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Moreover, the limits wouldn’t apply just to children but would also make it considerably more onerous to deliver cross-sex hormones or surgeries to adults. It seems likely that, if they take effect, some patients and some providers will be stymied.
At the moment, the new rule is in limbo; St. Louis County Circuit Judge Ellen Ribaudo has issued a temporary restraining order that will run until at least May 15. I can’t assess the legal merits. But I will say that, as policymaking, this is a bad idea.
Because this will make a lot of conservatives mad, let me start by acknowledging their sincere and valid concerns about gender medicine as it is practiced in the United States today.
Are those concerns tangled up, in some cases, with antipathy toward trans people, as the left so often alleges? Yes, no doubt. But many folks legitimately question whether medical transition actually makes people with gender dysphoria better off, because, decades after doctors started performing these interventions, there’s still no high-quality evidence that they’re beneficial for children — and even the evidence that they improve quality of life for adults is less clear than it should be at this late date.
This is not to say there is any proof they don’t work. The evidence is just distressingly limited either way — which is precisely why this debate gets so fraught.
Still others believe that medical transition can help people with severe gender dysphoria but nevertheless worry that the medical establishment is performing interventions too often, medicalizing marginal cases in which patients could have learned to live happily as their natal sex — which is to say, without a lifetime of medical maintenance and potential complications.
For people with such milder concerns (a group not limited to conservatives), some of what Missouri’s AG proposes might seem like reasonable attempts to prevent people from making life-altering mistakes. Informed consent would be revamped to strongly emphasize risks and uncertainties, while providers would be forbidden from proceeding with drugs or surgery until dysphoria has been clinically documented for at least three years — and the patient has undergone at least 15 hours of therapeutic evaluation, delivered over a period of at least 18 months.
However, other requirements, such as onerous demands for renewing written consent, seem better designed to harass doctors than to improve treatment. Still others seem like near-fantasy: Providers are enjoined to “ensure” that minors are not suffering from social media addiction and that patients of any age are not “experiencing social contagion with respect to the patient’s gender identity.” How could any physician ever be sure of such a thing?
More broadly, conservatives should think carefully about whether they really want to block adults from making medical decisions for themselves.
Thus far, most of this debate has centered on minors for good reason: Pretty much everyone recognizes that the state has some interest in standards of medical care for children, and that this interest can even justify overriding parents. Jehovah’s Witnesses have every right to refuse blood transfusions, but courts also have a right to say that decision must wait until you’re 18.
But the corollary is that adults do get to decide. Conservatives have a strong interest in preserving this principle, not only to protect religious minorities such as Jehovah’s Witnesses but also for the benefit of other groups — like, oh, say, Trumpy conservatives who don’t want to get vaccinated.
That’s not to suggest that conservatives should stand by and do nothing if they think a captured medical establishment is committing mass malpractice; it’s to say that whatever they do should assume adults are capable of running their own lives. Some of what Bailey is proposing would be a legitimate step in that direction, though it should be done through the legislature, not an emergency rule from a partisan AG who’s up for reelection next year. Go ahead and mandate better data collection and follow-up for research purposes, and ensure that informed consent contains the scary information that no one knows how well this works. Better yet, go even further by funding more and better-quality research into outcomes.
But, after all that is said and done, adults should be allowed to decide for themselves. Just as you can want what’s best for trans people while still worrying they’re making a mistake, you can also recognize that even if you think it’s a mistake, it’s their mistake to make.
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