Medicine, Health Care and Philosophy

, Volume 15, Issue 1, pp 31–40 | Cite as

Sliding doors: should treatment of gender identity disorder and other body modifications be privately funded?

Scientific Contribution


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.


Gender 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.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Reader of Bioethics, CSEP/iSEIThe University of Manchester, The School of LawManchesterUK

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