Sliding doors: should treatment of gender identity disorder and other body modifications be privately funded?
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Gender Identity Disorder (GID) is regarded as a mental illness and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It will also appear in the DSM-V, due to be published in 2013. The classification of GID as a mental illness is contentious. But what would happen to sufferers if it were removed from the diagnostic manuals? Would people lose their entitlement to funded medical care, or to reimbursement under insurance schemes? On what basis should medical treatment for GID be provided? What are the moral arguments for and against funded or reimbursed medical care for GID? This paper starts out with a fiction: GID is removed from the diagnostic manuals. Then the paper splits in two, as in happened in the Howitt’s 1998 film Sliding Doors. The two scenarios run parallel. In one, it is argued that GID is on a par with other body modifications, such as cosmetic and racial surgery, and that, for ethical reasons, treatment for GID should be privately negotiated by applicants and professionals and privately paid for. In the other scenario, it is argued that the comparison between GID and other body modifications is misleading. Whether or not medical treatment should be funded or reimbursed is independent of whether GID is on a par with other forms of body dissatisfaction.
KeywordsGender identity disorder Body modification DSM Access to treatment Cosmetic surgery Racial surgery
I wish to thank Simon Barnes, Dino Topi, John Harris, Soren Holm, Margaret Brazier and Charles Erin for reading and commenting on this manuscript, and for providing useful reference and insight for the realisation of this project. I would like to acknowledge the stimulus and support of the iSEI Wellcome Strategic Programme in The Human Body, its Scope Limits and Future in the preparation of this paper.
- APA. 2000. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-IV-TR (Text Revision), 4th ed. Washington: APA.Google Scholar
- APAa. American Psychiatric Association. DSM-V Development. http://www.dsm5.org/Pages/Default.aspx. Accessed 11 June 2010.
- Archer, J., and B. Lloyd. 2002. Sex and gender. Cambridge: Cambridge University Press.Google Scholar
- Arlene, Istar Lev. 2006. Disordering gender identity—Gender identity disorder in the DSM-IV-TR. Journal of Psychology and Human Sexuality 17(3–4): 35–39.Google Scholar
- Avicenna. 1030. Liber III, Fen XX, Tractatus I, cap. 43. De hermaphrodito, from the Canon Medicinae. At http://www.ncbi.nlm.nih.gov/pmc/articles/PMC234503/. Accessed 11 June 2010.
- Baumann, S. 2008. The moral underpinnings of beauty: A meaning-based explanation for light and dark complexions in advertising. Poetics 36: 5.Google Scholar
- BBC News 2000. Body Dysmorphic Disorder. At http://news.bbc.co.uk/2/hi/health/medical_notes/625913.stm. Accessed 11 June 2010.
- BMA. 2000. British Medical Association. Eating disorders, body image & the media. London: BMA.Google Scholar
- Brazier, M., and N. Glover. 2000. Does Medical Law have a future? In Law’s future, ed. David Hayton. Oxford: Hart Publishing.Google Scholar
- CCN. 2006. 13 September. At http://www.cnn.com/2006/WORLD/europe/09/13/spain.models/index.html. Accessed 11 June 2010.
- CoE. 2010. Council of Europe. At http://assembly.coe.int/Main.asp?link=/Documents/WorkingDocs/Doc09/EDOC12087.htm. Accessed 11 June 2010.
- Delemarre-van de Waal, A.H., and T.P. Cohen-Kettenis 2006. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology 155(suppl 1):131–137. At: http://www.eje-online.org/cgi/content/full/155/suppl_1/S131#F2. Accessed 11 June 2010.
- Endocrine Society. 2009. Wylie C. Hembree, Peggy Cohen-Kettenis, Henriette A. Delemarre-van de Waal, Louis J. Gooren, Walter J. Meyer III, Norman P. Spack, Vin Tangpricha, and Victor M. MontoriReprint. Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. First published in the Journal of Clinical Endocrinology & Metabolism, September 2009, 94(9): 3132–3154. At http://www.endo-society.org/guidelines/final/upload/Endocrine-Treatment-of-Transsexual-Persons.pdf. Accessed 18 June 2010.
- Fenner, B., and R. Mananzala 2005. Letter to the Hormonal Medication for Adolescent Guidelines Drafting Team. Presented at the congress Endocrine Treatment of Atypical Gender Identity Development in Adolescents, 19–20 May 2005, London.Google Scholar
- Furth, M.G., and R. Smith. 2000. Amputee identity disorder: Information, questions, answers, and recommendations about self-demand amputation. Ney York: 1st Books.Google Scholar
- Giordano, S. 2005. Understanding eating disorders. Conceptual and Ethical Issues in treatment of Anorexia and Bulimia Nervosa. Oxford-New York: Oxford University Press.Google Scholar
- Giordano, S. 2010a. Exercise and eating disorders. London: Routledge.Google Scholar
- Giordano, S. 2010b. Sex and gender: issues of public health and justice. In Justice, ed. M. Boylan. (in press).Google Scholar
- Giordano, S. 2010c. Where Christ did not go: men, women and frusculicchi. Gender Identity Disorder (GID): Epistemological and ethical issues. Submitted to Bioethics 2010.Google Scholar
- Giordano, S. 2010d. A heaven without giants or dwarfs: equality, gender and disabilities. In Collection of essay, ed. Soren Holm. Details not yet available.Google Scholar
- Haiken, E. 1997. Venus Envy. A history of cosmetic surgery. Baltimore: Johns Hopkins University Press.Google Scholar
- Hope, T., et al. 2008. Medical Ethics and law, the core curriculum. London: Churchill Livingstone.Google Scholar
- Kaw, E. 2003. Medicalization of Racial features: Asian American women and Cosmetic Surgery. Medical Anthropology Quarterly 7(1): 75.Google Scholar
- Kitzinger, C. 2001. Sexualities. In Handbook of the psychology of women and gender, ed. Rhoda K. Unger. New Jersey: Wiley.Google Scholar
- Little, M.O. 1996. Suspect norms of appearance and the ethics of complicity. In In the Eye of the beholder: Ethics and medical change of appearance, ed. I. de Beaufort, M. Hilhorst, and S. Holm. Copenhagen: Scandinavian University press.Google Scholar
- Little, M.O. 1998. Cosmetic surgery, suspect norms, and the ethics of complicity. In Enhancing human traits: Conceptual complexities and ethical implications, ed. E. Parens. Washington DC: Georgetown University Press.Google Scholar
- Lorber, J. 1995. L’invenzione dei sessi. Milano: Il Saggiatore.Google Scholar
- Lorber, J. 1994. Paradoxes of gender. London and New York: Yale University Press.Google Scholar
- McKie, R., and Hinsliff, G. 2008. This couple want a deaf child. Should we try to stop them? The Guardian 9 March. At http://www.guardian.co.uk/science/2008/mar/09/genetics.medicalresearch. Accessed 11 June 2010.
- Ruspini, E. 2009. Le Identità di Genere. Milano: Carocci.Google Scholar
- Scott, W.J. 1986. Gender: A useful category of historical analysis. The American Historical Review 91(5):1053–1075 at http://www.cedis.uni-koeln.de/content/e310/e625/Text1frWorkshopzurHermeneutischenDialoganalyse_gender_ger.pdf. Accessed 11 June 2010.
- United Nations 1948. Universal Declaration of Human Rights. At http://www.un.org/en/documents/udhr/. Accessed 11 June 2010.
- WPATH. The World Professional Association for Transgender Health. 2001. Standards of Care for Gender Identity Disorders. At www.hbigda.org/Documents2/socv6.pdf. Accessed 17 June 2010.
- WHO. 1992. World health organisation. ICD-10, International Statistical Classification of diseases. Geneva: WHO.Google Scholar