Another thought: say she gets the reassignment surgery, is she then moved to a women’s prison? If the treatment for the condition may include living as female, and we consider her to be female in all but external appearances, what about allowing her to be in a women’s facility, passing as female? Wouldn’t this be cheaper on the cost-of-treatment spectrum than surgery?
That’s a good example because it points out the folly of using what you can get outside prison as a standard for the kind of care you can get on the inside. I can remember in an earlier debate that touched on prison health care, someone who knew, probably Qadgop, said that prisoners often got much better dental care inside prison than they got on the outside. That’s because what they got on the outside was no dental care, which is what most poor people can afford.
Hell, 45 million Americans have no medical insurance. This means that they can’t get medical help when they need it.
It would simply be inhumane to deny prisoners basic medical care on the basis that there are people on the outside can’t get it, so why should they?
The ugly truth is, it’s inhumane to deny it to people on the outside, too.
Does it really? It’s my understanding that you will get care, but you will be in debt afterwards.
Depends. If it is life-threatening, you will probably be saved and spend the rest of your life paying it off (or do what millions do and end up bankrupt due to medical bills).
But there are big problems when it comes to things like preventative care, regular checkups, and various minor problems that- left unchecked- could turn into major ones. Most of us go to the doctors when things don’t seem right, but the uninsured wait until it’s a life threatening problem. Often this means a LOT more money gets spent in the end.
But if Qadgop is to be believed, gender surgery is not an effective treatment for depression and suicide even if the depression is brought about by the belief that one is of the “wrong” gender. See the following:
(Emphasis added.)
Likewise for this:
There is also no change in arrest rates. Thus gender surgery is not an effective way to treat recidivism.
And, given the very high costs of health care, you’re darn tootin’ treatment better be decided by “what is cheapest”. If aspirin works nearly as well as surgery, no surgery. Prisoners are not entitled to state-of-the-art treatments just because they are available.
Regards,
Shodan
The really rich irony is this. Suppose you’ve got a guy in prison on a 20-year seentence. He has a heart condition that’s easily treatable by some medium-costly meds which cost maybe $200 a month, and which can easily lead to stroke. But if the guy has a stroke, you have huge expenses associated with treating the stroke on an emergency basis, and if you’re unlucky enough to have the fellow survive, there’ll be additional expenses in the form of medications and physical therapy to help them cope with any disabilities the stroke might leave them with, not to mention wheelchairs, etc.
Your average prison is apt to have a lot of prisoners who need meds to prevent strokes and such – I believe black men are particularly vulnerable to hypertension, and I wouldn’t be at all surprised to learn that black men in prison are even more prone to hypertension than those on the outside. So overall, it makes very good economic sense to provide medications to prisoners before things get to the emergency-room level, even if they are scummy prisoners what no one loves except their mommies and sometimes not even their mommies.
Meanwhile, outside prison, we have plenty of honest, deserving, but very poor citizens who can’t afford the meds to prevent strokes and such and whose only recourse is to wait until things get really bad and then go to the emergency room.
It would make a lot more sense on a societal level, in economic terms, to provide such citizens with meds to prevent the emergency room trips, but hey, we’ve got lots of libertarians and conservatives who oppose that unreservedly, and so we go on in the American way, which to say, the very stupid way.
Anyway, relating to the OP, it makes no sense to decide the issue on the basis of “how does prison care relate to care on the outside” because if we were willing to equate the two, we’d have to be very cruel to our prisoners, and take full responsibility for it.
Prison healthcare is (or should be) based on meeting the same community standards for providing necessary medical care that physicians caring for non-inmates practice to.
Community standards give a lot of leeway in selecting which therapies are appropriate for a given situation, but certain benchmarks need to be observed.
In the case of gender identity disorder, such standards include evaluation by competent medical & mental health professionals, who are then expected to formulate an appropriate assessment and plan to deal with it consistent with said standards. But nowhere in the community standards will you find a benchmark saying “If X, then you must do gender reassignment surgery”.
Hypertension is much more clear cut. In fact, half my patients today had me reviewing the success of their therapy for hypertension, and tinkering some, where benchmarks were not being fulfilled.
So how’s that cite coming along, Doctor? While we’re waiting, perhaps you could clarify what exactly your experience in this area has been.
Priceguy, you’re not the only one to consider that statement a huge bomb, but contrary to the usual Straight Dope culture, Shodan appears willing to swallow it unquestioningly even in the absence of a cite.
If the good doctor was thinking of Meyer & Reter (1979), the considerable amount of criticism in response to it must be noted. For example, it was the called the “most noted and disputed” followup study. Sample criticism: “Because this publication is cited frequently by the professional and lay literature it seems important to us to demonstrate extensively why the results of this work are not very enlightening and cannot support the conclusions derived from them.” So if you try to argue against SRS based on Meyers & Reter, expect to get a vigorous counterargument from sexologists who have researched this issue.
The OP has focused on a difficult issue in a subject that is already difficult for sufferers outside prison who have often found sympathy hard to come by, let alone experiencing disgust and hatred aimed at them merely for existing–without the added issue of being a convicted murderer.
For those who answered “Oh hell no” or “fuck off” or the equivalent, how much of that judgment comes from anti-prisoner sentiment and how much from anti-trans? Forgive me if I’m a bit sensitive about the latter. I’ve seen a few too many opinions anonymously posted on the internet that my kind should all be put to death.
SRS is a medically indicated treatment – for a certain level of gender dysphoria. The Benjamin Scale is structured in a way similar to that of the more familiar Kinsey scale. Level 6 (transsexual with high intensity of gender dysphoria) is someone who is in danger of self-harm if they don’t get the surgery. The exact structure of the Benjamin Scale is open to debate, but not the fact that individuals exist who self-harm or commit suicide when denied surgery. For them SRS is 'indicated," and “Psychological guidance or psychotherapy [is] for symptomatic relief only” i.e. not sufficient in itself.
.pdf cite: http://wpath.org/Documents2/socv6.pdf section 10
A judge agrees, in a ruling based on “substantial expert medical testimony.” The losing side “failed to provide ‘a factual basis for its position,’ instead merely continuing to claim that in its opinion the procedure was not medically necessary” and “made “misdirected and unsubstantiated claims” that gender-reassignment surgery ‘is controversial, risky, and experimental’.”
So my opinion on the OP question is that it can only be decided on a case-by-case basis, because sometimes the surgery is medically indicated and sometimes it isn’t. There’s no one blanket answer.
Well Johanna, one thing I can think of (I’m not endorsing it, FTR) which appeared in the popular press a while back is this, and gets cited as a factoid a lot.
From: Sex changes are not effective, say researchers | Health | The Guardian
Sadly, detailed studies on the mental and physical health effects related to transsexual surgery (and for not having it) are lacking, and there is a huge amount of error in most studies I’ve seen. Even some basic health concerns, such as potential links between estrogen therapy and cancer/heart disease/stroke are still not very well understood. Nor are connections between life/career success and transsexualism. The subjects of studies, from what I recall Dr. Lynn Conway saying once, seem to have a remarkable ability to be some of the poorest in sticking to regimens, responding to surveys, keeping in touch with the researchers, and self-tracking symptoms and concerns. Couple this with a small population size, and I think it’s likely that people are going to be able to dig up cites that show a wide array of results with a large standard deviation.
Oh, and to the OP: I’m one of the most “pro-trans” people I’ve ever met, and even I have to say that I feel transsexual surgery for prison inmates is not a good idea. For one thing, I think that the prison environment may not be a very good one for allowing an accurate assessment of the mental status of a person. For another, it opens up the door to the potential of people committing minor crimes in order to get free surgery. However, I do feel that a person who was already waiting for SRS and who had had approval for it prior to incarceration should be allowed to proceed with it - but then the only question is who pays for it? If they are paying for themselves, then I say no problem.
But I still have a problem with the State paying for it, which I cannot really explain. I think that it’s possibly something that the State should not get involved in, especially with the potential positional inequity between prisoner and authority. I mean, for something like this, it seems that the prisoner needs to have fairly complete ability to ensure that the choice is theirs, without the State being involved either positively or negatively.
Those were both me, and my attitude is 100% anti-criminal. I understand why your instinct would be to question that, but as I mentioned before, had the question been “Should taxpayers pay for knee replacement surgery for prisoners?” my answer would have been exactly the same.
Aaaaand, took too long to edit. I’d like to add that had the question been “Should Medicaid cover gender reassignment surgery for the poor?” my answer would have been “Does it cover comparably “elective” procedures? Then absolutely. And if not, then no.”
I have no problem at all with transgendered people, but I don’t see any reason to treat transgenderism as unique. There are myriad medical conditions that affect quality of life and produce feelings of betrayal by or alienation from one’s own body.
What community standards. If you are poor, and not in prison, and don’t have medical insurance, health care consists of hoping cheap OTC drugs will treat whatever you got or going to the emergency room on an indigent basis. Is that the basis on which prisoners are treated?
Neither. I am not against either trans or prisoners. I am against tax dollars paying for expensive procedures that are inessential. Many people in prison have deep malfunctions. I wouldn’t necessarily be against prescribing them estrogen if that helps them feel more chemically balanced, but not for the cosmetic aspects of the procedure.
Fuck no. It clearly falls under the same category as orthodontics and plastic surgery: except in extreme and very rare cases, it is unnecessary for the well-being of the prisoner.
That is basically my feeling, as well. I don’t necessarily think it’s our duty to give prisioners whatever they need to make them feel comfortable and/or happy, as the removal of such is part of the punishment of being put in prison in the first place. The point is that we are denying them the freedom to pursue what makes them happy, and providing it at taxpayer expense seems somewhat contrary to what prison is supposed to be.
Everyone’s assuming that it is elective, nonessential, etc. But this is exactly what’s being debated, so you can’t assume this question has already been settled. Like I said, on a case by case basis, sometimes it’s a choice between surgery or suicide. If someone has been diagnosed as certain to commit suicide without the surgery, then how is refusal of it any different from extrajudicial execution? Likewise in the case of withholding treatment for any other life-threatening condition. I could see making this argument if one felt the death penalty ought to be applied more, but this seems like an underhanded way of getting more capital punishment.
How is it determined that someone is certain to commit suicide?
Having some editing problems today.
Anyway, bullshit. First of all, “cake or death” is an Eddie Izzard joke, not a genuine life decision. No one ever has no choice but to kill themselves. Secondly, how is it determined that someone is *certain * to commit suicide? And thirdly, what other concessions should we make to “suicidal” prisoners? I suppose we should just let them go, really. Who can withstand that sort of emotional blackmail?
Again, I’m not treating transgenderism lightly. I’m just also not treating is as so frikkin’ unique among conditions or assuming that transgendered people are so incredibly fragile that they must be appeased at any cost.
Oh now, really, that’s not helpful. For one thing, suicide risk is something that the courts and prisons are used to dealing with, and there is always the option of committing a prisoner to a mental or hospital-care facility if there is a real risk. For another thing, many transgendered folks take a very long time to undergo SRS, whether it’s due to monetary reasons (the most common ones), physical reasons, or other. And many of them never transition at all in their lives, and many of them are able to do just fine. Transgendered individuals are not fragile flowers that will fall over dead at the drop of a hat - some of them are among the strongest individuals I know.
The next point, as I’m certain you know, not all transsexual surgery is the same. There are a wide array of doctors and clinics with several different techniques and different effectiveness levels. Who chooses the doctor? What if a transsexual says that she needs Doctor X in Thailand to make her vagina? Does the State now fly them to Thailand all expenses paid? Then we have the additional/secondary surgeries. What if an M2F wants facial feminization surgery? Is that essential? What if they want breast implants? (for that matter, what if a non-transsexual woman decides she will commit suicide if she can’t have 44DD’s - does the State now end up paying for that too?) What if they want some of the more radical things, like tracheal procedures? Hair transplants? Really, once you go down that path, you end up with the potential for the State to be giving an all-expenses paid feminization that could rack up hundreds of thousands of dollars.
THEN, what happens when the patient decides that the whole thing was a mistake? We can dig up loads of cites, where people through one means or another (usually, because they “find God”) decide that the whole SRS was a mistake. Is the State now forced to pay for reversion surgery? Is the State now liable for lawsuits over the “attractive nuisance” of free SRS? What if there’s now a claim that they were “pressured” into doing it by the prison-provided psychiatrists?
Plus, I repeat what I said - a prison environment is a completely false basis for determining the ability of a newly-found TG person to transition effectively (how can one do a “real life” trial, when one is in the confines of a prison?), and I do not like having the State have influence or getting involved in this sort of thing. I think it can lead to either undue pressures on the individual, or else allow for a situation where things move too fast. To be a successful transsexual person means not just surviving but functioning constructively in the real world. Prison provides no opportunity nor insight into that at all.
Finally, well, when one makes the conscious decision to break the law - and we’re likely talking about felony convictions, if we’re talking about putting someone into prison for more than a year - then they really have assumed a certain risk themselves. At some point, people have to live with the consequences of their shitty decisions, and realize that the consequences are sometimes very far-reaching.
No, sorry, I’m 110% in support of transsexual rights and respect, but this is entirely the wrong fight to fight. It’s a stupid-assed distraction that will ultimately negatively impact the public perception of transsexuals.