September 28, 2022

Trans people should not have to ask doctors for permission, says activist

Abortion rights offer a good analogy for the trans experience

Doctors should not act as a gateway for people wanting to transition to the opposite sex, argues Canadian trans scholar Florence Ashley in the Journal of Medical Ethics. Trans people are not mentally ill and should only need to give their informed consent to medical procedures.

They (Ashley's preferred gender pronoun) contend that it is insulting and dehumanising for doctors to object to the intentions of trans people.

“If I were to doubt that person’s claim without serious reasons to believe otherwise, I would be committing an injustice because I would unjustly fail to recognise their authoritative knowledge of their own experience of the world … As being transgender is not a mental illness, treating gender dysphoria in this way is pathologising and, because it pathologises normal human variance, dehumanising.”

A woman’s right to abortion offers a good analogy for the trans experience, they say.

We do not typically think that it is ethical to require psychological assessments prior to abortions, for instance, an intervention which bears some parallels to transition-related care. Both are frequently justified by reference to personal autonomy and are frequently but not always motivated by distress, and yet neither pregnancy nor being trans is illness.

Furthermore, the distress of gender dysphoria is not the only reason why a person might seek to transition. There are at least two other reasons: gender euphoria and creative transfiguration. The former is a feeling of enjoyment at matching up gender identity with a new gender. The latter is the satisfaction of treating the body as “a gendered art piece”. To illustrate this, they quote an American activist who had a double mastectomy which gave them “a sense of being able to feel a way into the poetry of (their) gender”.

How old should people be before they no longer need a doctor’s permission to transition? Ashley does not address this tricky issue. But they told the National Post that “I personally go on the lower end of things, and I think that, generally, people who have a capacity to provide meaningfully informed consent should be allowed to choose their care.” Presumably this would apply to mature minors – adolescents as young as 14 or 15, depending on the jurisdiction.

Michael Cook is editor of BioEdge.

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