Crystal Beal, MD (they/them) is the CEO and Founder of QueerDoc and QueerCME. They are a clinical instructor at the University of Washington School of Medicine and the Medical Curriculum Review Committee Co-Chair of the Philadelphia Wellness Conference, and they are a Board Certified Family Medicine physician. And they are A Trans Physician Planning Civil Disobedience. This is their statement.
I am Trans Physician Planning Civil Disobedience
As a queer person in medical school, I often wondered would I have been on the right side of history during the AIDS crisis. Would I have had the empathy, ethics, and courage to provide medical care for patients with HIV and AIDS? Would my fear for my own health and security have limited my involvement? When I was even younger, I asked myself what my participation in the Holocaust would have looked like. Would I have helped save people or stood by and done nothing?
Our current political climate has provided me the opportunity to answer this question. We are facing an epidemic of hate. We are at risk of losing a generation of trans children. I can choose the relative safety of protecting myself, my paycheck, and my family by following these unconstitutional and discriminatory laws that directly oppose evidence-based best practices, national standards of care, my ethics, and federal laws, or I can choose to protect trans children.
I want to be VERY CLEAR: these targeted political attacks on gender affirming care providers and patients from the Alliance Defending Freedom, the Heritage Foundation, and the Family Policy Alliance are a public health emergency.
These attacks are killing trans kids and trans adults. These attacks are exacerbating minority stress, chronic health conditions, depression, suicidal ideation, suicide attempts, and completed suicides, in addition to fueling violence against trans people. We are on the cusp of the genocide of a generation of trans children.
Both scientific research and medical organizations agree that transition-related medical care is lifesaving, medically necessary, and evidence-based healthcare, as defined by 29 major medical associations in the United States with over 700,000 clinician members. Research repeatedly indicates that gender affirming medical care improves mental health, reduces suicidal thoughts and suicide attempts, decreases depression, and improves baseline functional status. This research is robust and reproducible. There is no actual clinical debate on this care’s benefits or medical necessity; there is only disinformation propagated by politicians. An amazing summary of the current evidence and the common critiques is available in Gender Affirming Care is Not Experimental Part I and Part II on Science-Based Medicine.
Politicians are attempting to practice medicine without a license and violate the 14th Amendment. Fourteen states (as of June 7, 2023,) have passed youth gender affirming care bans: Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Utah, South Dakota, Tennessee, and West Virginia.
The Federal government has affirmed the medical appropriateness of gender affirming care and that bans are illegally discriminatory. The Biden Administration, the Department of Health and Human Services, and the Justice Department have all issued statements. HHS-issued guidance makes it clear that denials of health care based on gender identity are illegal, as is restricting doctors and health care providers from providing care because of a patient’s gender identity. The Biden administration’s March 2022 Press Briefing, January 2021 Executive Order, and June 2023 initiatives announcement indicate the President’s support of equal rights for trans and gender diverse Americans. The Justice Department’s letter and lawsuit against Tennessee, Title IX, Section 1557 of the Affordable Care Act, and the Bostock ruling all prove that these youth care bans are unconstitutional and discriminatory.*
Our colleagues who practice reproductive medicine have faced similar attacks for many years. We cannot rely on patients being able to access care in “safe” states. I fear that if we bow to any individual state restriction on care, we risk expanding the loss of rights across all states. We continue to see this in the wake of the overturning of Roe and the growing erosion of state-based reproductive rights.
I am facing these questions today:
- will I follow these unethical and unconstitutional laws in these states because I fear for my license, my career, my finances, and my safety?
- Will I provide the care I know is best despite these laws to help save trans youth?
- How do I choose between what is ethical and what is legal, especially when Federal and State statutes and policies disagree?
The American Medical Association Code of Medical Ethics states that:
“Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties. In some cases, the law mandates unethical conduct… In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal obligations.”
I am so exhausted by hearing my colleagues ask about what they can do (legally) instead of what is the right thing to do. So many of my peers in this space seem to be operating from a space of fear, focused on state legislation. We took an oath to do no harm- do we only follow it when it is comfortable and safe?
I look to Dr. Kristen Ries, Dr. Linda Laubenstein, Dr. Rudolph Weigl, and Dr. Gisella Perl: all physicians who risked their personal safety and security to treat patients and save lives in the face of hatred. I hope to live up to their legacies. I will not be complicit in the murder of trans children, and I will not allow complacency to stop me.
*if you are experiencing healthcare discrimination based on your gender identity, file a complaint with the Office of Civil Rights.
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