Great article.

I was a medic in the military, but am not a doctor, but am a health care system educator

As far as the moral obligations issue, you have to realize that it is a big world, with cultures that perceive morals differently than those in the United States. Sex reassignment, however, is a lifestyle choice, like breat augmentation. So yes, doctors can ethically refuse to obligate such requests with certain patients seeking such procedures. However, in most other cases, I believe doctors are obligated to treat thier patients, regardless of thier socioeconomic status, morality, religion, and so forth. Doctors, ideally, strive to cure or treat, objectively and accurately. In other words, and for example, if I was a doctor working in an emergency department and a murderer arrived with a broken arm, as a doctor, you are obligated to treat this patient. It’s a requirement of the ethics of their profession.

Dan Abshear

Dan,
Thanks for your comments. I agree with you. As a nurse I have had many oppoprtunities to come in contact with a wide variety of patients. Although I may not always agree with their choices or the way they live their lives, my job is to help them recover, no matter what my personal opinion of them may be. This is difficult sometimes, but comes with the territory as a health care professional.
Sincerely,
Jennifer

Dan;

“Lifestyle choice?” Not! ‘Morals’ do not enter into this. For sufferers of Gender Disphoria (the medical term for the feeling that ones’ gender is not in congruence with the sex of their body, they can hold off for a period of time because of shame and the intense pressure a small minority of society place on those who fall outside the set called ‘normal’. We all want to fit in, and it’s terrifying to be perceived as different, much less in some way icky.

I’m reasonably certain, Dan, that you believe that children are born blank slates, ‘Tabula Raza’, and that parents patiently teach all the good stuff (including behaving in a manner congruent with the societal roles mandated for those possessing male or female genitalia,) and try to preserve the primordial innocence babies represent by shielding them from all the bad, bad ideas the big bad terrible world has.

Would you agree that children have to be taught how to behave in a gender appropriate manner? Then please explain what happened to David Reimer, the infant whose penis was destroyed in a botched circumcision and was surgically altered to be a girl? It didn’t take. Was David Reimer ‘gender confused’? He had surgically constructed sensate female genitalia that were distinguishable from ‘normal’ female genitalia only by experts. He had a closet full of dresses (which he refused to wear), a toy box full of barbies and other girl toys (which he refused to play with,) and parents who desperately tried to train him to be a girl. They called him confused. They force-feminized him. It didn’t work.
Was refusing to accept the gender role his parents, at the direction of John W. Money, Ph.D, a ‘lifestyle’ choice he made?

You will say, “Of course, he was born a boy, and he will always be a boy.” But he was given female genitalia and raised as a girl! Or is it something else? Chromosomes? That’s not 100%. There are XY females and XX males, as well as XXY,XYY, XXX and XO variations. Are having those variations ‘lifestyle choices’?

Did I make a ‘lifestyle choice’ to have my mother’s OBGYN prescribe her Diethylstilbesterol (DES), a synthetic estrogen shown to feminise 20% of male babies whose mothers took it in the first trimester. What kind of conservative drivel will you spew at me for finally, finally figuring it out and transitioning to the gender role that matches my feminised brain? I’m glad I have found medical professionals who have found my condition to not be a moral failing on my part, nor a ‘lifestyle choice’, but a medical problem requiring medical intervention.

Hazumu Osaragi

Dan Abshear wrote,

Sex reassignment, however, is a lifestyle choice, like breat augmentation.

Actually, transsexualism is a neurological intersex condition, and sex reassignment is the proven medical treatment for its sufferers. It’s more like having a painful tumor removed than breast augmentation.

Great post!

As a Nurse Practitioner in private practice, this is a question I often have to answer for myself.

Is it okay to turn away or discharge a patient? Under what circumstances? Am I discriminating when I tell the obviously impaired individual that I am unable to help them? What about the angry 6 foot tall man who is yelling in the waiting room? How about the schizophrenic diabetic who is insisting that the Pope will save him and my medicines are killing him? And then what about the person who is over 600lbs? Am I discriminating when I tell her I cannot help her (none of my equipment will accommodate her size)? And of course, what about for lack of payment?

My practice is very diverse in terms of individual with various sexual orientation, gender, educational levels, ethnic backgrounds, and religious preferences. We see folks who fall at various points on the economic and mental health scales. We happen to believe that a woman has the right to choose abortion, but also feel we have the obligation to teach prevention.

Yet, I have to say, I do reserve the right to treat someone based on the capabilities of my skills and knowledge, safety factors, and to be honest, the hassle factor comes into play. We can only do so much.

It’s great to see these kinds of questions come out of the closet and into full daylight. Thanks!

Barbara C. Phillips, NP

What about refusing to treat blacks or jews? If physicians are providing a public service, then they should perform according to the agreed standards of that public service. That includes not opting out of treating people because of your beliefs – and religious beliefs should not be privileged in this regard. If you are racist, sexist , homophobic or otherwise falling down on generally accepted principles, then keep it at home or get a different job.

Same applies to other public servants, e.g.: http://www.humanism.org.uk/site/cms/newsarticleview.asp?article=2468

Hello, I found this website by chance … as it tends to happen on the internet. Just wanted to drop a couple of cents, maybe 50. I have been in chronic pain for 29 years. And I have run through the gauntlet of many different physician’s ego’s, ideal’s, norm’s, social mores and convictions by which they were last exposed and well, generally speaking. With that said, I know first hand doctors do indeed have no obligation to treat a patient for any reason. Choice and ‘Free Will’. We can debate all day about rather as a society, the collective “we” ought to hold a physician liable to the condition that they should treat every patient that happens into their office. However, in reality physicians are but … mmm … mere humans. Simply, there is no means by which a society can hold an other person responsible for the being of an other. Even if that person choses/decides to become a medical practitioner. However, it is sad and can be rather harmful at times when a physician does not choose to hold themselves obliged to the betterment of people who need their services. It is a powerful position. And there are many people who do not have the mental capabilities to keep searching for help. Maybe that is one reason why society collectively desires physicians to be held liable for the wellfare of their patients. And why we are disgusted when we hear stories of physicians turning people away. For people who have needs that do not seem to fit into the mores of mainstream society, it is that much more sad that finding someone to treat them can come down to something like a “hassle factor”.