While Transgender Day of Visibility happens annually on March 31, this year it’s happening against a backdrop of state officials legislating transgender people out of public life. Right now, more than 140,000 transgender adolescents have lost or are at risk of losing access to best-practice medical care due to bans in 23 states. Health care providers in Washington have a chance to help save transgender lives.
As a family medicine physician specializing in care for transgender people, I was relieved when Washington passed a shield law last year. This law protects clinicians from police and legal action if the charges are related to providing lawful reproductive or transgender medical care in Washington. In accordance with the law, our Attorney General has already taken action to protect Seattle Children’s Hospital from the gross overreach of the Texas Attorney General who requested records for any Texas adolescent who had traveled to Seattle for care. This law protects providers with multi-state licenses from many of the risks of providing medical care for transgender and gender diverse (TGD) people. In this way, health care providers in Washington have a unique opportunity to save lives through civil disobedience while risking very little personal loss.
I refuse to let unconstitutional and discriminatory state laws affect my practice in other states. The American Medical Association’s Code of Ethics states, “Ethical responsibilities usually exceed legal duties… In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties.”
Across history, we can see several examples of physicians choosing ethics over state law. For example, some physicians refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War. Dutch physicians chose collectively to turn in their licenses rather than practice under Nazi rule. There are also individuals I look to such as Dr. Rudolf Weigl and Dr. Gisella Perl, who saved lives during Nazi rule.
Unfortunately, there are even more examples of providers conforming with bad laws and policies, even horrific ones. Physicians authorized forced-sterilization programs in the United States. Physicians in the Soviet Union used psychiatric hospitals as political prisons. Most physicians have not reported police brutality under apartheid in South Africa. More than half the physicians of Germany participated in the murder of people in concentration camps in Nazi Germany. I want to fulfill my ethical obligation and be on the right side of history. Washington state law makes it very safe for me to do that.
While Christian Nationals and the media have intentionally questioned the validity of medical care for transgender people, citing a lack of history or research, these claims are patently false. Over 150 precolonial cultures honored a third gender. The first Western medical clinic for transgender people was opened in 1919, and over 2,000 peer-reviewed publications about transgender medical care have been published since 1975. Every major medical association, which includes over 700,000 clinician members, in the United States supports essential health care for transgender people.
In my work with transgender youth, I’ve seen how necessary this care is. So many of the adolescents I support participate in the first few telehealth visits with their body only half in frame or their hair covering most of their face. But after months of us working together, they blossom as they feel affirmed and confident in who they are. They center their body in the frame, their hair is out of their face, they smile. I recently met one of my patients who I had supported for years, and she thanked me for saving her life. I also hear from parents, who commonly tell me they feel like they got their young person back after we start medical care.
Bans against essential health care threaten not only TGD lives but all lives. Allowing politicians to make medical decisions threatens bodily autonomy and health care access for everyone. Everyone deserves timely, affordable, essential health care in the community where they live. Washington health care providers are uniquely positioned to help save lives. We must uphold our ethical obligations to our patients and not let politicians get in the way of medical practice. Washington providers with licenses in other states must utilize telemedicine to stop the genocide of transgender and gender diverse people.
For those who are not health care providers, I encourage you to:
● Not assume someone’s gender or pronouns based on appearance
● Donate to A4TE, Abortion Defense Network, STYEP
● Get involved in legislative action
Taking these steps and more like them will help save trans lives. These actions make the world a safer place to be human- cis or trans!
Crystal Beal, MD, (they/themme) is a board certified family medicine physician and founder and CEO of QueerDoc and QueerCME. They’re also a clinical instructor at the University of Washington School of Medicine, and a field instructor for the University of Washington School of Public Health’s community oriented public health practice. Their opinions are their own and not representative of the University of Washington.
@1,2 Genders should never be assumed. I have no problem whatsoever identifying or being referred to as a cis man or cisgender man and the ferocious reaction to this term on the part of some cis people surprised me when I first encountered it and has baffled me ever since. (Maybe it sounds too uncomfortably close to “sissy”? I honestly don’t know, but it’s not rational.)
As for what is or is not appropriate care for gender-dysphoric children, as a layperson I’m happy to leave that determination (and the profession’s internal deliberations over same) to those who, like Dr. Beal, have the relevant training and credentials. One doesn’t become a clinical instructor at UW without thorough knowledge of one’s field. (And I’m sure they haven’t “forgotten” their oath. What a gratuitously hateful remark. No wonder there’s a doctor shortage.)
@4 “Man” and “woman” don’t need a qualifier in most instances, and I’ve never claimed otherwise. Trans men and cis men are both men; trans women and cis women are both women. Almost always, the noun by itself suffices. But when gender-related issues themselves are the subject under discussion, the terms “cis” and “trans” are often essential for the sake of clarity. This article is surely one of those instances. Objecting to their use here is like objecting to the terms “Black” and “white” in a discussion of racial prejudice.
@5 If you’re a doctor I’m surprised, because you aren’t putting the Hippocratic Oath in its proper context, i.e., don’t do harm that isn’t justified by the benefit gained. Strictly speaking, doctors do harm virtually every day — chemo and radiation therapy, for instance, do terrible things to the body but few people would say they should never be used to fight cancer. Same with amputating a limb to save someone from gangrene. Do you categorically oppose these treatments as well? If so, I give you points for consistency, but real-world medicine seems to me to involve continual, necessary trade-offs of harm vs. benefit. Why is that not the case for gender dysphoria, particularly the non- or minimally-invasive treatments typically used for children?
Obviously, I reversed the comment numbers above. Oops.
@8 So you’re saying “man” and “woman” with no preceding adjective should be presumed by default to mean people who aren’t trans or nonbinary, and you’re implying that discourse on gender-related issues could proceed unhampered if everyone would just agree to follow that rule. (I hope I’ve restated your position fairly as I don’t want to distort it.) But of course the problem with that idea is that it implies trans people are an aberrant subspecies, a deviation from the norm. Most of blue America has moved past that notion, even those who aren’t entirely in accord with all of the trans activist community’s goals and/or strategies. If you want to engage and influence the Seattle-area mainstream on gender-related topics reasonable minds can differ on and not be preemptively dismissed as a transphobic troll, I’m afraid you have to get over your aversion to “cisgender.” It carries no negative connotations, serves an essential purpose, and is here to stay.
As a European who has lived in the Seattle area for 27 years, it’s very clear that the drugs to halt puberty and even social interventions and their long term effects (such as telling a young child or teen that their biological sex is irrelevant or harmful to them) are untested. A huge experiment is happening in real time on thousands of children in the USA. In many European countries the lack of meaningful research on the long term effects of these interventions on children has meant a halt to these treatments on trans-identifying children. All the long term studies, especially those from decades ago are for ADULTS, adults who made a choice to transition after many years of therapy and usually when they were in their 30s, 40s and above and AFTER they had gone through their natural puberty. The enormous rise in trans identifying children in the past 15 years or so is a completely new phenomenon and coincides with the introduction of Smart Phones in 2007 and consequently social media. There has also been an increase in sexist stereotypes where feminine boys are being told they are girls because they enjoy the arts and masculine girls who prefer short hairstyles and sports are encouraged to think of themselves as boys. Gender nonconformity in children has also been strongly correlated with homosexuality in adulthood, so we are effectively warping the self-image and self-acceptance of many young gay children by forcing them into changing their bodies to be accepted for who they are.
The many current ideas of gender are upside down. Women for example can be any race, nationality, ethnic group, sexuality, have any skin color or hair texture, speak any language, have any political opinion, be of any religion, they can wear any clothes, hairstyle or makeup, have any talent or personality the ONLY thing they have in common is their biology. By ignoring biology you are ALWAYS referring to stereotypes of a biological sex and how their gender role plays out in the society they find themselves in.
Puberty is necessary for the brain to develop critical thinking and understanding of the long term consequences of our actions. We never expect or encourage children to make permanent decisions in any area of life. Medicalizing children in this way is the absolute opposite of progressive and is reactionary and conservative in nature. It’s also opposed by the vast majority of the population, not because they hate trans people but because they love and understand children and know that these decisions should be made once the brain has fully developed.