Sex Change Operations for Murderers

Great Debates
41

KellyM, thanks for that link. Thru it I was able to find this link, which is probably the best review of the literature I have found on outcomes for transsexuals who underwent surgery vs. those who did not.

And having read the data, I must say that I am still not convinced that a case has been made that surgery is better than hormonal treatment and therapy. The studies cited and reviewed suffer from very small numbers (2000 patients over 30 years is a good start but still mighty small once the drop-outs and lost-to-followups are totalled), lots of non-responders to the surveys, and what seems to me on initial glance to be a lot of “cherry-picking” (no pun intended, really) of the data, ie excluding bad outcomes (people who expressed regret over having surgery) for reasons such as: a)didn’t live as the opposite sex for long enough before surgery, b)schizophrenia developed after surgery, c)inadequate surgery.

I also note that the greatest weight of outcome, on which the best numbers are posted (70% satisfaction by m to f surgery), is on self-reported subjective satisfaction. This was the area where the difference between those who had surgery and those who did not showed a statistically significant difference.

Social functioning, on the other hand, based on contacts with partners, relatives, neighbors, and co-workers did not show statistically significant differences from those who did not have surgery.

And there was a statistically significant drop in economic functioning after surgery vs. the non-surgicals in the m to f population, even after correction for the time off from the medical procedure.

In short, it’s a fascinating assembly of studies, but far from a definitive answer as to whether surgery is the best route for the transgendered in general. Obviously, more work needs to be done, and more numbers of cases need to be evaluated over a longer period of time.

Is there a population of the transgendered who will do better with sex-reassignment surgery? Undoubtably! Can we identify reliably which ones are the best candidates at this time? I’m not sure we can. Probably some centers and some specialists are doing a better job than others. Should the state step in and tell non-incarcerated adults they can’t have the surgery, if the patient and their doctors think it’s in the patient’s best interest? I personally don’t think the state should get involved. Should the state enable and fund prisoners to have the surgery? I don’t believe so. For if the data on the general population of the transgendered is still murky, the data on the incarcerated transgendered is opaque as all hell.

As an aside, I really don’t understand the vitriol directed towards Dr. Money. He treated a lot of the transgendered, and facilitated a lot of their surgeries. He was, (and still is, I believe) a strong advocate of the surgical procedure for adults who fit the criteria. Where he seemed to go wrong was in believing that an infant or young child with ambiguous genitalia (from birth or accident) could be surgically re-assigned to whatever gender the body was closest to, and would develop the gender identity to match the body. He was tragically wrong, but this issue is not the same as sex re-assignment in adults. Dr. Money was very unhappy when Johns Hopkins Hospital stopped doing the surgery. And was very much at odds over this issue with Dr. Paul McHugh, the psychiatrist who was instrumental in stopping the surgical program. IIRC. And I was there at the time (as a lowly lab flunky and med student).

Once again, thanks for the link. I do want what is best for my patients, and it’s only be reviewing the latest information that’s out there that I’m able to do that. Based on what I see, for now I’ll recommend we keep our pre-op transgendered on their hormones, and housed in the special units. The post-op ones (m to f) currently do go to a woman’s prison.

42

QtM, the drop in economic function is probably attributable to sex discrimination. In my field (computer administration), a penis is worth $9,000 a year.

Dr. Money is the reason why insurance companies did not pay for reassignments for almost two decades. This policy made reassignment a perogative of the wealthy. This has driven many transsexuals to prostitution, drugs, or suicide. I don’t know whether Dr. Money deliberately argued for it, or simply published studies that convinced policy makers to adopt for the policy. Regardless, we blame him for that. It’s only in the past few years that we’ve seen a rollback of that policy, and it’s hard to estimate for sure how many people have died as a result of it, but it’s quite certainly not zero. Those deaths are on his hands.

43

KellyM re Dr. Money, I suspect that the powers that be grabbed hold of Dr. Money’s very publicized bad outcome about sex reassignment in infants, and twisted it as justification not to fund sex reassignment in adults. I don’t see how Money can be blamed for that. Frankly, he brought into the mainstream the term “gender identity” in the first place.

You might want to read a bit more on him, both pro and con, before deciding that “those deaths are on his hands”.

44

QtM, I also have Eve’s acknowledged distate for the man to go by. Perhaps she will drop in and explain her personal dislike of Dr. Money.

45

Personal dislike I can certainly understand. He was a very odd, even arrogant man, who could be quite condescending.

Even so, he always seemed to be the natural ally of the transgendered, and believed that, in adults at least, if the mind didn’t fit the body, changing the body was a viable option. As late as 1989, I heard post-op transgendered individuals referring to him as a friend of and advocate for all transgendered. I am just curious as to what precisely he did to have become the focus of wrath of the adult transgendered. The John/Joan debacle revolved around his theories of infant sexualization, not his theories on the viability of sex reassignment later in life.

If you’re going to hate him for ruining the lives of the transgendered, that’s certainly your privilege. But I would like to know just precisely how he did this. And I would think that you would want to know that too.

46

QtM, I do think his insistence on nurture as the cause of transgenderism is a major part of it. Our collective experience is that he’s wrong.

47

'k. 'Nuff said. We’ve wandered rather far from the OP anyway. Thanks.

48

The distinction is between life-threatening conditions, which should be treated for prisoners, and non-life-threatening conditions, which should not.

It is a misstatement to say that gender dysphoria is “just as deadly as heart disease”. No one, short of suicide, ever died because he thought he was a woman trapped in a man’s body.

What is the morally relevant distinction between sex reassignment surgery and rhinoplasty? Both involve patients who believe their bodies do not match what they want themselves to be. Both involve operations which, if not performed, will not significantly affect how long the patient lives. Why should we fund the one, and not the other?

If you are arguing that convicts should be supplied with whatever medical procedures they want, I disagree. The state is obligated (IMO) to provide a reasonable standard of health care. This does not include whatever they ask for.

Your mention of Prozac and so forth leads me to believe that you are willing to classify gender dysphoria as a mental illness. Is this the case?

And if so, why would we forcibly medicate a patient who believed that his illness was the result of CIA mind rays, but not forcibly medicate a person who believe that he was a “woman trapped in a man’s body”?

Yes indeed. I let them be. I have no interest in what they do or believe. Which is the good way to do things.

And when they come to me, and demand money from me to work out their issues, I refuse. Because they don’t really need it, and I refuse to supply luxuries to convicted murderers.

They aren’t going to die if they don’t get it. So they don’t get it.

At least not at my expense.

Because treating this alleged problem is a waste of scarce resources.

Just because some murderer declares his sexual issues to be a problem is not sufficient cause to declare that I am obligated to pay for what he wants to resolve them.

This is not being treated differently in any significant way from “other similar issues”. He is (allegedly) suffering from some sexual maladjustment. Boo hoo for him. The next guy is suffering from a lack of hair, and wants a hair transplant. I won’t give him that either, and equally, boo hoo for him.

So this murderer suffers from gender issues. I don’t particularly care. And I have seen nothing that shows that I should care.

Declaring that this is a gender issue changes nothing. I don’t care what his gender issues are. He is a murderer, and has no claim on my sympathy. He lost that when he killed his victim.

Regards,
Shodan

49

Brooks might be sincere, I don’t know, but I think a male inmate could conceivably come up with a “transgender scam”. Sure, no sane man would be willing to go through the operation just for kicks, but would he ever actually have to go through with it?

Our hypothetical male inmate might decide that it would be worth it to claim to be transgendered and go to court to demand gender-reassignment surgery. In order to be eligable for the surgery he’d have to live as a woman first, and that would likely mean a transfer to a women’s prison. He might get to live in a women’s prison with his own fully functional male genitalia intact for a good long time while the case dragged through the courts. That’s just the sort of fantasy likely to pop into a guy’s head during one of those long nights behind bars. Even if the court did eventually rule that the state had to pay for the operation, he could always back out at the last minute. No one’s going to force him to have the operation if he says he changed his mind about the whole “being a woman” thing.

Still not exactly a brilliant plan, but a guy doing time for murder might figure it was worth a shot. I used to have a friend who was a legal assisstant, and according to her lawyers are constantly getting weird letters from convicts making strange demands or claiming to be the victims of some wrongdoing at the hands of the state. She had stories little stranger than the scenario I propose above. These are, after all, people with a lot of spare time and little to lose.

50

The whole “live one year as a woman” thing isn’t set in stone or anything. It’s just something that surgeons do so that they are sure the patient understands what they are in for and are able to make a life for themselves like that before things become permanent.

I’m sure the surgeons could come up with some other plan for prisoners. And I’m almost 100% sure that would include tighter security around said prisoner, which wouldn’t be much fun.

And Shoden, we don’t forcibly medicate anyone unless they have committed themselves to a mental institution or they prove themselves an immediate danger to themselves or others (most likely others).

While I hesitate to call it a mental illness, gender dysmorphia is a problem between the brain and the body, and mental disorder wouldn’t be too far off. In this case the medically accepted treatment isn’t drugs, it is steps towards sexual reassignment. Due to the nature of the disorder, you wouldn’t have to force that one someone, since a primary syptom of gender dysmorphia is a desire to change one’s sex. But otherwise I think that treatment of gender dysmorphia ought to be treated with the same seriousness as the treatment of bipolor disorder, for the same reasons.

You still havn’t answered my question. Do you support treatment of mental illness- which is directly geared towards preventing suicide (the primary problem with mental illness from a medical point of view)- in prisoners?

51

How expensive are sex change operations to get?

If those in need of a sex change operation are desperate to the point of suicide, what is there to stop them from murdering someone just so they can get a free sex change operation?

Most importantly, why provide something to murderers before we provide it to decent people? Would it not be preferable to take all the free sex change operations that would have been given to murderers, and instead give them to an innocent who needs it?

52

A couple of questions:

  1. Lets say I, free and with no criminal charges pending, had gender dysmorhia, and I was poor with no insurance. Would the state even consider paying for the operation? Or would it consider that I could have one only if I could pay for it?

  2. Lets say I had gender dysmorphia and was well-to-do and had excellent insurance. And I said I wanted a sex-change. Does that automatically mean I would get one? Are there not tests and screening processes in place to weed out people who may not be helped by it, for whatever reason? Could someone be convinced that a sex change operation would cure their torment but be wrong?

53

spooje, federal courts have in the past ordered Medicaid to pay for reassignment surgeries for individuals who qualified for the Medicaid program and whose treatment has been consistent with the Standards of Care.

There is no “magic test” for gender dysphoria. The Standards of Care mainly seek to test the resolve of the individual requesting reassignment and to evaluate the individual for evidence of comorbid psychological disorders that might be involved. I have known a few people who were permitted to have reassignments who probably should not have been because their psychologists missed or underestimated the significance of their comorbidities. Quality of care is an issue in this field, as it is in any medical field.

54

Wouldn’t murdering someone be a big black mark on this person’s psych file?

55

In other words, we do not supply medical treatments unless it is necessary. Same here. Brooks is not a danger to himself or others as a result of his gender problems. Therefore, we need do nothing.

I suppose, using your definitions, I would support treatment of mental illness, but not mental disorders.

Since gender dysphoria is not as serious as, say, schizophrenia, and does not cause the patient to present a danger to himself or others, no treatment is necessary. Which is a good thing, since the surgery is so expensive.

You haven’t answered my question. What is the relevant moral distinction between sex reassignment surgery on the one hand, and nose jobs, breast implants (for women), and hair transplants on the other? All involve a disjunction between what the patient wants to be physically, all can be addressed by surgery, none involve life-threatening symptoms, and none involve progressive disease.

Are you arguing that persons in prison for murder should be able to demand any kind of cosmetic surgery they wish, at public expense?

Suppose Brooks decides that he wants to be a fundamentalist, and takes Jesus’ injunction that “if your right hand causes you to sin, cut it off” literally. Would you say that his right to practice his religion means that he must be supplied with the surgery to amputate his hand?

How far do you want to take this? If you want to confine it only to gender issues, what is the principle on which you base the distinction?

Regards,
Shodan

56

A lot of this comes down to what the role of prisons is, and what our societal duty toward the care of prisoners is. If you believe that prisons are for punishment, then, yes, deny care. If you believe that prisons are for rehabilitation when possible and segregation when not, then denying care is inhumane.

But that’s a separate debate, or at least should be.

57

Probably true, but you would need to demonstrate some connection between Brooks’ gender issues and his propensity to commit crimes. Then you would have some reason to expect that switching him from male to female would rehabilitate him in some way.

You would also, in a reasonable world, have to do a plausible cost-benefit analysis that would justify the expenditure of half a million dollars on one convict - or much more on all the transexuals in custody.

And we have not yet established that sex reassignment surgery falls under the definition of “care” which we are duty bound to supply.

Regards,
Shodan

58

The problem I have with this “four types of sexuality” classification is that, based on my own experience, only three of them really exist. I have a physical sex, sexual orientation, and a social gender role (although I don’t think that it can be adequately described as simply “male”). But gender identity, separate from the previous three categories? As far as I can tell, I have none. I suppose there are those that argue that I have become so used to that I don’t notice it, and that’s possible. It’s also possible I simply don’t have one. And even if I do, I don’t think that it’s inherent to being human.

Another problem that I have (and I don’t mean this to be flippant or rhetorical, I really am honestly asking for an explanation): suppose that gender identity does in fact exist. That is, there are two categories of people, category A and category B. Category A comprises mostly males, and category B comprises mostly females. So what? Does it make sense to say that category A have a “male” gender identity, simply because their gender identity is found mainly in males? Bald people are overwhelmingly male, and those with breast cancer are overwhelmiingly female. Does it therefore make sense to refer a bald woman as “folically male” or a man with breast cancer “oncologically female”? Or whatever the proper adjective forms would be?

One more question from the guy who just doesn’t get it: if gender identity is completely separate from physical sex, then why do people spend so much effort trying to get them to match?

59

Why don’t you ask the APA, healthcare professionals, and/or folks who are actually transgendered themselves, instead of making wild-assed guesses without doing any research? I know I have.

Esprix

60

The Ryan, it’s easy not to notice that there’s a difference between gender identiy and physical sex when they’re the same in most everyone you deal with. For those of us where they are discordant, it’s much more obvious that there’s a difference.