Should Gender Reassignment Surgery be Publicly Funded?

Abstract

Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery (GRS) is a procedure that can change the transgender person’s physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice. This paper will be divided in four key sections: First, the state of transgender health will be outlined, including the role of GRS and common objections to it. Second, a number of common objections to GRS will be analysed at the outset and shown to be unconvincing. Third, a constructive argument will be advanced, arguing that publicly funded GRS is clinically necessary, cost-effective, and demanded by principles of justice. Fourth, the paper will briefly discuss moralistic biases and why we demand a higher burden of justification for funding GRS compared with other analogous procedures.

Integrity and rights to gender-affirming healthcare

“…It has seemed to many, such as Bracanovic [1] and Go [12] (p528), that rights to GAH can only be grounded in rights to harm or illness mitigation or cure. This conclusion is at odds with the views of our rights to GAH articulated by trans theorists, authors, and activists.…”

“…A second natural way of grounding rights to GAH is in rights to have the harm one is experiencing mitigated: trans and non-binary people have very high rates of suicide and severe depression and GAH mitigates this depression. [2,12] (pp26-28). However, many trans people are not depressed or suicidal.…”

“…So, there are problems with holding that rights to GAH are entirely grounded in either of these two natural ways. Some, such as Bracanovic [1] (p99) and Go [12] (p528), have argued that trans theorists, authors, and activists cannot get what they want here: rights to GAH can only be grounded in one of the above two ways. And that means that either we should understand being trans and non-binary as an illness or as essentially related to depression or that we should hold that trans and non-binary people who are not depressed or ill do not have a right to GAH.…”

Should Gender‐Affirming Surgery Be Prioritized During the COVID‐19 Pandemic?

“…13 In the United Kingdom, arguments to publicly fund GAS via the National Health Service are based on clinical necessity, cost-effectiveness, justice, and ethical consistency. 14 Among GAS procedures, FFS can be more effective at relieving GD than genital surgery (because patients tend to focus more on the appearance of their faces than their genitals), while also protecting patients from violence and discrimination due to their physical appearance. 12 The importance of FFS may increase during a pandemic in which the widespread use of masks prevents others from seeing the nose and mouth, which can be made to appear more feminine with makeup.…”

“…A recent study found significantly reduced risk of mental health treatment in TGNC patients after receiving GAS but not HRT alone 13 . In the United Kingdom, arguments to publicly fund GAS via the National Health Service are based on clinical necessity, cost‐effectiveness, justice, and ethical consistency 14 . Among GAS procedures, FFS can be more effective at relieving GD than genital surgery (because patients tend to focus more on the appearance of their faces than their genitals), while also protecting patients from violence and discrimination due to their physical appearance 12 .…”