Would you, could you, should you?
Thomas Beatie has been on my mind a lot lately, mainly because I’ve been wondering what I would do in his situation, and if I could even go through with what he’s doing. One question led to another, and suddenly a million chaotic theories and thoughts were chasing each other around my mind, issues related to reproductive rights, societal behavior… everything. And out of that came more questions still - well, you see where this is going. Although these are questions that I asked myself (or more like rationalized out along a train of thought), I’d like to ask you as well. I’ll provide my own answers below each question; I’d like to hear your answers in the comments.
1. If you’re male or FtM, imagine that you’re capable of conceiving and carrying a child to term. If you’re female or MtF, imagine that you’re capable of impregnating a partner. If you could and your partner wanted it (whether it’s the only option for childbirth or one of many), would you?
Not just no, hell no - mainly because children give me the creepy-crawlies and I’m about as child-friendly as ball pool filled with rusty razor blades. I think people should have the right to pursue such avenues (such as a transwoman impregnating a biological female, or a transmale being impregnated by a biological male/artificial insemination) if that’s what makes them happiest, as it shouldn’t matter how the child was brought into the world or which parent was involved in what part of conception as long as neither parent was harmed and the child is wanted and happy. I just couldn’t do it myself, and any partner who asked me to wouldn’t be someone I’d end up with long-term, because it tends to ruin relationships if your partner doesn’t respect your decisions about children - whether you want them or not. Besides, I may have an extremely high pain threshold, but not high enough to squeeze something the size of a basketball out of any orifice of my body. No thank you, though I admire those who can.
2. Do you believe that doctors have the right to refuse treatment to patients based on their personal beliefs?
Again, hell no. I think doctors have a moral obligation above their personal beliefs, and that moral obligation is to see to the health and well-being of all their patients - which means performing procedures that they might not morally agree with. Can you imagine what would have happened to Thomas Beatie if every available doctor refused to treat his ectopic pregnancy because of personal beliefs? He could have died. The obligation to a patient’s life and its preservation stands far above any personal or religious beliefs. As long as the procedure is not damaging to the patient’s or anyone else’s mental or physical well-being, then yes, the doctor is obligated to perform it, and perform it to the best of their abilities. I can’t refuse to do one of my writing projects just because I object to my client’s obnoxiously masturbatory self-image based on my personal beliefs, and my work doesn’t even affect one’s health.
This can get into shady grey areas when it comes to optional procedures such as cosmetic surgeries or gender reassignment surgeries, but I’ll cover that in my answer to the next question, as I think that relates to safeguarding the patient’s mental well-being as well when it comes to allowing them to live happily as their chosen self without the struggles (depression, stress, etc.) that can come from being denied what they need.
3. Specifically in relation to reproductive rights: Do you think that doctors have the right to refuse to perform vasectomies on men or hysterectomies, tubal ligations, or implantation of contraceptive devices in women and FtMs based on their eligibility to breed?
…only in very specific situations, and only with consultation from an unbiased outside party.
Before you crucify me: I think that anyone, male or female, should have full control of their bodies and definitely of their reproductive systems - but I do understand somewhat why some doctors deny patients. Many doctors have been victims of malpractice suits by patients who said they wanted a certain surgery, then years later changed their minds, couldn’t have it reversed, and sued their doctor for allowing them to go through with the decision and rendering them unable to conceive. That’s one reason that doctors often deny people who are still of safe childbearing age.
But there are other reasons that I really can’t agree with - mainly patriarchal and religious stances that value a person’s ability to breed above the person themselves, their desires, and their health. Even if it would make them miserable, even if they’re staunchly against ever having children and are quite certain of their own minds, they’re told placidly that they’ll change their minds (because of course everyone wants children, it’s inconceivable that someone wouldn’t) and denied contraceptive surgeries…even if they’re getting them not to avoid children, but to transition from one gender to the other. Some people even view people who have such surgeries as sluts, who just want those surgeries so they can have indiscriminate sex with anyone and anything moving.
Those views, restrictive and condescending and dehumanizing, I cannot abide. Yes, some people do change their minds and regret it later, because they made hasty, impulsive decisions - but there are people capable of making up their minds after lengthy self-analysis, and there are perfectly normal, respectable people who just don’t want children. Ever.
The problem arises when asking a doctor to determine which is which. While a physician or surgeon is a licensed health professional, not so many serve double duty as a licensed mental health professional, capable of determining if a person is capable of making this decision in an educated adult fashion. The easiest way is just to say no, period, unless they can determine that the person is in actual physical danger and requires the procedure.
Or you could just bring in a licensed therapist.
Seriously; that would keep everyone’s balls out of the grinder. Why not make 6 months of professional therapy a pre-surgical requirement? The therapist would counsel the person on their reasons for wanting surgery to remove or limit their reproductive organs, whether it’s gender reassignment or just a serious desire not to have children, make them aware of the eventualities and pitfalls, ask all the right questions so that they analyze their motivations and don’t make the wrong decision…and at the end of the six months, determine if they’re in sound enough mind to be certain of the decision. At the end of the 6 months, both the therapist and the patient sign off on the counseling, with the patient also agreeing that they still stand by their decision and thus can’t sue the therapist or surgeon for malpractice. With that signature from the therapist, the doctor should then be bound by law to perform the procedure.
Wishful thinking, eh? Then again, there’s also the problem that the burden of personal beliefs then shifts to the therapist, who could still make judgments based on personal beliefs whether they’re supposed to or not and even though they’re trained to offer counsel without personal influence.
Then again, it’s my experience that mental health professionals are better equipped to handle these things than doctors, and can be a bit less biased…or at least put aside their bias more easily.
…now stop looking at me like that. I went to therapy voluntarily for a few months so I could kick my familial issues to the curb and get on with my life. I’m crazy, but I’m not that crazy.
So what are your answers? Would you, could you, should you?
thomas and nancy beatie, pregnant transman, male pregnancy, gender dysphoria, transgenders, transsexuals, mtf, ftm, m2f, f2m, gender identity disorder, reproductive rights, reproductive surgeries, hysterectomy, vasectomy, omg!babies!
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April 2nd, 2008 at 3:41 am
1. I would have a child, any way possible. I doubt it would even be my partner’s suggestion (if I have a partner when I decide it’s the right time in my life to have kids) but I wouldn’t let my gender identity stop me from having children, whom I’ve wanted for as long as I remember. And to my parents’ displeasure, I wouldn’t let my lack of a partner stop me, either. I think the want for children is independent of both gender and romantic commitments. It’s something above all that.
2. Ummm.. No. Wait. Yes. Wait. Maybe. In a perfect world, no. In life threatening situations, absolutely not. But with a case such as Thomas’s, I think it would have been acceptable of the doctor to turn away a patient because of moral judgments. I think that any good doctor can understand that their bias DOES get in the way of their treatment, and it would be better to direct them to a more LGBT friendly doctor than to treat the patient themselves in such a situation. It was absolutely wrong, however, for the doctor to both pass judgment and take Thomas Beatie’s money, stringing him along and giving him hope while having no intention of helping him conceive.
Likewise, I think for procedures such as cosmetic surgery and other non-life threatening situations, the doctors can trust their own discretion and direct the patient to someone else that would have no doubts about performing the procedure, the same way a physician would direct a patient to a specialist. Just as a doctor has the right to refuse to perform an abortion, they should have the right to refuse to help a couple conceive, as long as they are consistent in that stance and provide alternative resources for the couple.
3. I think doctors should have that right if they are in private practice. In fact, everything I’ve said so far about doctor’s rights has been speaking from the point of view of private practice, as state funded hospitals should be completely impartial and so should the doctors working within them.
In private practice, though, a doctor should have a right to refuse to do a procedure that stands against their moral beliefs. Mostly, this view is inspired by a fear of doctors botching procedures because they don’t agree with them. I’d much rather their patients went to someone who is more experienced and more supportive.
I think it’s important to remember that our health care professionals are one hundred percent human, and they have the same morals and feelings that any other human does. If I was a tattoo artist, I would refuse to tattoo a swastika on someone. If I was a doctor, I would like to have the same right to refuse to perform a procedure that I think goes as fully against my beliefs. And I do believe it is for that right that many doctors enter private practice.
Now, in terms of reproductive rights, I think it’s ridiculous to deny someone contraceptives because of religious beliefs or preservation of life or whatnot. But as long as the doctor is not working for an equal-access state institution, and hopefully as long as the doctor provides a patient with an alternative source to get the contraceptive, I don’t see why a doctor wouldn’t have the right to uphold their moral beliefs.
April 2nd, 2008 at 4:58 am
1. Yeah, probably. Rather have a baby myself, though. Except without the giving birth bit, if at all possible, because that sounds painful. But if that’s what my partner wanted and it was possible, there’s no reason why not.
2. No. Doctors are paid to treat people, not make moral judgements. If it’s not a life threatening situation and they really feel their moral position would impede them in carrying out their treatment, then they should tell the patient that and give them the choice of being transferred to another doctor. However, I don’t think professionals should have their work affected in that way by their personal belief. If you’re performing an operation, you’re performing an operation, no matter who you’re performing it on.
3. Yes, if the patient isn’t in sound mind. Otherwise, no.
April 2nd, 2008 at 7:27 am
1. Too many hereditary conditions in my family. I won’t do it to my children, and hell, I won’t do it to myself.
2. Doctors should treat everyone equally, but I can respect that they would say that the situation makes them so uncomfortable that they think it might compromise their work. They should say this well in advance, though, not like what that idiot of a doctor in Thomas and Nancy’s case did.
People should not be forced to deal with something. I would prefer if someone was honest with me, rather than ‘endure’ having to deal with me.
3. Absolutely. I think the same age and health rules should apply as with ‘regular’ males and females. You never know if you might regret it or not.
April 2nd, 2008 at 10:39 am
1. At this point in my life, no, I would not impregnate a partner. I assign my free time far too selfishly to take care of a child.
2. Hmm. I’m leaning towards yes, on the condition that the doctor recommend someone else willing to do the procedure. Although on this, I’m not sure I’d want a doctor performing a procedure he/she was uncomfortable doing in the first place– that sounds like a recipe for trouble to me.
3. Based solely on their ability to breed, no. If the doctor thinks his/her patient is uncertain, or might regret the decision, then yes, the doctor should be able to deny the procedure. If the doctor wants to deny because of a personal bias, the doctor should again send the patient to someone else. I agree with your therapist suggestion, incidentally.
April 2nd, 2008 at 11:13 am
Note: for brevity, the “doctor” I speak of uses male pronouns. I’m not being misogynistic, just avoiding 50 instances of “he or she” in my comment.
1. I don’t want kids. If it were possible, and I had some sort of change of heart and my partner and I wanted kids, I would do it in a second. God save the man (or woman) who tells me I can’t because I have a cock.
2. You and I disagreed on this one before. The guiding principle of the Hippocratic Oath is to first, do no harm. If I walk in spouting blood from a neck wound, the doctor _must_ treat me (despite liking people with the same sex organs I possess), or he’s going to lose his license and probably end up in jail. But if I walk in and tell a doctor, “I don’t want a cock anymore, get rid of it,” he can say no.
There is grey area, where I might have something mildly life-threatening or life-changing that is affecting me on a daily basis where it might be in my best interests to chop off my cock, but he doesn’t have to do it unless I’m in imminent danger.
In Tom’s case, any doctor who turned him away during the ectopic pregnancy should be fined, jailed, and at the very least have their license revoked. But the second pregnancy isn’t something a private doctor should be required to help with.
Public doctors are another story. You get public funds in your hospital or practice, you help everyone. There are specific anti-discrimination laws and rules governing those doctors, and they are required to do it.
Medicine is full of moral and ethical questions, and, unfortunately, the doctors have to protect themselves. Since most of the “is this acceptable” questions come down to morals and ethics, we can’t really tell them to make the decision in absence of morality. You just need to work on teaching people to keep their baseless moral objections are just that, baseless.
3. Yes and no. A doctor can refuse to start treating someone for any reason. I prefer to know that a doctor is an ass before I start seeing him. Once they are a patient…no, not ever, not unless the doctor is dead or closing their practice. You start treatment and you take responsibility for their well-being. You can’t pull out last-minute on that shit. Not only does it prove you are a shitty human being, it’s immoral and illegal.
Funny, though, how none of this is an issue with a vasectomy. Granted, I can get the little swimmers to come back…as the often do without surgery…but there’s no questions, no though, just walk in outpatient and 30 minutes later I’m shooting blanks.
And, Adri? Remind me to tell you about the crap my baby brother’s doctor pulled when he broke his leg.
April 2nd, 2008 at 1:32 pm
1. If you’re male or FtM, imagine that you’re capable of conceiving and carrying a child to term. If you’re female or MtF, imagine that you’re capable of impregnating a partner. If you could and your partner wanted it (whether it’s the only option for childbirth or one of many), would you?
No. What gender or sexuality I am has zero bearing on the fact that any partner I choose to be with would not pressure me into having children, and if they did, I would no longer be with them.
2. Do you believe that doctors have the right to refuse treatment to patients based on their personal beliefs?
FUCK no. If you’re going to enter a profession which requires you to provide medical treatment to other people, you should be able to differentiate between what you think is right for you and what your patient needs. All those cretin pharmacists who have refused to provide emergency contraception should not have become pharmacists because the very nature of the profession opens the possibility that they will experience a conflict of interest based on personal or spiritual beliefs. Doctors who refuse to perform or provide medical care based on personal or spiritual beliefs should not be doctors, and if they are caught doing so should have their licenses to practice removed.
3. Specifically in relation to reproductive rights: Do you think that doctors have the right to refuse to perform vasectomies on men or hysterectomies, tubal ligations, or implantation of contraceptive devices in women and FtMs based on their eligibility to breed?
Absolutely not. Then again, as you point out in the article, idiots who undergo sterilization or reassignment surgery without thinking it through and then sue the doctor for malpractice have ruined things for the rest of us, and perhaps a mandatory period of evaluation by a qualified therapist prior to the procedure would cut down on this.
No doctor should ever tell a woman (biological or trans) that they cannot have a procedure done because they, the doctor, don’t think they should have it done for reasons other than medical concerns. “I’m not going to do LASIK on you because your corneal tissue is too thin and it would be dangerous” is okay. “I’m not going to do LASIK on you because it’s unnatural and I feel it contravenes my religious or moral principles” is not. Reproductive surgery is surgery, and should be treated like any other form of surgery.
Fuckers.
April 2nd, 2008 at 6:48 pm
So…basically what some people are saying is that it’s okay for doctors to be homophobic, transphobic, misogynistic, prejudiced, and/or discriminatory assholes who don’t have to answer for their behavior towards other human beings as long as they’re in private practice. ~tilts his head~ Am I getting this right? As I wouldn’t want to misconstrue things, considering that we tend to hold doctors to higher moral standards than your average human being, and there’s a pretty strong movement to end discrimination among the everyday populace and fight for equality and fair treatment for GBLT folks, women, and various other minorities who face discrimination - you know, those people who deserve just as much human consideration as morally subjective doctors. But…it’s okay to discriminate against these people if you’re a doctor in a private practice? Does it stop being okay when the doctor leaves the office and just becomes Mr./Ms. Doctor Person, and not Dr. Doctor Person? Or does it only stop being okay when you’re the one turned away with the possibility of there being no other resources that you can afford?
Gods know I wouldn’t want to inflict myself on someone who doesn’t want to deal with me; it would be uncomfortable for both of us. But saying that doctors have the right to refuse treatment based on their personal beliefs doesn’t even begin to address the root issue: that if those beliefs are founded in prejudice or discrimination of any type, for any reason, then it’s my personal belief they aren’t acceptable from anyone - and least of all from someone who’s supposed to be following a higher calling.
April 2nd, 2008 at 9:25 pm
No, I don’t think it’s OKAY for doctors to treat patients with prejudice. I’m also not going to pretend that doctors don’t do it, and I would rather said doctor does not treat a patient (especially for a non-life threatening issue) than be forced to treat a patient by a law, which can lead to disaster.
As much as I would love to spread a magic fairy dust through the land and in a moment make everyone accepting of all others, that is not going to happen. And if a doctor is honest about their prejudice and refers their patient to someone else, I can only respect them for their weaknesses.
Instead of focusing on forcing doctors into uncomfortable positions where they may do more harm than good, LGBT rights groups should allocate resources to creating more alternatives for LGBT patients, such as LGBT clinics (which are working out great in my area) and awareness in public practice of LGBT issues. Despite the whole idea of “seperate is in itself not equal,” we can’t ignore the fact that complete equality eliminates efficiency, and health care is a prime example of that.
April 2nd, 2008 at 9:45 pm
1) See any answer to the question, “Would I like to have a kid someday” (answer varies by time of day, attitude towards the world, and whether or not I’ve had a social science class that day), but bias the answer towards yes compared to that answer (since actually getting pregnant myself is terrifying)
2) Yes, as long as the doctor is still following medical ethical standards. In general, one should not enforce behavior on others when they consider it immoral.
On the other hand, people should make moral distinctions clear at the beginning and not be an asshole like Thomas’s doctor.
3) Strangely worded question. Based solely on ability to breed is kind of silly. I’m not sure it should be a factor, at least directly. There are lots of reasons to require a therapist before that kind of life-changing surgery, and it’s not necessarily related to breeding in the future. But I guess in specific situations where it *is* a factor in a patient’s decision, it has some influence, so the answer is technically yes.
April 2nd, 2008 at 10:45 pm
People. If I want to attach a penis to my forhead and implant tentacles in my vagina, it is NOBODY’S right to say nope, sorry, I’m morally and ethically against that and so you’ll just have to find some back alley doctor to do that for you. A doctor’s job is to treat people. They do not get to decide who they want to treat and who they don’t. They don’t get that luxury. They’re doctors. They can decide the best course of treatment, and what would work best for the health of the patient, but they are not gods in white jackets, and they do not get to make moral judgments with other people’s lives and happiness. Their profession is in the physical, and all the mental crap is someone else’s business.
Not even plastic surgeons should have the right to be choosey. They make money off of the insecure and the rich, they get paid well to shut up and do their jobs. They live in mansions and drive expensive cars and can act like total assholes to pretty much anyone they please outside of the office. But not in. Inside, they’re still doctors, and their patients have just as much right as anyone else to do whatever the hell they want to their own bodies.
Whether they agree with your lifestyle or your choices or your freaking curtain patterns doesn’t matter one fat fuck. It is their JOB to do what they paid a buttload of time and money to do. If someone is sick, they treat them. If someone is hurting, they help them. If someone wants to replace their uterus with an inflatable arm float, as long as it doesn’t hurt them or someone else that doctor has to bloody well shut the fuck up and do it.
April 2nd, 2008 at 11:09 pm
I was kind of given a revelation today, made to see things through Thomas’ eyes. Doctors hold a position of respect, people look up to them and seek them out as bastions of knowledge and respect and integrity. How would you feel when someone in that position of power looks at you like you are subhuman filth and dismisses you and your wellbeing as inconsequential? What happens when that person has rule over matters of life and death?
When I was younger, I was very involved in the church. I knew early on that it’s not for me (yeah…just not religious), but they supported some very worthy causes in the third world and it was a great way to gain a huge amount of IT experience in a fast paced environment without needing to have IT experience (yeah…early career Catch-22). My group leader was a paid staffer and I kind of grew up working with her and the people on our team. When I was 14, almost 5 years later, I finally had enough of the double life and came out to her.
To have someone in that position of trust and authority turn around and treat you as if you aren’t human, like you’re some kind of monster…there is nothing so horrible and traumatic. And it was just because I was gay (bi). Imagine if she told me I was a monster because of the sex organs I was born with? Merely because I have a cock, I’m somehow less than human?
You probably can’t imagine that…hell, I can’t imagine that. But that’s what happened to Thomas, and happens to transmen and transwomen all over the world every day. I can’t wrap my head around that kind of discrimination, but I can come pretty close. No, doctors should never be able to turn down a patient for their personal beliefs. That’s what being a doctor means.
April 3rd, 2008 at 12:05 am
Indikaze: Yeah, um…you completely missed the point of question three.
Tone: There are laws that protect black people, Hispanic people, people of all race, creed, and color, establishing their rights as citizens and making it punishable by law to refuse to serve, treat, or employ them based on those traits. That means that a white supremacist doctor still has to provide services to a black patient, whether it makes him/her uncomfortable or not, because they are bound by law to treat that patient in an impartial fashion and respect their humanity. They’re held to an obligation to put racist personal beliefs aside regardless of discomfort they may feel treating that person. Why should sexuality and gender identity be any different? Acknowledging the difficulty of enforcing change doesn’t mean it can’t happen. Civil rights movements, suffrage, all were difficult. But they took place and are still taking place today. So what’s the point of saying “Eh, it’s too hard, don’t want to make people uncomfortable by proposing they treat people as equals, so forget about it”? You can’t exactly say that expending money to build more medical facilities and hire more doctors to staff separate facilities just for GBLT patients is more efficient. It’s expensive, and the lack of funding for such ventures would reduce the quality of care - much as it did during segregation when facilities and resources for black medical care were light years behind those for white medical care. It didn’t work then. It won’t work now. Education, awareness, and enforcement are about the only options that we have, which means setting standards of objectivity for doctors and upholding them.
April 3rd, 2008 at 1:00 am
I think in this case, the civil rights movement does not extend to LGBT health care. They’re not comparable. Blacks, hispanics, Jews, whatever, have generally the same medical needs as the average white person, and do require the same care. The only real difference is maybe some genetic predispositions to certain diseases.
Many LGBT people, though, and especially transpeople, have the kinds of health care needs where specialized care would be more efficient. It would enable LGBT patients to be treated by doctors that not only respect them, but would also be able to get all the answers to the kinds of questions they would have, rather than the uncertain guesses that I could probably expect from my physician when it comes to many LGBT-related issues.
And in such a case, I would appreciate if my physician directed me to someone else. It’s not so much a matter of, “you don’t deserve to be treated because who you are is morally incorrect in the eyes of god,” or whatever the reasoning is, but more a matter of, “I don’t have experience with this and so I may not be the best person to treat you.”
April 3rd, 2008 at 1:10 am
In that case, I can agree about seeking out a specialist who’s better-versed in those specific needs, as long as the only reason the doctor is turning them down because they don’t feel as if they’re experienced enough to offer proper care.
But most of the time people are turned away just because the doctor has a problem with who they are, not for valid reasons like the lack of experience with patient-specific needs. I’ve had it done to me, several times, before I found a gay-friendly doctor that I tend to refer my friends to. I’ve had people look at me in complete disgust because I needed a routine physical or blood tests and yes, I am a little obviously gay. It’s the same look I’ve gotten for being darker than pasty white in certain areas of the deep South: that look that tells me that they find me reprehensible, disgusting, subhuman. So you may not think it’s the same, but my experience tells me otherwise. Prejudice is prejudice, regardless of the setting in which it’s practiced.
April 6th, 2008 at 11:24 am
1. I would conceive a child with my partner if that was what we both wanted and I was out of school and one of us had a stable full time job and one of us was willing to quit his or her job and stay home with the kids. So several big ifs on that one. I love kids, and I want to raise kids. But I don’t want to do it while I’m in school- I don’t need to deal with kids and school expenses at the same time-, and I want my kids to have two parents, one of whom is a full time parent, because that’s the best way for kids to grow up.
2. I think doctors should have a limited right to refuse care for moral reasons. I think doctors- and all human beings- have a moral obligation to save human life that overrides all rights, so no doctor has the right to withhold potentially lifesaving treatment from anyone for any reason. On the other hand, doctors should have the right to refuse to perform any purely cosmetic procedure for any reason. In the middle are reproductive and trans issues. I think doctors should be able to refuse to perform such procedures, as long as they give a prompt referral to a more progressive doctor and take no fees for doing so.
April 10th, 2008 at 9:06 am
1. I probably wouldn’t but think others have the right to that decision.
2. I don’t necessarily think doctors should be refusing treatment based on their personal beliefs but they do. At the same time I would prefer knowing someone was prejudiced against me ahead of time so I wouldn’t get substandard care or be put at risk because of their views. In Canada, some doctors refuse pap smears because of religious beliefs and get away with it because of a “conscience clause”.
http://www.rhrealitycheck.org/blog/2008/02/06/abnormal-paps-pap-smears-doctors-refusing-canada In California a lesbian was refused treatment by a doctor to be artificially inseminated because it went against his religious beliefs.(http://www.afterellen.com/node/447)
3. I’m not sure but think giving it time with therapy is a good idea.
April 11th, 2008 at 5:14 pm
1. I don’t wish to have children of my own; I am Bipolar, and I would not want to put any children at risk for developing it. If my partner has them already, I will adjust.
2. Not at all. The Hyppocratic Oath beats out morals by being ETHICAL, and there is NO ethical reason for a doctor to refuse to treat someone.
3. I think all prospective parents should have counselling at least six months prior to becoming pregnant or during the first two trimesters of the pregnancy.
June 6th, 2010 at 6:58 pm
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