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Culture War Roundup for the week of September 16, 2024

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Is plastic surgery an essential medical procedure that a Department of Corrections must pay for, if a prisoner is sufficiently distressed about it? And if a M-to-F transwoman undergoes full reassignment surgery, will that prisoner be transferred to women's prison in due course?

A federal judge ruled the Indiana Department of Correction's ban on gender-affirming care is likely unconstitutional, and an inmate from Evansville is at the center of the lawsuit.

Source, archived version.

The prisoner (neé Jonathan Richardson, now Autumn Cordellioné) is serving a 55-year sentence for almost two decades for killing one's baby stepdaughter. The prisoner was diagnosed with gender dysphoria four years ago and put on testosterone blocker and female hormone.

While the medicine has helped, the lawsuit states Cordellioné continues to experience symptoms of gender dysphoria including depression and anxiety. [...] Cordellioné was on a wait list for evaluation for the surgery, but a new Indiana statute does not allow the DOC to provide or facilitate "sexual reassignment surgery." The ACLU [representing Cordellioné] argues in its suit that for some, the surgery is a medical necessity. In this case, Cordellioné is seeking a orchiectomy, which removes the testicles, and vaginoplasty, which is the construction of the vagina.

"By prohibiting the surgery, regardless of medical need, the statute mandates deliberate indifference to a serious medical need and therefore violates the Eighth Amendment," the suit states. "Additionally, the statute discriminates against Plaintiff and other transgender prisoners in violation of the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution."

The judge agreed, issued a preliminary injunction against the Indiana statute in question.

Here's a summary of the statute (HEA 1569, passed in 2023) that perplexity.ai provided:

It prohibits the Indiana Department of Corrections from performing certain surgical procedures for the purpose of altering the appearance or affirming an inmate's gender identity if it's inconsistent with their sex assigned at birth. Specifically, the law bans the following procedures [gives a list including castration and vaginoplasty, and in general removing healthy tissue or non-diseased body part].: The law does not define "gender" or "sex" but appears to use "sex" to refer to an individual's sex assigned at birth.

The law doesn't prohibit hormone therapy (which the prisoner got) or social transitioning:

The lawsuit states Cordellioné has lived as a woman to the "extent possible" while in a prison housing only men. She has been permitted gender-affirming items such as makeup and "form fitting clothing."

I will put aside for now how utterly annoying I find the assumption that, to be a woman, one wears makeup and form-fitting clothes. By all means fellas, go all 17th-century Versailles. My main question is this: if the Indiana Department of Corrections is required accommodate "gender-affirming" transitions, including the extreme surgeries of removing testicles and shaping the penis to look like a vagina, wouldn't the reasonable next step be to affirm the prisoner's womanhood by placing the prisoner in women's correctional facilities?

(My husband said that if he ever had to go to prison and there was an option to go to women's prison rather than men's, his only question is: what needs to be chopped off and how soon?)

Let me end on a controversial (for The Motte) note: maybe I simply shouldn't care. Cordellioné has been in prison since early 2000, which makes the person at least 40. So even if I don't see this person as a woman, this is a middle-aged male on testosterone blockers with some serious surgeries between his legs. How dangerous would he really be to the female prisoners, compared to other female prisoners already serving there?

The issue here is that the government had abdicated the role of deciding what counts as "medically necessary treatment" to doctors. This probably seemed like a good idea at the time, but now we have reams and reams of court precident citing professional standards generated by private doctor's associations as evidence of medical nessesity, such that it now overrules state laws attempting to regulate medical care.

I think that probably is a good idea going forwards, in the sense that the legislatures are probably not the right body to be making that determination.

It is sad that the professional bodies are beholden to nonsense, but at least they have the capacity to know what they are talking about and make the evidence-based call.

Ultimately, it seems like a choice between those that don't know and those that know better.

make the evidence-based call.

It isn't always evidence that is the deciding factor. To point to another hot-button issue, I don't trust doctors to decide "when is abortion murder?", because it is more a question of moral philosophy than medicine.

because it is more a question of moral philosophy than medicine.

This conflation of "expertise in a given field" and "ability to make complex moral judgements", already far too common in PMC spaces, became turbocharged during Covid. It's baffling the number of people who seem to think that simply being extremely knowledgeable about epidemiology automatically makes you qualified to judge which civil liberties can be indefinitely suspended.

(It's easy to expose how facile this reasoning is: no one thinks extensive training in firearms automatically makes you qualified to make a moral judgement on how easy it should be to buy a gun.)

Complicating that is that Covid revealed a lot of those "experts" weren't extremely knowledgable about epidemiology either -- e.g. the charts coming from the Canadian CDC showing predicted rapid exponential growth in deaths in the short term, which kept not happening. Either these people were lying, or they were failures even in their own field.

Absolutely. I don't believe that even one of Neil Ferguson's enormously pessimistic projections came to pass, but for some reason he's still held up as some kind of guru.