GESTIÓN EN SALUD PÚBLICA: BioEdge: If sex reassignment surgery is the answer, what is the question?

sábado, 18 de febrero de 2017

BioEdge: If sex reassignment surgery is the answer, what is the question?

If sex reassignment surgery is the answer, what is the question?

by Michael Cook | 18 Feb 2017 |

Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?

The answer to this theoretical question has practical consequences. If it is a therapy, then transgenderism is a disease. If it is an enhancement, then it hardly deserves to be funded by the government.

In a very interesting article in the Journal of Medicine and Philosophy, Tomislav Bracanović, of the University of Zagreb, in Croatia, analyses the competing conceptions.

Transgender scholars contend that sex reassignment surgery is not a therapy for gender identity disorder, because the feeling of being a man in a woman’s body or a woman in a man’s body is not a disorder. It is a “normal, albeit rare, human condition that is medicalized as a consequence of general discrimination of transsexual population. It should be removed, therefore, from all classifications of mental disorders, and sex reassignment surgery should be made available without medical “gatekeepers” deciding who qualifies for it and who does not.”

Their conclusion is that a sex change is no more a therapy than a “nose job”. They would prefer to describe sex reassignment surgery as an enhancement, like cosmetic surgery.

But is it plausible to describe it as non-therapeutic enhancement? Bracanović believes that it is not. “It does not improve, augment, or increase—above average—any trait or function typically mentioned in philosophical debates about enhancement. Intelligence, vision, hearing, physical strength, and immunity, for example, after sex reassignment surgery remain more or less the same as they were before.”

There is another way of framing enhancement, though: the welfarist model – does it enhance quality of life? At first blush this seems plausible because people who have had the operation report more satisfaction and a decrease in dissatisfaction. However, Bracanović points out that the evidence for this is weak. There have been very few long-term studies of postoperative transsexuals’s quality of life.

... imagine the “sex change drug” that has the same risk–benefit ratio as sex reassignment surgery. Even if it improved the condition of many clinical trial subjects, it would probably not be approved by any regulatory agency (as either “therapy” or “enhancement”), if a large number of subjects mysteriously disappeared from the trial after taking the drug.

So Bracanović concludes that it would be wise to keep the gatekeepers for this type of surgery and to restrict access to it. Given the current state of knowledge, there is too great a risk of harm to the patients. Furthermore, if it is an enhancement which increases a person’s well-being, as transgender scholars contend, it is obviously more like enhancement for artistic ability rather than curing paraplegia. With limited resources, society would normally focus on paraplegia rather than gender dysphoria. The only way to prioritise it above paraplegia would be to medicalise it and describe it as a serious disorder – which theorists vehemently reject.

Winston Churchill was once voted the “greatest Briton of all time” in a BBC poll, edging out Isambard Kingdom Brunel (who?), Lady Diana, Shakespeare and John Lennon. Now, in addition to his gifts as a statesman and politician, orator and historian (and artist), we have been reminded that he helped to popularise science as well.

As reported in Nature, an historian has discovered an 11-page manuscript which Churchill penned in 1939 but never published, speculating about life on other planets. It turns out that the great man was deeply interested in modern science and followed developments keenly. Gazing at the gathering storm, he wrote pessimistically:

“I, for one, am not so immensely impressed by the success we are making of our civilization here that I am prepared to think we are the only spot in this immense universe which contains living, thinking creatures, or that we are the highest type of mental and physical development which has ever appeared in the vast compass of space and time.”

But despite the reminder that Churchill was a fan of science, it’s also good to remember that he believed that there were moral limits to science. In one of his most famous speeches, he foresaw dark days for the world if Germany were to win the War:

If we can stand up to [Hitler], all Europe may be free and the life of the world may move forward into broad, sunlit uplands. But if we fail, then the whole world ... will sink into the abyss of a new Dark Age made more sinister, and perhaps more protracted, by the lights of perverted science. Let us therefore brace ourselves to our duties, and so bear ourselves that, if the British Empire and its Commonwealth last for a thousand years, men will still say, "This was their finest hour."

Science, so Churchill believed, was fascinating, but not good in itself. It had to be governed by morality, lest it become “perverted”. It’s not a bad reminder for us, three generations on, as we enter an era of genetic engineering.