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There are at least three examples where bodily integrity and moral responsibility come into conflict...gender reassignment surgery (GRS) of transsexuals, elective physical impairment of the transabled, and assisted suicide. There may be others. Bodily integrity deems the individual to have complete autonomy over their own body (for good or ill), but moral responsibility obliges us to ensure that people who choose to harm healthy tissue (or end their lives) are mentally competent.

To that end, here are the prerequisites for GRS:
Mandatory Prerequisites for Gender Reassignment Surgery (GRS/SRS)

• A true transsexual with gender dysphoria
  
• Surgery recommended by 2 mental health specialists trained in gender identity issues.
  
• Hormone treatment for at least one year.
  
• Living “true life” test for a minimum of one year.
  
• Emotionally stable
  
• Medically healthy with any medical conditions being treated and under control.
  

- http://www.thetransgendercenter.com/inde...sites.html

Are these reasonable and ethical? Are they sufficient, or would you strengthen or weaken these restrictions for any of the three examples?

Hi Syne.  I’m glad you joined.  I hope you'll stick around for a while. You’re a smart one.  I read that post at the other forum.  It’s an interesting topic.  Did Tiassa ever bite?  Last time I looked, the responses were pretty pathetic.  Unfortunately, it’s past my bedtime, and in order to tangle with your mind, I'll need to be fresh.  

Nite, Syne.

Hi Trooper/SS. I hadn't been to the other forum in a very long time. Don't know if the replies have slowed dramatically or everyone worth debating has left. Looking forward to your thoughts on this topic.

Standards of Care V7 2011 WPATH .pdf

Criticism of the WPATH-SOC

This blogger said that the set period of living "full-time" in your desired gender role was no longer a requirement, but even though the "Standards of Care" are non-binding protocols, they definitely influence the clinicians' decision.  The Philadelphia Center for Transgender Surgery that you linked, states that they’re flexible with the WPATH Standards of Care, but the 12-month experience of living is mandatory. Unfortunately, this criterion is hotly debated.  Some feel that forcing someone to live as their desired sex before their transition can be mentally harmful and physically dangerous.  I would have to agree.

Rationale for a preoperative, 12-month experience of living in an identity-congruent gender role:

OMG!  I’ve never even heard of transability before.  I’ll have to do some more reading.

I didn’t get as much sleep as I should have.  I had a bad dream about a scary clown.  Thanks to Magical’s creepy clown topic.  

I think I can see where you’re going with this now.  

Body Integrity Disorder vs. Gender Dysphoria, am I right?

So, let me get this straight. There’s BIID disorder also known as apotemnophilia, which is a neurological disorder, and then there’s transability, which is an umbrella term.  Devotism is a sexual fetish but apotemnophilia has frequently been connected to sexual desires.  It’s very confusing because it’s similar to alien hand syndrome and/or somatoparaphrenia.

Vilayanur S. Ramachandran believes that apotemnophilia arises from a congenital dysfunction of the right parietal lobe and, in particular the right superior parietal lobule, which receives and integrates input from various sensory areas and the insula to form a coherent sense of body image.

If that’s where you’re headed, the physiological harm is pretty clear cut with BIID, and it’s not just limbs.  Some want to be blind, some want their spinal cord severed, etc.  I don’t think there’s any evidence showing an improved outcome for BIID sufferers, but there’s a great deal of evidence showing that sex reassignment surgery reduces gender dysphoric, anxiety, and depression. Although, some have regretted it, they’re not becoming lesser beings or disabled.

While I would refute that GRS outcomes are a net positive, no matter how marginally, I'm really not interested in looking at efficacy in this topic (maybe a later one), since it could derail the discussion. So for this topic, I'll grant that they are.

I'm not, here, equating BIID with GD (although both are objectively altering anatomically normal structures...for now, I'll assume this a superficial equivalence). I think the crux here is determining whether the person is suffering from BIID/GID/depression (in the case of assisted suicide) before allowing permanent body alteration. I assume we can agree that, even if most transgenders do not, some people seeking GRS may suffer from a legitimate Gender Identity Disorder. Just because the DSM has defined GD as not a mental illness, does not mean that some mental illness could not present as GID. I'm not sure this is standard, but I'm using gender dysphoria (GD) as accepted, healthy behavior and gender identity disorder (GID) as possibly symptomatic of actual mental illness.

What do you, personally, think about the ethical considerations? Are those for GRS mostly good precautions? Would you add more for transabled? What about assisted suicide? I'm much more interested in an objective view of the ethics than I am subjective, anecdotal opinion from those most biased. Where does our obligation, as society, end and the individual's autonomy begin?

Personally, I think the prerequisites I listed for GRS are fairly adequate for that case. We do want a reasonable barrier to those suffering from mental illness. It's much easier to see transableism as self-destructive, and the self-destructive are often not exclusively so. Giving the mentally ill what they think they want often exacerbates their condition. Apparently there are doctors willing to blind people, according to one case I've read, although I really don't see any ethical justification for a doctor to do so. Similarly with the other permanent loss...assisted suicide. I see no ethically justifiable reason for doctors to involve themselves. The person can do it themselves, and a doctor giving them "an easy way out" also eases their burden of justifying their decision to themselves. Suicide should not be an easy decision.

Will you risk your life for me?  Will you die for me?  Will you live for me? 

Life is "Nature's war"—the great tribulation—cooperation and competition. There are warriors, victims, prisoners, and casualties. 

There are those who are tormented.  They seek death but cannot find it.  They desire death but it flees from them.  They feel helpless and trapped.  Are we their tormentors and are they our prisoners? 

There are those who seek life but cannot find it. They desire life but it flees from them.  They feel ugly and shunned.  Are we their tormentors and are they our exiles?

My initial gut reaction towards BIID disorder was biased and purely emotional. After giving this matter some serious thought, I realized I was wrong.  There is evidence that their lives improve after the surgery.

My personal opinion is that if we cannot alter the image in the brain to match the body then we should alter the body to match the image in the brain, reduce the symptoms for their comfort and well-being.  It may very well be the body that creates the image/your identity, and your identity and your body is your own.  As long as you have the mental capacity to understand and appreciate the consequences, the choice should be yours, and yours alone.

If we can make a male and a female into a single one?  If we can make eyes in place of an eye, a hand in place of a hand, a foot in place of a foot, an image in place of an image, then they will live—they’ll walk through the gates—they’ll see tomorrow.  



The Diving Bell and the Butterfly

The Sea Inside

Great topic, Syne!

I appreciate your input, but I'm not really interested in whether any of these are, themselves, justifiable. I'm interested in whether the prerequisites we impose on them are. Here's a simple question. What do you consider the minimum prerequisites we should impose to ensure people are prepared to live with their choices? As a minimum, we can probably just deal with GRS, since it is the least permanently disabling.

I'll be happy to go into neural plasticity to deal with self-image disorders in a later topic, but I'm trying not to judge these here.

(Aug 21, 2016 05:13 AM)Syne Wrote: [ -> ]Are these reasonable and ethical?

I thought the living a "true life" test for a minimum of one year was unreasonable, harmful, and even dangerous.  

At present, no hospital offers healthy limb amputations, but I’ll think of some potential prerequisites, if you’d like. The ethics of aesthetic surgery presents all sorts of dilemmas as physicians switch from a healer to an artist.  Improving a patient’s self-image, while acting in the patient’s best interest is very difficult. The real value of person cannot be reduced to his or her appearance, but unfortunately our society serves vanity.

Quote:I'm much more interested in an objective view of the ethics than I am subjective, anecdotal opinion from those most biased.

I don’t understand.  Objective view of the ethics?  Ethics are a set of moral principles. Objective morality?  Is there such a thing?

(Aug 21, 2016 05:13 AM)Syne Wrote: [ -> ]There are at least three examples where bodily integrity and moral responsibility come into conflict...gender reassignment surgery (GRS) of transsexuals, elective physical impairment of the transabled, and assisted suicide. There may be others. Bodily integrity deems the individual to have complete autonomy over their own body (for good or ill), but moral responsibility obliges us to ensure that people who choose to harm healthy tissue (or end their lives) are mentally competent.

To that end, here are the prerequisites for GRS:
Mandatory Prerequisites for Gender Reassignment Surgery (GRS/SRS)

• A true transsexual with gender dysphoria
  
• Surgery recommended by 2 mental health specialists trained in gender identity issues.
  
• Hormone treatment for at least one year.
  
• Living “true life” test for a minimum of one year.
  
• Emotionally stable
  
• Medically healthy with any medical conditions being treated and under control.
  

- http://www.thetransgendercenter.com/inde...sites.html

Are these reasonable and ethical? Are they sufficient, or would you strengthen or weaken these restrictions for any of the three examples?

I think about the case where a therapists poured drain cleaner in the eyes of a willing patient who felt she was meant to be blind.  To me that seems insane.  Or the guy who cut off his legs with a circular saw.  Those sound like mental illness to me.  Assisted suicide?  I suppose it would depend on the quality of life for the person asking.  But if it were someone who is close to me, I don't know.

As for the transgender issue, though I think it dangerous to fart with hormones, I think that is actually the best way to proceed.  From what I understand, the process either makes or breaks the desire for transitioning.  A person gets to experience a taste of what they are wanting, and they sometimes find that it's not the path they really want.