Medical Treatments for Transgender Minors--Oral argument in Supreme Court

 Yesterday the Supreme Court heard oral arguments about the Tennessee ban on transgender treatment for minors.

Supreme Ct. Hears Case on Medical Treatments for Transgender Minors
"The Supreme Court heard oral argument in United States v. Skrmetti, a case on whether Tennessee’s ban on transgender medical treatments for minors violated the Equal Protection Clause of the 14th Amendment. Tennessee enacted its law in March of 2023, which stated that there was a “compelling interest” to protect minors from physical and emotional harm by banning health care providers from administering hormone/puberty blockers and surgery to minors for transgender purposes. Transgender minors and their families sued the state, and the Justice Department intervened on their behalf, arguing the law discriminated on the basis of sex. A district court then stopped the ban on hormone and puberty blockers, but the Sixth Circuit Court of Appeals reversed that decision. The Justice Department then appealed to the Supreme Court. Chase Strangio, who argued on behalf of trans minors and their parents, was the first openly transgender lawyer to argue before the Court. 

Opening statement (text compiled from uncorrected Closed Captioning):

"MR. CHIEF JUSTICE, AND MAY IT PLEASE THE COURT, THIS CASE IS ABOUT ACCESS TO MEDICATIONS THAT HAVE BEEN SAFELY PRESCRIBED FOR DECADES TO TREAT MANY CONDITIONS INCLUDING GENDER DYSPHORIA. BUT SB-1 SINGLES OUT AND BANS ONE PARTICULAR USE. IN TENNESSEE THESE MEDICATIONS CAN'T BE PRESCRIBED TO ALLOW A MINOR TO IDENTIFY WITH OR LIVE AS A GENDER INCONSISTENT WITH THE MINOR SEX. IT DOESN'T MATTER WHAT PARENTS DECIDE IS BEST FOR THEIR CHILDREN. IT DOESN'T MATTER WHAT PATIENTS WOULD CHOOSE FOR THEMSELVES, AND IT DOESN'T MATTER IF DOCTORS BELIEVE THIS TREATMENT IS ESSENTIAL FOR INDIVIDUAL PATIENTS. SB 1 CATEGORICALLY BANS TREATMENT WHEN AND ONLY WHEN IT'S INCONSISTENT WITH THE PATIENT'S BIRTH SEX. TENNESSEE SAYS THAT SWEEPING BAN IS JUSTIFIED TO PROTECT ADOLESCENT HEALTH, BUT THE STATE MAINLY ARGUES THAT IT HAD NO OBLIGATION TO JUSTIFY THE LAW AND THAT SB 1 SHOULD BE UPHELD SO LONG AS IT'S NOT WHOLLY IRRATIONAL. THAT'S WRONG. SB 1 REGULATES BY DRAWING SEX-BASED LINES AND DECLARES THAT THOSE LINES ARE DESIGNED TO ENCOURAGE MINORS TO APPRECIATE THEIR SEX. THE LAW RESTRICTS MEDICAL CARE ONLY WHEN PROVIDED TO INDUCE PHYSICAL EFFECTS INCONSISTENT WITH BIRTH SEX. SOMEONE ASSIGNED FEMALE AT BIRTH CAN'T RECEIVE MEDICATION TO LIVE AS A MALE, BUT SOMEONE ASSIGNED MALE CAN. IF YOU CHANGE THE INDIVIDUAL SEX, IT CHANGES THE RESULT. THAT'S A SEX CLASSIFICATION FULL STOP, AND A LAW LIKE THAT CAN'T STAND ON BARE RATIONALITY. HERE TENNESSEE MADE NO ATTEMPT TO TAILOR ITS LAW TO ITS STATED HEALTH CONCERNS. RATHER THAN IMPOSE MEASURED GUARDRAILS SB 1 BANS THE CARE OUTRIGHT NO MATTER HOW CRITICAL IT IS FOR AN INDIVIDUAL PATIENT. THAT IS A STARK DEPARTURE OF PEDIATRIC CARE IN ALL OTHER CONTEXT. SB 1 LEAVES THE SAME MEDICATIONS AND MANY OTHERS ENTIRELY UNRESTRICTED WHEN USED FOR ANY OTHER PURPOSE EVEN WHEN THOSE USES PREVENT SIMILAR RISKS. THE SIXTH CIRCUIT NEVER CONSIDERED WHETHER TENNESSEE COULD JUSTIFY THAT SEX-BASED LINE BECAUSE THE EQUAL PROTECTION CLAUSE REQUIRES MORE, THIS COURT SHOULD REMAND SO THAT SB 1 CAN BE UNDER THE CORRECT STANDARD. I WELCOME THE COURT'S QUESTIONS. 

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HT: Kim Krawiec

 

Medpage Today summarized the hearings under this headline:

Supreme Court Appears Likely to Uphold Bans on Transgender Care for Minors
— Justices' decision is not expected for several months

Vatican statement on gender-affirming surgery and human dignity

 A new statement from the Vatican has been widely covered in the press.

Here's the story from the National Catholic Reporter:

Vatican condemns surrogacy, gender-affirming surgery, gender theory in new doctrinal note. Vatican doctrinal chief calls it 'painful' that some Catholics support gay criminalization  BY CHRISTOPHER WHITE, April 8, 2024

"Sex change operations, gender theory and surrogate motherhood pose grave threats to human dignity, according to a major new Vatican document released on April 8. 

While the highly anticipated treatise, "Dignitas Infinita: on Human Dignity," which has been the source of much speculation for months, offers a broadside against the creation of new rights motivated by sex and gender, it is largely a reiteration of long-held Catholic teaching on a number of social and moral concerns. 

The new document, however, seeks to elevate a number of social themes emphasized by Pope Francis during his decadelong papacy — such as poverty, migration and human trafficking — as being equally a part of the full panoply of potential threats to human dignity as bioethical concerns, such as abortion and euthanasia.   

...

"Among the newly identified threats to human dignity are poverty; war; the travail of migrants; human trafficking; sexual abuse; violence against women; abortion; child surrogacy; euthanasia and assisted suicide; the marginalization of people with disabilities; gender theory; sex change; and digital violence.

Gender theory, according to the document, is a subject of considerable debate among scientific experts, and risks denying "the greatest possible difference that exists between living beings: sexual difference."  

The document repeats a frequent warning of Francis against "ideological colonization," where the pope has sharply criticized western governments for allegedly imposing their sexual values on the developing world. All efforts to eliminate sexual differences between men and women must be rejected, says the document. 

At the same time, the document also begins with a caveat that all persons, regardless of their sexual orientation, must be respected, and "every sign of unjust discrimination is to be carefully avoided, particularly any form of aggression and violence."

"For this reason," the document continues, "it should be denounced as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation."  

Last year, Francis became the first pope to specifically condemn the criminalization of homosexuality and said that the Catholic Church must work towards an end to what he described as "unjust" laws that criminalize being gay. At present, at least 67 countries have laws criminalizing same-sex relations. 

In its brief section on gender-affirming surgeries, the document avoids using the term "transgender" and instead offers a muted prohibition against medical interventions for such purposes.

...

"Catholic LGBTQ groups criticized the new Vatican document within hours of its publication, saying it failed to acknowledge the concrete experience of transgender and nonbinary individuals.

New Ways Ministry, an advocacy group that had an historic meeting with Francis at the Vatican last October, said in a statement that the text "fails terribly" and shows the limits of the church's understand of human dignity.

...

"The new document also goes on to repeat the pope's recent call for an international ban on the rising practice of surrogate motherhood, declaring that the "legitimate desire to have a child cannot be transformed into a 'right to a child' that fails to respect the dignity of that child as the recipient of the gift of life."  

In January, Francis used his annual "State of the World" address to ambassadors accredited to the Holy See to push for a global ban on surrogacy. 

While the pope had previously condemned the practice, the pope's sweeping remarks on the topic — where he called it a "grave violation of the dignity of the woman and the child" — marked the first time he had made such a specific policy proposal. Last month, the Vatican's ambassador to the United Nations, Archbishop Gabriele Caccia, also pressed for an international prohibition against the practice. "

Gender neutral words in gendered languages

Novel pronouns haven't been widely adopted in English, but committees now have chairs or chairpersons, and there are some attempts not merely to avoid assigning male or female genders to words when they're not needed (like chairman), but also to avoid suggesting genders at all.  That's going to be tougher in languages in which all words have genders, or in which the conjugation of verbs involves choosing a gender.  Take Spanish for instance.

The NY Times has the story:

In Argentina, One of the World’s First Bans on Gender-Neutral Language. The city of Buenos Aires blocked the use of gender-inclusive language in schools, reigniting off a debate that is reverberating across the world.   By Ana Lankes

"Instead of “amigos,” the Spanish word for “friends,” some Spanish speakers use “amigues.” In place of “todos,” or “all,” some write “todxs.” And some signs that would say “bienvenidos,” or “welcome,” now say “bienvenid@s.”

...

"Similar gender-neutral language is being increasingly introduced across Latin America, as well as in other languages, including English and French, by supporters who say it helps create a more inclusive society.

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"The city government in Buenos Aires, the nation’s capital, last month banned teachers from using any gender-neutral words during class and in communications with parents. 

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"The policy, among the first anywhere to specifically forbid the use of gender-neutral language, provoked a swift backlash. Argentina’s top education official criticized the rule and at least five organizations, a mix of gay rights and civil rights groups, have filed lawsuits seeking to overturn it.

"Jaime Perczyk, Argentina’s education minister, compared the measure to prohibitions against left-handed writing under the fascist dictatorship of Francisco Franco in Spain.

...

"Argentina is a surprising place for such a heated debate on gender-neutral language because the country has largely embraced transgender rights. In 2012, it became one the first countries in the world to pass a law allowing people to change their gender on official documents without requiring the intervention of a doctor or a mental health therapist."

Trans as a gender identity

 New freedoms continue to be recognized.

It is not so long ago that sexual orientation and then same sex marriage were at the forefront of the cultural clash between individual rights and freedoms, and social repugnance.  Those battles aren't over, but the rights of individuals to love who they love have won important legal and cultural battles.

Lately, sexual identity is drawing increasing attention, with a growing recognition that some people's brains aren't wired the way their genitalia would suggest.  Two articles in the NY Times help (me at least) to understand some of the issues.

The first is written under a pseudonym by the mom of a transgender child, who notes that many people are trans starting as young children.  The second, by a trans man, argues that we should think of transgender a a gender identity of its own, not as a transition from one traditional gender to another. 

Where in the World Are All the Trans Children? Everywhere. By Marlo Mack

"I learned that while many transgender people do not transition until adolescence or adulthood, significant numbers of young children are aware of their gender identity from a very young age. Dr. Kristina Olson, a psychologist at Princeton University who studies gender development in children, says, “Research shows that there are a set of trans people who first identify with their gender by the toddler or preschool years and continue to do so throughout their lives.”

...

"But if transgender children are a global phenomenon, so are their struggles. Just as in the United States, parents who have spoken publicly are often harassed and threatened. (For safety reasons, I am not naming them.) Nearly all saw relationships with friends and family members disintegrate when their children came out as trans. Several families immigrated to countries that felt safer for their children. “When my daughter is older,” said one mother who left Mexico for the United States, “I’ll tell her the real reason we left.”

"These kinds of moves are likely to become more common, as courts and legislatures around the United States and in other countries chip away at transgender rights, restricting access to gender-affirming (and lifesaving) medical care for children like mine. On my social media feed, parents around the world are asking one another: Where can we go now? Where will my child be safe?

"It is not always easy to stay hopeful while raising a transgender child in a world that so rarely chooses to welcome her. I wonder what I would do if my own state passed a law making her medical care illegal. I worry about where she will be able to live and travel safely when she is older. I worry about the children who live in places where being transgender remains a crime.

"Yet I am hopeful, because I have witnessed the ferocious, protective love of parents around the world. And that is not a liberal Western fad."

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What I Saw in My First 10 Years on Testosterone  By Thomas Page McBee

"I also wanted it known that despite the media fixation on a trite narrative about what it meant to be trans, I was not “a man trapped in a woman’s body or any cliché like that,” as I emailed my friends and family. I was a man and I was born trans, and I could hold both of those realities without an explanation that could be written on the back of a napkin.

“I will not become a different person,” I wrote in that email, defiantly and, as it turns out, correctly. “I am myself. I just want to feel more like me.”

New legislation expressing repugnance to gender transition

 Trans people are facing new obstacles from state legislatures, concerning sports teams, healthcare, and toilets.  Here's a story from the Guardian.

Mapping the anti-trans laws sweeping America: ‘A war on 100 fronts’. In an extraordinary attack on trans rights, conservative state lawmakers proposed more than 110 anti-trans bills this year  by Sam Levin

"On the first day of Pride month, the governor of Florida, Ron DeSantis, signed a law banning transgender girls from participating on girls’ sports teams in middle school through college.

"It was just one of 13 anti-trans bills conservative lawmakers in the US passed this year, and one of more than 110 bills that were proposed – by far the largest number in US history.

...

The most common anti-trans proposals were focused on sports, many of them specifically seeking to ban trans girls from competing on girls’ teams.

...

"The bulk of the other anti-trans bills sought to outlaw gender-affirming healthcare, with at least 36 proposals related to medical treatments across 21 states.

"In April, Arkansas passed the first ban on affirming healthcare for youth, with a policy that threatens to discipline or revoke the licenses of doctors who provide it. Experts and clinicians had strongly objected, arguing that the state was prohibiting care that is considered standard and best practice, and advocates said it was one of the most extreme anti-trans bills to ever be enacted.

...

"Five states also considered anti-trans bathroom bills, with Tennessee ultimately passing two separate laws. One prohibits trans kids from using bathrooms and locker rooms at school that match their gender. Another requires that if businesses allow trans people to use the correct bathrooms, they have to post a sign that says, “This facility maintains a policy of allowing the use of restrooms by either biological sex, regardless of the designation on the restroom.”

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And elsewhere (from the WSJ):

Hungary Bill to Restrict How Media Depicts Homosexuality, Transgender Rights. Legislation restricts content depicting individuals who are gay or who no longer identify with the gender they were assigned at birth  By Drew Hinshaw

"The bill—which prompted thousands of protesters to throng the capital of Budapest on Monday—is part of a wider battle within Europe, as a small camp of Central and Eastern European governments, led mainly by socially conservative nationalists, pass legislation aimed at slowing the rising acceptance of gay and transgender rights on the continent.

The region, along with neighboring Russia, has seen a series of laws and government-backed measures similar to the bill passed in Hungary. In 2013, Russia’s parliament unanimously passed a federal law banning the dissemination of “propaganda of non-traditional sexual relations” among minors.

"More recently, nearly 100 local governments in Poland declared themselves “Free from LGBT Ideology,” with signs posted around small towns that read “LGBT Free Zone.” Those moves prompted the EU to cancel some funding that would have gone to infrastructure and economic development in those parts of Poland.

"Last year, Romania’s parliament adopted a bill, later scrapped by a high court, restricting schools and colleges from teaching that “gender is a concept different to biological sex.”

Boy scouts reverse their position and accept transgender boys

That was fast. After the Cub Scouts recently expelled a transgender boy, the NY Times reports Boy Scouts, Reversing Century-Old Stance, Will Allow Transgender Boys

"Reversing its stance of more than a century, the Boy Scouts of America said on Monday that the group would begin accepting members based on the gender listed on their application, paving the way for transgender boys to join the organization.

“For more than 100 years, the Boy Scouts of America, along with schools, youth sports and other youth organizations, have ultimately deferred to the information on an individual’s birth certificate to determine eligibility for our single-gender programs,” the group said in a statement on its website. “However, that approach is no longer sufficient as communities and state laws are interpreting gender identity differently, and these laws vary widely from state to state.”

The announcement, reported on Monday night by The Associated Press, reverses a policy that drew controversy late last year when a transgender boy in New Jersey was kicked out of the organization about a month after joining.

“After weeks of significant conversations at all levels of our organization, we realized that referring to birth certificates as the reference point is no longer sufficient,” Michael Surbaugh, the Scouts’ chief executive, said in a recorded statement on Monday.

The announcement came amid a national debate over transgender rights, with cities and states across the nation struggling with whether and how to regulate gender identity in the workplace, in restrooms and at schools.

In recent years, the Boy Scouts of America has expanded rights for gay people. In 2013, the group ended its ban on openly gay youths participating in its activities. Two years later, the organization ended its ban on openly gay adult leaders."

Repugnance watch: Gender identity. 8-year-old transgender boy barred from Cub Scouts in NJ and NYC issues an "intersex" birth certificate,

Two (otherwise unrelated) recent news stories suggest that social attitudes towards gender identity may be tested in the new year in ways that resemble the transformation that has taken place in our collective outlook on sexual orientation.

The first story concerns the cub scouts.  It happened in Secaucus, NJ, and NorthJersey.com has a report: 8-year-old transgender boy barred from Cub Scouts

"From the moment he joined, 8-year-old Joe Maldonado eagerly looked forward to camping trips and science projects as a member of the Cub Scouts. But his expectations were dashed after his mother said she received a phone call from a Scouting official who told her that Joe would no longer be allowed to participate because he was born a girl.

"Kristie Maldonado said she was stunned because her son had been a member of Cub Scout Pack 87 in Secaucus for about a month and his transgender status had not been a secret. But some parents complained, an official from the Northern New Jersey Council of Boy Scouts told her — even though her son had been living as a boy for more than a year and was accepted as a boy at school, she said
...
"Joe's case could be the first time someone has been barred from participating in Scouting because of transgender identity, said members of the LGBT community. And it comes as the Boy Scouts of America appeared to be emerging from a period of turmoil involving sexual-orientation issues, reversing long-standing bans against gay Scouts and gay Scouting leaders over the past few years. Those policy changes were made amid an internal debate that saw at least one local council defy national Scouting decrees by hiring a gay camp counselor and pressure brought from corporations that withheld donations from the organization.

"The Boy Scouts did not address the transgender issue at the time, LGBT advocates said, perhaps because the organization had no written policy related to gender identity. Transgender rights only recently emerged as a national issue, often focusing on the use of restrooms based on gender identity. Dozens of North Jersey school districts, including Secaucus, have granted that right, among others, to transgender students.
...
"Effie Delimarkos, the communications director for the Boy Scouts of America, said in a statement that the organization’s Cub Scouts programs are for boys age 7 to 10 and that "the classification on the participant’s birth certificate” would be used to “confirm legal status.”
...
"Delimarkos said in her statement that the Boy Scouts consider membership for transgender children to be a separate issue from that of gay children.

“No youth may be removed from any of our programs on the basis of his or her sexual orientation,” she said, but added: “Gender identity isn’t related to sexual orientation.”
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The second story concerns a newly reissued birth certificate issued by the New York City Department of Health and Mental Hygiene (DOHMH):
Nation's First Known Intersex Birth Certificate Issued in NYC

"On Tuesday, 55-year-old Sara Kelly Keenan received something in the mail she's been waiting for her entire life: an accurate birth certificate.

Keenan was born intersex, with male genes, female genitalia and mixed internal reproductive organs. Now, Keenan, who uses female pronouns, is making history. Hers is believed to be the first birth certificate ever issued in the United States that reads "intersex" in the gender field, instead of "male" or "female."