The Conservative government has ordered Correctional Services Canada to halt all medical coverage for gender reassignment surgery. The change took effect immediately, on Friday November 19th.
“The courts have ruled that CSC must provide essential medical services to inmates. However, we do not believe that sex change surgery is an essential medical service or that Canadian taxpayers should pay for sex change surgery for criminals,” Public Safety Minister Vic Toews told QMI Agency.
Even so, regardless of what they may have been convicted of, inmates are entitled to essential medical treatment. A 2001 Canadian Human Rights Tribunal decision, backed up by a 2003 federal court ruling, required that GRS be considered essential medical treatment. So the Conservative government is in direct violation of what it has already been ordered to fund. The 2003 National Post article is no longer online, but is archived at Prisonjustice.ca:
Friday, February 07, 2003
OTTAWA – Canada’s federal prisons will be forced to allow sex-change surgery for transsexual inmates as a result of a court ruling that concluded a blanket ban is discriminatory.
“If the medical opinion is that sex reassignment surgery is an essential service for a particular inmate, it follows that it should be paid for by Correctional Services Canada, as would any other essential medical service,” wrote Madam Justice Carolyn Layden-Stevenson of the Federal Court of Canada.
Corrections Canada will revise its policy because of the decision, spokeswoman Michele Pilon-Santilli said.
But she warned that sex-change operations will not be available for all transsexual inmates.
The decision upholds a 2001 decision from the Canadian Human Rights Tribunal in the case of Synthia Kavanagh.
The tribunal said that it was discriminatory for prisons to have a blanket ban on sex-change operations but not on “non-essential” services such as the removal of tattoos.
The Corrections and Conditional Release Act requires prisons to provide essential health care to inmates.
The timing of this is curious, considering it coincides with a wave of religious right opposition to Bill C-389, which would extend equal rights to trans people. One has to wonder if the intent is to exploit Canadians’ lack of sympathy for convicts in order to show off a faux worst case scenario of “we’re going to have to pay for sex changes for murderers and rapists if we give them rights.”
“CSC is legislatively mandated to provide every inmate with essential health care and reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful reintegration into the community,” said CSC spokeswoman Sara Parkes.
Of course, what could better facilitate a transsexual person’s reintegration into the community than helping align their physical sex with their identity if they need it? Although we tend to think of the extreme of murderers and sex offenders when we think of inmates, the majority of those convicted are there because of a poverty issue or come from an environment of poverty that made it easy to slide into crime. I fail to see how releasing someone into society with an inevitable poverty issue (having to self-fund GRS) is going to help them avoid reoffending.
Currently, CSC houses inmates according to the genitalia they have. Amazingly, CSC fails to see how this might make someone particularly vulnerable to the problem of prison rape. One quarter to half of trans inmates are not taking hormone therapy or denied access to it.
(Crossposted to The Bilerico Project)
The following reprises the earlier article, Why “Sex Change” Surgery is Medically Necessary:
Popular opinion has it that Gender Reassignment Surgery (GRS, often popularly nicknamed “sex change surgery”) is a cosmetic issue and motivated by a simple “want” to be female or male, by someone who was not born as such. However, extensive medical research into transsexuality dating as far back as the 1920s and continuing through modern studies have demonstrated otherwise, and consequently, medical standards of care have included GRS as a necessary procedure for decades. In order to understand this, people will honestly need to put aside preconceptions for a moment — and also realize at the same time that most transsexuals would rather see a health system in which preventative and quality-of-life treatments were uniformly covered, rather than one in which someone’s eye surgery or tendon issues are not, thus creating fighting amongst people in simultaneous need.
The experience of being transsexual involves one’s entire identity. They attempt to hide who they are, living a lie that feels unnatural in order to live up to others’ expectations, the hiding driven by a spiralling sense of shame and self-loathing, until it becomes an experience many liken to “suffocating,” or vents itself in an explosion of frustration. Transsexuals are unable to explain why they feel that their gender should be something different than their birth sex, and sometimes spend years attempting to mask themselves, to “pass” as the gender that society expects them to be. This restricts their ability to function socially, emotionally, psychically, spiritually, economically (it’s hard to be productive while constantly feeling out of one’s element and/or “backwards”), maybe sexually, and leaves them often suicidal as a result. If this continues into later adulthood, often a crisis point is reached in which the person suffers a complete emotional collapse.
“Gender Dysphoria” is the name for this condition, and treatment follows the standards of care established by the World Professional Association of Transgender Health (WPATH, formerly HBIGDA), which includes GRS. No less than the American Medical Association has stepped forward advocating the necessity of surgery and its coverage. In fact, like the AMA, the American Psychiatric Association and their Canadian counterparts support GRS as a medically necessary part of treatment. It was partly for this reason that the Ontario Human Rights Commission ruled in 2008 that that Province should restore coverage of the procedure.
Treatment of Gender Dysphoria encorporates surgical and endocrine intervention, because analytical and aversion therapies have historically proven damaging. As much as mainstream society would like to believe that electroshock therapy, anti-psychotic drugs or conversion (“ex-gay”) therapy would help transsexuals “just get over it,” modern medicine has realized that this approach simply does not work, and usually results in suppression, suicide or extreme anti-social behaviour. Aligning body to mind, however, has enabled transsexuals to become valued and successful people in society. There are, in fact, a few transsexuals who feel that they can live without having GRS, but they are the exception and not the rule.
Gender Dysphoria (sometimes called “Gender Identity Disorder,” or GID) is currently listed as a mental health issue, but ongoing study of both genetic ”brain sex” and Endocrine Disrupting Chemicals (EDCs) show the possibility of some biological causal factor. In a study released in October 2003, UCLA researchers identified 54 genes in male and female mouse brains that led to measurable differences by gender, and went on to indicate the possibility of a brain being gendered differently to one’s physical sex. Studies of EDCs show another, possibly concurrent potential that exposure to chemicals that simulate hormone characteristics — particularly between the third and eighth week of pregnancy — can affect the signals sent out to determine psychological gender and biological sex, which appear to develop at different times during gestation. In all fairness, nothing is conclusively proven at this point, and there is not a lot of research money being put into further study, as most pharmaceutical companies do not yet see a payoff from doing so. But the anecdotal and observational data from EDC and brain studies of human and animal populations would tend to support an innate origin or component of transsexuality, and coincides with transsexuals’ convictions that they “just knew” that they were female (in the case of male-to-female transsexuals) or male (in the case of female-to-males).
There is more. Current legislation asserts that most forms of identification and legal documentation can only be changed to reflect one’s new gender after surgery has been verified. Without GRS, many pre-operative transsexuals experience severe limitations on employment, travel beyond Canada’s border, and treatment in medical, legal and social settings in which verifying ID is necessary. Prior to GRS surgery, transsexuals also face limitations on where they can go (i.e. the spa or gym, or anywhere that involves changing clothes) and difficulties in establishing relationships — as well as being in that “iffy” area where human rights are assumed to be protected, but have not yet been specifically established as such in policies and legislation. In hospitals, prisons and such, they are housed by physical sex rather than their gender identity, creating potentially risky situations, unless the authorities directly involved choose to keep them in isolation instead. And at the end of the day, without GRS surgery, one’s gender is always subject to being challenged or stubbornly unacknowledged by those who don’t realize that a transsexual’s gender identity was not a matter of choice. There is also an extremely high risk of violence faced upon the accidental discovery that one’s genitalia does not match their presentation. No other supposedly “cosmetic” issue so completely affects a persons rights, citizenship and safety.
Transsexuality is not widely known or understood in mainstream society, and should not be confused with other aspects of the larger transgender (an umbrella term) culture. Although much sensationalism can be made of something like medical coverage of Gender Reassignment Surgery, the realities paint a very different story.