Novel assisted reproductive technologies (ART) are poised to present our society with strange new ethical questions, such as whether lesbian, gay, bisexual, and transgender (LGBT) couples should be allowed to produce children biologically related to both parents, or whether trans-women who want to experience childbirth should be allowed to receive uterine transplants. Clinicians opposed to offering such technologies to LGBT couples on moral grounds are likely to seek legal shelter through the conscience clauses enshrined in U.S. law. This paper begins by briefly discussing some novel ART on the horizon and noting that it is unclear whether current conscience clauses will permit fertility clinics to deny such services to LGBT individuals. A compromise approach to conscience is any view that sees the value of respecting conscience claims within limits. I describe and critique the constraints proposed in the recent work of Wicclair, NeJaime and Siegel as ultimately begging the question. My purpose is to strengthen their arguments by suggesting that in the controversial situations that elicit claims of conscience, bioethicists should engage with the metaphysical claims in play. I argue that conscience claims against LGBT individuals ought to be constrained because the underlying metaphysic—that God has decreed the LGBT lifestyle to be sinful—is highly implausible from the perspective of a naturalized metaphysic, which ought to be the lens through which we evaluate conscience claims.
Brummett A. Conscience claims, metaphysics, and avoiding an LGBT eugenic. Bioethics. 2018;00:1–9.
Lawsuit claims Catholic health care organization is breaking law by denying coverage for all transgender services
The ACLU of Washington has filed a civil rights lawsuit against a Catholic health care organization for refusing to cover the medically necessary surgery required by a transgender son of one of their employees.
The ACLU is suing on behalf of Cheryl Enstad, a medical social worker at PeaceHealth St. Joseph Medical Center in Bellingham, Wash. Enstad decided to file a lawsuit after PeaceHealth refused to cover the medical expenses of her transgender son, Pax, even though the treatments that were denied were recommended to treat his gender dysphoria.
Because PeaceHealth is a Catholic health care organization, it tries to abide by the teachings of the Catholic Church when it comes to issues surrounding sexual orientation or gender identity. It used that as justification for refusing to provide coverage for a recommended chest reconstruction surgery and other treatments for gender dysphoria under its medical benefits plan. . . [Full text]
Dignity Health moves patient’s surgery to another hospital over Catholic directives
Two days before Evan Minton’s scheduled hysterectomy last September at Dignity Health Mercy San Juan Medical Center, a nurse called to discuss pre- and post-operation care. Toward the end of the call, Minton had a request.
“‘I just want to let you know that I’m transgender and my pronouns mean a great deal to me,'” he recalled saying.
According to Minton, the nurse was affirming. He hung up with a positive feeling. But the next day his doctor called with bad news. The hospital had canceled the procedure. He was terrified that the cancellation would add months or years to his physical transition.
Now, seven months later, the 35-year-old is teaming up with the American Civil Liberties Union to sue Dignity Health for denying care to a transgender patient. . . [Full text]
SAN FRANCISCO, Calif. — A California woman who identifies as a man has filed a lawsuit against a Catholic hospital and its parent company for prohibiting her surgeon from performing a sex change-related hysterectomy at the facility because of the organization’s religious convictions.
The 35-year-old woman, who goes by the name Evan Minton, had been scheduled to undergo a complete hysterectomy at Mercy San Juan Medical Center in Carmichael last August. She believed the procedure was necessary to comport with her preferred identity.
However, the day before her appointment, after she noted to a nurse that she identifies as “transgender,” the surgery was canceled.
“In general, it is our practice not to provide sterilization services at Dignity Health’s Catholic facilities,” said spokeswoman Melissa Jue in a statement at the time. . . [Full text]
Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?
The answer to this theoretical question has practical consequences. If it is a therapy, then transgenderism is a disease. If it is an enhancement, then it hardly deserves to be funded by the government.
In a very interesting article in the Journal of Medicine and Philosophy, Tomislav Bracanović, of the University of Zagreb, in Croatia, analyses the competing conceptions. . . [Full text]
British doctors have been told not to call pregnant women ‘mothers’ in a British Medical Association (BMA) document that has been slammed by conservative commentators.
In a booklet entitled A Guide To Effective Communication: Inclusive Language In The Workplace, doctors are instructed to use “inclusive language” that demonstrates “a commitment to equality and inclusion”. This includes revising conventional language used during pregnancy:
“Gender inequality is reflected in traditional ideas about the roles of women and men…We can include intersex men and transmen who may get pregnant by saying ‘pregnant people’ instead of ‘expectant mothers’.”
In an introduction to the guide on the BMA’s website, senior executive Dr Anthea Mowat wrote: ‘I would encourage you all to read and share this guide, and think about how you can apply it in your day-to-day work. This is a time where we need to come together to support and protect our colleagues and our patients.’
Conservative MP Philip Davies described the guidance as ‘completely ridiculous’: “If you can’t call a pregnant woman an expectant mother, then what is the world coming to?'”
Women’s rights campaigner Laura Perrins was equally critical of the document:
‘As every doctor knows only females can have children. To say otherwise is offensive and dangerous. This will offend women up and down the country, and is an example of the majority of women being insulted for a tiny minority of people.’
The BMA controversy comes just weeks after British media outlets reported the ‘first male pregnancy’, involving a transgender who halted her gender transition to being a male so that she could have a child.
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CMDA – The Point
What do healthcare professionals and health institutions need to know about and how can they defend themselves from the Obama administration’s newly enacted transgender mandate?
What happened when?
The transgender mandate, promulgated by the U.S. Department of Health and Human Services (HHS) under the assumed authority of the Affordable Care Act (Obamacare), went into effect July 18, 2016. A new website explains what the mandate requires, why it violates the law and what conscientious objectors can do to protect their rights.
Whom does the rule target?
HHS recently mandated that healthcare professionals must perform gender transition procedures on any child referred by a mental health professional, even if the physician believes the treatment or hormone therapy could harm the child.
Healthcare professionals who follow the Hippocratic Oath to act in the best interest of their patient instead of this new mandate can face severe consequences, including losing their jobs. The transgender mandate also requires virtually all private insurance companies and many employers to cover gender transition procedures or face stiff penalties and legal action. . . [Full text]
Mail on Sunday
Sanchez Manning, Stephen Adams
Children as young as nine will be given controversial drugs on the NHS to prepare them for sex-swap surgery, The Mail on Sunday can reveal.
The treatment, which halts the onset of adulthood, is aimed at youngsters who believe they are trapped in the wrong body. But critics accused the clinic offering the puberty- postponing injections of ‘playing God’.
‘I think many people will be horrified at the thought of a nine-year-old being provided with a drug that effectively stops them developing and maturing naturally,’ said Conservative MP Andrew Percy.
Others insisted that undisputed research shows that the vast majority of under-16s who are troubled about their gender do not go on to take the drastic step of surgery. Many turn out to be gay, but no longer feel confused about whether they are male or female.
Although the gender treatment is reversible, there are concerns about the long-term effects on brain development, bone growth and fertility.
The drugs, known as hypothalamic blockers, stunt the development of sexual organs so less surgery is required if a child chooses to change sex after reaching adolescence. . . [Full text]
CHICAGO – A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.
It’s an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones.
An 8-year-old second-grader in Los Angeles is a typical patient. Born a girl, the child announced at 18 months, “I a boy” and has stuck with that belief. The family was shocked but now refers to the child as a boy and is watching for the first signs of puberty to begin treatment, his mother told The Associated Press. . . [Full text]