Franciscan Alliance v. Becerra

Becket Role:


Decision Date:
August 26, 2022
Deciding Court:
U.S. Court of Appeals for the Fifth Circuit

Case Snapshot

A federal mandate issued in 2016 as part of Obamacare requires doctors and hospitals across the country to perform gender-transition procedures on any patient, including a child, even if the procedure violates the doctor’s conscience and could harm the patient. Becket has challenged this unlawful mandate on behalf of an association of over 19,000 healthcare professionals and two religious hospitals, seeking a ruling that protects patients, aligns with current medical research, and ensures doctors aren’t forced to violate their religious beliefs and medical judgment.


In 2021, a federal district court permanently blocked the transgender mandate. And on August 26, 2022, the Fifth Circuit Court of Appeals unanimously affirmed—ruling that doctors must be free to practice medicine without being forced to perform controversial gender-transition procedures in violation of their conscience and experienced professional judgment.
Franciscan Alliance

Case Summary

In May 2016, the federal government issued a mandate requiring that virtually every healthcare provider in the country be willing to perform and provide insurance coverage for gender-transition procedures. The mandate made no exception for providers who believe those procedures to be harmful or object to them on religious grounds, and it applied to all patients, including children.

The mandate elevated ideology over medicine. A growing body of research shows there significant risks with gender reassignment therapy, such as heart conditions, increased cancer risk, and loss of bone density. Moreover, most children who experience gender dysphoria grow out of it naturally without these invasive and irreversible procedures. So under the mandate, many doctors were being required to violate not only their religious beliefs, but also the Hippocratic Oath, on pain of draconian penalties.

An association of over 19,000 healthcare professionals, eight states, and two religious hospitals challenged the mandate in the federal court for the Northern District of Texas. (A similar suit, involving other challengers, was filed in North Dakota). In December 2016, the Texas court issued a preliminary ruling that the policy was an unlawful overreach by a federal agency and a likely violation of religious liberty. And in October 2019, the court confirmed its earlier ruling, explaining that doctors must be free to practice in their field of medicine without being forced to perform these controversial procedures that violate their faith.

The court did not, however, issue an order permanently stopping the government from imposing this unlawful mandate on religious hospitals and doctors. Becket therefore appealed on behalf of the challengers. In April 2021, the U.S. Court of Appeals for the Fifth Circuit ruled that the district court should consider further whether to grant that lasting protection.

Back at the district court, in August 2021, the judge granted the permanent relief the doctors and hospitals sought. The federal government and ACLU appealed. Then, on August 26, 2022, the Fifth Circuit unanimously affirmed the district court, permanently protecting the freedom of doctors and hospitals to care for all patients in accordance with their conscience and experienced professional judgment.  

Importance to Religious Liberty:

  • Individual Freedom: The freedom of conscience is the human right to believe, express beliefs, and act according to the dictates of an individual’s conscience. Becket defends the right of all individuals to live according to their consciences without government coercion.

Case Information

Becket Role:
Case Start Date:
August 23, 2016
Deciding Court:
U.S. Court of Appeals for the Fifth Circuit
Original Court:
U.S. District Court for the Northern District of Texas
Practice Area(s):