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| HBIGDA STANDARDS OF CARE - 2001 (version 6) |
SECTIONS |
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X. Surgery
Sex
Reassignment is Effective and Medically Indicated in Severe GID. In persons
diagnosed with transsexualism or profound GID, sex reassignment surgery,
along with hormone therapy and real life experience, is a treatment that
has proven to be effective. Such a therapeutic regimen, when prescribed
or recommended by qualified practitioners, is medically indicated and
medically necessary. Sex reassignment is not "experimental,"
"investigational," "elective," "cosmetic,"
or optional in any meaningful sense. It constitutes very effective and
appropriate treatment for transsexualism or profound GID.
How to
Deal with Ethical Questions Concerning Sex Reassignment Surgery. Many persons,
including some medical professionals, object on ethical grounds to
surgery for GID. In ordinary surgical practice, pathological tissues are
removed in order to restore disturbed functions, or alterations are made
to body features to improve the patient’s self image. Among those who
object to sex reassignment surgery, these conditions are not thought to
present when surgery is performed for persons with gender identity
disorders. It is important that professionals dealing with patients with
gender identity disorders feel comfortable about altering anatomically
normal structures. In order to understand how surgery can alleviate the
psychological discomfort of patients diagnosed with gender identity
disorders, professionals need to listen to these patients, discuss their
life histories and dilemmas. The resistance against performing surgery
on the ethical basis of "above all do no harm" should be
respected, discussed, and met with the opportunity to learn from
patients themselves about the psychological distress of having profound
gender identity disorder.
It is
unethical to deny availability or eligibility for sex reassignment
surgeries or hormone therapy solely on the basis of blood seropositivity
for blood-borne infections such as HIV, or hepatitis B or C, etc.
The
Surgeon’s Relationship with the Physician Prescribing Hormones and the
Mental Health Professional. The surgeon is not merely a technician
hired to perform a procedure. The surgeon is part of the team of
clinicians participating in a long-term treatment process. The patient
often feels an immense positive regard for the surgeon, which ideally
will enable long-term follow-up care. Because of his or her
responsibility to the patient, the surgeon must understand the diagnosis
that has led to the recommendation for genital surgery. Surgeons should
have a chance to speak at length with their patients to satisfy
themselves that the patient is likely to benefit from the procedures.
Ideally, the surgeon should have a close working relationship with the
other professionals who have been actively involved in the patient’s
psychological and medical care. This is best accomplished by belonging
to an interdisciplinary team of professionals who specialize in gender
identity disorders. Such gender teams do not exist everywhere, however.
At the very least, the surgeon needs to be assured that the mental
health professional and physician prescribing hormones are reputable
professionals with specialized experience with gender identity
disorders. This is often reflected in the quality of the documentation
letters. Since fictitious and falsified letters have occasionally been
presented, surgeons should personally communicate with at least one of
the mental health professionals to verify the authenticity of their
letters.
Prior to
performing any surgical procedures, the surgeon should have all medical
conditions appropriately monitored and the effects of the hormonal
treatment upon the liver and other organ systems investigated. This can
be done alone or in conjunction with medical colleagues. Since
pre-existing conditions may complicate genital reconstructive surgeries,
surgeons must also be competent in urological diagnosis. The medical
record should contain written informed consent for the particular
surgery to be performed.
| Some
of the resources in this section contain differing viewpoints comprising
a variety of authors, committees, and interest groups. Additionally,
some of these materials are delivered in an advisory context, covering
legal, ethical, medical and social issues. These materials do not
necessarily represent the guidelines of TransGenderCare or
the philosophies of our staff. |
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