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Luke’s Journal July 2026  |  Vol.31  No.2  |  Sexuality

Christian medical professionals sometimes feel they walk a tightrope, balancing Biblical truths that shape our worldview, and the increasingly secular positions taken by governing medical and legal bodies. The threat of being sued under the amended Sex Discrimination Act (SDA) of 2013 has been brought to the forefront of Christian minds by the Federal Court’s decision in Giggle for Girls Pty Ltd v Tickle [2026].¹

Medicolegally, AHPRA has recently engaged in the practice of ‘name and shaming’, where investigations are publicly announced before due process to determine innocence or guilt can be properly conducted. This risks tarnishing the reputation of a medical professional without allowing the thorough process of investigation and appeal.² While a large majority of aspects in the SDA and the powers of AHPRA are healthy and necessary to protect the rights of different groups of Australians, it has also cast a shadow of fear over the careers of Christian healthcare professionals.  These are clinicians motivated by a desire to support the physical, mental, social and spiritual health of their patients.

Dr David Mackereth, a British Medical Doctor who worked for the Department for Work and Pensions (DWP), lost his employment after refusing to use a patient’s preferred pronouns. The 2022 case ruled that:

“belief in Genesis 1:27, lack of belief in transgenderism and conscientious objection to transgenderism in our judgment are incompatible with human dignity and conflict with the fundamental rights of others, specifically here, transgender individuals.”³

In an article by HuffPost, the author details how a reporter’s use of a transgender woman’s government name “violated a deeply personal boundary that perpetuated the single most harmful misconception about trans people… that our true gender identities — who we are at our core — are the ones we were assigned at birth.”⁴

Who we are at our core. Human Dignity. True Identity. The choice of these words is important to observe before we dive deeper. While formulating one’s identity around an aspect of one’s life is not unique to the LGBTQIA+ community, these are terms the community associates with their sexuality.  Any questioning or evidence-based concern raised — whether intentional or accidental — is amalgamated with assault towards their individual and communal identity, dignity and value.

“Who we are at our core. Human Dignity. True Identity. The choice of these words is important to observe before we dive deeper.”

The discussion around the use of preferred pronouns is not a standalone issue but fundamentally points to an underlying distinction between the worldly and godly perspectives on identity. We as Christians view the fundamental concept of identity not as based on relationships between human beings, but based on the relationship between humans and God. So, what God declares about the identity of our patient, whether or not they profess belief in their Maker, should formulate our response.

Ultimately, the two questions I hope to address are:
How does that inform our decision on whether to use someone’s preferred pronouns?
How does the Bible describe the identity of all people (even those who do not believe in Him)?

Identity as Creation

One of the first passages that explores the concept of identity is found here:

“So God created mankind in his own image,
  in the image of God he created them;
  male and female, he created them.”
(Genesis 1:27 NIV)

Among the riches of this passage, three concepts are held simultaneously:

1. Created in His Image

“Bliss” is the name of the infamous Windows XP background that occupied the consciousness of millions of minds across the globe. However, the photograph by Charles O’Rear only reflects the simplicity and beauty of Northern California’s landscape. As you stare into its wonder, you can begin to ponder and imagine yourself walking along that hill, watching the clouds sweep by, as the blades of grass brush your feet.

Just as the image of the hill merely reflected the bliss of the hills themselves, the purpose of mankind being made in His image is to reflect and point back to the wonders and glory of God. The goodness of creation is designed to reflect the goodness of God.

However, our sin has distorted that image. The evil of mankind has smeared faecal matter on the beautiful image of Bliss. And the calling for all people, no matter what sex, race, class, or background, is to repent of their ways and call on God to wipe away the stain we have so willingly smeared on ourselves, to then find ourselves being able to boldly proclaim that we “have taken off (our) old self with its practices and have put on the new self, which is being renewed in knowledge in the image of its Creator” (Colossians 3:10).

2. Created with Value

As Creator, God has the unique and sole authority to declare the worth of mankind. All individuals, whether they profess His name or not, are imbued with value and dignity not because of who they are or how people see them, but because God has created them.

In 1 Peter 2:17, when Peter writes to the exiles of Pontus, Galatia, Cappadocia, Asia and Bithynia, he calls them to “show proper respect to everyone”. The word respect comes from the Greek root word timaó. This root word is also found in passages that call Christians to “honour (tima)” their mother, their father (Matthew 19:19), Jesus Christ, and God the Father (John 5:23). One of the ways we are called to honour our Father is by showing honour to those our Father has fearfully and wonderfully made.

“One of the ways we are called to honour our Father is by showing honour to those our Father has fearfully and wonderfully made.”

Honour and respect are not due because one’s actions deserve it, but because one’s worth is inherent and God-breathed. As such, during our interactions with patients, although our own understanding of the truth must occupy centre-stage of our minds, it is important that respect is still extended in all conversations and interactions because, despite their rejection of God, God is ultimately still their Maker.

3. Created Male and Female

And yet, we cannot escape the fundamental truth proclaimed in Genesis 1:27, despite our own reservations and our desire to treat people with respect. That God has created the male and female sexes, and has called it good. The male and female sexes were designed, like much else described in Genesis 1, to reflect the glory of God.

With a bit of imagination, picture one day when Christ the groom comes back to Earth. The heavens open, the old becomes new, and the bride of Christ, who has longed with deep expectation, finally gazes upon her groom in His fullness and wonder, in complete awe. The perfect wedding has finally come. And Christ turns to us and says, “Men and women, marriage, it was meant to point to this very moment here.”

A component of the truth God has given us is found in this: male and female sexes are real. They are godly and God-given. They are beautiful. We glorify God when we dwell upon and engage in their riches.

This does not deny the reality and lived experience of intersex people, and a helpful quote from Jennifer Anne Cox’s 2018 Publication “Intersex in Christ” summarises it beautifully:

“…this does not necessarily imply that people who are unambiguously sexed are closer to the image of God than those who are intersex…to intersex believers, I want particularly to emphasise that you are acceptable to God without alteration, because you are created in His image, made because of love, and are valued and dignified as an intersex person.” ⁶

With these truths held together, the battle is set. While we must treat all our patients with respect and dignity because of their innate worth as God’s creation, we must also imprint Biblical truths on our hearts and call all people not to a self-tarnished standard, but to a godly standard.

Practical Guidance on Navigating Pronouns

Now, with all the suspense that has been generated, I want to make a disclaimer that I do not have an answer on whether or not it is always necessary to directly address a patient’s desire to use different pronouns. While our beliefs about sexuality should be unambiguous, gospel ethics are somewhat vague on whether there is a ‘right time and place’ to address it, or whether it should be addressed at every possible moment, even when it feels awkward or ‘uncalled for’.

With that being said, hopefully these practical tips help navigate this tightrope that has been set up for us:

1. Use their Names

Names are utilised as a point of convention. While my given name is Josias, I will sometimes introduce myself as Joe. Hopefully, you can agree with me that this does not introduce major theological tensions. Therefore, instead of saying

“Kate is a 45-year-old female. They need…” you could say, “Kate is a 45-year-old female. Kate needs…”

In most conversations with patients the pronoun “you” can be used in the majority of situations, sidestepping the issue in the short term. Over time, a relationship may be established and built to the point where a spiritual conversation can be engaged in as a free conversation that allows for discussion, and may prepare a place for a seed of the gospel to land.

2. The Patient’s Desire for Preferred Pronouns should never affect Quality of Care

From a medicolegal standpoint, when a patient is treated negatively or with a lower standard of care because of their gender identity or identified sex, this is considered direct discrimination. Not only can this open up the potential for lawsuits, but it also goes against the Biblical concept discussed above, since we are called to treat everyone with respect because God has created us all.

Even if you are insulted or cursed at, the calling of 1 Peter 3:9 does not dissipate, for:
“Do not repay evil with evil or insult with insult. On the contrary, repay evil with blessing, because to this you were called so that you may inherit a blessing.”

3. Prepare an Apology

“Always be prepared to give an answer (apologia) to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect, keeping a clear conscience, so that those who speak maliciously against your good behaviour in Christ may be ashamed of their slander.“ (1 Peter 3:15b-16 NIV)

The word apologia used in 1 Peter is not a mea culpa of our views, but is synonymous with defence, a well-reasoned reply, and a thought-out response.⁷ If a patient or a colleague asks you, “Why don’t you  use my requested pronouns?”, a potential defence could be:

“I honour you, and I care for you as someone who was made by God. Out of that care, I believe a much more wonderful and rich identity – who you truly are – is found when you know that God loved you so much that He sent His one and only Son for you.”

In prayerful consideration, have a thought-out response that is tailored to the patient or colleague before you, and do so with gentleness, respect and clarity of truth, so that no one may accuse you.

While the way you communicate may be tailored to what works best in each situation, the Biblical principles must remain constant.  Even if you are accused, may the truth of God be more important than the judgment of the people around you. Hold firm. Stand upright. And may the God of grace and peace guide you in all things.

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1. Abraham P, Kennett J. Giggle for Girls Pty Ltd v Tickle. 2026.
2. Burge K. AHPRA enacts power to publicly name practitioners [Internet]. NewsGP. 2025 [cited 2026 May 25]. Available from: https://www1.racgp.org.au/newsgp/professional/ahpra-enacts-power-to-publicly-name-practitioners
3. Eady DBE J, Bleiman D, Smith DG. Dr David Mackereth v DWP and Anor. 2022.
4. The Establishment. Deadnaming A Trans Person Is Violence — So Why Does The Media Do It Anyway? [Internet]. HuffPost. 2017. Available from: https://www.huffpost.com/entry/deadnaming-a-trans-person-is-violenceso-why-does_b_58cc58cce4b0e0d348b3434b
5. Bliss. [Photograph]. Microsoft; 1996 [cited 2026 May 26]. Available from: Windows XP operating system.
6. Cox JA. Intersex in Christ : Ambiguous Biology and the Gospel. Eugene, Oregon: Cascade Books; 2018.
7. Bible Hub. Strong’s Greek: 627. ἀπολογία (apologia) – a speech in defence [Internet]. biblehub.com. [cited 2026 May 26]. Available from: https://biblehub.com/greek/627.htm