The ethics of 'therapeutic' elective surgery

There's a difference. One is a change. The loss of a penis but the gain of a vagina. The other is a complete loss of a functioning limb.

I have no problem with the ruling, in general, so long as the father is not presented with the bill (which will likely be what happens).

But if all those who were acting "on the child's behalf" on the issue are the ones paying for the surgery, more power to them.

A loss of a functioning limb that was causing extreme mental distress, and a gain of peace of mind once it's gone.

True. Urg, I am conflicted, need to think about this more.

@Swish: it's in Australia, in this case, which has some degree of public health. Anyway, all that the girl is being given before 18 is hormones, which aren't extortionately expensive.

As the treatment was therapeutic the taxpayer got fitted for the bill. Although unlike say in the US public healthcare is fairly unpoliticized in Australia.

edited 18th Mar '11 4:26:35 PM by joeyjojo

So then, what about people who want to be androgynes?

But yeah, I think the distinction would be that sex-change surgery would presumably help one live a more satisfying life. I'm not sure about limb amputation; having four functioning limbs/limb-like things is kind of a requirement for most activities.

Kind of a side thought: if I could get enhanced artificial limbs I might want to amputate. Otherwise I don't really understand the appeal, but I'm pretty libertarian about what other people do with their own bodies. If you want to handicap yourself go ahead, it's not my problem.   ^*

"if you pay for it yourself, that is. Not sure yet how I would feel if welfare is brought into the situation"

What about this [1]?

I feel like the big problem people have with the latter example is "but I just don't understand how someone could want to be an amputee!"

Well, I simply don't understand how someone could want to get a sex change. A lot of times, I hear people trying to explain it via analogy: "Imagine you woke up tomorrow, but you were of the opposite gender! Wouldn't you feel trapped in your own body!?" I've thought about this little thought experiment and decided that no, I would not. First thing I'd do would probably be investigate the new plumbing, but after that, just shrug and go on with my life. Gender does not factor into my identity at all, and if I woke up a man tomorrow, I don't see how it would affect me at all. I simply do not understand people who make such a huge deal out of their gender that they go through all this surgery just to fix their "problem."

But I realise that my viewpoint is not universal. I do not speak for everyone. There are people in this world to whom their gender is an integral part of their identity, and dammit, if they feel trapped in their body, they should change it if it will make them feel better. Same thing goes for the amputees. Sure, I don't understand how someone could hate a part of their body so much that they want it gone, but dude, if it's causing them this much distress, then by god, they have my blessing to go hack that thing off.

Well, there's also the gender roles issue, and having to pick from an entirely new range of potential sexual partners. I heard that gay/bi people are a pretty small percentage of the population, so that could be a problem if you were straight before the bodyswitch. So it's a little more complicated than just having different plumbing.

if you're born male and are attracted to men, yet identify as female. Are you not in fact straight?

edited 18th Mar '11 4:46:58 PM by joeyjojo

I'm a female neurology/mathematics double major who can't cook for shit, hates children with a burning passion, almost never wears skirts/dresses and would rather kill myself than become a housewife. I also don't have that big of a problem with being single. So, no gender role issues for me.

And on that train of thought, if you're going to say "people shouldn't be allowed amputations because how can you be happy without all four limbs?", can't I just as easily argue, from what you've presented, "people who get sex changes have to go through all this gender role/finding sexual partners crap, in addition to being ostracised by society! They shouldn't be allowed to do it!" You fail to realise that these things have no doubt already occurred to them, and they still think that the surgery is the best option for them.

As the treatment was necessary for the well being of the patient, the government-controlled health care system paid for it. Unlike in the US, where private health insurance companies are politicized actively biased against treating a disorder that is treated for free in countries with universal health care, such as the UK, Australia and parts of Canada.

Yes.

Have you ever had your body feel wrong in such a deep, unexplained way? It's not gender that's the problem. It's sex. My sex is weird and wrong. My gender is fine.

edited 18th Mar '11 7:57:37 PM by Jace

Gender is one thing, but why should someone identify as a amputee?

edited 18th Mar '11 8:56:14 PM by joeyjojo

Well, damn—someone other than me finally went here. I do think that Sir Psycho Sexy's description (in another thread) of why he's a transsexual sounded incredibly similar to the description of self-amputee thought processes in [[ http://en.wikipedia.org/wiki/The_Man_Who_Mistook_His_Wife_for_a_Hat The Man Who Mistook His Wife for a Hat]], which makes me wonder if the therapy that allows potential amputees to integrate the offending limbs into their body image would also work for transsexuals, at significantly lower cost and greater convenience than hormones and surgery. That said, I'm at a disadvantage trying to make recommendations here, since my body image is naturally fluid and I don't consider it part of who I am—I imagine that to some people the very idea of changing their body image rather than their body sounds as abhorrent as artificially induced personality modification. Besides, there's more than one motivation for being a transsexual, and therapy wouldn't be a one-size-fits-all solution. (And besides besides, I'm at least theoretically a transhumanist—if I have no problem with someone using surgery to give herself a tail, I shouldn't have a problem with her using surgery to give herself a tail.)

(Also note that this doesn't apply at all in relationship to people who crossdress but don't have surgery. I have no understanding of their thought processes, so I'll let them speak for themselves.)

edited 19th Mar '11 2:53:42 AM by feotakahari

1) Will the elective surgery make the patient happier / more comfortable with themselves / less distressed?

2) If it is irreversible, will they regret it in five years (or less)?

If the answers are yes and no, respectively, then I consider this type of thing perfectly ethical. I would probably want three opinions: the patient, a psychiatrist, and a psychologist. The psychiatrist to diagnose whether the patient is suffering from any mental problems that could be adversely affecting their judgement (for example, identifying as an amputee is not a psychosis, but I would not advocate letting an unmedicated schizophrenic or a severely depressed person decide to have their legs cut off) and treat any existing conditions before making a decision about the surgery; the psychologist to confirm that the patient is fully informed and comfortable with what they're deciding to do; and the patient, well, that's self-explanatory.

Apart from those few precautions, I see no reason why elective surgery would even be an ethical concern. As long as they're competent to make the decision and are certain that it'll improve their quality of life, let them do it. If worst comes to worst, medical technology has made such improvements that many of these procedures are, if not reversible, partially fixable anyway. (I am thinking of those magical prosthetics that turn people into Olympic sprinters. And Ft M surgery does exist, it's just not as well-known.)

There is parallels between the two, they both feel that they need major surgery and physical alterations to be 'whole'.

^^^ Do you honestly think that heathcare would cover this if it could be "fixed" by therapy, like no one ever tried that before?

The American Psychiatric Society has deemed that it's more harmful to try to force body acceptance and they do not recommend that course of treatment. They also don't recommend sex changes being done casually either.

Your body, your business.

It's actually that simple.

Normally I would agreed, but surgery is a positive right. If you are a doctor performing an elective medical procedure you need be held in public scrutiny.

edited 19th Mar '11 9:19:44 PM by joeyjojo

And they are. This is the accepted medical treatment for a medical condition the same as a root canal treats a rotten tooth. Lack of treatment can cause depression, anxiety, anti-social behaviour, and death. Therefore, lack of surgery is often not medically optimal.

I wouldn't class your limbs or genitals in the same category as a troubling tooth. But I conceded your point.

Not quite what I said. I speculated that not having all 4 limbs would restrict their abilities to do [whatever], not that they would be unhappy (plenty of handicapped people are happy, but I suspect many of them would want to have a greater range of activities).

Transgender people are actually prevented from activities that they would want to do (a transwoman can't have vaginal sex and vice versa).

The not-enough-gay-people thing could be an issue, but not for all transsexuals. Plus I would consider boinking/romance to be less of a crucial life issue than say, driving or climbing stairs.

@joeyjojo: Ooh, now ask a transsexual who needs to see the dentist, about which one is worse!