PeaceHealth is based in Vancouver, with over 15,000 employees and 10 medical centers in Oregon, Washington and Alaska. It traces its history to the institution founded in 1890 by the Sisters of St. Joseph. On its website it describes itself as "the legacy of the founding Sisters" that "continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its mission."
Its system's Dec. 21, 2018 announcement described its history of employee health care coverage for transgender care.
"In 2016, prior to the filing of the Enstad lawsuit, PeaceHealth began the process of updating its employee medical plan," the healthcare network said. "Effective January 1, 2017, PeaceHealth's employee medical plan was changed to cover medically necessary transgender surgery as determined under Aetna's Gender Reassignment Surgery policy, a nationally-recognized guideline."
Brehany said Catholic institutions should not cover such services because "they are often provided based on the mistaken belief that one can and may change his or her outward bodily appearance in a significant manner to match an inner belief about 'true gender identity'."
Catholic ethics includes principles like "respect for the body as created" and "the inadmissibility of mutilating or destroying one's body or parts," he said.
Brehany's organization, the National Catholic Bioethics Center, does not provide medical or legal advice, but "ethical discernment" about bioethical issues based on Church teaching and the Catholic moral tradition.
For Cheryl Enstad, the result was "bittersweet" because the policy change did not go far enough.
"Our number one priority in bringing this case was to ensure access to gender-affirming care for transgender people, and we are pleased PeaceHealth changed its policy," she said. But we hope that PeaceHealth eventually removes the age-related limitation on coverage."
The plaintiffs in the lawsuit still objected to the amended policy because Aetna's gender reassignment coverage does not include mastectomies and chest reconstruction surgery as a treatment for gender dysphoria
Because Paxton is no longer a minor, the lawsuit cannot challenge the amended plan.
The PeaceHealth statement stressed its commitment to "an inclusive healthcare environment for all" and said it "does not discriminate based on sex, sexual orientation, gender identity or any other basis prohibited by applicable federal, state, or local law."
(Story continues below)
Subscribe to our daily newsletter
In its over 100 years of service, it said, "we have been dedicated to embracing and celebrating the diversity of our communities, our caregivers and the individuals we are privileged to serve."
Paxton's problems reportedly began around puberty, with poor functioning and withdrawal from activities. Attempts to treat depression had little effect, the northwestern U.S. news site Crosscut said.
Paxton claimed to have self-diagnosed gender dysphoria through self-research.
Paxton's doctor suggested the surgery, which took place in 2016. The family took out a second mortgage and used college fund money, but also paid $11,000 out of pocket for the operation.
Brehany said there is a need for caution in accepting minors' claims about their identity.
"Minors in particular should be protected from their own immaturity and from advocacy organizations who claim to have their best interests at heart," he told CNA. "The vast majority of minors resolve doubts about their gender identity by age 18. Interventions, such as puberty blockers, provided early in life make it harder to accept that biological sexual identity and can cause major health and developmental issues, including sterility."