Susan Walsh/Associated Press
Amelia Wheaton is a senior majoring in public health and a 2020-21 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.
Arkansas was the first state to ban gender-affirming care for transgender youth on April 12th, 2021. The “Arkansas Save Adolescents from Experimentation (SAFE) Act” bans providers from performing any surgical transition procedures, gender-affirming hormone treatments, and/or puberty blockers on the basis that “[of the] children who are gender-nonconforming or experience distress identifying with their biological sex … the majority come to identify with their biological sex in adolescence or adulthood, thereby rendering most physiological interventions unnecessary” (HB 1570). Policymakers used this grossly unsupported claim to conclude that gender-affirming treatments put children at undue risk with no benefit. The Human Rights Campaign warns that this is just one of 60 bills introduced in the last two years across the U.S. that would limit access to gender-affirming care. Similar bills have been passed on the House floor of both the Florida and Oklahoma legislatures and await Senate approval right now.
Physicians are bound by bioethics and take an oath to practice medicine to the highest and most revered ethical standards. They regularly balance the call to do no harm (maleficence), to do good (beneficence), to respect a patient’s autonomy (respecting a patient’s decisions about their own health), and to act with justice (treating everyone equally). State policymakers take no such oath and are not bound by these principles.
Trans youth attempt suicide much more often than the general youth population. The medical community has validated the value of gender-affirming treatment for trans youth over and over again. Gender affirming care has been found to improve mental health for trans youth and puberty-blocking hormone treatments were found to decrease suicidal ideation among trans adults. Most compelling may be the fact that trans folks who received the gender-affirming care they wanted had lowered risk of prior-year suicide attempts. Through rigorous scientific investigation guided by strict ethical guidelines, especially when vulnerable youth are concerned, the medical community has found that the risks of non-treatment far outweigh the inherent risk associated with any medical procedure.
Given the wealth of data to support the value of gender-affirming care, it’s clear that physicians offer these treatments and procedures to do right by the patient, to help heal, and to reduce suffering. Many physician organizations that certify doctors for practice also maintain strict ethical guidelines for their members and routinely develop reliable data and recommendations. For instance, on March 16th, 2021, the American Academy of Pediatrics (ACP) recommended that “youth who identify as transgender have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space.” The ACP also advised that “pediatricians are best able to determine what care is necessary and appropriate for these children, but these bills interfere in the physician-patient-family relationship and would cause undue harm.
With such overwhelming support for these treatments by the professional medical community, this Arkansas ban on gender-affirming care, and similar bills in other states, beg the question, “What right do policymakers have to override the scope of medical practice, and on what grounds?” The data and the recommendations of the medical community clearly are in conflict with these laws. The willingness of state legislatures to disregard medical knowledge and ethics in favor of unfounded and frankly transphobic claims can be seen as negligent and reckless. It sets a dangerous precedent and paves the way for further government interference in the evidence-based practice of medicine. If policymakers are truly trying to serve their communities then the reckless endangerment of vulnerable youth populations should lead us all to question their ability to serve in these positions faithfully.
The relationship between the medical community and policymakers at any level is also tested by these bans. Politicians are often involved in lobbying, party politics, and are interested in re-election. These influences enable policy makers to serve their communities for longer periods of time but they are also rooted in the need to be popular.
On the other hand, medical research and treatment recommendations are guided by ethics and as such, are not swayed by popular opinion. Medicine is interested in healing people and doing it with data, evidence, and ethics. The different motivations of these professions are important when it comes to policy. When popular opinion leads us away from data, evidence, and ethics, then what does that say about our country—about the construction of knowledge and faith in science? Moreover, do politicians have a responsibility to value medical knowledge and to take it seriously in the face of contradictory, yet popular, opinions?
With the power to implement policy comes the responsibility to use the carefully constructed medical standards of care to best serve the communities policymakers represent. It is irresponsible to enact policy with little more than an opinion and a drive for re-election. To serve ethically is to educate yourself on best practices and strive to make evidence-based decisions on behalf of the community. To ignore professional recommendations in favor of re-election is to be selfish and to choose one’s career over the health of their community. Leadership is so much more than being popular. True leadership manifests itself as a dedication to and deep respect for those served. Our communities deserve the best practices, they deserve access to quality health care, and they deserve policymakers that respect them enough to serve faithfully, even when it may be unpopular.