THERE is broad legal and medical consensus that providing gender-transition care is medically necessary. It is legally and morally the right thing to do, as well as inexpensive when compared with the cost of denying such care.
Chelsea Manning, a soldier formerly known as Pvt. Manning, came to the world’s attention after revealing state secrets to WikiLeaks. She told the world last week that she was undergoing a gender transition and would be known as a woman from then on. In coming out, she ignited a debate around the medical necessity of gender transition and the treatment of transgender people in prisons.
All major medical bodies have issued statements affirming that this care should be covered, including the American Medical Association, the American Psychiatric Association and the World Professional Association of Transgender Health. Several federal court judges have ruled that transgender inmates have an Eighth Amendment right to medically appropriate treatment for gender dysphoria, the clinical term for the severe distress that transgender people experience.
This medical condition is treated with a combination of therapy, hormones or surgical interventions to more closely align their bodies to internal gender. As with any major medical decisions, the course of treatment should be a decision between patients and their physicians, not bureaucrats or politicians.
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While often portrayed as cosmetic or frivolous, the statistics tell quite a different story about the medical importance of gender reassignment. Forty-one percent of transgender people have attempted suicide, according to the National Transgender Discrimination Survey of nearly 7,000 people.
Chelsea is entitled to constitutional protection from cruel and unusual punishment under the Eighth Amendment. Otherwise, the horrifying reality is that Chelsea may face torture, abuse and rape while incarcerated. The unconscionable prison conditions for many transgender people were captured in the 1994 U.S. Supreme Court case Farmer v. Brennan. The court ruled in favor of a transgender woman named Dee Farmer, who sued the federal government for failing to protect her from assaults and repeated rape, resulting in her contracting HIV while incarcerated in an all-male federal prison.
Since that case, the Prison Rape Elimination Act
was passed at the federal level, but it has only just begun to address this ongoing nightmare. A recent California study found that transgender women are 13 times more likely to be raped while incarcerated and more than 200,000 people are sexually assaulted while incarcerated each year. We must demand an end to these dehumanizing conditions.
The difficulties transgender individuals face in and outside of prison were turned into a punchline. Transgender people became the object of ridicule in the media coverage of Manning’s declaration, from the
deeply offensive joke on CNN by commentator Richard Herman about how prison rape will serve as “good practice” for being a woman, to Seattle Times columnist Bruce Ramsey’s blog post saying he “burst out laughing” when he saw Manning’s photo.
The media’s refusal to use Chelsea’s name and feminine pronouns followed an all-too-familiar script for transgender people. Many of us experienced the announcement of our gender transitions with shock, disrespect and violence.
Like many in the transgender community, I will fight for insurance coverage for all medically necessary gender transition care both in and out of prison. As U.N. Special Rapporteur Juan Mendez
said about Manning’s treatment even before she came out, “ … the 11 months under conditions of solitary confinement constitutes at a minimum cruel, inhuman and degrading treatment in violation of Article 16 of the [Geneva] Convention against torture.”
Many of us in the transgender community, including our families, friends and allies, will continue to demand the dignified treatment of all incarcerated transgender inmates as we watch fearfully for what Chelsea may endure at Fort Leavenworth. It’s what Mendez would surely describe as torture.
Danielle Askini is founding executive director of Seattle’s Gender Justice League. On Twitter @danielleaskini