Jul 26, 2010
Gender Reassignment Surgery, Limited Resources, and ‘Positive Results’ for Society
Yesterday’s Sunday Tribune reported that Labour councillor, Colm Keaveney (left), is of the view that the HSE ought to desist from funding gender-reassignment surgery abroad (provided under the Treatment Abroad scheme) when there are children waiting for and being deniefd medical treatment here in Ireland. His view seems to be based on a multi-part premise that can be discerned from this quote from the article:
“When allocating scarce resources, we must establish what actually delivers best value for society and the individual,” he said.
“Depriving children of necessary aids and appliances at this point in their life will have a devastating social outcome in later years when compared to some very expensive procedures being paid for by the taxpayer.
“While I understand this may be offensive to transgender people, I would ask them to look at this through the eyes of a parent and try to empathise with how they feel about their child’s wellbeing.
“Given the dire straits the country finds itself in, it is vital that we focus government spending on areas that will deliver positive results for our society in the long run.”
So what are the elements of this premise upon which he rests his view? It seems to me that they are: (a) gender-reassignment surgery does not, relatively speaking, deliver ‘value’ or ‘positive results’ for society and the individual; (b) the healthcare needs of children should trump the healthcare needs of trans people where there are limited resources. Both of these elements are, to my mind, very worrying from a human rights perspective.
Delivering ‘value’ and ‘positive results’ through healthcare
The idea that healthcare ought to provide value and positive results for society as well as for individuals needs some disentangling in order to identify the ways in which this contention is of concern from a human rights perspective. First of all, of course, there is nothing objectionable about insisting that state-provided healthcare would deliver value in terms of decreasing waste, increasing productivity and quality of healthcare etc… That is not, however, what it appears to me that Cllr. Keaveney meant here. Rather, from the context, it seems to me that his contention is that some kinds of health are more beneficial to society generally than others; that whether or not a trans person who elects to undergo a gender-reassignment surgery can in fact secure that surgery is not fundamental to that individual’s health. In fact, we know that being able to secure surgery where it has been elected for is extremely important and that failure to access such medical treatment can have detrimental effects on one’s mental health and sense of wellbeing, identity and autonomy.
Furthermore, Cllr. Keaveney appears to me to be glossing over the fact that individual health and wellbeing is in fact fundamental to society. A society is, after all, a collection of individuals and in a society such as Ireland where we have elected to have a welfare-based approach to the provision of healthcare for those who do not or can not secure private health insurance, part of our societal ethos lies in recognising the fundamentality of individual wellbeing to societal wellbeing. The right to healthcare and bodily integrity inheres in each person regardless of what their healthcare needs happen to be. Certainly, there will be times when resource realities require us to make decisions regarding how we react to the healthcare needs of different people but in making those decisions it is fundamental that we do not allow our analysis to be skewed by unreflective and generalised perceptions of some kinds of healthcare being more important, delivering more ‘value’ and having more ‘positive results’ for society than others.
Deciding healthcare priority on the basis of status rather than medical need
More worrying to me, from a human rights perspective, is the insinuation within Cllr Keaveney’s intervention that allocating healthcare resources can be done on the basis of status; that this is a child v trans person analysis. Such a method of resource allocation is both deeply offensive (why does child trump trans person in this analysis?), overly simplistic, and blind to the proper basis for the allocation of healthcare resources: medical need. Certainly there will be some cases in which the medical need of a child will trump the medical need of a trans person who has elected to undertake gender reassignment surgery but that will not necessarily be the case. It will be entirely dependent on the particular circumstances of the case. To suggest that this can be constructed as a competition for resources based on status rather than medical need is to wholly undermine the important role that medical treatment can play in the full realisation of one’s right to privacy and gender identity as well as to suggest some kind of medical triviality in respect of being transgendered.
None of these insinuations are helpful. Neither do they lay the foundation for a rights-based allocation of limited resources, which in my view is the only justifiable mechanism for deciding on priority in the context of the provision of medical services.
Oh I’m sorry but I really have to demur.
I have every sympathy with the plight of transgender people, but to state that medical treatment should be based on a ‘right to privacy and gender identity’ places way too much pressure on an already overstretched healthcare system.
One’s privacy and identity should be assured by the state, but none of us have an absolute right to physically be what our psychological makeup insists we are.
To say that there should be a ‘rights-based allocation of limited resources’ when speaking of medical treatment is to start down a very dangerous road, which could end at a destination far different to the one you seek.
I was supposed to go to England in march just gone in order to have a gender op assessment. In order for me to do this I needed to have secured the nesscesary funding since no one performs these operations in the Republic of Ireland( I don’t know about the north)The fact that these operations are not performed in Ireland begs question’s in and of itself but that aside when I made inquiries about the funding and to get some other information from the overseas department I was told that due to some mistakes made in the filling out of the form It had been returned to the endocrinologist consultant who oversee’s the regieme of hormone treatments required.
I would like to point out that I first identitfied as trans gender when I was nineteen years of age I am now 49 years old. The reason it took me so long to arrive at the point of surgery had little to do with me and everything to do with the lack of facilities in this Country for Trans people and the desrimatory attitude adopted by the medical profession and politicians so after reading this article the question is begged (for me at least) if the forms had not being filled out incorrectly what other excuse would have been adopted in order to deny me.
Another interesting point is that the H.S.E. said that the forms had been returned to the consultant. I have seen him twice since this supposedly happened and there has been no sign of said forms so it would appear that the fianna Gael politician is getting his wish irrespective of what form it takes in order for him to get it.