Minister Orders Inquiry Into 4,000 % Rise In Children Wanting To Change Sex

[Gadianton]

sure; say hi to Binger next time you're taking a good look in the mirror.

[Res Ipsa]

I don’t understand the relevance of what term other people use in some other context. If you and I are talking about the subject, why would use a term that we both agree is emotionally loaded?

We should be able to talk about a subject without getting unnecessarily feisty. It was the term that was being used when I entered the conversation. I thought it was interesting to pursue the issue with the use of the term as opposed to starting out by rejecting the term to see where that would go.

It certainly wasn’t my intent to be feisty at all, let alone unnecessarily feisty. If I came off that way, I apologize. It was not a term I had used in the conversation, and you used it in response to me. You are a person that I trust I can be blunt and direct with, and I certainly did not intend to communicate any judgement of you personally

I’m skeptical that the concept of “voluntarily” in and of itself will be that helpful. There is pretty good evidence that our brains are influenced by all kinds of things that we aren’t conscious of. Just as an example, is religious affiliation truly voluntary? If so, why is there a correlation between the religious affiliation between parent and child? Given the absence of any reliable way to determine whether any given act is truly voluntary, I suggest that the fundamental issue is who gets to decide?

If nothing is voluntary, then why talk about freedom at all? I guess I don’t see your point. So kids can be brainwashed to think they should be another gender? I guess gender politics are now cultural brainwashing to get us to reject the Biblical model of Adam and Eve?

Er. . . .

The point is to not kid ourselves about our ability to determine whether someone’s acts are “voluntarily.” If that’s the actual goal, then any category-based decision will be completely arbitrary, as individual circumstances will be highly determinative of whether any decision is voluntary. Absent you and I actually having an opportunity to assess each individual case, I don’t see a rational basis for determining which statements by an adolescent or their parent or guardian is voluntary or the product of brainwashing. If brainwashing of adolescents and their parents or guardians are a legitimate concern, then the best we can do is decide who should be empowered to make that decision. Put another way, if the best interests of an adolescent are the primary objective, who is more likely to do what is in the best interest of the child: your state legislature or the adolescent or the adolescent and parent/guardian, after informed consent to a procedure consistent with the standard of caste within the profession?

One of my “leftist” law professors had a way of framing these types of issues that I generally use: Should we use the coercive power of the state to do X? And X should be described with specificity. As one of the core value of liberalism is personal autonomy, phrasing issues in this manner is a reminder that what we are really talking about is depriving an individual of personal liberty by imprisoning them, depriving them of their livelihood by taking away licenses, or taking their property. And that centers the discussion on the real world practical effect of what we are talking about.

So the coercive power of the state might interfere with a parent assisting a child in obtaining gender reassignment surgery? Should African Muslim have the right to remove the clitoris of a daughter in the family or not?

I don’t think it’s “might” interfere. Several states have passed laws that make it a crime for a health care professional to perform certain procedures on a minor even if the parents and minor have given informed consent to a procedure that meets the standards of care. That’s actual reaction of the personal Liberty of the minor, the parent or guardian, and the medical professional.

In my opinion, your African Muslim example is irrelevant to the issue of who gets to decide medical treatment for adolescents in the US. First, I have no say at all in who gets to decide that. My ability to have any effect on the issue is so attenuated, it is actually a question of whether I should lobby my government to use its economic power to punish or reward a foreign government for engaging in certain behavior or support organizations that attempt to persuade governmental or religious authorities to change their minds or boycott the purchase of products or services from a given country. In contrast, my ability to actually have input into the issue is much more direct when we are addressing my rights and my children’s rights to personal autonomy. I can choose to vote for my representatives in government based on their position on the issue. And I can appeal to the court system to protect those rights.

Second, the African case has a religious dimension that is simply not present in the issue of medical treatment for minors.

Third, the issue we are dealing with involves a medical treatment for a condition. To my knowledge, routine clitorectomy is not a standard or care for any health related condition.

Fourth, in the situation we are discussing, the state is overruling the informed consent of the minor and the parent or guardian. To my knowledge, religious based clitorectomies do not involve informed consent.

Finally, I have no moral or ethical obligation to declare a consistent position on every hypothetical example that has something in common with the issue I am addressing as a condition of taking a position on that issue. There is absolutely nothing wrong with taking a position on an issue in front of me. But we’ve had that discussion, I think.

[Kishkumen]

I apologize. I did introduce the term genital mutilation. The reason I did so—don’t know why I thought it was already in play—was because a lot of this gets down to how one views body modification. Loaded terms show us that the same thing you or I might view as a needed medical procedure others see as genital mutilation. The circumcision many American males underwent might be viewed, and is viewed, by others to be genital mutilation. I don’t recall what the medical justification for circumcision was when I was a kid. I do know that the doctor donned a yarmulke and intoned a Hebrew prayer when he did mine (so my parents told me). Utah. LOL!

In any case, it seems to me that the definition of medical necessity has experienced mission creep as time has gone by. Generally, I am in favor of letting adults do as they please, so long as they do not harm others. I will note that the state has a history of telling parents what they should do in the case of their kids. I am not surprised that those who are skeptical about gender reassignment surgery on children would want the state to intervene.

[Res Ipsa]

I apologize. I did introduce the term genital mutilation. The reason I did so—don’t know why I thought it was already in play—was because a lot of this gets down to how one views body modification. Loaded terms show us that the same thing you or I might view as a needed medical procedure others see as genital mutilation.

No apology needed. I understand why you introduced it. In responding, I'm going to be a little more feisty, but not about you as a person, your use of language, or your choice to deploy any form of argument. I'm going to be addressing something that I think is important about arguing based on catgories or labels -- how the form of argument obfuscates more than it enlightens.

Something you may have already noted is that I will continually focus on the specifics of the question to be answered. If we're going to talk about surgery on minors in this context, then what we are specifically talking about is breast augmentation or reduction of 15-18 year olds. No one is proposing that a 15 year old should be able to just walk in and have that kind of surgery. It takes place in a specific factual context with a specific set of requirements. Those are: (1) informed consent by the patient; (2) informed consent by the parents/guardian; (3) compliance with the standard of care required within the medical/psychological profession. A good source for understanding the standard of care are guidelines like those found here: https://www.tandfonline.com/doi/epub/10 ... ole=button (this was the most recent set of guidelines I found). All three of these things are already required by law. Failure of the medical professional to comply with these legal requirements results in loss of professional license and payment of damages.

The actual of issue being debated publicly is whether the state should imprison or take the license from a medical professional even when those requirements are met. So we have one individual who will be directly impacted by this decision -- the adolescent who is suffering from gender dysphoria. The parents or guardians of the adolescent will also be significantly affected, as they will be exposed to and responsible for helping the adolescent through the effect of having or not having the surgery. The medical professional will be less directly affected, as their ability to provide treatment consistent with the recognized standard of care will be different depending on the decision. For everyone else, the effect ranges from non-existent to tangential. No adolescent is being forced to have surgery without their consent. No adult who has legal decision making authority over the adolescent is forced to give consent. No physician is being compelled to violate the medical standard of care.

The issue involves a very small number of people whose life, liberty and pursuit of happiness will be affected by the decision. So, given this situation, who should decide whether the surgery should occur in any given case? The combination of the patient, parents/guardian, medical professional, or a bunch of ordinary people who know absolutely nothing about the patient or the medical/psychological issues involved but are able to win an election?

We all use categorical reasoning to try an address this type of issue because it is familiar and comfortable. We're all taught the basic formal syllogism at some point:

All men are mortal.
Socrates is a man.
Therefore Socrates is mortal.

And that's a good way to teach how the rules of formal logic work. But its all based on the definition of categories: men, mortal, Socrates (a category of one). But what we aren't taught is one of the most important lessons demonstrated by postmodernism: arguing from categories/labels cannot determine the answer to a specific question in any consistent manner. First, the categories themselves are arbitrary human constructions. For any issue in genuine dispute, there is no principled way to determine which category should apply. Second, even if we agree on whether something falls in a category, that does not determine what we should do in a specific case.

You've already demonstrated the first one. Is the relevant category "genital mutilation" or "gender affirmative treatment?" My assertion is that there is no principled, consistent line one can draw between the two. We have a specific factual situation. Arguing about how to label it doesn't help us answer the question at hand at all. All they functions as are abstractions of "I think the government should make the decision" or "I don't think the government should make the decision." Assigning the labels doesn't help us make a decision at all. That's my first criticism of the form of argument. I think the fact that different people will assign the specific situation to different categories is completely irrelevant to deciding who should have the power to make this specific decision.

For my second point, I'm going to use your suggested category "body modification." And I'm going to agree that the surgery I've described falls into the category "body modification." Has that helped us decide who should have the power to decide whether the surgery should occur? I don't think so. The category "body modification" is so broad that it could range from temporary tattoos to the intentional blinding described by Ajax. Why should we treat that range of actions the same way simply because we can agree on a category that applies? Again, reasoning from categories or labels does not help us decide who should make the specific decision we are discussing.

So, I think that approaching this issue through categorical reasoning is a mistake because it cannot help us answer the question. I also argue that it introduces unrecognized biases into how we think about the issue. Most importantly, it fools us into thinking about abstract concepts rather than viewing the issue as a choice that will benefit or harm real individuals. Second, because categorical reasoning is indeterminate, it biases the participants toward the status quo. The participants are disempowered to change the current situation because the result of using this reasoning is something like "we'll just have to agree to disagree." Absent a convincing reason for change, the natural inclination is to shrug and go on to the next thing.

The circumcision many American males underwent might be viewed, and is viewed, by others to be genital mutilation. I don’t recall what the medical justification for circumcision was when I was a kid. I do know that the doctor donned a yarmulke and intoned a Hebrew prayer when he did mine (so my parents told me). Utah. LOL!

I got a good chuckle out of that. I would not have imagined that happening in Utah. But my response to the substance of your point is, the label doesn't help us decide who should have the power to decide whether circumcision should be performed. I was adamantly opposed to circumcising any of my children simply on the basis that it was an unnecessary infliction of pain. But I would as adamantly argue against taking the power to make that decision away from other parents and giving it to my state government. (As far as I recall, the medical profession didn't consider it a significant medical issue.)

In any case, it seems to me that the definition of medical necessity has experienced mission creep as time has gone by. Generally, I am in favor of letting adults do as they please, so long as they do not harm others. I will note that the state has a history of telling parents what they should do in the case of their kids. I am not surprised that those who are skeptical about gender reassignment surgery on children would want the state to intervene.

So now we have a new category introduced into the discussion -- medical necessity. Does it help us figure out who should decide? Again, I would say that it serves mainly as a distraction that leads us away from addressing the specific question presented. First, "medical necessity" isn't a term that is relevant to the medical standard of care. It is a term used by the health insurance industry to deny payments for medical costs you incur. Second, even the common definition of "medical necessity" isn't as stringent as the term leads one to believe. You can find the definitions used by different health insurers, but the "necessary" part is something like "isn't purely for the convenience of the patient." I'd suggest that's a pretty low bar.

So, if there has been "mission creep" in "medical necessity," that has nothing to do with the medical standard of care -- just what your insurance company will pay for. But beyond that, even if "medical necessity" were an element of the medical standard of care, would that help us at all in deciding who should make the decision as to whether the surgery should be performed? I don't think so. All it does it takes the question to be decided and abstracts into "does it fit into this category?" And even if we agree on the category, that won't tell us who should make the decision.

So, why not skip the whole category exercise and ask: who should have the power to decide and why?

I'm not surprised at all when Americans of any political flavor run to the government when they see other people doing something that they don't like. (With the exception of actual Libertarians, for whom this question should be a no brainer.) Every American has the right to have an opinion. Every American has the right to express their opinions. Every America has the right to petition the government for redress of grievances. And, given that our citizenry includes people who believe that certain elite leaders literally drink the blood of children, I'm not surprised by objections to anything and people who want to use the government to force other people to do things or refrain from doing those things.

But none of that tells us who should have the authority to decide whether the surgery happens or not.

Again, to the extent I've been feisty, it's with a common form of argument and has nothing whatsoever to do with you as a person or the fact that you, personally, are using the argument. If I think it will help me win a motion in court, I'll make a categorical argument. And if the other side makes a categorical argument that the judge might bite on, I'll deconstruct it. And I'll do it completely aware of the fact that I'm trying win an argument that benefits my client and not trying to arrive at a principled opinion on how the issue should be decided.

[Kishkumen]

Thanks for your long and detailed response to my comments. It seems to me that we are aiming at different things here, and that is OK by me. You seem to want to press the argument in such a way that we arrive at your preferred conclusion. We don’t really have a whole lot to argue about there, as I have already stated that my preferred outcome is that parents have the right to support their children in the decision to change their bodies to match their internal sense of gender.

But, I am not interested so much in advocacy that bypasses the objections of opponents through lawyerly arguments. You essentially say that these arguments about values and beliefs are a waste of your time because they go nowhere. Well, uh, OK, but they still constitute the deep-seated feelings of those who disagree with you. That is exactly why I introduce the loaded terminology. You can certainly wave it away with your hand as you engage in trying to persuade me that we just need to get on with the business of reaching the right conclusion, but I get the feeling that this is why we end up fighting these long, drawn out culture wars in the first place.

But that’s not your problem. It is where my interest lies in all of this, but it is not your problem. I can save you some trouble by saying that I agree with you in principle while considering a lot of what you have written likely to appear to those who do not agree with you like a fancy dodge of dealing with fundamental disagreements about assumptions.

We could take the medical and psychological standards that you reference, for example. Many of the people who would disagree with you do not put a lot of trust either in doctors or the dubious science of psychology. I put a lot more stock in what doctors say than psychologists, who, on their best day, seem to be reasonably effective behavioral managers and that’s about it. Neither profession is really good at tackling profound questions of what humanity and gender are in a scientific way. What causes gender dysphoria? Is it a genetic issue? Environmental? Permanent? Passing? How do we tell the difference between different kinds? (I understand there are diagnostic tools that constitute reasonable indicators and precautions, etc.)

Let me remind you that I am on your side. I say, let the parents have the power to support their kids in modifying their bodies to conform to their feelings and sense of identity. If we can all agree to keep the government out of the lives of kids, at least where the decisions do not have the potential to spread a deadly disease, then we will all be better off. If, that is, we can be consistent in how we apply this. As long as we give the power to the state to intervene in preventing child abuse, then anything that enough people deem to be child abuse may potentially be put within the province of the state to prevent. The problem as I see it is that there will not be consistency. Another problem is that gender is an intensely emotional issue, not just for people who have been marginalized for their identities, but also for those who want to affirm what they believe to be traditional gender roles.

In any case, time is on our side, and eventually those who have these big hang ups about others’ gender expressions will die, and then there will be little real opposition to body modification of this kind. Indeed, it may be that what happens is that body modification of many different kinds becomes so common and so easy to get as an outpatient elective procedure that standing in the way of gender changes will just seem bizarrely incongruous with the entire culture. So, I really have to say that I like my choice to go with body modification. If I change my earlobes, my butt, my breasts, my nose, or my genitals, what’s it to you, eh? Why should you be able to get breast augmentation, but I can’t get a vagina?

[Res Ipsa]

Thanks for your long and detailed response to my comments. It seems to me that we are aiming at different things here, and that is OK by me. You seem to want to press the argument in such a way that we arrive at your preferred conclusion. We don’t really have a whole lot to argue about there, as I have already stated that my preferred outcome is that parents have the right to support their children in the decision to change their bodies to match their internal sense of gender.

But, I am not interested so much in advocacy that bypasses the objections of opponents through lawyerly arguments. You essentially say that these arguments about values and beliefs are a waste of your time because they go nowhere. Well, uh, OK, but they still constitute the deep-seated feelings of those who disagree with you. That is exactly why I introduce the loaded terminology. You can certainly wave it away with your hand as you engage in trying to persuade me that we just need to get on with the business of reaching the right conclusion, but I get the feeling that this is why we end up fighting these long, drawn out culture wars in the first place.

But that’s not your problem. It is where my interest lies in all of this, but it is not your problem. I can save you some trouble by saying that I agree with you in principle while considering a lot of what you have written likely to appear to those who do not agree with you like a fancy dodge of dealing with fundamental disagreements about assumptions.

We could take the medical and psychological standards that you reference, for example. Many of the people who would disagree with you do not put a lot of trust either in doctors or the dubious science of psychology. I put a lot more stock in what doctors say than psychologists, who, on their best day, seem to be reasonably effective behavioral managers and that’s about it. Neither profession is really good at tackling profound questions of what humanity and gender are in a scientific way. What causes gender dysphoria? Is it a genetic issue? Environmental? Permanent? Passing? How do we tell the difference between different kinds? (I understand there are diagnostic tools that constitute reasonable indicators and precautions, etc.)

Let me remind you that I am on your side. I say, let the parents have the power to support their kids in modifying their bodies to conform to their feelings and sense of identity. If we can all agree to keep the government out of the lives of kids, at least where the decisions do not have the potential to spread a deadly disease, then we will all be better off. If, that is, we can be consistent in how we apply this. As long as we give the power to the state to intervene in preventing child abuse, then anything that enough people deem to be child abuse may potentially be put within the province of the state to prevent. The problem as I see it is that there will not be consistency. Another problem is that gender is an intensely emotional issue, not just for people who have been marginalized for their identities, but also for those who want to affirm what they believe to be traditional gender roles.

In any case, time is on our side, and eventually those who have these big hang ups about others’ gender expressions will die, and then there will be little real opposition to body modification of this kind. Indeed, it may be that what happens is that body modification of many different kinds becomes so common and so easy to get as an outpatient elective procedure that standing in the way of gender changes will just seem bizarrely incongruous with the entire culture. So, I really have to say that I like my choice to go with body modification. If I change my earlobes, my butt, my breasts, my nose, or my genitals, what’s it to you, eh? Why should you be able to get breast augmentation, but I can’t get a vagina?

Thanks for your thoughtful response as well. I've spent most of my energy critiquing a form of argument. As you can tell, I think focussing on the specific facts at hand when formulating the question to be discussed is important. But I think you'll find that I do so pretty consistently when I discuss these types of issues regardless of my position. For example, if states were passing laws banning circumcision of minors, I would phrase the issue exactly the same way, even though I would take the opposite position. So, I can understand why you would reasonably interpret what I'm doing as result oriented, but it's actually not.

By critiquing categorical reasoning, I'm not rejecting anyone's viewpoint. But I am saying let's not spend hours arguing about categories and labels that don't help us figure out how to answer the question. In fact, trying to construct a persuasive argument is going to require me to start from some kind of common value. In fact, if you and I did not agree on this specific issue, I would likely start by asking why we the people should give the state the power to make this decision. What is it that worries you about allowing adolescents, parents and doctors to make this decision? And I would try to listen to and understand their concerns. Then I would reason from the values they express to try and persuade them that keeping the government out of this specific decision is consistent with their deeply held values.

In my opinion, the concept of consistency is as indeterminate as categorical reasoning. Just for example, let's take the gamut of medical/surgical treatment that theoretically could be available for minors: puberty blockers, hormones, breast augmentation or reduction, facial reconstruction surgery, adams apple reduction, penectomy, orchiectomy, feminizing genitoplasty, oophorectomy, hysterectomy, metoidioplasty, phalloplasty, and scrotoplasty. There may very well be different reasons why we should give the government the power to make some of these decisions and not for others. I would suggest that focussing on sensible result for each case would be more productive than making consistency a primary concern. There may situations in which the degree of inconsistency in how we handle different issues reaches a point where it makes sense to adjust something about one or both issues. But requiring consistency as any kind of precondition to deciding an issue that presents itself is, in my opinion, disempowering. We should be able to address issues as they arrive. If we arrive at an answer that we think is incompatible with something else, we can adjust one, the other, or both.

[ajax18]

If I change my earlobes, my butt, my breasts, my nose, or my genitals, what’s it to you, eh? Why should you be able to get breast augmentation, but I can’t get a vagina?

This is just the first step onto the slippery slope. What do you care about what consenting adults do behind closed doors? Now my kids are seeing this agenda pushed upon them at 6 years old. They want to inculcate them with the idea that this normal and moral just like a heterosexual relationshop contrary to beliefs, wishes, and faith of the parents.

What do you care if a woman blinds herself? Why hold the psychologist responsible if she's a consenting adult? I

[canpakes]

Now my kids are seeing this agenda pushed upon them at 6 years old.

Who is doing that to your 6-year old, and how are they doing it?

[Doctor CamNC4Me]

Now my kids are seeing this agenda pushed upon them at 6 years old.

Who is doing that to your 6-year old, and how are they doing it?

They’re homeschooled and this is why he hates his wife.

[Doctor Steuss]

[...] Why hold the psychologist responsible if she's a consenting adult? I

Because he is a psychologist.