The Ethics of Transgender Interventions

Insofar as male-to-female transgenderism is more common than its opposite, some critics have seen in transgender therapy the extension of male privilege. Janice Raymond has argued that male-to-female transgenderism trivilalizes women because it treats femaleness as a trait that men may adopt as they wish. She characterizes female-to-male transgenderism as an attempt to bypass constraints on female participation in a male-dominated society (Raymond). Raymond would not ban transgender therapy, but she believes that a greater social emancipation of women would eliminate the reasons for seeking it. By contrast, other commentators believe that the origins of cross-gendered identities are ultimately beside the point: Those commentators think that the proper focus of interest in these identities is not prevention and treatment but social accommodation so that people may live in whatever modes of sex or gender expression they find desirable (Devor).

Some commentators object to gender interventions for adults on the grounds that medical interventions violate the natural law principle of bodily integrity. However, other commentators working within the same tradition have defended medical interventions on the grounds that they protect psychic health (Springer). It is also possible to argue on utilitarian grounds that if psychiatry has no meaningful treatment for cross-gendered identities, gender interventions can help people achieve happiness. Even commentators who defend a pathological interpretation of cross-gender identities agree that "the most reliable conclusion is that the overwhelming majority of post-operative transsexuals are content with their decision to undergo sex reassignment" (Green and Blanchard, p. 1660). Utilitarian ethics not only advocates the greatest happiness for the greatest number of people, as in the philosopher John Stuart Mill's formulation, it also asserts the liberty principle, a principle of noninterference with individual pursuits insofar as they do not harm others. A case can be made that atypical gender choices do not intrude on the rights of others any more than atypical religious or political views do.

Defending atypical gender identities and expression in adults does not of course establish what priority gender interventions should have in a health-care system. Some critics argue that too little research has been done on ways to improve the surgical needs of transgendered people (Devor). Some people have found that private insurers and government health programs are unwilling to pay for interventions because the interventions are voluntary and do not cure an underlying disorder. Other commentators have argued that gender interventions meet an important psychic need, that they work, and that their limitations can be overcome through better selection standards (Gordon). Those commentators therefore argue that private insurers and the government should pay for gender therapies.

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