During Biden’s first year in office while the covid pandemic raged on, I watched in bemused fascination as the rightwing insisted that mask mandates were unconstitutional (they aren’t — the Constitution says nothing about masks or any public health stuff for that matter) and that vaccines were going to kill us all (they didn’t). I thought to myself, “I wonder if this will help conservative people understand why liberals advocate for bodily autonomy and medical freedom.”
The right to decide what happens to your own body is probably considered one of the the most fundamental human rights nowadays.
This fundamental human right is NOT spelled out in the Constitution. The phrase about “life, liberty, and the pursuit of happiness” is in the Declaration of Independence, not the Constitution. The Constitution said nothing at all about bodily autonomy. In fact, it famously legitimized slavery. Even the 13th Amendment, which did away with most slavery, still allows convicted criminals to be enslaved. The 14th Amendment says someone can’t be deprived of life, liberty or property without due process of law, but the “life” referred to in this amendment is imprisonment or the death penalty, not medical care.
So let’s make this one point exceedingly, absolutely clear: The U.S. Constitution does not say one single word about medical issues. Not public health. Not bodily autonomy to seek out or refuse any particular medical procedure. No one has a Constitutional right to medical help. No one has a right to refuse a medical procedure. No one has a right to get a medical procedure. In the Constitution. Everyone see that? The Constitution itself does not say a word about medical stuff or health care, or even that your body is your own.
There are lots of laws and cases about medical care that has developed over the years. It just isn’t based on the Constitution.
When Biden mandated vaccines, a plastic surgeon in Utah, Kirk Moore, signed up to distribute vaccines with the intent to “give people a choice” to circumvent the vaccine mandate. He falsified vaccine cards, and was willing to give saline shots instead of the vaccine. He was on trial for doing this when Pam Bondi halted the trial and ordered the Utah prosecutors to drop all charges. [Salt Lake Tribune article dated 12.17.2025 ]
This quote from the article, this quote right here, mirrors nearly word for word the liberal defense of bodily autonomy and medical freedom:
In an interview that lasted nearly two hours, Moore said choosing whether to get vaccinated is deeply personal and the decision should be made between patients and their doctors — not mandated by government or businesses. The Trump administration has similarly framed vaccination as a personal choice in its dismissal of established public health guidance.
Alright folks. The conservatives can say vaccines are a personal choice. The decision should be made between patients and their doctors. Okay. I think that’s not very smart, but if the conservatives will please be consistent in granting “medical freedom” to everyone, then go ahead and refuse vaccines.
Having an abortion is a deeply personal choice, and the decision should be made between patients and their doctors.
Taking birth control is a deeply personal choice, and the decision should be made between individuals and their doctors.
Transitioning genders is a deeply personal choice, and the decision should be made between patients and their doctors.
Be consistent. Anything to do with someone’s medical care is a deeply personal choice, and the decision should be made between patients and their doctors. Including abortion. Including birth control. Including transgender treatment, whether that takes the form of hormones or surgery.
This is the Amendment I want added to the Constitution: An individual’s right to their own body shall not be infringed.
Or words to that effect. Basically, something that means no laws can require or forbid any form of personal medical care. Yes, we’ll see more measles outbreaks and that completely sucks. (My personal opinion is that, if we take medical decisions away from politicians, science can reassert itself and the anti-vaxxers will go back to being a small fringe group once the Republicans stop dragging them into the mainstream.)
It is the height of hypocrisy for the Republicans to try and ban transgender care for minors nationwide while also undermining vaccines that would protect kids from measles. Here’s an article pointing out that Long Covid has now surpassed asthma as the most common chronic childhood illness. Okay. Don’t mandate covid vaccines for kids. But also don’t take away a transgender kid’s opportunity to take puberty blockers and hormones.
The “We Want to Save Lives!” and “Protect the Children!” rallying cry can be used by both sides of the argument. Which side you’re on depends on whether you accept science or religion. So take politics out of the issue entirely. If the Constitution guarantees bodily autonomy for all, the politicians have no more incentive to campaign on these topics. The discussion will remain active because churches and scientists can still speak out. But we remove medical care from politics.
Your thoughts?
- Neither side of the political aisle is going to win this argument. What do you think about giving all medical decisions back to individuals and their doctors?
- Conservatives tend to want to ban or reject healthcare. Banning abortion, banning gender affirming care, making vaccines optional. Liberals tend to want to allow access to healthcare. Allow abortion, allow gender affirming care. (And to point out the obvious — the vaccine mandates are gone. Those were only ever going to be temporary.) Do you see a difference in banning certain types of healthcare, as compared to ensuring access to certain types of healthcare?
- There will be some tricky situations if we allow bodily autonomy for all. Try to separate out the discussion about bodily autonomy for most of the adult population from a couple of categories. Here are two areas in which bodily autonomy will need a lot of discussion:
- Criminals with psychiatric issues. I don’t know much about this, but I think there is a way for a court to order someone to take medication?
- Children. At what age do kids get medically emancipated from their parents? Meaning, how old does a child have to be to go get vaccines over their parents’ objections? Or how old does a child have to be to start taking hormones as gender affirming medical care over their parents’ objections?
Wheat & Tares 
I don’t think I’m the only one who is pro-vaccine but anti-vaccine mandate. In other words, I like that I live in an era of vaccines and I take them for my own good. But I don’t want anyone else to feel compelled to do so, especially by the government.
The one area I have not quite worked out, given the above, is how to treat kids in public schools. If your kid is not vaccinated might that affect my kid even if he is? Not sure.
My first reaction is toward an absolutist bodily autonomy position both for choosing medical care and for avoiding medical care. But I know the hard cases and they come in two big blocks.
One block is the issue of who pays? Who pays for medical care? Even universal health care systems have rules and limits and queues that are decided by somebody other than the patient needing the care. And who pays the cost of not receiving medical care? Public health measures and infectious diseases are a real thing. And who bears the cost of emergency care after choosing no care when it would have been cheap and easy?
The other block is who decides? Even if we exclude the state in the decision process, does the doctor belong in the room? If so, are there certain doctors qualified and not others? Does a widely accepted standard of care have a role? How about experimental procedures? Does a minister or personal advisor belong in the room? Parents? The father (sperm donor)? (A debated issue in some abortion cases but not others.) How about interested parties? The beneficiaries under a will, for example. What if the person whose autonomy we want to honor is not competent to make her own decisions? Who decides competency? What about people who will bear the costs—the hospital administrator, the insurance company, your employer? And does that last question circle back to the state? And of course there’s the second order issue of who decides who gets to be in the room? The state? The church? In every case? In some cases?
Age of majority and mental illness raise issues, as noted. They are real, but just the beginning.
I have opinions about most of these questions. Some of my opinions are actually informed or tested opinions. What I don’t have are simple or global answers.
christiankimball – Your questions aren’t really ones that need to be answered before giving people the right to their own body. About payment – Health insurance pays (or doesn’t). If you end up in the hospital with covid and you didn’t get vaccinated, the bill goes to your health insurance. Medical freedom wouldn’t change the way health care is paid for.
Your second question is a red herring. The person who owns the body makes the decision about the body. They don’t have to talk to a doctor before deciding not to get vaccinated. You have to talk to a doctor before gender affirming medical care since you need a doctor to write a prescription or do the surgery. No one needs a priest in the room for anything unless they invite a priest. Who makes the decision? The person. The individual. That’s who makes the decision. People can consent to participate in medical trials or experimental procedures already. We already have procedures in place to declare someone competent or incompetent to make their own healthcare decisions, and rules about who takes over. I mean, why on earth would the beneficiary of a will be involved?
The idea in this post is that state and federal govt stop passing laws that ban certain healthcare or require certain healthcare. It doesn’t change how payments are made, or who makes the decision. The govt just steps out.
josh h – the question about vaccinating school kids already exists. Right now, in Utah, a parent can just give the school a piece of paper and that exempts the kid from all vaccine requirements. This situation already exists. At least in Utah, there isn’t a law requiring schoolkids to be vaccinated. So nothing would change if medical freedom became an absolute. I mean, vaccines aren’t required by law anyway. The covid vaccine mandate was very short-lived. If an unvaccinated schoolkid affects your kid, well, that’s already something that can happen.
I agree that there is a lot of hypocrisy on this topic in the policies being advocated (both sides of the political aisle).
A few thoughts or questions for consideration on the proposed amendment
1. What about smoking? Would public health or public good mandates whether that be smoking or a future pandemic related mandate be unconstitutional? I could see that being a really sticking point that is litigated.
2. Birth Control and Transgender treatment feel like they get clear handling with that amendment. Abortion could get tricky depending on how the baby was viewed as an individual with rights?
3. Also, I am assuming you would add some kind of age clause in there? As a parent and as a citizen not having some age limitations could also be problematic
Efforts to ban gender affirming care for minors seem to acknowledge that banning it for adults would go against most Americans’ sensibilities, even if bodily autonomy isn’t specifically enshrined in our constitution. What it doesn’t acknowledge is conservatives’ inconsistency on a different question that you alluded to: when parents vs. the state should be the primary decision makers on matters affecting children. When you bring up questions like home schooling or opting out of some particular public school curriculum, conservatives are big cheerleaders for the parents as decision makers, so why not on gender affirming care? I challenge someone who takes opposite sides on those questions to articulate a governing principle that doesn’t rely on their personal beliefs about gender.
Questions related to child welfare can get very tricky. There are easy and obvious cases that will get overwhelming agreement, but then there are questions affecting what kinds of choices parents and their kids can make. I lean toward giving parents a lot of leeway, but we have to accept that not everyone will be happy with every outcome.
I have pretty strong thoughts on all of these issuses and I feel like I am sufficiently informed in all of them to feel confident in where I have landed with respect to my opinions. Granted, many might not agree with me. But with respect to bodily autonomy, I do believe that is supported by the US constitution in the 14th ammendment (section 1):
“No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”
A lot of rights (life, liberty, property, pursuit of happiness) are derived from the French Enlightenment (Declaration of the Rights of Man – 1789: https://avalon.law.yale.edu/18th_century/rightsof.asp)
-Abortion: this is controversial because no consensus has been reached about when life begins. We have to acknowledge that this is the fundamental tension (right of the woman vs right of the yet-to-be-born child and what gestational stage it is at).
-Vaccines: One person’s right to not take a vaccine creates a problem because diseases are communicable, so someone’s maximalist version of freedom/liberty poses a health danger just by being around other people. I support a parent not allowing their child to get vaccinated. But I would want to make a good faith effort to communicate to that parent the accurate science by someone they are likely to trust. But at the end of the day, I respect the parent’s wishes on this because not getting a vaccine is not life-threatening. It does result in sub-optimal public health, but it’s not something that I would chalk up to parental neglect. I also support other parents deciding not to want their vaccinated children to share a classroom/school with unvaccinated children. If given the opportunity, I would vote for an unvaccinated child to be provided alternative public education (online school might be more appropriate).
-Transgender medicine: There are certain procedures which are irreversible (surgeries, cross-sex hormones, puberty blockers, etc.). People regret a lot of their choices and it can be devastating for people who might have wanted to bear children or decide that they are no longer transgender or they regret their transition. Personally, I cannot support medical interventions before the legal age of consent (18). I can support social transitions, appropriate pronouns, and lots of other interventions for dealing gender dysphoria, but I simply do not support pediatric gendere medicine and it should rightly be considered experimental. For a healthy and clear-eyed debate that is fair and balanced, I recommend the NYT’s The Protocol.
Bryan Hinton – smoking isn’t healthcare, so this Amendment wouldn’t affect it.
A few commenters brought up abortion. That’s actually a very easy situation. The person with the uterus makes the decision. The whole debate about ‘when does life begin’ is about religious beliefs. If you believe that life begins at conception, that is a religious belief. You don’t get to impose your religious belief on someone else’s body. You can follow your religion for your own body, but your beliefs don’t affect anyone else’s body. Christians have learned to speak about their pro-life religious beliefs in secular terms, but the whole idea of fetal personhood is Christian. I acknowledged in the post that people will come down on different sides based on whether they accept science or religion. This is just one more place where science and religion differ. Bodily autonomy and medical freedom means the pregnant person makes the decision about abortion.
Also about abortion — no other law infringes on someone’s body, even to save someone else’s life. Say a five month old baby goes into kidney failure. The baby’s life could be saved by a kidney transplant. Mom has kidney disease and isn’t a donor. Dad is a compatible donor. Should we write a law saying fathers must be organ donors to their children? Should the law compel that? Dad has to donate a kidney (or liver) if a child needs it. I mean, to save the baby’s life, do the father’s right to his own body matter? If you aren’t going to pass a law to force Dad to donate a kidney, then you shouldn’t be passing laws to force Mom to carry the pregnancy. Full stop. Bodily autonomy is bodily autonomy. Putting medical freedom in the Constitution would mean no law can require Dad to donate a kidney.
The transgender stuff is also a red herring. Your opinion does not matter. At all. Your opinion should not control someone else’s body. Jacob L has read rightwing commentary about transgender treatments. So what? Jacob L is not trans, and is not raising a trans child. Jacob L’s opinion should not control the medical care available to someone else’s transgender child. (Sorry to pick on you Jacob L; I value your comments and appreciate you participating in this discussion. I’m just using your comment to make a point). Everyone has a right to make decisions that they might later regret. My coworker had his hip replaced at age 44 and the surgeon told him his serious hip problems were caused by all the skiing and soccer he did as a teen while his bones were still growing. Should we ban skiing and soccer for teenagers because they may regret it when they’re in their 40s? Of course not.
Having the country turn against vaccines is causing real harm. I acknowledge that. But we don’t mandate vaccines. I, too, hope that people would get good information from reliable sources about vaccines. I believe that putting bodily autonomy in the Constitution would lead to this result eventually. If personal medical decisions stop being political issues, all the Republicans who have embraced anti-vax stuff to appeal to their voter base will move on to other topics. In the absence of the political motive to drown the country in vaccine misinformation, good information can come back.
I’m a medical freedom absolutist. Will it cause some issues? Yes. Do we already have issues? Yes. Is someone else’s medical care any of my business? No. Is someone else’s medical care any of your business? No.
Some background: I am a registered nurse with extensive medical training. I have treated transgender patients and always do so with dignity and care. My former business partner is transgender; she transitioned after we ran a business together, and we have had many long, thoughtful discussions about this (we don’t agree on quite a few points, including pediatric gender medicine). I also have a transgender cousin. While it is true that I am not raising a transgender child myself, my views on transgender medicine do not come from right-wing talking points. They come from clinical experience, the medical literature, and the current state of the medical establishment. I’ve read most of the Cass review, including refutation of the Cass review, and refutations/rebuttals of the refutations.
Suffice it to say, these issues are far from settled or firmly established. Transgender medicine (particularly pediatric gender interventions) should appropriately be considered experimental. Many countries in Europe are now significantly scaling back or reconsidering these interventions. The Cass Report is good solid though, and I take issue with the vitriol that has been lobbied at Dr. Cass.
In response to the argument, “Should we ban skiing or soccer for teenagers because they may regret it when they’re in their 40s?” I say no, because those activities are generally considered benign. The degree of risk is not the same to power medical hormones and surgical alterations. However, I do feel differently about tackle football for children under 25, given that the brain is not fully developed and we now understand the long-term neurological risks. For similar reasons, I do not believe it is ethical or appropriate for anyone under 25 to begin puberty blockers, cross-sex hormones, or other hormonal interventions. These treatments can significantly alter brain development.
Sports carry inherent risks, but not risks of the magnitude involved with impaired fertility, permanent physiological changes, and serious medical complications. Regret is not the only issue. Taking exogenous hormones or surgically altering sex organs is fundamentally different from participating in sports. In my view, the comparison is not appropriate.
By analogy, I would not allow teenage boys to use anabolic steroids to treat muscle dysmorphia. That would be using a powerful physiological intervention to address a mental health condition, which is simply not the right tool for the problem.
From a medical and legal standpoint, I view gender dysphoria as a mental health condition that should be treated with the least restrictive intervention possible—primarily counseling and psychological support. Allowing cross-sex hormones or surgical modification of sex traits in minors is not an appropriate first-line treatment. Once an individual reaches adulthood (preferably age 25) they should be able to make informed decisions following a rigorous and lengthy evaluation process that rules out other contributing factors, including autism, untreated sexual abuse, childhood trauma, body dysmorphia, or the possibility that the individual is gay or lesbian rather than transgender. For consistency, I also do not believe cosmetic surgery is appropriate for anyone under 18 and would support bans on that as well.
I view parental consent for medical transition in minors as analogous to consenting to underage marriage. A child simply does not have the cognitive or emotional capacity to fully understand the lifelong consequences of such decisions.
As for abortion rights, my views are similar to the approach taken in France and to the traditional Democratic position: safe, legal, and rare. I believe abortion should be permitted when the health or safety of the mother is in jeopardy, and that decision should be made by the physician and the woman, not second-guessed by a bureaucrat. In that sense, I agree that the doctor and the patient should make the decision. Where I differ is that I do not believe every abortion is inherently good, nor do I believe every abortion should be permitted without limits. I believe in regulation.
I read this opinion earlier this year and I quite agree with Andrew Sullivan, particularly in his essay “How the Gay Rights Movement Radicalized and Lost Its Way.”
I believe transgender issues are meaningfully different from gay rights. I believe Americans are only now beginning to grapple with the nuances and complexities involved. These issues never should have been placed under the same umbrella, especially where children are concerned.
My position is threefold:
-Absolute protection against discrimination for transgender individuals in employment, housing, and healthcare
-No surgical or hormonal interventions for children
-No transgender women competing in women’s sports
I never use to get the flu shot.I said to my doctor, “I’d rather get the flu.” I remember being sick in 8th grade with high fever, vomiting and diarrhea. So I may have had the flu once. So yeah, I was cavalier. But then I was around an immunocompromised person I cared very much for, and now I get every damn shot I can. Even if it no longer personally necessary. I have no idea what the constitution says about spreading diseases, but it’s basic human decency not to. Yep, my perception has changed. I’ve seen the harm caused by people who don’t give a shit.
As for children, I would have been horrified as a developing teenage girl, if I started turning into a male. I think I should have a right to treatment.
I do remember teenage me seeing guys who had bigger breasts than me and thinking–They don’t have to wear a bra, why should I? When it comes to gender affirming care, in 1924 over 26,000 males had breast reduction surgery. The recommendation for male teenagers is to wait until hormones have stabilized at ages 16-18. Those younger (and these surgeries happen) have to have significant emotional distress.
I would have had distress if I started turning into a dude.
Oh. and Jacob L.
Andrew Sullivan, really? Really!
As for giving all medical decisions back to individuals and their doctors. What country are we talking about. I favor legitimate medical organizations. And not those bastardized by quacks and religious fanatics.
Jacob L,
I appreciate your perspective.
Quentin,
I’ve always thought parents should have considerable control over their children’s lives. Yet civilized society must have some agreement on boundaries – things from which children are protected, no matter the approval or consent of the parents. I favor society having an open conversation about these questions so that the morality/ ethics can be debated and considered and society is better informed.
Janey,
I’m curious what gives you such great confidence in medical professionals. I have my own close personal observation that medical professionals can be brilliant and they can also be idiots. And when medical corporations have a great profit motive – which pharmaceutical companies especially have – it reasons to be skeptical of their claims and their motives. When a company has immunity from liability for harms caused by its product how eager should you be in using that product?
I think too many people, particularly on the conservative and libertarian sides, have lost sight of what the larger problems are that medicine is trying to solve. Their narratives often don’t seem to acknowledge the problems at hand or purpose possible workable solutions to these problems.
Problem 1: dangerous diseases are killing people and straining the health system.
Solution: mass vaccination to eradicate or curb the disease.
Conservative/libertarian: what if I or another person don’t want to get vaccinated or allow my kids to be vaccinated?
Response: What is your solution to the diseases killing people and straining the hospital system?
Conservative/libertarian: they either deny their is a problem, concoct a conspiracy theory, or just kick and scream about bodily autonomy against vaccines.
Problem 2: A small percentage of human beings, which numerically is quite large, feel that they are men trapped in women’s bodies or vice versa.
Solution: Acknowledge and accept that these people are transgenders. Overwhelmingly science has revealed that these people lead happier lives when we make medical and societal accommodations for their acceptance as the opposite gender.
Conservative/libertarian: But they’re harming women’s sports, they’re going into the weekly public bathrooms, they’re a threat somehow and should be railed against ceaselessly.
Response: But what is your solution then for transgenders to make them feel happier and accepted and enjoying rights and freedoms?
Conservative/libertarian: Deny they really exist, continue to go down rabbit hole of women’s sports, claim that they’re somehow the victims of transgenders existing, and more kicking and screaming.
Let’s not lose sight of the root problems.
Brad D
The interventions restrictions on movement in public spaces are different than those I would support when hospital systems are collapsing. Right now, Covid is endemic, no longer a pandemic. I was dismayed when anti-vaxxers showed up protesting filled with misinformation while our healthcare system and the hospital I was working in was buckling. But we’re no longer in that phase any more and so I would tend to support a more liberal view of bodily autonomy. I think mandatory vaccination is wrong even as I acknowledge that most vaccine skeptics are so full of misinformation that it is extremely difficult to talk them out of the bad science rabbit holes they have gone down. Still, we have to try. And some approaches work better than others. I’ve found that trust and respect can open the door to curiosity and planting the seed for questioning. But mandates rarely work when someone has a paranoid personality or is extremely distrustful of institutions in general based on past experience.
With regards to societal accomodations, that is of course a sticky point. I don’t believe that trans women should be allowed to share public restrooms and changing rooms with biological women. If we are going to talk about solutions, let’s talk about creating private, unisex, individually lockable spaces for changing and using the restroom for all. Incidentally, the Provo rec center has done this very well. What I cannot accept and will actively push back against is trans women using public restrooms and changing facilities. If such 3rd spaces don’t exist, we should develop a process that allows a trans person to use a communal restroom of their choice in a private way. Temporarily closing the restroom seems appropriate and allowing single-use. This happens to me all the time when a female cleaner closes down the male-only restroom at Harmon’s temporarily so that other guys don’t go in when she is cleaning. Realistic compromises like this will be necessary as different groups are not going to agree.
With regards to sports, the solution is to create an “open” category that is open to all (men, women, trans). In fact, men’s sports can easily just morph to this. It’s typically not a problem in terms of fairness for a younger kid to play up a grade/age-group; but it is a problem if they play down.
Here is a very good article that details the state of the science (Alex is maybe the best sports writer out there right now and is extremely good at parsing the white papers and teasing out what is known vs unknown):
Sex Differences in Sport Are Hugely Controversial Right Now. Here’s What Science Does (and Doesn’t) Know.
https://www.outsideonline.com/health/training-performance/sex-differences-in-sport/
Jacob L – thank you for explaining your personal experiences with transgender individuals, and your medical background. That’s helpful to better understand your perspective.
This post isn’t actually about gender-affirming treatment for minors, although I’m not surprised that it’s come up. The post was supposed to be mainly about medical/bodily autonomy for adults. If you want to talk about transgender minors, please throw in a couple sentences about your opinion on the post’s main topic as well. Does anyone have a problem with a Constitutional amendment that would guarantee medical/bodily autonomy for transgender adults?
Transgender athletes are off topic. So are transgender use of bathrooms/locker room. Please don’t. We’ve heard it all before. Playing sports isn’t healthcare.
Suzanne, great comment, thank you. I agree that it would be best if all laws about medical care were informed by actual science instead of religious-beliefs-as-medicine and politicians convincing people that they should control someone else’s body. My proposal to grant medical/bodily autonomy to everyone is offered with the hope that, once the politicians go away, science can reassert itself as the best guidance for healthcare.
Disciple – my confidence is in the individual owner of the body. I’m assuming they will talk to a doctor. Maybe they won’t. You don’t have to go to a doctor to NOT get a vaccine, for example. If someone wants an abortion, or gender affirming care, that requires a medical professional to be involved. So yeah, they would talk to a doctor. Doctors already get pressure from Big Pharma (witness the opioid crisis). My proposed Constitutional amendment just takes the situation as it exists now, and removes political motives from the discussion. An individual can freely turn down their doctor’s recommendation. For example: my son’s oral surgeon prescribed him opiod painkillers after he got his wisdom teeth out. He took one and it made him nauseated. He wouldn’t take anymore of them, instead using just ibuprofen for pain relief.
Disciple – and to add. I don’t think the individual will make the “right” decision all the time. People regret medical decisions. My friend had back surgery and it didn’t work — she’s still in pain. She regrets having the surgery. Still, it was her choice. I have another friend whose back surgery had good results. I have another friend who, pre-ozempic, had some sort of surgery on her stomach so she could lose weight. I wouldn’t personally want surgery for that, and so I will never have that surgery, but do I have the right to tell my friend she can’t have that surgery? The point is that people should be able to make their own decisions about their medical care and bodies. Having a politician (who is trying to get votes) take over the decision is a negative thing.
Brad D – good summary of the forest, as we speak about trees. Do you think guaranteed medical/bodily autonomy would have any impact on the root causes? I keep saying that I think guaranteed medical/bodily autonomy would remove politics, and the incentive to make stuff like this part of a culture war to get votes, from medical discussions. Do you think that might happen? Or not?
I believe that people should choose, but they do not get to choose the consequences. Too many people are claiming religious exemptions to vaccines when really their objection is conspiracy theory beliefs. So, they should be allowed to suffer the consequences. 50 years ago, one child out of 100 (this is a guess, but I do remember lining up in school for vaccinations and two kids out of the whole school had exemptions for religion) now, it is about one child in 10 is being exempted in some areas. This allows things like measles that were almost nonexistent a few years ago to start killing children.
So, If public schools want to mandate vaccines, then every child gets the vaccines, or they go to private schools. Oh, the screaming this one is going to cause. But the rights of all the other children in that school count. Now, for children who cannot get vaccinated for medical reasons, they get an exemption and if ALL the other children are vaccinated, they will be as safe as they can be. But religion is a choice and if that choice say they do not get vaccinated, well, they can go to private schools. Now, yes, this could be accomplished by giving the parents a voucher for private school, but that voucher is not one penny more than public school costs per pupil and the parent pays the difference. I would even prefer it be less than the cost of public schools, to keep as many children in school as possible. But parents also get vouchers for private schools for any other choice they make.
Same goes for adults. Your boss gets to mandate vaccination to protect other employees. You have total choice. You can get vaccinated and take the job or not. The military gets to mandate vaccinations to protect other military. Your choice, take the job or not, but the military should not give up the right to protect the health of soldiers to protect your right to choose. You choose, but you suffer the consequences. Once again, people who have valid medical reasons are exempt. If we still had a draft this might be a problem, but as it is now, military service is a choice and if you make that choice, you can blasted we’ll protect your fellow soldiers by being vaccinated or you can pass on military service. Your religion choices should not put others at risk. And as long as we have people who are allergic to vaccines, you should not be at liberty to risk their lives.
OK, gimme the down votes. I just don’t think people should decide they have religious beliefs when it is really conspiracy beliefs and claim a religious exemption.
Oh, medical transition trans folk, I have a trans woman in my list of family. So, yes, this gets me riled up. She will never pass as cis. She was denied puberty blockers and developed as male. Over six feet tall, very low voice, and broad shoulders and muscles. This is why puberty blockers are better than banning any care for minors. When you deny puberty blockers during puberty, you deny necessary care. You are not protecting children from anything permanent. You are denying necessary care. So, puberty blockers until 18, or judged competent to decide about more permanent care. Just like judges are used to decide other medical stuff that is challenged. Then body autonomy after 18. Yes, there are side effects of puberty blockers, but I am just learning some of the things my loved one did to try to block her developing as male and those side effects are much worse. Trust me, she did some permanent damage by trying to stop developing as male. Please stop to think how you would have felt in a body that was turning into a gender that you knew was wrong. She was desperate and damned near killer herself trying not to be male.
As far as restrooms the long term solution is single person locking rooms, but those are more than a simple remodel and the people providing the restrooms want to get by as inexpensively as possible. But having “family” restrooms with baby changing, handicapped assessable, and gender neutral solves a lot of problems. Too few places have changing tables, and even fewer have them in the men’s rooms. And after taking my mother into the handicapped booth, and frequently finding them too small for me to assist her, there just needs to be better options for several groups. But places tend to do the least expensive option and that tends to harm marginalized groups.
Jacob L, you’re thinking like a rational person who acknowledge root causes and tries to come up with solutions. Your solutions might work and they might not, but you live on planet earth. What I’m talking about is illustrated in this recent poll by conservative think tank Manhattan Institute:
https://manhattan.institute/article/the-new-gop-survey-analysis-of-americans-overall-todays-republican-coalition-and-the-minorities-of-maga
66 percent of current GOP voters believe that COVID was leaked from a lab in China, 51% believe that the 2020 election was stolen, 41% that 9/11 was an inside job, 37% that the Holocaust was exaggerated or did not happen as historians claim, 36% that the moon landing was faked, and 33% that vaccines cause autism. Among those who believed 5-6 of those above-mentioned conspiracy theories, 70% of those believed political violence was necessary (for comparison, only 27 percent of all the US believes political violence is necessary). Conspiracy theorists are dangerous people, conspiracy theories are dangerous ideas, and they overwhelmingly inhabit the conservative realm. There has to come a point where we declare conspiracy theories a public health threat and a danger to public individuals and no longer protected under free speech. The conspiracy theorists are like termites, slowly eating away at the structure of society and even humanity itself. They’ve made huge inroads under Trump. What happens when the next pandemic hits? We surrender to them? It we trust science and give experts authority? What happens when there are national emergencies, such as hurricanes? Do we surrender to FEMA conspiracy theorists and allow them to block aid? It do we tell them to shut up?
Brad,
I was under the impression that in 2025, the idea the Covid virus leaked from a lab was possible but not certain. None of the hypothesis of the virus origin are proven so I am curious why belief in one of popular theories carries the “conspiracy” label – and the lab leak theory is backed by multiple “official” groups. Per Google AI, Germany Intelligence reports with a 80% -90% confidence that Covid leaked from a lab and a majority of Italians support this theory.
Some of the poll positions you listed are nutty, such as the moon landing. Others are simply a difference of perspective where the American political left has taken a dogmatic position and other Americans are open minded.
That the American political left is an outlier on the question of Covid origin, yet unaware of this reality, is a bad look for the American political left. And yes, that a faction of “MAGA” rejects the moon landing and questions the Holocaust is also a bad look. What I interpret from the poll article is many on “MAGA” are knee- jerk skeptics and many on the political left are overconfident in what they claim to know.
Now back to originally scheduled programming, an open question to all:
If a family member or friend asked how do you know vaccines are safe, what would you answer?
“taken a dogmatic position”
Conspiracy theory is a religion with unquestionable truths that have little to know evidence. No one more dogmatic than conspiracy theorists.
“Other Americans are open minded”
An open-minded person considers all the evidence, defers to experts (because there is no way to be an expert on everything), and asks questions AND formulates answers. The closed-minded 1) hyper focuses on apparent anomalies in mainstream explanations and never weighs all evidence, 2) treats everything mainstream and official as inherently false, 3) asks never ending questions without attempting to formulate answers, 4) ignores root causes and root problems, 5) repeats lies that have been debunked ad nauseum, 6) is paranoid, 7) lives in an echo chamber, 8) claims to have discovered anomalies by doing “their own research” without acknowledging the conspiracy theory websites that they’ve consulted and relied on, 9) and arrogantly claims that they do their own research without acknowledging the research that experts have done.
“If a family member or friend asked how do you know vaccines are safe, what would you answer?”
You illustrate my point about ignoring root causes. Again, how do we treat dangerous diseases if not for inoculation and vaccines? How did we wipe out polio, etc?
We can’t just ignore experts. We can’t just treat all mainstream research as inherently suspect. We can’t just believe whatever we want. We can’t just imply that there is a grand conspiracy out there that is pulling the wool over our eyes. To do so is profound ignorance that is dangerous. January 6th was a pure product of conspiracy theory and was but a small taste of what is to come if we don’t fight harder to stamp out this evil that has seized so many individuals minds in the US.
I’m strongly in favor of body autonomy. I’m not convinced that absolute body autonomy in all cases is perfect policy,
but it has the advantage of being a simple unambiguous policy that’s almost always right, workable when it isn’t, and that shouldn’t be that hard for people to agree on.
One point that hasn’t been mentioned is that I think everyone is assuming that the kind of existing regulatory system that ensures treatments are safe and effective stays in place. Any proposed medical freedom amendment should specifically say that, because we have quite the history of Constitutional amendments getting interpreted in ways that eliminate nuances like that.
@Jacob L
Gender affirming procedures do not have unusually high regret rates (see peer reviewed study below), so unless you’re proposing that children wait until 18 for all medical procedures with equal or greater regret rates then it seems like you’re singling out us for medical neglect instead of being principled.
The problem with waiting until the child is 18 is that doing nothing is very far from a neutral decision. I deeply wanted my puberty to stop in elementary school and I didn’t even know that puberty blockers were a real thing. (That might have been a tender mercy because they didn’t give puberty blockers to nonbinaries when I was a kid, which would have infuriated me.) Instead, and without my consent, some of my body grew into the wrong shape and that has been a thorn in my side since my mission at least. The regret rate for cis puberty in trans kids is sky high, so it’s curious you haven’t expressed at least equal concern about that.
Puberty blockers would have been the right choice for me, but that doesn’t mean that making trans kids take blockers and wait until 18 before getting hormones is a neutral decision either. It’s a compromise that appeals to cis people, but it’s not fair to force kids who know which hormones are right for them to not grow up at the same rate as their peers just because they’re trans. We don’t force cis kids to wait until they’re 18 to get the right hormones for them.
—
Thornton SM, Edalatpour A, Gast KM (2024). A systematic review of patient regret after surgery- A common phenomenon in many specialties but rare within gender-affirmation surgery. The American Journal of Surgery doi:10.1016/j.amjsurg.2024.04.021
If a family member asked me if vaccines are safe, I would say, “of course not. But they are so much safer than the disease they prevent as to be no comparison.” No medication or vaccine is perfectly safe. But compared to getting the disease, the risk is minimal, next to nonexistent for things like polio. So, yeah, I would take the vaccine ten times in order to prevent the disease.
Janey, what was this discussion supposed to be about again? Conspiracy theories? Oh, yeah, passing a law to give people complete medical autonomy.
It won’t happen. Too many people have only one purpose in life and that is controlling other people and taking away their right to do anything that the controllers disagree with. They may call themselves Christians, but really they are bossy pants.
Former Nonbinary Sunbeam – thank you! For transgender minors, care delayed is care denied. Citing to regret rates for transitioning is a tiny segment of the population. How many transgender people regret NOT being able to access puberty blockers and hormones as a teen?
As for the claim that gender affirming care is all experimental, it’s fortunate that we have a government agency (the FDA) that (used to be) non-political and based on science, staffed with doctors, who could evaluate experimental care. Was it always right? No, but the tiny number of misguided approvals (like oxycontin) are certainly much less than the misguided stuff produced by crowd sourcing medical information and then appointing politicians as the gatekeepers.
I am assuming the FDA, Food and Drug Administration, stays in place and it returns to being politically neutral and its recommendations are controlled by actual science, instead of politics. The FDA is a government entity. The AAP, American Academy of Pediatric, is a non-governmental organization that reviews medical stuff for children and offers recommendations. I trust scientists more than I trust politicians and propagandists who are fighting a culture war.
Get politics out of the doctor’s office.
I think Anna’s point about religious exemption is very important. It used to be a requirement that a “religious exemption” was actually a doctrine of a specific religion. It’s why Oaks oversaw the writing of the Proclamation–to prove that the church was anti-gay marriage when Hawaii was gearing up to legalize it. That concept (and more onerous requirement) went out the window with this latest rise of the fanatical far-right, and the cake baker who lost her shit over the very idea that a gay couple might legally get married and that she might have to (as a business person operating in the public sphere) bake them a cake–even a poorly done cake or an off-the-shelf no frills cake. Rather than act like a professional, she wanted to beat up on gay people by denying them service outright. Her business wasn’t a bakery; bigotry was more important to her than turning a profit or providing a public good. And here we are. That was just one of many looney cases in which individual “conscience” or belief in anything at all is what constitutes a religious exemption and allows you to harm others in society. I’m honestly horrified at how far we’ve fallen as a society. I don’t know how anyone can support these monstrous viewpoints.
@Janey
You suggested my comment was off topic, but I do not believe it was, since you mentioned gender-affirming care in your section question. That said, allow me to answer your follow-up question:
“Does anyone have a problem with a constitutional amendment that would guarantee medical/bodily autonomy for transgender adults?”
There would be a lot of details to work out in a constitutional amendment. I don’t think a constitutional amendment is something I would support, but I do support trans adults getting procedures they believe they need once they are fully apprised of the possible side effects and long-term consequences.
Long-term risks of cross-sex hormones include blood clots, strokes, heart disease, fertility loss, osteopenia/osteoporosis, and increased cancer risk. Even the recommended use of estrogen for peri-menopausal and post-menopausal women shifted due to the risks of blood clots, stroke, breast cancer, and other cardiovascular issues. Long-term use is now highly discouraged. Instead, it is used at the lowest effective dose for the shortest time possible for symptomatic relief.
One cannot talk about gender-affirming surgeries for adults without touching on pediatric gender medicine, because inevitably the issue of puberty blockers and going through the “wrong” puberty comes up. So that is where the conversation inevitably goes.
I also wanted to address the concept of regret, since Former Nonbinary Sunbeam mentioned it. Regret isn’t the metric I would use to measure the outcome of sex-trait modification surgeries or the application of cross-sex hormones. Regret is poorly defined. There is no universal, validated measure of regret used across studies. Some patients may not disclose regret due to social pressures, stigma, or limitations in follow-up, which could underestimate true rates.
Gender dysphoria is not something that can be quantitatively measured. It’s not like we can run a hemoglobin A1c test or look at blood-pressure values for hypertension. I simply do not believe that treating the mental-health aspects of gender dysphoria with medication or surgery makes sense, any more than I would treat bigorexia (muscle dysmorphia) with anabolic steroids or anorexia nervosa with GLP-1 medications. I believe in psychological interventions, not drugs and surgeries, for gender dysphoria in those under 18. I also don’t believe it is cruel for someone to go through what they term the “wrong” puberty.
Gender dysphoria often goes away on its own in children, sometimes goes away in teens, and usually does not go away in adults. I support medical regulation and waiting until at least age 25, even for adults, before any sort of medical intervention is considered (surgeries, hormones, etc.).
So much of our gender and sexuality changes throughout our lives. I’m in my mid-40s and still feel like I’m learning about myself. I also think we should recognize that many people don’t like certain aspects of their bodies — that’s actually kind of normal. Read some stories about Las Vegas surgeon Dr. Kevin Debiparshad, who has been performing leg-lengthening surgeries for men who want to gain three or more inches in height.
Jacob L
Since nothing is happening here, I’ll jump in
Since pregnancy causes such harm to woman’s bodies, I support government regulating and not allowing pregnancy before 25.
And I really don’t get why puberty blockers are allowed for cis girls, we don’t allow it for not cis girls. Give them time for things to sort themself out, before the body horror makes itself permanent.
As for “cross sex”, I’m not for a societal definition of a strict binary being enforced on all people.
Meanwhile I’ll get to work on the mandate of no pregnancy.
@Suzanne Neilsen
To me, there is a clear difference between using puberty blockers for precocious puberty and using them to treat gender dysphoria. In one case, the medication is used to temporarily delay an abnormal biological process; in the other, it is used to interrupt a normal biological process for identity-related reasons. For that reason, I don’t think the comparison between cis girls and trans girls is equivalent. For me, this isn’t an issue of equity, it’s about diagnosis and the appropriateness of the treatment.
For similar reasons, I don’t believe breast reconstruction is the same as breast augmentation, nor do I think gynecomastia surgery—which corrects an abnormal development in adolescent males—is the same as trans male chest surgery, which intentionally removes a normally developed body structure to align physical appearance with gender identity.
When I was younger, my entire identity revolved around basketball. I would have given almost anything to be three or four inches taller. Both of my younger brothers were taller than I was; they played high school basketball and went to state championships. I wasn’t as tall, struggled to be competitive as a point guard, and seriously considered traveling to Mexico to illegally obtain growth hormone because basketball felt that important to my life. I am incredibly glad I didn’t do that.
I could have taken growth hormone before my growth plates closed and likely would have been taller. GH is appropriately prescribed for conditions like idiopathic short stature, chronic kidney disease–related growth delay, Turner syndrome, or Prader–Willi syndrome. But in my case, it would have been a misuse of a medication to address a psychological desire (I didn’t feel tall enough).
I don’t believe adolescents are capable of fully understanding or consenting to life-altering medical decisions such as puberty blockers, cross-sex hormones, or surgical interventions. In the same way that we don’t believe someone under 18 can consent to sexual relationships with an adult, I don’t believe there is a level of informed consent here that is either sufficient or ethical. For that reason, I don’t support allowing minors to make irreversible medical decisions of this magnitude.
@Jacob L
I just thought about all the diagnoses my family members and friends have, and almost none of them were made based on a quantitative measurement. They were almost all decided based on it hurting when the person does a certain thing. Gender dysphoria is a catch-all term, but it still just boils down to it hurting when the person does gender-related things, and by the time it’s recognized it’s usually as subtle as a freight train.
You won’t find a lot of experts anymore that say that gender dysphoria often goes away for people like me when we get to be adults because that doesn’t seem to be actually true. I can tell you why people used to think that. Does being reminded of the existence of gender or that I’m expected to behave a certain way based on my anatomy hurt me like it did when I was a Sunbeam? No, I’ve finished grieving the fundamental unfairness of my lot in life. That doesn’t mean I don’t still have gender dysphoria. It just means that my dysphoria has matured into forms that early researchers weren’t aware of.
They do say now that it tends to be less severe in adulthood for us, and that aligns with my experience. Still, nothing in that sentence takes away the pain that puberty caused me or undoes the changes to my body that still cause me pain.
You say you don’t believe it’s cruel to force someone to go through the wrong puberty, but what do you base that on? It’s obvious that you don’t have any personal experience. How many current and former trans kids have to tell you it’s torture before you’ll believe us?
More importantly, why do you believe your judgment about which options are appropriate should supercede that of the experts and individuals involved when you don’t have to live with (or even see!) the negative consequences of your decision?
@Jacob L
Looks like you posted something while I was replying so I’ll respond to that as well. Let’s take your basketball example and make it remotely comparable. Let’s imagine that the world is divided into two groups: basketball players and baseball players. The first thing the doctor does when you’re born is take a tape measure and declare whether you’re a basketball player or a baseball player.
Every person in our imaginary world is required to play the sport they were assigned at birth for hours every day for their entire life. People who aren’t very good at their biological sport are insulted and socially rejected while those that try to stay at the sidelines get beaten up. Children are often segregated by sport even for activities where that makes no sense, and most people rarely form friendships with people of the opposite sport.
You’re expected to love your socially assigned sport. You’re told that wanting to play the other sport is unnatural and that people who would rather play the other sport are defective. They even end up murdered sometimes but no one acts like that’s a huge loss.
If you were born into that world you would have naturally been announced to the world with “It’s a baseball player!” and raised to be that way. Your parents would have given you baseball gloves to play with as a baby and proudly attended your first Little League games as a toddler.
Yet at some time before you’re an adult you realize that playing baseball really isn’t all that appealing. Basketball sounds a lot more exciting. You clandestinely play a forbidden game of 1-on-1 with a basketball playing friend and despite all the shame and embarrassment and the feeling of novelty you get a glimpse that there’s something there you might like.
At first you just sneak onto the court to practice when no one is around, but eventually you start letting basketball players you trust in on your little secret, just a few at a time, and you have pickup games together. You grow to love basketball just as much as you do in this world, and having to play baseball just hurts. Soon playing basketball in secret isn’t enough. You start to want to play in the real games that count.
Gathering all your courage, you show up to tryouts for a local team. Some people treat you like you’re dangerous or unclean. Some make fun of you or call you confused. Some people bite their tongues. A few people are open minded, but most refuse to play with you. You walk off the court, heartbroken. Everywhere you go people call you a baseball player because of the way you look.
Meanwhile you realize that those weird feelings you’ve had in your legs for years are because some part of your brain expects your legs to be longer than they actually are. You’d heard that phantom sensations happen to some people that don’t want to play their biological sport from your transsport friends on the Internet, but you never thought it would happen to you. You start to wonder if “biological” really describes your relationship with baseball. Your assignment at birth seems a lot more arbitrary than your affinity to basketball.
Then you hear about some hormones that can make you tall enough that no one looking at you would think you’re a baseball player! Maybe it would make those strange feelings go away too. There are possible complications from taking them, but they’re not horribly risky. After all, it’s what the cis basketball players make naturally and most of them do ok. Don’t you think you might be at least a little more likely to take them in that world than in this one? Don’t you think that as either a happy basketball playing adult or a miserable forced baseball playing adult you’d look back and think that taking the hormones would have been the right choice?
So let’s say you did choose to get hormones. You go the doctor. You explain what you want, and the doctor gives a sympathetic frown. He explains that growth hormones are for people who are born as basketball players but that due to some unfortunate defect don’t grow as fast as they’re supposed to. They’re not for baseball players like you that start out small. Even though you’ve been called defective for years for wanting to play basketball and playing it the best you can whenever you can, as soon as you walked through the door you suddenly became perfect and don’t need them. (Not to worry! You’ll still be defective again when you walk back through that door.) Furthermore, it would be unethical to give them to you because unlike cis basketball players, you’re not capable of consenting to take them, even though they’re the same thing with the same effects.
The doctor tells you to look at the bright side. When you’re 25 you can choose to get a procedure that will make you taller! (Before that age you can only be trusted with insignificant decisions like your career, where you live, who you marry, or whether to volunteer for war.) Of course, at that age you’re not a candidate for growth hormones, but a lovely surgery is available. It’s not as good as real bone, of course, and it’s painful and takes a long time to recover from, but it’s an option the cissport members of society are willing to let you consider. As you leave he wishes you luck on finding a job that won’t fire you as soon as you get it.
Regardless of how you answered my first question, how would you feel about the people in this story who made the choice for you and forced you to go without the growth hormone? Do you think the reasoning behind it is fair and compassionate, or do you suspect it might be motivated by other factors?
@Former Nonbinary Sunbeam
appreciate the thought you put into your sports analogy. I believe that sex is deterministic at birth and that gender is a social construct. Even intersex conditions, or disorders of sexual development, do not negate the underlying biological reality of binary sexual dimorphism. As such, I believe that both males and females should be able to be basketball or baseball players. I’m just as likely to support my son playing football as I am to support him dancing in a dress. I would largely agree with your assertion that social gender norms are fairly rigid, and that’s unfortunate. I do think our society has evolved and can make further progress: men can be tender, women can be tough. My lesbian niece is a D1 soccer star and has been athlete of the year for three of the four years she played.
I’ve had endless discussions about trans medicine. As I mentioned, my former business partner is now a trans woman. She was born male, married, and had two children, the oldest of whom is now a teenager. When her mom passed away during COVID is when she decided to transition. I knew her for many years pre-transition, and when I knew her there were no inclinations expressed that she was dissatisfied with her gender—at least none that she expressed openly.
I also think COVID was a strange time because of what I’ve seen with a huge uptick in rapid-onset gender dysphoria and certain online communities that are rather insular. I do think there are self-reinforcing communities that convince people they are trans as a stable identity when they may not actually be, or where there may be an element of unresolved trauma, autism, anxiety, abuse, or the individual may simply be gay or lesbian.
My former business partner’s transition to female ended her marriage for obvious reasons, as her former spouse did not sign up to be in a marriage with a trans woman. She did go through top and bottom surgery. She was also suicidal pre-transition and post-transition (and post-surgeries and hormones). I was one person who was constantly texting to check in with her and talk her out of suicide. I would say our relationship has frayed substantially because of our strong differences pediatric gender medicine. She has made continued insistence on our friendship conditional on me accepting certain premises which I do not believe are supported by science or medicine.
I do not know what it is like to personally experience gender dysphoria, but my study of the literature and careful evaluation of the evidence is what leads me to my opinions. I’m always open to learning more (science is evolving constantly) and I think we really have not had robust longintudal studies of many interventions.
You asked a lot of questions in your post, and I think I’ve tried to give you some background as to why I believe the way I do. I think I’ve explained why I oppose cross-sex hormones, surgeries, or puberty blockers before age 18 for gender dysphoria. But you must understand that I don’t even believe children under 18 should be able to be baptized, and that involves no medical intervention. I also don’t believe children under 18 should be able to get rhinoplasty, breast augmentation, tattoos, play tackle football, or use tanning beds. Because 18 is the age of legal consent, where we have determined liability for informed consent, that is where I would support people making their own decisions. That said, realistically, I would recommend most people wait until 25 before undergoing medical or surgical trans interventions—just as I believe most people shouldn’t get married before 25.