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Bioethicist Proposes ‘Right’ to Gender-Affirming Care

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Wesley J. Smith
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It is important to keep an eye on mainstream bioethics journals, because seemingly ludicrous ideas that begin in the ivory tower often become public policy.

That has certainly been true in the transgender moral panic. A few years ago, bioethicists were pushing puberty blocking in their journals. And so it came to pass, to the point that the Biden administration pushes such “gender-affirmation” as official U.S. policy, pretending that the “science” is settled. (Thankfully, some countries are now hitting the brakes.)

An article published in the Journal of Medical Ethics shows that an idea is brewing that would conjure an absolute right to access medical-transitioning interventions. On what basis? A supposed right to “live with integrity.”

How does that work? Because people have freedom of religion, the author argues, transgender people have the right to receive surgery and medical interventions to live as “who” they really are. From, “Integrity and the Right to Gender-Affirming Healthcare:”

Many states permit exemptions to laws for those with particular religious beliefs. For instance (unlike non-Sikhs), Sikhs in the UK are permitted to ride motorcycles without wearing a helmet and to carry ceremonial daggers in public. In Sherbert v Verner the US Supreme Court ruled that individuals who refuse Saturday work due to their religious convictions cannot be denied unemployment compensation even though others who refuse such work without such conviction can be. Other religious exemptions involve exemptions from uniform policies (to wear headscarfs or jewellery). The most popular account of rights to religious exemptions grounds these rights in our right to live with integrity.

Without getting into the philosophical bases for the right, religious freedom prevents the state from forcing people to violate their religious beliefs. It does not require the community to provide the resources for — and means of — living faithfully.

But somehow this distinction is lost, as the author argues that accessing medical transition is necessary for transgender people to live “authentically.” And that requires the ability to “pass” as the sex they were not born:

Trans people are not generally treated in these ways socially until they look more like a member of the gender with which they identify than a member of the gender they were assigned at birth: they are not treated as a man/woman until they pass as a man/woman (at least in dominant social contexts). Passing is an important part of many people’s transition because their transition involves, for them, their being socially treated as a member of the gender with which they identify and passing enables this. And it is much easier for (many) trans people to pass if they have had certain kinds of GAH and some trans people can only pass with GAH…

This is because we are attributed a gender by others, in part, based on whether our facial features meet the stereotypes of either gender which are to a significant extent determined by the effects of oestrogen. Many trans women do not pass as women without facial feminisation surgery, but do pass with such surgery… And trans men may find it easier to pass with the masculine physique, facial hair and deeper voice that testosterone produces. In sum, to be able to be taken as a woman/man many trans women and men need GAH. So, for many trans people, GAH is essential to the transition which they desire and which enables them to live authentically, because this transition involves their being socially perceived and treated in certain ways and GAH is key to this happening.

The right to live authentically and with integrity would have no limiting principles, since it would be based entirely on subjective states of mind. We are already heading down that road, the author notes:

In Brazil free cosmetic surgery is given to the poor in order to enhance their well-being and/or their social and economic prospects—rather than to mitigate some harm.And in most European countries cosmetic surgery to alter physical features that are merely non-average—rather than physical features that cause any medical harm—is provided by public health systems

Those are (misguided, in my view) policy enactments that can be repealed or amended — not a right.

With regard to the transgender issue, a right to live with integrity would require gender-affirming puberty blocking and surgeries for children. It would also mandate free genital reconstructions be made available on demand, and once “safe,” entitle transgender women to uterine transplants — something which has already proposed — so they can experience gestation. And, I suppose, consistency would require that if one wanted to de-transition, the right to whatever interventions required to accomplish that goal would also have to be made available (although, somehow I would bet that that would not be included in the “right”).

Moreover, the right to live authentically and with integrity would not long be limited to transgenderism. For example, there is a condition known as body-integrity identity disorder (BIID), a condition in which an able-bodied person identifies as disabled. If medical interventions for transgenderism are a right, why not a right to be made disabled by having a doctor snip one’s spinal cord or amputate the right arm that the BIID sufferer thinks should not exist? Indeed, some are now calling this condition “transable” (get it?), and there have been bioethics articles arguing that such interventions should be deemed a proper form of care.

And what about a right to have implants to look more like an animal? Some people fixate on that and believe it is necessary to be their authentic selves.

Bioethics discourse is pushing us toward the supremacy of the subjective. Once again, attention must be paid because, over time, consensuses reached in bioethics discourse often becomes the bases for court decisions and legislation enacting such propositions — unless popular resistance forecloses these policies. Forearmed is forewarned.