Federal judge rules transsexual inmate should receive surgery
I thought I'd bring this to P&C, since it seems like good P&C fodder in a lot of ways, and I've had some interesting (I think) thoughts on it.
The argument goes, more or less, like this: This person is in prison for life without possibility of parole, as a ward of the state. The prison doctors have said that she needs to receive SRS (sex reassignment surgery, kind of an outdated term) for her continued well-being. She's repeatedly tried to kill herself, self-harmed, etc. On practical grounds, it makes sense to do this because just one life flight trip to the hospital when she was bleeding out cost way more than the surgery will cost. On humanitarian grounds, it makes sense to do this because she's clearly in great suffering and there's no other known cure for gender dysphoria. (Not everybody needs or has SRS, but some process of transition is the only thing that's ever been shown to reduce the feelings of dysphoria.) On legal grounds, the state acts as the legal guardian of prisoners, and has a responsibility to provide required medical care as prescribed by the state's own doctors (who in this case prescribed SRS).
Kosilek is a horrible horrible person who has done unforgivable things. But that doesn't mean that it's okay to refuse to meet her medical needs out of some sense of squeamishness or outrage, particularly when the state's own doctors say it has to be done for her well-being.
So, being trans myself, I have to applaud this decision.
Now for the hard part.
There's another side to the decision that's very very troubling, involving a great deal of moral hazard. You see: there are a lot of young, desperate trans people out there. Many of them end up in the sex trade when they have difficulty finding other work, and they're desperate to keep paying for their treatment and saving for surgery. Some would do almost anything to get the treatment they need, the only thing that gives them hope of being able to stop hurting.
I think you see where this is going.
If you're desperate for treatment, and you know that if you're in prison and demonstrate suicidal tendencies over your gender dysphoria that the state is required to provide treatment up to and including surgery, and if you're considering doing sex work to make money for your treatment... yeah, prison is going to look at least a little appealing.
That's not to say, of course, that the state doesn't have the responsibility to provide these things in desperate cases. In cases that are less desperate, I think the state has the right to say "you're dealing with this okay, you can do this on your own once you get out". (Although, of course, that opens up another big can of worms: when does a suicide attempt move from being a mock attempt to being a real attempt?) But in truly desperate cases, where the prison doctors say "this is necessary for the prisoner's well-being", the state should not second-guess the doctors. If they say it's needed, it's not an elective procedure. You can be sure that prison doctors are weighing carefully whether something is needed or not, and making their choice after thinking it over carefully. But they have a great responsibility as well, because prisoners generally have [em]no[/em] other recourse. They can't go get a job and try to afford the insurance or medical procedures they really want. Especially if they're imprisoned for life.
No, the real problem is on the other side: It's not that prisons are required to provide prescribed treatments to prisoners, it's that the American health care industry is not. Many insurance companies treat trans surgery as an elective, cosmetic procedure. But for some people, it really really isn't. There are other things that are treated this way that have nothing to do with trans issues, but I think that the insurance companies can easily choose to categorize trans stuff this way primarily because it doesn't affect many people, and because those people do not have much of a voice to speak out with.
Certainly, there is more likelihood outside of the prison system that someone can find a corrupt doctor willing to prescribe just about anything—but it doesn't have to be "sure, you got a prescription from any old doctor you wanted to, we'll take their advice". It just has to allow for the possibility with a fair review of the facts of the case. I personally don't think that many people who [em]aren't[/em] trans are going to start lining up to get their stuff chopped off in any case, but most trans folk would be willing to jump through a few hoops to have our insurance cover things. (Heck, there are enough hoops we have to jump through just getting to the point where surgery makes sense.)
Anyway, those are my thoughts. To summarize: Prisoners deserve whatever procedures the prison doctors say they need to have, and officials should not be able to refuse that on any grounds. The knowledge that prisons are required to provide certain forms of care in certain desperate situations is troubling, because there are some very desperate people in the trans population. And the real travesty is that in some ways prisons provide better medical care than most of us can get—but it's not because they shouldn't, it's because the health care industry should do better.