Should taxpayers pay for gender realignment surgery for prisoners?

From this story.

A man serving a life sentence in Massachusetts, for murder, is sueing the prison system, saying that not allowing a sex-change operation is cruel and unusual punishment. She (dang, which gender do I use?) has had hormone treatment, laser hair removal and therapy (I believe at the government’s expanse, the article doesn’t specifically say), but still says she is suffering from depression.

I’m not looking for a debate on the whole issue of transgenderism, but just on if the prison system should be paying for it. Would a woman, claiming depression because of bad body self-image, be given plastic surgery, on the taxpayers dime? Are men who lose their hair able to claim anxiety and get transplants? Are these even valid comparisons?

I don’t think they are valid comparisons. I’m all for insurance covering sexual reassignment surgery and making sure that transgendered individuals don’t lose their jobs but I’m not so sure about the state paying for this persons operation.


Oh hell no. Assuming that the state doesn’t pay for non-incarcerated people’s sex change operations, I feel fine about letting the felons among us fend for themselves in this area.

Two questions.

Might not the depression be due to, I don’t know, being in jail?

Would they have to reassign him to a women’s prison after?

I agree with DianaG. The government doesn’t pay for anyone else to have such surgery. No reason to give people incentive to get jailed so they can get it free.

No, the state should not pay for such a procedure. As already pointed out, the state would not pay for this for another non-incarcerated person. The state is obligated to provide solid, basic health care for prisoners. Nothing more. Becoming a ward of the state through your own criminal behavior should not give you an advantage that most people do not have already.

But the state won’t pay for my x-rays, either. The reason the state pays for a prison inmate’s x-ray is that the state is preventing inmates from getting a job with health insurance or seeking their own medical care by incarcerating them.They take on the legal role of (essentially) parent, which includes providing necessary medical care. Whether or not gender reassignment surgery is necessary is an issue I think best left to the doctor and the patient.

I don’t like the idea of “the state” telling us what medical procedures *anyone *is entitled to - that way lies bad things in the abortion debate, which is dear to my heart. Medical issues should be between patients and doctors, period.

When the patient is paying for their own medical care, I entirely agree. In fact, I believe that a *law-abiding * citizen on Medicaid is entitled to whatever medical care their doctor prescribes (I believe it, Medicaid does not, and that’s pretty relevant, in my opinion). And believe me, keep your laws off my body is a motto I absolutely live by.

Murderers can fuck right the hell off, though.

So should murders then receive no health care in prision, or just not gender reassignment?

And what about “lesser” criminals? White collar criminals, car-thieves, rapists, drug-users? At what point of criminality must we tell the prisoner to “fuck right the hell off?”

I’m not sure they’re seperable. I, and I’m guessing most Dopers, think the gov’t should provide all medically justifiable health care to people in prison. Assuming that most criminals aren’t independently wealthy enough to pay for their own care without working, the alternative is to let ill prisoners fester. The question then becomes “is gender realignment” a medically justifiable procedure, from which I think we can’t get away from a debate about transgenderism.

But if you’re too poor to afford x-rays, and you need one for a critical health reason, you can still get the x-ray. If you’re too poor to afford gender reassignment surgery, you don’t get gender reassignment surgery. There’s something about paying for a murderer to get this surgery while thousands of law-abiding transgendered people can’t afford it doesn’t sit right with me.

On the other hand, I do think that Medicaid should cover gender reassignment, and it occurs to me that a ruling that holds that the state has to pay for gender reassignment surgery for inmates might be a foot in the door for getting wider coverage of the procedure for non-homicidal transgenders, which would be a good thing.

Hmm. Honestly not sure which way to go on this one.

Hell no!

How do we draw the line as to what is medically justifiable? A female prisoner becomes depressed and a doctor is convinced that her size A breasts are at least partially responsible. The recommendation is that breast implants will increase her satisfaction with herself. It’s not a procedure required to keep the body in good shape. Should it be covered?

On the assumption that you guys are interested in a serious discussion, I’ll just let this float out there unremarked-upon – but there is blood figuratively seeping from my mouth, I’m biting my tongue so hard.

More to the point: Nope, not a penny. We can’t even get the Centennial State to pay for first-time offenders to get college credit classes in a prison that sits less than 10 miles from one of the state’s premier 2-year college. And I know the OP asked that this not disintigrate into a brawl over sex change operations, but you can’t discuss this without talking about the need vs. the want.

As I understand it, the reasons for getting gender reassignment surgery are mental health reasons: being in the wrong gendered body is an extremely and long-term traumatizing condition.

But you know what else is an extremely and long-term traumatizing condition? Being in prison. There are plenty of prisoners who suffer from the trauma of being locked in a cell (I bet everyone here is thinking of exactly the same prisoner right now), and I’d wager that the psychological trauma of being locked up is, on average, worse than the trauma of being in the wrong-gendered body.

The two are not comparable, of course: locking up a prisoner protects the public, whereas denying GRS does not. On the other hand, we don’t spend a tremendous amount of money to minimize the trauma of being locked up; we tend to say, “tough noogies” to criminals who complain about that, and indeed we mock prisons with too many amenities, amenities that minimize that exact trauma.

If we’re to treat transgendered folks equally, it seems that we ought not grant them expensive treatments designed to minimize psychological trauma.

And then on the other hand, how much do we spend to treat conditions like depression, schizophrenia, etc. in prisons? Are these the better comparison?

I dunno.


I’m skeptical a Dr would recommend such a thing, and seriously doubious such a recomendation would survive a second opinion.

But yeah, there’s deffinately a wide spectrum of mental health disorders, from mild depression and discontent to stark raving mad and suicidal. I’d say that we obviously need to treat the extreme end (if for no other reason then getting schizophrenics and the like in treatment will lessen the chance of them causing further problems or hurting themselves, both in jail and after release) while obviously spending large amounts of money on a disorder which is merely causing mild unhappiness is sort of silly, after all, I doubt many people are wildly happy to be in jail.

Which was sort of my point in the previous post. It’s hard to have this debate without discussing where being transgendered and unable to get gender reassignment falls on this scale. The doctors in the article seem divided, and I certainly haven’t a clue.

But then aren’t you punishing the transgendered folks twice as much? You’re punishing them by locking them up AND you’re punishing them by denying them the surgery that can cure their medical condition - which you claim is traumatic as well. Would you tell a manic-depressive he couldn’t have his lithium because we aren’t going to minimize his psychological trauma while he’s in jail?

(It’s kind of odd being on this side of the debate, actually. Usually this question comes up about Viagra or really expensive experimental treatments for cancer. And those I have no problem saying “tough noogies” to. But this one I’m feeling differently on, for some reason. I just can’t reconcile my general stance that transgenderism is a legitimate medical condition with the idea of not treating it because you happen to be incarcerated.)

They should receive whatever care is necessary to prevent death and to keep their bodies in reasonably good working order, barring extraordinary measures. For what it’s worth, I don’t think the state should pay for a criminal’s liver transplant, either. Appendectomy yes, knee replacement, no. Limp, fucker.

And yeah, that applies to “lesser” criminals as well.

I acknowledge transgenderism as a legitimate medical condition. I also acknowledge arthritis as a legitimate medical condition. And then I acknowledge that both are quality of life as opposed to life-threatening conditions. If you’re on the outside and you can afford it, you get a sex change operation, or a joint replacement. If you’re in prison, you get counselling or an anti-inflammatory.

The penal system is obliged to keep prisoners alive, not to treat them to a better quality of life than your average law-abiding poor person.

Exactly what DianaG said.

Aren’t people suppose to be depressed in prison? Doesn’t it prove that the prisons are doing what they are designed to do? Perhaps the state can spend some money on counciling this person as to the real reason of their depression.

I agree that this is what should happen in a case like this. Ultimately, it boils down to a self-image problem. The person is unhappy with some aspect of their body that they cannot readily change. They should receive quality psychological/psychiatric treatment to help them cope with this unhappiness.

At some later point in time, when they are able to afford the cosmetic surgery, more power to them. I see no reason for the government to fund something like this, though.

The state must pay for medically necessary care for inmates, not medically justifiable care.

And IMHO, and I do have experience in this area (sex reassignment AND inmate health care), it hasn’t been demonstrated that gender reassignment is really medically necessary.