UPDATE, December 20, 2:59 p.m.: This story has been updated to include comments from an official from the U.S. Conference of Catholic Bishops, who responded to a request for comment after Rewire’s deadline.

Acceptance can be a matter of life and death for transgender people. When they are accepted by their families, trans people are less likely to face a range of negative experiences, including attempting suicide. That hasn’t stopped the U.S. Conference of Catholic Bishops and other religious leaders from issuing an open letter that effectively encourages parents to reject their transgender children, and deny them access to gender-affirming care.

The letter, entitled “Created Male and Female: An Open Letter from Religious Leaders,” denies the existence of transgender people, claiming that “human beings are male or female and that the socio-cultural reality of gender cannot be separated from one’s sex as male or female.”

It appears to urge medical institutions to withhold gender-affirming care for children.

“Children especially are harmed when they are told that they can ‘change’ their sex or, further, given hormones that will affect their development and possibly render them infertile as adults,” the letter claims. “Parents deserve better guidance on these important decisions, and we urge our medical institutions to honor the basic medical principle of ‘first, do no harm.'”

Harper Jean Tobin, director of policy for the National Center for Transgender Equality, criticized the intrusion of religious judgment in medical care.

“They are urging parents and medical providers to withhold affirming psychological and medical care and to put off limits even the consideration of affirming psychological or medical care,” Tobin told Rewire. “That is medical malpractice.”

The letter’s assertions contradict leading medical organizations. In a brief to the U.S. Supreme Court in support of transgender student Gavin Grimm, the American Academy of Pediatrics, the American Psychiatric Association, the American College of Physicians, and 17 other medical and mental health organizations noted that “transgender children who live in accordance with their gender identity in all aspects of life have lower rates of depression compared to transgender children who have not socially transitioned.”

The U.S. Conference of Catholic Bishops with its unscientific claims continues to guide medical policy across the United States. Catholic hospitals, which account for one in six acute-care beds nationwide, follow directives issued by the Bishops that deem abortion and direct sterilization “intrinsically evil.” Hospital officials have cited the directives to deny gender-affirming surgery to transgender patients.

In an emailed statement to Rewire, Andy Lichtenwalner, executive director of the U.S. Conference of Catholic Bishops’ Committee on Laity, Marriage, Family Life and Youth, denied the letter calls upon parents to reject their transgender children.

“[A]t no point does the letter express any imperatives for parents. On the contrary, it expresses an imperative to the medical community to be honest with parents of children who struggle,” Lichtenwalner wrote. Without citing specific evidence, Lichtenwalner said there’s “considerable evidence that children who identify as transgender will naturally desist in this identification in time with the proper care and support. … Children who experience gender incongruence ought to be supported and protected in every way possible that is consistent with the truth of their sex. They deserve care and compassion, not experimentation.”

In a recent survey by the National Center for Transgender Equality (NCTE), respondents with supportive immediate families were less likely to report homelessness, serious psychological distress, and attempting suicide; 37 percent of respondents with supportive families had attempted suicide versus 54 percent of those with unsupportive families.

“The danger of advice like [the letter] for families is that it is giving parents who don’t understand what it means to be transgender and who are desperate for information and guidance for how to best protect the children that they love … the worst possible blueprint for what to do,” NCTE’s Tobin told Rewire.

While the USCCB letter calls for “compassion, mercy, and honesty” for the transgender people whose existence it simultaneously negates, the letter omits any mention of structural threats, like the killings of at least 26 transgender people in 2017.

“If people want to show compassion, or uphold the inherent dignity of transgender people, then they need to take some tangible steps that will protect transgender people from job discrimination, from housing discrimination, from actual violence,” Ross Murray, who leads religion-related work at GLAAD, told Rewire. “This year is on track to perhaps become the deadliest year for transgender murders, particularly transgender women of color, and to just make a reference to compassion but then in the next breath encourage parents to reject their transgender children, kind of perpetrates that same level of violence.”

One of the signers of the letter is Andrew Walker of the Southern Baptist Ethics & Religious Liberty Commission, whose book, God and the Transgender Debate, lays out religious arguments for rejecting trans people, as Zack Ford noted at ThinkProgress. Other signers included leaders from the Anglican Church in North America and the North American Lutheran Church, which split from the Evangelical Lutheran Church in America (ELCA) after the latter adopted more accepting policies toward LGBTQ clergy and parishioners.

Murray, an ELCA deacon, also founded the Naming Project, a faith-based camp for LGBTQ youth and allies.

“My message directly to transgender youth—and hopefully their parents are listening too—really is that God made you and knows you and loves you for who you are and who it is that you are becoming,” Murray said.

The Bishops’ letter appears consistent with Catholic hierarchical teachings on LGBTQ people. Pope Francis has compared transgender people to nuclear weapons in the threat they pose to humanity. But that doesn’t mean all Catholics agree.

“As a Catholic Sister, our faith compels us to honor the human dignity in each and every person, to take action to ensure that the sacredness of every life is respected, and to take steps to build a more inclusive society as Jesus did more than 2,000 years ago,” Sister Alison McCrary, a Catholic nun and social justice attorney in New Orleans, Louisiana, wrote in an emailed statement to Rewire. “We have an obligation to … end transphobia and discrimination based on gender expression.”