Should the state pay for sex change operation?
- Thread starter Cathleen
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rbone04
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First... Kudos, Cathleen, on the followup after over 5 years! I remember seeing this years ago, and having strong opinions that this case was even under consideration.
Second... This is one of the most appalling and saddening judicial decisions I have ever heard of. I think it is a step back in our progress towards recognizing the power of human sexuality's diversity, and its impact on our society. Maybe as a member of the LGBT community, my views on this case are a bit more impassioned and complex than necessary, or maybe it's just my new migraine medication causing me to over-analyze things... Either way, this bullshit has my mind racing so hang in there!
I believe our identity is exactly that--who we are born into this world to be, and never what someone else wishes we would all be. It defies logic to think that anyone is capable of being anything they are not. Identity is a trait we are awarded by chance, born with the sole ownership rights to, and must bear without exception. As long as no one imposes any burden or passes any judgment on another just because they disagree, we all have the right to explore our own desires and to be left the fuck alone as we pursue our choices. The choices we make by acting on our desires is what guarantees each of us a unique identity.
That said, I think the complex spectrum of human sexuality would be far better understood by everyone--that is to say; more well-tolerated, widely accepted, and even respected for what it is--if everyone could comprehend the concept that one's gender identity is irrespective of their biological sex assignment. I think maybe this is a topic US District Judge Mark Wolf could stand to do some research on himself.
I believe Michelle Kosilek has every right in the world to identify as a female; and out of respect for that, I will refer to her as such. Perhaps sex-reassignment surgery would make it easier for her to cope with her gender identity disorder (for the record, I don't like the use of the word disorder here, but maybe it is fitting since her mental well-being--along with that of many other transgendered individuals'--clearly depends upon it). Gender identity disorder is a serious clinical diagnosis. It is not about someone who is just fantasizing about what it would be like to be the opposite sex, or someone who can't decide on a sexual orientation. In Michelle Kosilek's case, it is the cause of her suicidal depression.
Now most people would would agree that suicidal depression constitutes "serious medical need". I even think Judge Wolf would have been dead on stating that surgery is "the only adequate treatment" for Kosilek's "serious medical need". That is, except for one thing... she is a prisoner, isn't paying for anything, and there are other options that would keep her alive. I would argue that keeping the person alive I just described would constitute "adequate treatment".
Pretend that Michelle isn't a prisoner, and she has good health insurance:
It is an unfortunate fact that most (if not all) insurance providers will not pay for her sex-change operation--even if 20 mental health specialists were to agree it is the best possible treatment option. Even without professional opinions, coverage for Michelle's sex-change operation may seem more justifiable than whether a woman is depressed to the point of suicidal as a result of her flat chest and believes breast implants should be covered... The reality is that these patients are denied coverage for the same reasons. They aren't denied because the insensitive, evil health insurance companies refuse to believe that some people need a sex-change or fake breasts just to be able to tolerate life.
These types of claims are denied on the grounds of "elective surgeries" because, while as real as their clinical diagnoses may be, a doctors' orders for a sex-change or breast implants isn't exactly well-documented as an effective treatment decision for transgendered individuals or flat-chested women. Maybe an operation would be the best solution for someone like Michelle, but the lack of documentation as a standard, or even successful practice for that matter, makes it an ethical obligation for health care providers and insurance companies to make evidence-based decisions that are most likely to protect the life of a patient. Accomplished, in this case, by assuming that even though a sex-change is likely to make Michelle's life more tolerable, her disorder isn't what is killing her. Depression is.
Well, Michelle is serving life in prison for fucking murdering her wife because she spilled hot fucking tea in her lap. So let's get back to reality where insurance coverage is back off the table. Since we are a humane civilization, the government (taxpayer) has a moral obligation to provide health care for the inmates who need it. Fine... but the decision on a treatment should be the same as the insurance companies would have been willing to pay for. After all, they base their formulary and treatment coverage decisions on the very guidelines set forth by the government (FDA) as it approves which treatments are to be used and when... These treatments are to be theoretically regarded as having the highest favorable risk-to-benefit ratio.
Furthermore, the treatment guidelines followed by health care providers are a result of the exact same fucking process. As long as they do no harm, HCP's often have the freedom to use their own judgement, but the government provides guidelines for a very good reason. Not because it is the most efficacious treatment, but because it is the most "favorable treatment" option for the HCP's in the event of a malpractice lawsuit. The initial thought is that these options should be no different... however, a standard treatment with mediocre success but 50 years of favorable litigation history (i.e., treating Michelle's depression with psychotherapy and medication), is far more likely to keep a provider in business and/or out of jail than a cavalier medical breakthrough procedure with significantly higher efficacy but only a few years of weathering against the courts (i.e., treating her gender identity disorder with sex-reassignment surgery).
Taking risks in health-care increases the chances of mistakes and lawsuits driving up costs. Regardless of the experts' opinions, government calculates the consequences of taking these risks for them. Regardless of whether the government uses tax dollars or forces a HCP to eat the cost of ANY service rendered--the FDA's guidelines ultimately determine the most inexpensive options when an HCP is looking at the whole picture.
SO... Why in the FUCK should this murderer's wish to be able to tolerate her life by DEMANDING the most expensive, risky option for her well-being even be considered? What does her gender identity have anything to do with raising any question about whether she should be forfeiting her rights and liberties as a convicted killer, only to be rewarded with some of the most expensive, technologically advanced medical treatments available... the justification for it should stretch infinitely beyond the bounds of even the most charitable, forward-thinking, and forgiving taxpayer's willingness to oblige when a $12 bottle of generic benzodiazepines and weekly psychotherapy should be more than enough to satisfy the state's requirement to avoid "cruel and unusual punishment". Why would any special treatment due to her atypical, complex, perceptions of whether she is a man or woman be regarded as anything more than laughable... let alone grounds for winning an appeal?
Most transgendered people don't commit murder. Pandering to Michelle's gender identity disorder is not going to undo the heinous crime she committed. It will only succeed at associating an all-around foul situation with something most of society already perceives as being "wrong", and nothing more than a conscious decision to engage in a sexually irresponsible lifestyle... all the while, most men and women in need of similar care didn't take the life of another human and are still suffering without any means of affording a better life.
* Mind-blowing factoid -- Judge Wolf was actually nominated by President Regan... Not saying I'm all in with that camp, but I'd love to hear his perspective on this egregious use of tax dollars. Did Barney Frank need a favor?
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Lord Pmann
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What a fucking joke. This is possibly the stupidest decision I've ever seen. How is it that someone who became a judge can have less common sense than my left testicle?
SimplySZQ
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culloden
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I think the problem is a little thing called "stare decis", which means something like "settled law". In many cases, judges aren't looking just at the law itself (or in the case of the SCOTUS, at the Constitution). They're looking at how other courts have interpreted the same law. The argument in favor of this is consistent interpretation of the law, but I'd argue it's more like judges playing Telephone over decades, or even centuries. Eventually, the message that comes out bears only a passing resemblance to the message that went in.
wicked woman
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Cate you're lucky it's you that bumped this thread and with good cause. But did you have to make me miss Bobmi357 in doing so? 
Cathleen
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rbone04, that was quite a thoughtful and thought provoking response. The decision has caused a lot of anger here and to pile more on the judge ordered the state to pay all legal fees on behalf of Michelle.
The state has decided to appeal the decision so it still isn't a done deal. Originally the surgery was to be scheduled quickly but that too is on hold.
WW, when I saw Bobmi and EJ's name I sighed too.
The state has decided to appeal the decision so it still isn't a done deal. Originally the surgery was to be scheduled quickly but that too is on hold.
WW, when I saw Bobmi and EJ's name I sighed too.
Eilan
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Scaly's frogged-out posts made me sigh.
Of course, I miss EJ, too. We had a lot of fun posting and simultaneously IM-ing each other with smartassed commentary about stuff that was being posted. Never really got along with Bob, though. *shrug*
bobsgirl
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midwestyankee
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Not to hijack or anything, but can we get some big blue state to cover the bill to have Paul Ryan neutered? I'm sure it would be cheaper than a full-blown sex-change operation but it would have a salutary effect on the genetic makeup of future generations.
I'd even toss in a quarter for the project if someone at the IRS put the appropriate check box on my 1040.
I'd even toss in a quarter for the project if someone at the IRS put the appropriate check box on my 1040.
bobsgirl
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Send him my way. I just had my kitchen knives sharpened.
Killer wants state to pay for sex operation
To answer Cathleen,
1) Fact:He has been convicted for murdering his wife;
2) Fact: denying him the operation does not amount to cruel and unusual punishment since he is a convict;
3) Fact: the act of denying him the operation does not violate any basic human right, therefore, it is not unconstitutional.
4) Every year many convicted people commit suicide, let him do it if he wants. Why should he be treated differently than the others?
He might be entitled to have the sex change operation, but why should he use OUR tax money?
I don't see why the court ruled in his favor, it's preposterous.
At this point, all those who want to become women (or the other way), should go to Massachusetts and commit a crime of some sort so they can have the operation for free. Absolutely preposterous and ridiculous.
Aside from this, have fun everybody!
To answer Cathleen,
I think this guy is totally nuts!
1) Fact:He has been convicted for murdering his wife;
2) Fact: denying him the operation does not amount to cruel and unusual punishment since he is a convict;
3) Fact: the act of denying him the operation does not violate any basic human right, therefore, it is not unconstitutional.
4) Every year many convicted people commit suicide, let him do it if he wants. Why should he be treated differently than the others?
He might be entitled to have the sex change operation, but why should he use OUR tax money?
I don't see why the court ruled in his favor, it's preposterous.
At this point, all those who want to become women (or the other way), should go to Massachusetts and commit a crime of some sort so they can have the operation for free. Absolutely preposterous and ridiculous.
Aside from this, have fun everybody!
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