Well-being and the possibility of being unwell: on the goals of trans medicine in troubled times

Every major US medical association has agreed that gender-affirming care (GAC) is medically necessary. Unfortunately, transgender patients are frequently unable to use their health insurance for GAC, due to both blanket exclusions and denials that classify it as cosmetic or experimental - in other words, not medically necessary.

These denials raise questions about the goals of healthcare both broadly and for transgender people. As trans bioethicists, we contend that the goals of GAC are consistent with the normative goals of many other areas of medicine in that they target not just healing an injury or curing disease, but overall well-being. As in reproductive healthcare, for example, not being able to access GAC when one needs it has substantial negative effects on overall life prospects - leading to questions of social justice.

Whether the goal of care is broad (“well being” or “employability”), or more specific (“improved psychological functioning” or “being recognized as one’s gender), access is still conditioned on the presumption that transition will be “successful.” This means that it ought to lead to “good” outcomes - and that should not be undertaken if it does not. In this talk, we explore well-being as a goal of care, highlighting its emancipatory potential while interrogating how it may yet reinscribe the very harms it aims to circumvent. We ask, finally, whether well-being as a goal of care can nevertheless be used as an advocacy tool for those fighting for access and justice amidst an onslaught of anti-trans legislation in the US.

Theodore Schall – Berman Institute of Bioethics – Johns Hopkins University