In one of the single most complex, ethically-charged, and difficult political issues to come along in decades, Donald Trump has managed to make at least one portion of the gender affirming debate painfully easy. He simply insists that a parent can sip their coffee in the morning, say good-bye to their son on his way to the bus, only to be shocked when Davie comes home from school as Darlene. Easy answer? Laugh, it doesn’t happen. Let Trump be absurd.

But we best guard against thinking that he isn’t touching on something real. The real issue does need to be addressed because it’s really important to votes and keeping trans-gendered kids alive.

What did Trump actually say which absurdly does touch on a real issue? Got it:

“Can you imagine you’re a parent and your son leaves the house and you say, ‘Jimmy, I love you so much, go have a good day at school’ and your son comes back with a brutal operation.”

“Can you even imagine this? What the hell is wrong with our country?”

No, we can’t imagine this and that’s okay because it never happens. As said, though, the fact that it never happens doesn’t mean that there isn’t a very important underlying issue. The medical questions surrounding gender dysphoria (GD) are painfully difficult to clinically treat and even more difficult to manage when one considers society, politics, and religion.

To dispense with the obvious let’s get two things out. First, be sure that gender affirming care is wholly supported by the American Academy of Pediatrics, which is good because their imprimatur is science-based, important to a person’s development, and is far healthier if addressed earlier in life, hence the “pediatric” issue.

Indeed, there is a terribly serious debate as to whether parents that don’t provide gender-affirming care to their child are being abusive. On the political spectrum, both liberals and conservatives naively find the issue simple. Liberals push for acceptance and care with respect to a child’s true identity as found by doctors (There are cases where three to five year old children assert they are not a boy or girl but the opposite). Conservatives find the whole thing preposterous, an affront to God, and a violation of parents’ rights.

We liberals are absolutely right, children must get medical care, damn it. And yet, conservatives are absolutely right to claim that the parents must be involved and have a voice, damn it…

Well, conservatives are right to a point. Either way, it’s not Donald Trump’s point but we dispensed with that easily. He is really getting at the parents’ role in gender-affirming care and that is where it gets viciously hard.

We can’t simply toss out “Do whatever is medically best for the child. The end.” We must responsibly address conservatives’ legitimate views regarding parental rights.

There is probably no more critical freedom in this country than the right to parent a child according to one’s own values. A parent can even shut loving grandparents out. More tellingly, if my 17 year-old daughter has appendicitis, the hospital and doctors need my signature before they wheel her into the operating room. She is, according to the formal and old legal term – an “infant,” under 18, and cannot lawfully consent. I have to decide for her.

That’s the rub. Let it play out and, remember, gender affirming care may not work even with the best care and is best addressed early – as children. A parents’ views do matter and if you think the only issue is what the child sincerely believes and don’t care about the parents’ values then reverse roles. Put yourself in a red state that makes it against the law to give or seek such care. You will very suddenly believe in parents’ overriding rights in the matter.

On this issue, let’s all do ourselves the favor of acknowledging that Trump is trying to address a real concern even if he doesn’t actually know it and lies about it anyway, never mind finding any sort of answer to the issue.

No one knows the answer.

Because there is medical care already, non-controversial medical care, where we do set parental consent aside in favor of adolescents’ needs. Obviously, if there is any sign of parental abuse at any age the rights are immediately limited. Less obvious is when an early adolescent seeks medical care for depression, or anxiety that is compounded by a parent. Perhaps the child simply wants to keep it private?

The adolescent needs an outlet and no side of the political spectrum opposes the ideal because it’s just not political.

Let’s skip the abortion issue as analogous because it simply compounds the complex issues around gender-affirming care. Ask transgender advocates if they want their issue lumped into the abortion debate.

Denying a child his or her true identity or gender, or worse – ridiculing it or punishing it, leads to a devastating number of suicides and incalculable depression (See here, but be prepared, it’s even worse than you think). It must be treated. And yet, if the parents aren’t in agreement, how much good can treatment really do? Moreover, can a doctor really evaluate clinical gender dysphoria or the more common, but just as devastatingly clinical, crushing teenage depression, anxiety, and drift, without parental input? No, parents must provide answers in any context.

Parents have extremely serious rights and often, too easily overlooked responsibilities in these matters.

Let’s end this with some inarguable points. First, schools are not performing operations for god’s sake. Donald Trump isn’t doing anyone, even conservatives, a favor by resorting to the stupid. Second, the American Academy of Pediatrics isn’t some monstrous organization that wants to hurt kids, their position is based on science and outcomes. Conservatives? Deal with it.

In considering the parents’ role it gets extremely difficult and nowhere near as obvious as some think. Liberals? Deal with it. If Trump is pointing to the belief that parents are shut out in these decisions, that is an issue that liberals better address if we want to progress in gender affirming care – and we should. One simply can’t shut parents out. Perhaps a parent’s role is phased out at different points, from 14, to 16, to 18, as it is in other treatments, but it isn’t going to be absolute, nor should it be. Notice, at least, is obviously needed.

Now, we best not sit back smugly and laugh at how “wrong” and stupid Donald Trump can be. We only help people if we toss away the ridiculous and concentrate on the problem. But you and I won’t have any more luck than Trump in finding a simple answer. That reality is inherent to the issue and it sucks.

It isn’t easy. Nor should it be, at least not as a political concern. Parents might find it blessedly simple and beautifully addressed in some cases. But only so long as treatment is available. So, let’s deal with it because, as pediatricians know, treatment better damn well be available.

Again, click here and be devastated by teen suicide risks when it’s not dealt with. Get tissue.

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4 COMMENTS

  1. All very good points. Hell we can’t even define homosexuality in this country, thinking if a person has a sexual experience with the same sex person, that automatically makes them gay. WRONG. It may define them as adventurous, curious, rebellious, or maybe it’s a natural thing to experiment to understand what your preferences are. Either way, so what? These poor children are at the mercy of a sick culture. No wonder so many just say ‘phuck it…I’m outta here.’ Hell the idiot spewing this shit is in a neck and neck race for the most powerful job in the western world, oh…and half the goddamn country is FINE WITH THAT! No doctor can fix that.

  2. It’s a simple question applicable to many areas.

    Do we treat a problem with logic, reason, science, and best practice, as decided by experts in the field, or do we base action on politics based on superstition and partisan bias.

    Our side has always gone with reason and evidence.

  3. You seem to have overlooked a very CRITICAL aspect about “parents’ rights” and that parents, sometimes, make the WRONG decisions.

    That “appendicitis” story you spun, for instance. For 99% of parents out there, there’s no question that they would *immediately* sign the consent forms for the doctor to operate on their child. But, then again, you’ve got RELIGIOUS EXEMPTIONS out there: Jehovah’s Witnesses, for instance, have very strict limitations placed on allowing medical procedures be done on themselves AND THEIR CHILDREN (who have no legal recourse because “parents’ rights” overrule a child’s medical needs in many states). Or Christian Scientists or any number of “faith healing” groups. States have allowed “religious freedom” and “deeply-held religious beliefs” to override legitimate medical concerns and, unfortunately, the Federal government usually goes along with this claptrap.

    And guess where most transgender care winds up? That’s right: Under the FALSE guise of “religious freedom” and “deeply-held religious beliefs.” Of course, there’s a significant difference between an appendicitis and gender dysphoria: One is an immediate, life-threatening issue while the other tends to be a bit more long-term.

    But, we’ve got far too many “conservatives” who are IMPOSING their beliefs on others. For instance, most of the bans on gender-affirming care for minors is based on a FALSE NARRATIVE that “outsiders” or “outside forces” are “filling kids’ heads with nonsense” or “confusing kids” and then performing gender reassignment surgery behind the parents’ backs. (Let’s not forget the sheer hypocrisy over women’s sports issues. The same people who cry the loudest about the “sanctity” of women’s sports and letting “boys” play “girls’ sports” are also the same ones who want to ban puberty blockers–which would largely prevent these “boys” from developing the very “male” characteristics that give trans girls an “unfair” advantage.)

    I get tired of this fake “parents’ rights” nonsense being used so hypocritically; just talk to SUPPORTIVE parents about the hoops they’re forced to jump through in order to get their kids the necessary treatment in states where “parents’ rights” has been used to BLOCK all gender dysphoria treatment (hell, to block any discussion of gender dysphoria) or the idea that a teacher has a student who wishes to be called a different name or use different pronouns from the “assigned” name/pronouns MUST disrespect the child’s wishes or face legal ramifications–even if the parents sign a form saying “This is the name and pronouns my child wishes to use,” these anti-trans bills and laws just ignore THEIR wishes.

    • If you want gender affirming care available, you better put protections in for parents’ rights. They need not be absolute, just like in other areas, but they absolutely have the right to know and be involved.

      I don’t find the issue as clean cut as you.

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