Bill Approved to Limit Treatment for Transgender Youth
A bill sent to the Senate in South Dakota would penalize physicians who provide treatments for transgender youth. Lawmakers from other states are considering similar bills as advocacy groups stand in opposition. Read on to learn about the debate around House Bill 1057.
South Dakota’s House of Representatives approved a bill, on February 29th, that would criminalize physicians who treat transgender children with hormones and sex reassignment surgeries. The Vulnerable Child Protection Act will now be sent to the state’s Senate for a committee hearing. Rep. Fred Deutsch, the bill’s primary sponsor, explains the legislation will protect vulnerable children who “are being chemically castrated, sterilized and surgical mutilated.
South Dakota’s House of Representatives is the first state to pass a bill to restrict medical treatment for trangender teens. However, more than half a dozen state houses are considering similar bills.
House Bill 1057
Under the bill, it would be a Class 1 misdemeanor for a physician to prescribe hormone replacement therapy or perform sex reassignment surgery to youth under the age of 16. This includes:
Performing a mastectomy
Gender affirming surgery (vasectomy, penectomy, vaginoplasty and others)
Prescribing, dispensing or administering puberty blocking medication, supraphysiologic doses of testosterone to females and supraphysiologic doses of estrogen to males
Removing any healthy or non-diseased body part or tissue.
The penalty would be a maximum of 1 year in jail and a fine of $2,000. Nurses would be exempt from prosecution.
The Debate
Republicans and Democrats debate represent a larger culture war with conflicting values, beliefs and practices. The debate is bigger than just the medical issues and extends into parenting and the role of physicians.
Opposition to the Bill
Parents, many members of the medical community and advocates of transgender youths make the following arguments (although there are many more) in opposition to House Bill 1057:
The bill is a form of discrimination that would withhold life saving treatment
The bill is unconstitutional and the decision about gender expression should be between the youth, parent and doctor.
Sex assignment surgeries and are rarely performed on youth
Puberty blockers, requiring parental consent and extensive counseling, are reversible
Libby Skarin, policy director for the American Civil Liberties Union of South Dakota, issued a statement after the vote, stating “By blocking medical care supported by every major medical association, the legislature is compromising the health of trans youth in dangerous and potentially life-threatening ways.”
A conservative Christian organization, Liberty Counsel, has offered legal counsel to defend bill, at no cost to state taxpayers.
Proponents of the Bill
Lawmakers supporting the bill make debate these points (among others):
Need to protect youth from making life altering changes until they are old enough to consider all available options
Too young to understand the potential consequences
Sex-reassigment surgery and administration in youth are harmful, abusive and criminal acts
The website https://hb1057.com/, promotes Deutsch’s bill and features resources and videos from the Heritage Foundation, the Minnesota Family Council, a Christian organization.
For Thought
In 2018, the American Nurses Association released a position statement, Nursing Advocacy for LGBTQ+ Populations and applied the nursing code of ethics to this population.
Quote
“..nurses must advocate for patient centered treatment, equal access, equal services, and equal resources for all populations that may be adversely affected by bias or prejudice. Nurses have an ethical duty to honor and respect the identities, beliefs, values, and decisions of all patients.”
Specializes in 25 years exp: NICU, Mat/Child, ICU, MedSurg, Exec.
I am happy to see that there is legislation being considered and/or passed on this subject. There are many blogs on the internet and videos on YouTube from youth who regret the decisions they made and the stress they put on their parents or caregivers. Children need guidance and when indicated, counseling, especially if they threaten suicide for any reason. "Nurses have an ethical duty to honor and respect the identities, beliefs, values, and decisions of all patients." We don't have a duty to encourage someone to make a change. The bottom line is that children/minors are classified as a vulnerable population and we need to remember this when advocating.
The language of your question, “...limiting transgender healthcare for youth,” is loaded with bias. It promotes a false dilemma: either you get in line with the politically acceptable position that supports unnatural hormone treatments and radical elective genital alteration of minors, or you are an evil intolerant bigot who opposes providing healthcare to transgender youth. The most disturbing thing is the unofficial punishing prohibition disallowing the same type of rigorous medical research on the long-term effects of these treatments that is considered an absolute necessity in every other medical specialty. Exogenous hormone therapy outside of transsexual treatment has rightly been scrutinized in many studies because of increased risk of myocardial infarction, stroke, and several cancers. It’s impossible to have an honest risk vs benefit discussion apart from this knowledge. These topics don’t even earn a mention in the articles and discussions I have seen related to gender reassignment. Studying long-term psychological risk of gender reassignment is a career-killer politically, so these topics are similarly exempted from rigorous study. Would we tolerate this kind of carelessness in any other area of pediatric medicine? I don’t think so.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
5 hours ago, JerseyTomatoMDCrab said:
Using the term “enhance one’s appearance” implies these are cosmetic procedures which they are not. They are gender reaffirming procedures, not plastic surgery. Two different things. Individuals seeking these procedures aren’t simply dissatisfied with the shape or size of a part of their anatomy, they instead feel profoundly uncomfortable and “wrong” in their bodies.
I don’t find a difference in what you have said as to what I said. There IS NO DIFFERENCE between plastic surgery and gender reaffirming procedures. Quit trying to make one out to be more significant than the other. No one chooses to go to such extremes to “fix” their appearance without feeling “profoundly uncomfortable” and “wrong” in their body.
People in their youths in general “feel wrong” in their body. It is called adolescence and it sucks. Not a good reason to allow CHILDREN or their over indulgent and understanding parents to have procedures preformed. I encourage and support them in their journey. I wholly support them using the restroom gender the identify with, dressing room, etc. I support them being able to wear the clothes they feel best in and changing their looks, non medically, in any way they wish until they are 18 and can choose to have medical procedures done. But no, doctors and nurses should not be able to profit off of youths who scientifically have been proven to not even have a fully formed brain to make these decisions. And if we went by science adulthood would not start until 25. But since the legal age of adulthood in the USA is 18, that is what I will stick to.
What is the need for unnecessary euphemisms? Some of the implants prove to be defective or irregularly shaped, I wouldn't call that an enhancement. Fake is more apt.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
23 hours ago, Kelli Anne Busey said:
Dear Nurses, you would be subject to arrest, imprisonment and loss of your nursing licenses should this bill and the other 7 that were filled pass.
The SD House State Affairs Committee amended HB 1057, changing the potential penalty from a Class 4 felony to a Class 1 misdemeanor and the lowering of the age of the targeted minors from 18 to 16.
As amended, any physician, surgeon, physician assistant, clinical nurse specialist, or nurse practitioner found guilty of “attempting to change or affirm the minor’s perception of the minor’s sex” including prescribing hormones blockers would be subject to conviction of a Class 1 misdemeanor with potential punishments of up to one-year imprisonment and up to $2,000 in fines.
The bills to 'protect vulnerable children' are a coordinated attack against healthcare providers after the Heritage Foundation failed to pass bathroom bills, which they also authored, the last few sessions.
You are being targeted by the Heritage Foundation and other far-right groups because you are, as we have seen from the lack of outrage expressed here, the most compliant, and therefore a target of opportunity.
I am not a medical professional but I am transgender and have been writing about our people since 2007.
I feel that it is perfectly appropriate for doctors and nurses to be subject to arrest, imprisonment, and loss of my license were I to help a minor medically “change or affirm the minor’s perception of the minor’s sex.”
Medically our job is to “first do no harm”. That is the very first and sacred primary directive of medicine. I am not a “right winger”. I believe that policies to make things more acceptable for teens experimenting with their looks and who they are is needed. That socially we do not need to get wigged out if a boy teen shows up to school in girl’s clothes as long as they comply with the school’s dress policy for girls...and vice versa.
But for transgender persons to be upset and view this law as conservatives just tying to push their biblical agenda is a very biased point of view. It is like transgender persons and homosexuals feel they are the only ones who suffered emotional distress related to being accepted by their family and peers during adolescence. And while I will agree that in some ways, SOME of them had it much harder than average, that is not a valid reason to manipulate the primary directive of healthcare.
The body is changing a great deal during childhood and adolescence. There is no VALID reason to mess with that process medically unless there is a problem affecting the health and physical function of the patient. A mental anguish is not a valid reason to do it either until the patient is developed enough to understand the consequences of these decisions (hormone therapy and increase cancer chances, financial considerations of the need for life long therapy to maintain their appearance, etc.). In the USA that age has been determined to be 18....scientifically that age has been determined to be around 24-25.
If you told me this bill had a clause where physicians and nurses would face repercussions affirming a minor’s perceptions of their sex by allowing them to wear clothes of the opposite sex, wishing to be called a name other than their legal name, or not being able to give verbal support and encouragement when the minor expresses a desire to change sex....well that would be a problem. But a law that protects children from medically unnecessary therapies and surgeries is a good thing....and should be expanded to include ALL body altering surgeries for minors. Medical persons should be punished for providing a breast enhancement surgery to a 16 year old girl even if her parents are willing to allow it. Or to give a 14 year old with no medical issues a nose job just because he is very uncomfortable with the shape of his nose. Those should ALL be decisions made once the minor is an adult.
Personally, I think the government needs to butt out. These decisions should be left up to parents, providers (including psych/social work), and ultimately the patients themselves. As the article stated, these surgical procedures are so rarely done on young patients. Hormone regimens are reversible and could be an effective treatment for gender dysphoria, provided it's considered safe (psychologically and physiologically). Calling it child abuse is extreme, in my opinion: parents already consent to growth treatments, ADHD medications and other invasive therapies.
Of course, teens shouldn't be allowed free reign for these issues, but they're not allowed that for really any medical decision. Even something as common as birth control requires counseling, education and a prescription from a provider.
** as a note: the proper terminology is "transgender person/people", NOT "Transgenders". It's a descriptor; not a noun.
Abortion is an invasive medical matter that teens have all the time without parental consent or even parental knowledge.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
14 hours ago, Kooky Korky said:
Abortion is an invasive medical matter that teens have all the time without parental consent or even parental knowledge.
What is wrong with Transgenders?
No, most states sill require parental consent. But, since you asked, in states where the patient has become pregnant they are no longer considered a minor because they are going to be a parent and thus emancipated as an adult until they are no longer a parent and then revert back to being a minor.
Or that was what I notice in the 2 states that I traveled too. Also, an abortion is not a cosmetic issue. Birth is a medical concern in those who are to young with increased complications. Transgenders wishing to change their sex, no matter how much they want to argue emotionally that it is more than cosmetic, is really a cosmetic issue. It is not medically necessary for them to survive and I am totally okay with them making that decision at 18. Also, choosing to being another person in the world and support them for the rest of your life or not affects the life of both the patient and the unborn with a definitive time limit on the decision. Thus the decision should and has to be made by the teen by 20 weeks. If, for some weird reason, those teens could pause their pregnancy until 18 to make that decision I would totally vote for that. But that is physically impossible so the decision has to be made before adulthood. Transgendered people do not have such a time constraint on gender reassignment surgery.
The government needs to get out of people's personal lives. This one size fits all bill is wrong.
There may, at times, be extreme circumstances present and this bill would not take that into account. You can't legislate for every variable that may occur and everyone is different.
Unless it's your child, it's none of your business.
That's exactly my point-- If I had a child who was trans, I would be extremely cautious (if I didn't outright refuse) about allowing them to physically transition before they had reached adulthood. But the fact is, I don't have a trans child, and I can't in fact know what I would do in this scenario.
I don't think the SD legislature necessarily has a ton of expertise on the care of pediatric trans patients. I don't think we should allow anyone but a child's guardian and their care team to make these decisions.
It's similar to saying "a black" vs "a black man" -- it's unnecessarily dehumanizing, and considered offensive by many who hold that identity. And since transgender is an adjective, it's also just plain bad grammar. https://www.merriam-webster.com/dictionary/transgender
Specializes in Surgical Specialty Clinic - Ambulatory Care.
2 hours ago, Bloop41 said:
That's exactly my point-- If I had a child who was trans, I would be extremely cautious (if I didn't outright refuse) about allowing them to physically transition before they had reached adulthood. But the fact is, I don't have a trans child, and I can't in fact know what I would do in this scenario.
I don't think the SD legislature necessarily has a ton of expertise on the care of pediatric trans patients. I don't think we should allow anyone but a child's guardian and their care team to make these decisions.
I don’t think so either. But I do find it perfectly legitimate for the government to bar people of the medical community to agreeing to do such procedures on adolescents. It goes along with the medical directive to first do no harm and it makes litigation less likely for those participating in transgender reassignment surgery because there is a clear line on what they can and cannot do.
I think the children should have time to grow up and mature before making those major decisions. However, I also wonder how many of these state legislatures have medical professionals in their ranks. For example, I can't remember which state it was that had women getting unnecessary lady partsl exams when seeking abortions and other personal women's care. I think that's ridiculous and it opens them up to infections and it's inhumane. I think they changed it somewhat but it hasn't made a big difference.
I wouldn't allow my child to get any of these major, life changing surgeries anyway until they've fully matured physically and mentally.
The government should not be able to dictate or penalize how medical professionals think or practice. They decide what is the appropriate plan of care for their patient, not the state.
SD is a conservative state with politicians who are uncomfortable or outright want to discriminate against the lgbtq community. I don’t think it protects these kids at all. LGBTQ youth are are much more likely to commit suicide than their heterosexual peers. This kind of legislation sends a message to these kids that undermines their self worth, indicates that there is something inherently wrong with them and dehumanizes these kids. They get enough judgment already.
I can see why people want to delay any type of gender affirming surgery at a young age, to avoid these situations of regret but it’s none of the government business. Why would a kid choose to be trans if they didn’t truly have gender dysphoria.
We have a duty to treat all patients with dignity and respect, regardless of there gender identity. We must advocate for their needs and well being. This includes supporting trans patients and families.
NurseDonna, MSN, RN
7 Posts
I am happy to see that there is legislation being considered and/or passed on this subject. There are many blogs on the internet and videos on YouTube from youth who regret the decisions they made and the stress they put on their parents or caregivers. Children need guidance and when indicated, counseling, especially if they threaten suicide for any reason. "Nurses have an ethical duty to honor and respect the identities, beliefs, values, and decisions of all patients." We don't have a duty to encourage someone to make a change. The bottom line is that children/minors are classified as a vulnerable population and we need to remember this when advocating.