Editorial: Sex reassignment surgery

Majority:

The university administration announced Monday that it is considering a change in the health plans for students and employees that would, for the first time, cover the costs of sex reassignment surgery. The Editorial Board endorses this change and encourages the University to help those members of our community suffering from what is commonly classified as gender identity disorder get adequate medical treatment.

The American Medical Association and American Psychiatric Association, along with numerous other healthcare and mental-health advocacy groups, have recognized that those individuals questioning their gender identity can suffer from emotional distress, self-injury and suicide; these medical organizations have also deemed proper treatment, including transition treatments, medically necessary, challenging the widespread misconception that sex reassignment surgery is either elective or cosmetic. Most doctors and insurance companies that do cover the procedure require potential recipients to meet stringent requirements, including numerous evaluations, referrals and time spent living in their preferred gender role. Accordingly, should the University elect to include the costs of reassignment surgery in its health plan, it too would likely require such diagnoses and referrals, thus ensuring that only the individuals who truly need the surgery have the process covered by the University.

The American Medical Association has issued a resolution urging public and private insurers to cover “treatment[s] of gender identity disorder as recommended by the patient’s physician” — treatments that sometimes, but not always, include surgery. The student plan already covers hormone therapies but, like many private providers, stops short of covering reassignment surgery.

But the standard set by insurance companies should not be the standard to which we hold the University. Princeton has obligations that go beyond those of traditional insurers — the University is not a for-profit enterprise, and the mission of the health plan should be to provide students and employees with the care they need. It is the University’s responsibility, as an extension of its policy of nondiscrimination and its commitment to creating a welcoming, inclusive community on campus, to help transgender students and staff pay for medically necessary procedures. This imperative should outweigh the discomfort of those who disagree with the medical community’s assessment and dismiss gender reassignment surgery as elective.

Because relatively few students would elect to have the surgery while on the University’s health insurance plan, the financial impact on the University of covering sex reassignment surgery would be negligible, but the benefit to the few students and staff members in need of this surgery could be life-changing, and perhaps even life-saving. Even if few take advantage of the new policy, it would signal an important shift toward fulfilling Princeton’s mission of tolerance and diversity. A growing number of schools, including Brown, Penn, Harvard and Cornell have already made this commitment. Yale covers sex reassignment surgery for faculty and staff and is considering extending coverage to students. The Board urges the University to join our peers in providing for the medical needs of the transcommunity.

Dissent:

According to a study published in General Psychiatry, “Sex reassignment surgery confers no objective advantage in terms of social rehabilitation” (Meyer MD, et al.). Paul McHugh, chief psychiatrist at Johns Hopkins University, has even observed “a great deal of damage from sex-reassignment” and urges an end to the procedure. The Board, however, has boldly deemed it “life-saving.”

Promoting sex change operations furthers the problematic thesis that one’s actual body must be in accord with one’s notion of the “right” body for him or her in order to be healthy and to have dignity. It supports the thesis that a person with gender dysphoria is diseased because of his or her sex. This would suggest that other cosmetic procedures are also necessary. Breast implants, for instance, would alleviate the disconnect in self-perception of some self-conscious women. Should the University health plan also cover these surgeries? Certainly not. Healthcare is about restoring health, not engendering transformation.

Though sexual dysphoria is indeed an unfortunate source of significant suffering, it is not clear that sex reassignment surgery is the right medical response. While other universities have done as the Board has prescribed, Princeton should make this decision independent of the fickle public opinion.

Signed,

Zach Horton ’15