CaptainFluffyBunny wrote: ↑ https://www.nytimes.com/2018/11/24/opin ... icine.html
Disturbing. The confidence of youth, soon to meet the politics of regret.
The very essence of practicing a profession (save for the world's oldest) is that you are obligated to give people in good faith your best opinion, advice and work, not that you give them what they ask for. This writer would have us simply sign a prescription for whatever the patient demands, and if we do that we will have more in common with the world's oldest profession than we would like. She also exhibits the classic creeping symptomatology of body dysphoria; fix one thing and the complaints move on to something else - fingers, in her case.The medical maxim “First, do no harm” assumes that health care providers possess both the means and the authority to decide what counts as harm. When doctors and patients disagree, the exercise of this prerogative can, itself, be harmful. Nonmaleficence is a principle violated in its very observation. Its true purpose is not to shield patients from injury but to install the medical professional as a little king of someone else’s body.
Let me be clear: I believe that surgeries of all kinds can and do make an enormous difference in the lives of trans people.
But I also believe that surgery’s only prerequisite should be a simple demonstration of want. Beyond this, no amount of pain, anticipated or continuing, justifies its withholding.
She is right to point out our discomfort at colluding with the quasi-delusional complaints of body dysphoria, but any reasonable person would agree that when you lack any other treatment, doing so is right and proper if it is proven to reduce distress and has an acceptably low incidence of side-effects. We don't have good evidence for the first, and lots of evidence that the unwanted effects are huge. Then she admits with great candour that transitioning has not helped her, but has actually made her more unhappy, yet still intends to dive deeper into the transition with some frankensurgery. She knows it won't help. She probably knows it will make things worse again. Yet she still wants it, and one has to feel terribly sorry for someone with the insight to know this and is still persisting.
We do know one thing that is politically unpalatable, and that is that most young gender dysphorics will 'desist' in time and come to accept their bodies, and often turn out to be gay. But you get smeared and fired if you follow that approach at a gender clinic. It isn't accurate for all, but we would do better in statistical outcomes if universal policy for young gender dysphorics was to tell them "That's alright, you're just gay. It's perfectly fine and normal for you to feel you're in the wrong body but it will work out in the end", but that obviously won't fly when people are accustomed to getting whatever they ask for and with no waiting. Lacking much understanding of body dysphorias as a whole, and having no idea of what proper treatment ought to look like, an approach of harm-reduction doesn't seem unreasonable. Hormones and SRS are very temporary palliatives for the underlying disorder, and an approach that meshes with the commonest outcome might be worth trying.