one outside of care providers in the clinic should have known the sexual orientation or gender identity of the clinic’s patients, let alone what they were seeking treatment for.  BYU seems to have a history of sharing information between offices and departments where it is not appropriate to do so, but this one in particular is concerning. While it is possible that patients signed some form of information release, it seems doubtful that whatever information was provided in this case was within the scope of that release.  

The implications of this are, to me, alarming. What if a single woman went to the medical treatment for a routine exam and was found to be pregnant–would the clinic report her? I certainly hope not, but that scenario is not far off from what happened here.  

BYU’s Receipt of Federal Funding & Other Community Support.  Again, I’m not a legal expert on this.  But BYU currently receives significant federal funding.  That’s right–your tax dollars are going to an institution that declines to provide standard-of-care medical treatment if it determines that treatment contradicts the Church handbook.  (Your tithing dollars are, too, obviously.)  

I’ve also been thinking about BYU’s relationship with the community more generally.  I live and work in Provo.  There are some real challenges and headaches that come with living in a University town.  There are stresses to our infrastructure caused by the school and student population that aren’t borne by the school or students because the school doesn’t pay taxes and many of the students are non-residents and don’t pay, either.  Traffic, parking, roads, real estate, etc.  Now, there are also some awesome benefits to living in a university town–access to lots of great cultural and athletic events, camps, educational resources, and–yep–free clinics!  I think this is a fine partnership generally.  But if BYU starts picking and choosing which members of the community it’s willing to open its doors to and which standards of medical care it chooses to follow, that partnership gets very one-sided. Whoever those trans people who were shown the door are, their tax dollars and possibly their tithing dollars have gone to support BYU, and assuming they live in the area, they are part of the BYU community. I’m not OK with the way BYU is contracting the way it defines its community.  

Whether We Can Call Ourselves Christian.  Hyperbole?  I really don’t think so.  One of Jesus’s most beautiful roles was as a healer, and I posted above an account of giving the gift of hearing and speech to a man. The irony that BYU at the Church’s direction is denying healing and speech to a marginalized group–truly one of the most marginalized groups in our community, by the Church’s own admission in the Handbook–is astounding.  

So, too, is the idea that the Church is by its own choice shrinking the populations it is willing to serve because it insists on holding tight to its bigotry. We’ve already seen the demise of LDS Adoption Services (driven primarily, as far as I know, because they did not want to facilitate same-sex adoptions), and the serious retraction in services offered by LDS Family Services (as their therapists are constrained in the kinds of therapies they are permitted by the Church to offer). No number of new logos or name changes will make us look Christian in the face of such unchristian behavior.  

Jesus said, “Inasmuch as ye have done it unto the least of these my brethren, ye have done it unto me.” 

I believe it. 

Does BYU?


*My daughter’s favorite song is Speechless, which seems fitting here.

**Updating this to add additional resources as I find them:

BYU Chooses Fealty Over Ethics by Denying Voice Therapy to Trans Community

[1] I’ll generally say “BYU,” but I acknowledge that many–maybe most–of BYU faculty and administration could be unhappy with this decision. My guess is the decision was dictated from somewhere else.