lgbtq equality - Bill of Health

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Certainty and Uncertainty in Trans-Intersex Science Politics

September 22, 2023September 22, 2023 The Petrie-Flom Center Staff Leave a comment

By Maayan Sudai

Joanna Wuest’s Born This Way: Science, Citizenship, and Inequality in the American LGBTQ+ Movement describes the evolution of the “born this way” framework through pivotal moments in the history of the LGBTQI+ movement.

A central theme of the book’s analysis is the role that “certainty” and “uncertainty” play in the legitimation of science-based policy regarding sexuality and gender issues. Uncertainty of what might happen has been pitted against LGBTQI+ reforms, from when conservative researchers and practitioners argued the exposure of young children to an openly gay guardian or schoolteacher could be harmful (p.92), to present-day attempts to leverage uncertainty to block trans access to sex-segregated bathrooms, prisons, and shelters (p.181).

Medical Caduceus Symbol as Scales with backlight over Wall in dark room.

Gender-Affirming Care, Abortion, and the Politics of Science: A Response to Wuest’s ‘Born this Way’

September 21, 2023September 21, 2023 The Petrie-Flom Center Staff Leave a comment

By Aziza Ahmed

On August 21, 2023, the 11^th Circuit issued a decision that allowed a ban on transgender care to go into effect in Alabama. The Alabama ban, formally called the Alabama Vulnerable Child Compassion and Protection Act, is one of the most extreme of the many bans on gender affirming care. The law defines sex as the “biological state of being female or male, based on sex organs, chromosomes and endogenous hormone profiles…genetically encoded into a person at the moment of conception…” and targets physicians who might undermine this notion of sex with criminal prosecution. Their punishment could be up to ten years in prison.

SACRAMENTO, CA, U.S.A. - OCTOBER 9, 2021: A mother and child march with Proud Mom and Trans Rights are Human Rights signs during the National Trans Visibility March.

Protecting Trans Children: Scientific Uncertainty and Legal Debates Over Child Custody and Access to Care

September 20, 2023September 20, 2023 The Petrie-Flom Center Staff Leave a comment

By Marie-Amélie George

A tweet turned Luna Younger’s personal struggle into a national controversy. Using 148 characters, Texas Governor Greg Abbott announced that the Texas Attorney General’s Office and the Texas Department of Family and Protective Services would be investigating the seven-year-old’s family. Prompting his declaration was a jury’s award of custody to Luna’s mother, Anne Georgulas, a pediatrician who supported Luna’s gender transition. A year before the case made its way into court, Luna had asked her parents to call her Luna, rather than her (traditionally male) legal name, to reflect her gender identity. That same year, a therapist diagnosed Luna with gender dysphoria, which is distress from the mismatch between a person’s assigned sex at birth and their gender identity. As a result, medical professionals recommended that Luna be referred to as “she” and be allowed to wear the feminine clothing and keep the long hair that she preferred. Luna’s father, Jeffrey Younger, registered his objection to Luna’s gender identity by shaving her head, even as he allowed Luna’s twin brother to maintain his locks. Georgulas petitioned for an order prohibiting her ex-husband from “engaging in non-affirming behavior and/or taking Luna outside the home as [her birth name], or allowing others to do so.” Jeffrey Younger counterclaimed for sole legal custody.

Washington, DC, USA - December 1, 2021: Abortion rights rally at the Supreme Court, Jackson Women's Health v. Dobbs.

Biological Determinism, Scientific Uncertainty, and Reproductive Rights

September 19, 2023September 27, 2023 The Petrie-Flom Center Staff Leave a comment

By Mary Ziegler

As Joanna Wuest writes, the role played by science in the LGBTQ+ movement “is at once a celebratory and cautionary story.” Something similar could be said of struggles over reproductive rights in the half century since the Supreme Court decided Roe v. Wade.

Today, after decades of staying on the sidelines, physicians have once again been at the forefront of struggles over abortion, launching a ballot initiative in Ohio, bringing lawsuits, and speaking against state criminal bans. Physicians’ investment in the struggle — and the scientific arguments they bring to bear — seem like a possible turning point in future struggles over reproductive rights and justice. After all, medical professionals have both special expertise and political capital that could make a difference at a time when disapproval of abortion bans is already high.

But history suggests that arguments based on science have played a far messier role in struggles over reproductive rights. As often as scientific evidence has advanced reproductive rights, abortion foes have used claims about scientific uncertainty to justify new restrictions — and have harnessed claims of biological difference to assert that there is no connection between sex equality and abortion.

MONTREAL, CANADA -16 AUG 2015- The annual Fierte Montreal parade took place on August 16, 2015 on Boulevard Rene Levesque in Central Montreal. It is the largest Gay Pride in the Francophone world.

“Born This Way,” LGBTQ+ Rights, and the Politics of Uncertainty

September 18, 2023September 18, 2023 The Petrie-Flom Center Staff Leave a comment

By Joanna Wuest

“Medical uncertainty” is no straightforward matter when it comes to LGBTQ+ health and civil rights. Take for instance the 11^th Circuit Court of Appeals 2020 decision striking down a pair of municipal ordinances in Florida that had banned so-called “conversion therapy” for minors (contemporary psychology’s preferred nomenclature is “sexual orientation and gender identity change efforts”). In an enormous blow to the evidence-based notion that such change efforts are harmful — they are indeed responsible for much trauma and death — two Trump-appointed judges declared that the science of sexual orientation and gender identity was much too uncertain to justify the bans. Gesturing to the American Psychiatric Association’s (APA) renowned 1973 removal of homosexuality from its list of disorders, the judges explained that “it is not uncommon for professional organizations to do an about-face in response to new evidence or new attitudes.” Ergo, because the APA had changed its mind once fifty years ago, it may just as easily reverse itself again. According to this view, we may one day wake up to find that mental health professionals have reclassified queerness as a malady to be cured rather than a sense of self to be embraced and protected by law.

WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

303 Creative, Transgender Rights, and the Ongoing Culture Wars

July 27, 2023July 27, 2023 The Petrie-Flom Center Staff Leave a comment

By Michael R. Ulrich

The Supreme Court’s ruling in 303 Creative LLC v. Elenis suggests a willingness to ignore the rights and health implications for minority populations under the guise of protecting against theoretical harms. The decision is a crucial blow to strides made in achieving gay rights, and may bolster other attacks on LGBTQ+ rights. As laws that restrict the rights of transgender people in the U.S. face challenges in court, the legal, public health, medical, and bioethics communities have an essential role to play both in properly framing the legal issue, as well as explaining what is truly at stake in these cases to minimize the chances of similarly harmful rulings for the transgender community moving forward.

Brooklyn, New York, United States - JUNE 13 2021: Protest in Brooklyn, NY for trans youth rights.

Misleading, Coercive Language in Bills Barring Trans Youth Access to Gender Affirming Care

May 17, 2022May 17, 2022 The Petrie-Flom Center Staff Leave a comment

By Arisa R. Marshall

On Friday, a federal judge temporarily enjoined part of a new Alabama law that would make it a felony for physicians to provide gender-affirming care to trans youth. The law had been in effect for less than a week.

This is only the most recent development relating to a raft of anti-trans legislation sweeping the country. More than twenty bills that would impose life-changing healthcare restrictions on transgender children have been introduced in statehouses nationwide over the past two years, threatening the wellbeing of transgender youth and communities. Most of these bills aim to entirely ban gender-affirming medical care for minors, including surgeries, prescription puberty blockers, and hormone replacement therapies.

These laws are detrimental to the mental, physical, and social health of children. They are dismissive of the experiences of transgender children and teenagers, misleading, and manipulative.

Affirming Nondiscrimination Rights: HHS Needs to Acknowledge a Private Right of Action for Section 1557 Violations

March 11, 2022March 11, 2022 czhang Leave a comment

By Cathy Zhang

Last week, on the heels of attacks on trans youth and their families in Texas, the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) issued a notice and guidance expressing support for transgender and gender nonconforming youth and highlighting the civil rights and privacy laws surrounding gender affirming care.

OCR all but names the Texas attacks as unlawful under Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability by federally funded health programs or activities. It notes that for federally funded entities, restricting medically necessary care on the basis of gender — such as doctors reporting parents of patients to state authorities — “likely violates Section 1557.”

The guidance directs those who have been discriminated against on the basis of gender identity or disability in seeking access to gender-affirming health care to file a complaint through OCR. HHS can go further, however, by formally acknowledging that individuals have a legal right to enforce Section 1557 when they have experienced prohibited health care discrimination.

LGBTQ Health Equity and Health Justice

October 5, 2021October 5, 2021 The Petrie-Flom Center Staff Leave a comment

By Heather Walter-McCabe

LGBTQ communities experience health inequities compared to heterosexual and cisgender peers. The health justice framework allows advocates to move the work upstream to the root causes of the problems, rather than placing a band-aid on the resultant consequences once the harm is caused.

It is not enough to provide individual treatment for the harm caused by stigma and bias. Health justice is a crucial means of ensuring that health care is equitable and that impacted communities are involved in policy and system advocacy.

The health justice framework, with its emphasis on community involvement in structural and governmental responses to systems-level transformation, must guide work in the area of LGBTQ health equity.

The Many Harms of State Bills Blocking Youth Access to Gender-Affirming Care

May 24, 2021May 24, 2021 Chloe Reichel Leave a comment

By Chloe Reichel

State legislation blocking trans youth from accessing gender-affirming care puts kids at risk, thwarts physician autonomy, and potentially violates a number of federal laws, write Jack L. Turban, Katherine L. Kraschel, and I. Glenn Cohen in a viewpoint published today in JAMA.

So far this year, 15 states have proposed bills that would limit access to gender-affirming care. One of these bills, Arkansas’ HB1570/SB347, already has become law.

This legislative trend should be troubling to all, explained Cohen, Faculty Director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. In an email interview, he highlighted “how exceptionally restrictive these proposed laws are,” adding that they are “out of step with usual medical, ethical, and legal rules regarding discretion of the medical profession and space for parental decision-making.”

Turban, child and adolescent psychiatry fellow at Stanford University School of Medicine also offered further insight as to the medical and legal concerns these bills raise over email.

Tag: lgbtq equality