Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States

Joseph K. Canner, Omar Harfouch, Lisa M. Kodadek, et al

Abstract

Importance

Little is known about the incidence of gender-affirming surgical procedures for transgender patients in the United States.

Objectives

To investigate the incidence and trends over time of gender-affirming surgical procedures and to analyze characteristics and payer status of transgender patients seeking these operations.

Design, Setting, and Participants

In this descriptive observational study from 2000 to 2014, data were analyzed from the National Inpatient Sample, a representative pool of inpatient visits across the United States. The initial analyses were done from June to August 2015. Patients of interest were identified by International Classification of Diseases, Ninth Revision, diagnosis codes for transsexualism or gender identity disorder. Subanalysis focused on patients with procedure codes for surgery related to gender affirmation.

Main Outcomes and Measures

Demographics, health insurance plan, and type of surgery for patients who sought gender-affirming surgery were compared between 2000-2005 and 2006-2011, as well as annually from 2012 to 2014.

Results

This study included 37 827 encounters (median [interquartile range] patient age, 38 [26-49] years) identified by a diagnosis code of transsexualism or gender identity disorder. Of all encounters, 4118 (10.9%) involved gender-affirming surgery. The incidence of genital surgery increased over time: in 2000-2005, 72.0% of patients who underwent gender-affirming procedures had genital surgery; in 2006-2011, 83.9% of patients who underwent gender-affirming procedures had genital surgery. Most patients (2319 of 4118 [56.3%]) undergoing these procedures were not covered by any health insurance plan. The number of patients seeking these procedures who were covered by Medicare or Medicaid increased by 3-fold in 2014 (to 70) compared with 2012-2013 (from 25). No patients who underwent inpatient gender-affirming surgery died in the hospital.

Conclusions and Relevance

Most transgender patients in this national sample undergoing inpatient gender-affirming surgery were classified as self-pay; however, an increasing number of transgender patients are being covered by private insurance, Medicare, or Medicaid. As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them.


Canner JK, Harfouch O, Kodadek LM, Pelaez D, Coon D, Offodile AC, Haider AH, Lau BD. Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States. JAMA Surg. Published online February 28, 2018. doi:10.1001/jamasurg.2017.6231

 

Rethinking Rural Health Solutions To Save Patients And Communities

National Public Radio

Adrienne St. Clair

Heidi Schultz grew up traveling from one end of South Dakota to the other, tagging along as her sister saw doctors and specialists in the “big cities” to treat her diabetes.

Schultz thought she knew rural America well when she took a position with the Helmsley Charitable Trust overseeing their rural health program in seven Western and upper Midwestern states, including Montana and Wyoming.

But even she has been surprised by how she can drive hours on country highways seeing few cars and just “a handful of gravel driveways going somewhere you can’t see.”

“It’s almost scary,” Schultz says. “You’re thinking, ‘If something happened to me here on this road now, how long would it take for someone to get to me? An ambulance? And where would they take me for care?’ ” [Full text]

Professor David Oderberg joins Protection of Conscience Project Advisory Board

News Release   

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes David S. Oderberg, Professor of Philosophy at the University of Reading, UK to the Project Advisory Board. Professor Oderberg joined the university after completing his doctorate at Oxford in the early 1990s. He is the author of many articles in metaphysics, ethics, philosophy of religion, philosophy of science, and other areas. He is also the author of several books including Moral Theory and Applied Ethics (Blackwell, 2000) as well as co-editor of collections in ethics such as Human Values: New Essays on Ethics and Natural Law (Palgrave, 2004) and Human Lives: New Essays on Non-Consequentialist Bioethics (Palgrave, 1997).

Prof. Oderberg has been working on freedom of conscience in health care over the last few years, with a recent article in the Journal of Medical Ethics on co-operation, and a forthcoming policy monograph to be published by the Institute of Economic Affairs. He is Editor of Ratio, an international journal of analytic philosophy, and Senior Fellow of the Higher Education Academy. In 2013 he delivered the Hourani Lectures in Ethics at SUNY Buffalo, and has a book forthcoming based on those lectures, to be called The Metaphysics of Good and Evil. [Faculty Profile] [Website]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

 

 

What happens after Repeal?

The Phil wades into the Repeal discussion to question what will come if the 8th amendment is repealed

Trinity News

Georgina Francis

Last Tuesday, the Phil hosted “Beyond Repeal”. The Phil sought to discuss what will happen if the eighth amendment is repealed with a panel of highly respected and knowledgeable speakers.

Beginning with a brief introduction each of the speakers outlined their involvement with the campaign. Julie O’Donnell spoke first of her personal experience with a fetal abnormality in her pregnancy, revealing she “just felt so alone” and that she “thought I’d be treated in my own country”. After seeing the founders of Terminations for Medical Reasons (TFMR) O’Donnell contacted them and became involved. . . [Full Text]

Medical professionals divided on bill allowing them to refuse to perform abortions, other procedures

New Hampshire Union Leader

Dave Solomon

CONCORD  –  The national debate over the rights of health care workers to refuse to perform procedures like abortion or assisted suicide is working its way through the New Hampshire State House as lawmakers consider “an act relative to the rights of conscience for medical professionals.”

The medical community is divided over the bill, which would allow medical professionals to refuse any procedure that goes against their personal beliefs, including abortion, providing contraceptives or contraceptive counseling.

Doctors at a public hearing last week testified for and against the bill (HB 1787), which would also cover physician’s assistants, nurses, pharmacists, medical students … basically anyone and everyone who works in the health care profession. The lengthy definition of “health care provider” in the bill includes “hospital or clinic employees.” . . . [Full Text]

Protection of Conscience Project welcomes new advisor from Scotland

News Release
For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Mary Neal, PhD, LLB Honours, LLM to the Project Advisory Board. Dr. Neal is Senior Lecturer in Law, University of Strathclyde, Glasgow.  She researches, writes, and teaches in the fields of Healthcare Law and Bioethics, focusing on beginning and end-of-life issues.  In 2014-15, she was Adviser to the Scottish Parliamentary Committee scrutinising the Assisted Suicide (Scotland) Bill, and she is a current member [2018] of the British Medical Association’s Medical Ethics Committee. She has published a wide range of academic articles and blogs on a range of topics including, most recently, conscientious objection by healthcare professionals; the nature of ‘proper medical treatment’; the role of the emotions in end-of-life decision-making; and the conceptual structure and content of human dignity.

Dr. Neal was a co-editor of and contributor to the recent volume Ethical Judgments: Re-writing Medical Law (Hart, 2017). Her works-in-progress include articles and book chapters on conscientious objection; the idea of ‘vulnerability’ in healthcare; physician-assisted suicide; and the role of dignity in human rights discourse. Among other research activities, Dr. Neal is currently leading two funded projects relevant to the issue of conscientious objection in healthcare. One is a British Academy/Leverhulme-funded project exploring conflicts between personal values and professional expectations in pharmacy practice. The other is a multi-disciplinary network of academics and healthcare professionals (the ‘Accommodating Conscience Research Network’, or ‘ACoRN’), funded by the Royal Society of Edinburgh, and beginning with a series of roundtables exploring various aspects of conscientious objection in healthcare. Dr Neal is also a spokesperson for the Free Conscience campaign supporting the Conscientious Objection (Medical Activities) Bill currently before the UK Parliament.[Faculty Profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

Conscientious objection is an important medical principle

Doctors are expected to have integrity. Does this not entail that they should do what they think is right?

The Spectator

Toni Saad

Something interesting is happening in the House of Lords. Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill, now at the committee stage, has put on the agenda an issue which well-deserves to be there. Its point is simple: all healthcare professionals should have a legal right to opt out of certain procedures which they find objectionable. It specifies three areas: abortion provision, withdrawal of life-saving treatment, and actions relating to certain reproductive technologies.

This is not particularly radical; the 1967 Abortion Act already explicitly protects conscientious objection. Indeed, it could even be asked why this should, in a country with a tradition of liberty like ours, even be up for debate. Do we really need law to protect the right to conscience?

Sadly, it has become clear that we do. Armchair philosophers have been discussing the merits of forcing doctors and nurses to act against their conscience (or lose their jobs) over the last few years. Many papers against conscience have been published. . . [Full Text]

International constitutional and human rights lawyer joins Protection of Conscience Project Advisory Board

News release 

For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Iain Benson, Professor of Law, University of Notre Dame Australia, Sydney and Extraordinary Professor of Law, University of the Free State, Bloemfontein South Africa to the Project Advisory Board.

Born in Edinburgh, Scotland, the father of seven children, Professor Benson is an academic, lecturer and practising lawyer specialising in pluralism and human rights.  His particular focus is on freedoms of association, conscience and religion, the nature of pluralism, multi-culturalism and relationships between law, religion and culture. He has been involved in many of the leading cases on rights of association, conscience and religion in Canada and abroad for two decades.  As a barrister he has appeared before all levels of court and his work has been cited by the Supreme Court of Canada and the Constitutional Court of South Africa.

He was one of the drafters of the South African Charter of Religious Rights and Freedoms (signed by all major religions in that country in September 2010) and remains closely involved in advancing the Charter in that country and similar projects elsewhere.

Author of over 40 academic articles and book chapters, he is co-editor with Barry W. Bussey, of Religion Liberty and the Jurisdictional Limits of Law (Toronto: Lexis Nexis, 2017) and authored Living Together with Disagreement: Pluralism, the Secular and the Fair Treatment of Beliefs by Law (Ballan Australia: Connor Court, 2012). His scholarly work is referred to in many books and articles.

He teaches Legal Philosophy, Legal History, Public International Law, Human Rights and Contemporary Legal Issues. He works in English and French, dividing his time between Australia (where he now lives) and France, South Africa and Canada (in the latter two of which he has appointments).[Faculty profile]

Contact:
Sean Murphy, Administrator
Protection of Conscience Project
protection@consciencelaws.org


The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

New HHS office that enforces health workers’ religious rights received 300 complaints in a month

The Hill

Jessie Hellman

More than 300 individuals filed a complaint with the Health and Human Services (HHS) Department over the last month, saying that their religious or conscience rights have been violated by their employer, a state or state agency or a health provider.

The complaints follow the creation of a new division within HHS that focuses on enforcing those rights and investigating complaints from individuals who say their rights have been violated.

For example, a nurse could file a complaint against their employer if they are coerced into participating in an abortion or disciplined for refusing to do so . . . [Full Text]

World medical body pushes back on conscience fight

The Catholic Register

Michael Swan

The international society of Catholic doctors is using Canada as an example of what can go wrong when doctors are forced to refer for abortion.

The World Federation of Catholic Medical Associations is drawing on Canada’s experience to counter proposals before the World Medical Association to adopt forced referrals and signal ethical acceptance for euthanasia. . . [Full Text]