Should taxpayers pay for gender realignment surgery for prisoners?

Great Debates
61

[QUOTE=Una Persson]
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.
[/QUOTE]

I agree that the raising of this issue isn’t likely to help the cause of trans rights in the public’s mind, and would prefer it had never come up. Just when it looked like things were starting to go better, too. The reason I joined in was the opinion that SRS is never medically indicated at all, which I have to disagree with. Posing the question in a prison context complicates a discussion of the merits of SRS itself. It genuinely is a matter of life or death to some individuals and I was concerned that calling it “elective” trivializes that. It isn’t comparable to a nose job.

The point you made about the real life experience is a good one, given that it’s an essential feature of the SOC-- and I’m basing my argument in part on the SOC.

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What Una said. I’m not going to advocate for public-funded SRS without clear and compelling credible evidence that such a procedure makes a significant positive difference in measureable outcomes. Especially in the rather unique corrections setting I practice in.

I’m all for treating the transgendered with appropriate hormones and garb while they are incarcerated. Sadly my state legislators forbid even this medical practice, but that is presently tied up in the courts, and I’m able to continue to prescribe such meds for my patients.

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[QUOTE=Qadgop the Mercotan]
clear and compelling credible evidence
[/QUOTE]
Perhaps you, Una, and I can agree that we need more research on this question because there isn’t clear and compelling evidence the other way either. In the medical and psych literature reviews that I’ve found online, the hostile opinions are pretty outdated (mostly from the 1960s and '70s) and the more favorable views tend to be more recent as the science has advanced.

My medical insurance (Anthem) gotten through my job has an exclusion clause specifically disallowing anything related to transgender. Bastards. I was miserable (and at times suicidal) until I got on hormone replacement therapy, now thanks to the Whitman-Walker Clinic in Washington DC I am finally getting relief. I’m just lucky to live within easy reach of the place, but trans people who don’t live near such clinics are SOL. I would have to pay over $100 out of pocket each month for HRT, but the Whitman-Walker pharmacy fills my prescriptions for only $22. Otherwise, physicians are forced into subterfuges of entering different codes to justify prescribing hormones.

I’m tired of the assumptions among the uninformed that my medical needs are just a frivolous whim. There ought to be more research to establish this to everyone’s satisfaction. Counseling and real life experience are able to sort out who genuinely needs to transition. I’ve been living openly female consistently for almost 2 years, but it was awfully rough before I got on HRT.

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[QUOTE=Johanna]
Perhaps you, Una, and I can agree that we need more research on this question because there isn’t clear and compelling evidence the other way either.
[/QUOTE]

I’ll certainly agree to that. And if research clearly indicates that SRS is superior for certain types of patients, I will then advocate for such surgery for such patients under my care.

But for the meantime, I will continue my battle with the powers that be, which are trying to prevent me from even prescribing hormones, which have clear evidence of benefit.

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[QUOTE=Johanna]
Perhaps you, Una, and I can agree that we need more research on this question because there isn’t clear and compelling evidence the other way either.
[/QUOTE]

Absolutely.

I certainly don’t think that. And I do support transsexual prisoners getting HRT - although I can see some potential problems with that, I think it serves the greater good with a minimal risk.

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[QUOTE=Johanna]
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.
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I’ll start by acknowledging that, other then the SDMB, I’ve had very little exposure to the transgender community. I’m sure there are issues I can’t even begin to understand. I’m basing my line of thinking on people I know with other depression/suicide inducing issues.

It seem that a person who feels that surgery or suicide are the only options open to them has problems in addition to their desire for surgery. Problems that probably need to be dealt with before surgery should be considered. If someone is driven to the point of being suicidal, is SRS going to make all of the issues go away? Would SRS be considered for someone that was that unstable?

If the answer is no, then am I correct that SRS is an option for someone that is unhappy with their current situation, but who is mentally stable enough to think through the option and deal with the outcome of the surgery? And at that point, is that person really in a surgery or death situation?

It kind of seems like a catch-22. If you are stable enough to make the decision to have the surgery, then you are stable enough to live without it (although probably not happily).

ETA - I’m not trying to reduce transgender issues to a psychological problem. I’m calling suicidal desires, no matter the source, a psychological problem.

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Johanna What about the surgery actually makes a medical difference? Reducing the testosterone production by removing the testes? As I said hormone therapy for a hormonal imbalance I would support, but what about the surgery actually makes a functional difference in the body?

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Wouldn’t the next step be a prisoner saying that he was going to commit suicide if he was not released from prison? By this train of logic, keeping him in prison after he made this threat would be extrajudicial execution. The reality is that we don’t allow prisoners to hold their own lives hostage to our policies. If they have a medical need, we address it. If they are suicidal, we address that. But we treat these problems as seperate issues.

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[QUOTE=mswas]
Johanna What about the surgery actually makes a medical difference? Reducing the testosterone production by removing the testes? As I said hormone therapy for a hormonal imbalance I would support, but what about the surgery actually makes a functional difference in the body?
[/QUOTE]

No, it means being able to feel the sense of being a whole, integral entity in one’s life. When the body contradicts the inner sense of gender, it’s like one is divided against oneself, a very painful psychological fracturing. It can’t be compared to a fat person with a thin person inside wanting to get out, or wishing to have a nose job. That would trivialize it–Gender is the primary category by which human beings categorize themselves and each other. Gender, more than race, class, ethnicity, religion, or anything else, orders where a person fits in life (more stringently defined in some cultures than others, cf. Afghanistan, but it’s in effect in every culture, as sure as binary restrooms).

Gender usually has such a strong perceived connection to sexual phenotype that when the two are in contradiction, a person may feel torn, fragmented, not whole, having nowhere to fit in life. It’s a profound sense of alienation from one’s own existence.

That at any rate, speaking personally, is what brought on my episodes of suicidal ideation, when this pain just got to be too raw and aggravated. Certainly HRT can help a lot to alleviate this contradiction. For level 5 transsexuals, HRT alone might suffice (for MTF it includes androgen blocker, which nullifies the effect of testosterone without surgery). At least to reduce it to a level of everyday discomfort one can live with. For level 6 it isn’t enough and they need to reshape the phenotype itself to escape the contradiction and feel whole, to feel they can have a place where they can fit in life.

This is one reason why recent radical gender theory has been trying to dismantle the tight link between gender and sexual phenotype, so that no one would have to feel displaced in existence due to gender identity. In theory, anyone should feel free to identify and be accepted without needing to fit one side or the other of a prescribed binary. Then no one would need therapy or surgery. In practice, I doubt this will ever work. The gender-phenotype connection has much too strong a hold on most people’s conceptions of themselves. Although some individuals report being free of it, not everyone is capable of that. Especially since both gender identity and sexual phenotype are based in the cells of the body–transsexualism is a contradiction between brain sex and and gonad/genital sex. Being able to match one’s place in life with one’s inner sense of self can be achieved by transitioning into the needed gender role. Level 6 transsexualism means the sexual phenotype has to come along for this to succeed.

70

[QUOTE=Tastes of Chocolate]
It seem that a person who feels that surgery or suicide are the only options open to them has problems in addition to their desire for surgery. Problems that probably need to be dealt with before surgery should be considered.
[/quote]
By and large, that is the whole problem. Comorbidity (the additional problems you mention) is the result of the gender mismatch, like depression at failure to be accepted as one’s real self. Hell, that’s enough to make anyone depressed. The Standards of Care (SOC) require screening to make sure there are no separate psych problems before going ahead with transition–for the reasons you asked about.

Yes, that is exactly what makes the problems go away. That’s the whole point, that’s why it works. SRS is the only known cure for that type of instability.

That’s what counseling and the rest of the SOC are for, to clarify that this course is best. A person has to meet stringent guidelines and scrutiny to qualify for surgery. This has kept the rate of post-op regret down to a very safe level, since the poor candidates for surgery are screened out before they get there. Times when the SOC were neglected, disaster was known to result. (For one example, read As Nature Made Him–a tragic case.) Over time, the SOC have proven an adequate safeguard. For this reason I’m very concerned about the high rate of SRS taking place in Iran these days, because of indications that the SOC are being ignored.

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[QUOTE=Johanna]
Yes, that is exactly what makes the problems go away. That’s the whole point, that’s why it works. SRS is the only known cure for that type of instability.
[/QUOTE]

Una has already provided a cite for some of the things that you were questioning. Could you please provide one that demonstrates what you allege?

Regards,
Shodan

72

[QUOTE=Left Hand of Dorkness]
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.

Daniel
[/QUOTE]

Prisons have psychiatrists who spend their time keeping a percentage of the population doped up (or not, depending on their feelings).

Depressed cons who are diagnosed by the prison shrink can get happy pills paid for by the taxpayer.

As for the surgery in question, I would put that down as an expense that is outside of the paid for services. I consider it the equivalent of filet mignon - we feed you in prison, we don’t coddle you.

http://www.1union1.com/new_heart.htm

A prisoner recieved a new heart in the article above. Assuming that there is a limited number of hearts, and that there is a list of NON criminals waiting, I also have no problem putting cons at the end of the waiting list for transplants as well.

73

[QUOTE=Algher]
Prisons have psychiatrists who spend their time keeping a percentage of the population doped up (or not, depending on their feelings).

Depressed cons who are diagnosed by the prison shrink can get happy pills paid for by the taxpayer.

[/QUOTE]

I’ll thank you not to refer to anti-depressants as “happy pills”.

:dubious:

As for SRS for prisoners, hell no. The state isn’t paying for SRS for law-abiding citizens. Why should convicts be any different-especially convicts.

Hell, I’m receiving public aid for my hospital bills, and I don’t even get full coverage. I’m paying for my Lamictal out of my own pocket, for the most part. I would think THAT would be more of a priority, than SRS.

And no, Johanna, that has nothing to do with my feelings towards transexuality. But you think whatever you want.

74

[QUOTE=Guinastasia]
I’ll thank you not to refer to anti-depressants as “happy pills”.

:dubious:

As for SRS for prisoners, hell no. The state isn’t paying for SRS for law-abiding citizens. Why should convicts be any different-especially convicts.

Hell, I’m receiving public aid for my hospital bills, and I don’t even get full coverage. I’m paying for my Lamictal out of my own pocket, for the most part. I would think THAT would be more of a priority, than SRS.

And no, Johanna, that has nothing to do with my feelings towards transexuality. But you think whatever you want.
[/QUOTE]

Please excuse my flippancy - no insult towards legit users intended.

75

Thank you. I’m sorry if I’m a bit touchy about the subject.

76

[QUOTE=Johanna]
Times when the SOC were neglected, disaster was known to result. (For one example, read As Nature Made Him–a tragic case.)
[/QUOTE]
Yes, it was a tragic case, but I don’t think it is necessarily relevant to what is being discussed here. The boy in that situation was surgically and hormonally altered to become a girl because of an accident during his circumcision, which destroyed his penis. He was biologically a boy and was a baby at the time the decision was made to raise him female. He never really “felt” female, and eventually, upon discovering what had happened to him, decided that he wanted to essentially “go back to” being male. I heard several years after reading the book that he had committed suicide. A very, very, sad case, and certainly one that was caused by a lack of understanding of what gender is.

I am not trying to claim that your feelings and those of other transgendered individuals are not valid, but I do not want anyone here to get the impression that this case was about a transgendered individual. He was only “transgendered” because of a very, very bad decision made by his parents on the advice of doctors.

77

Johanna The problem with that is that many people in prison are there due to a profound sense of alienation. That’s what makes them criminals. The question is to what level does society have an obligation to lessen that sense of alienation, and by what criteria do we choose who we help?

I tend to be a fan of compassion for alienation, but that would require a massive paradigm shift within society as a whole rather than doing it from within the prison system.

I am not sure how comfortable I am with radical gender identity politics. I think we should encourage compassion, but not redefining what we consider ‘normal’. However, that being said, I think that synthetic biology and AI are opening the doors to question the very bases for our identities, which I find very interesting. I just tend to be rather skeptical of radical progressive linguistic social engineering. I don’t think there is any reason to fear or hate someone who does not fit with the norm, but I do see some benefit in having norms.

78

[QUOTE=Guinastasia]
But you think whatever you want.
[/QUOTE]

I wasn’t presuming to know your state of mind. I just asked.

79

[QUOTE=Johanna]
I wasn’t presuming to know your state of mind. I just asked.
[/QUOTE]

And yet, you barged in, all aflame, accusing everyone of being transphobic because we stated that taxpayers shouldn’t have to foot the bill for SRS.

You’re lucky-your insurance pays for your homone treatment. There are those of us who don’t have insurance and have to deal with potentially life threatening conditions. Forgive me if I’m a little irritable.

80

[QUOTE=Guinastasia]
And yet, you barged in, all aflame, accusing everyone of being transphobic because we stated that taxpayers shouldn’t have to foot the bill for SRS.

[/quote]
I didn’t accuse anyone here of anything. I asked about it, though, because I’m sensitive about transphobia. Asking means withholding judgment and not presuming to know, while noting I have a personal concern.

That’s actually the contrary of what I wrote. Take another look…

Sorry if the the meaning of the terms “exclusion clause” and “specifically disallowing” wasn’t clear. It means my health insurance policy says in effect “no way in hell will we pay one red cent for anything to do with transgender, don’t even think about it.” This is typical of most, if not almost all health insurance, by the way.

How about a deal–I forgive you for being so irritable as to misread what I said, you forgive me for being sensitive about this topic after what I’ve been through (PM if you care to hear the story).