Could doctors be forced to perform sex reassignment surgeries?

Washington D.C., Aug 24, 2016 / 19:03 pm

Following the federal government stating that doctors cannot decline performing sex reassignment surgeries, a group of states, doctors, and hospitals are suing in the name of medical ethics.

"The effect is that there are doctors all across the country that are going to be asked to perform gender transition procedures, even when they believe it is going to be physically and emotionally harmful to the patient and against their best medical judgment," Luke Goodrich, deputy general counsel at the Becket Fund for Religious Liberty, told CNA.

"And this rule says if you follow your medical judgment, you can face massive liability."

Current health care law bans discrimination against patients on basis of sex. New regulations from the Department of Health and Human Services interpret such discrimination to include cases where requests for procedures involving gender reassignment are denied.

The HHS would evaluate whether a denial of services meant discrimination on a "case-by-case basis," Goodrich explained, basically if they thought a doctor didn't "have a good reason" for saying no.

The rule could affect doctors and hospitals everywhere: as many as 900,000 doctors, the Becket Fund claimed. The religious freedom law group is representing various religious health providers like the Franciscan Alliance hospital network and the Christian Medical & Dental Associations. Five states – Texas, Kansas, Kentucky, Nebraska, and Wisconsin – have joined the lawsuit.

The government does not mandate coverage for sex-reassignment surgery under Medicare and Medicaid, because the evidence is not conclusive that it is safe, the group said, pointing to a June memo by the Centers for Medicaid and Medicare Services.

That memo stated that "there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria."

Another study – by a group cited by the HHS – stated that "in most children, gender dysphoria will disappear before, or early in, puberty." That was from a 2012 report by the World Professional Association for Transgender Help, which also pointed to studies showing as many as 94 percent of children with gender dysphoria eventually moving on from it.

Another report by the science and technology journal The New Atlantis agrees, noting that children may have mental health problems even after reassignment surgery.

"Only a minority of children who experience cross-gender identification will continue to do so into adolescence or adulthood," the report's executive summary stated.

Furthermore, it added, "compared to the general population, adults who have undergone sex-reassignment surgery continue to have a higher risk of experiencing poor mental health outcomes. One study found that, compared to controls, sex-reassigned individuals were about 5 times more likely to attempt suicide and about 19 times more likely to die by suicide."

With such evidence casting doubt on the merits of gender transition, doctors must be free to do what they believe is the medically appropriate course of action, Goodrich maintained.

Johns Hopkins University, once a pioneer in sex reassignment surgery, has since ended the practice, finding that it was actually damaging to those who undergo it.  

"A lot of these doctors have purely medical reasons for not wanting to perform procedures that could harm children," Goodrich said. "The idea that HHS is requiring doctors to perform these procedures on children when the vast majority of them will grow out of these feelings naturally is really troubling."