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

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Abstract

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.

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Notes

  1. GID is also called ‘transsexualism’, ‘transgenderism’, gender dysphoria, gender variance, atypical gender identity organisation. In this paper I will use the terms as synonymous.

  2. I use ‘medical care’, ‘intervention’ and ‘treatment’ as synonymous, even if there is no ‘illness’ to ‘cure’ in gender dysphoria.

  3. I use ‘cosmetic’ in inverted commas for the following reasons: first, it is unclear what it is that makes some interventions ‘cosmetic’ rather than, ‘reparative’, or ‘regenerative’, for example. Thus the term appears too imprecise to qualify what it proposes to qualify. Second, the adjective has important normative connotations. It qualifies the intervention as ‘non-medical’, as somehow superfluous. This begs the question as to why some types of requests are thought of as based on a ‘clinical’ necessity whereas others are regarded as based on a somehow more ‘arbitrary’ preference. Finally, it implies that a claim for ‘cosmetic’ intervention does not have the same compelling force than a claim based on a ‘clinical’ need: this assumes somehow what needs demonstrating. One of the arguments of this paper is that the way requests are qualified (as cosmetic rather than otherwise) bears no normative relevance.

  4. This is an example of how this works: in 2010, in Italy, in a family with a cumulative income of over 40,000 Euros per year, a dermatological visit at a specialist clinic costs 24 Euros (against anything between 60 and 150 Euros in the private sector, and in addition to normal yearly tax based on income). Families with a cumulative salary of less than 40,000 Euros will be exempt.

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Acknowledgments

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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  1. Reader of Bioethics, CSEP/iSEI, The University of Manchester, The School of Law, Williamson Building, Oxford Road, Manchester, M13 9PL, UK

    Simona Giordano

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Correspondence to Simona Giordano.

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Giordano, S. Sliding doors: should treatment of gender identity disorder and other body modifications be privately funded?. Med Health Care and Philos 15, 31–40 (2012). https://doi.org/10.1007/s11019-010-9303-y

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