Exploring the Role of Physicians and Legal Oversight in Gender-Affirming Care
The U.S. Supreme Court is currently reviewing state bans on gender-affirming care for transgender youths. This issue has sparked significant debate, yet many information sources on the topic remain blocked. Despite this, I recall my own experience as a medical student in 1967, living through the early days of gender-affirming care. The story of Dr. John Money and his work with Bruce Reimer, later known as David, remains a cornerstone in this conversation.
Dr. John Money and the Reimer Case
Dr. John Money, a psychologist at Johns Hopkins Hospital, is known for his controversial treatment of Bruce Reimer. Bruce was one of twin boys who suffered a botched circumcision that left him with severe damage to his genitals. Dr. Money’s solution was to raise Bruce as a girl, renaming him “Brenda” and performing procedures like castration and estrogen therapy. Over time, it became clear that this intervention had a devastating impact. Bruce, now David, chose to transition back to his original gender. Tragically, David Reimer later took his own life in 2004, which cemented the story as a cautionary tale.
The Ethics and Complexities
Advocates for transgender rights argue that bans on gender-affirming care represent an attack on transgender youth. These bans prevent access to treatments that major medical organizations, like the American Academy of Pediatrics (AAP) and the American Medical Association (AMA), have endorsed. However, these organizations also call for more research, acknowledging the controversy and uncertainties surrounding gender-affirming care.
AAP’s position distinguishes between “best practices” and “standard of care.” The standard of care is a widely accepted medical practice that competent practitioners should follow. It is grounded in scientific evidence. Best practices, on the other hand, reflect consensus rather than proven scientific certainty. The AAP emphasizes the need for more research to establish clearer guidelines in this area.
Who Should Decide?
Should the decision about gender-affirming care rest with medical professionals or the Supreme Court? Medical professionals make decisions based on scientific evidence, with a 95 percent confidence level. In contrast, the legal system uses the preponderance of evidence, which represents a 50 percent probability. This raises critical questions about the intersection of law and medicine. Physicians should make medical decisions, not judges, who cannot always account for the nuances of medical knowledge and patient care.
A Collaborative Decision-Making Process
Ultimately, the decision about this should be made between the patient and their doctor. This aligns with the notion of patient autonomy and recognizes the physician’s role in guiding treatment. Just as Dr. Money’s actions in the Reimer case would be subject to modern malpractice laws, today’s treatment decisions must be made carefully, with the patient’s well-being as the foremost concern. States that ban gender-affirming care may attempt to prevent harm, but it’s essential that the decision-making process remains centered on the patient, their doctor, and ethical considerations.
To understand more about the evolving landscape of gender-affirming care, visit Stanford Physician Advocate.