[wk_end]

The "sterilizing children" is how anti-trans activists talk about giving trans children gender-affirming care. Framing it this way makes it sound monstrous rather than an unfortunate side-effect of a medically necessary procedure, in the same way that characterizing a surgeon who performs hysterectomies for women with ovarian cancer as "a doctor who goes around sterilizing women" would be painting them in an unfair light.

And of course he's not directly accusing his coworkers of "sterilizing children", but he's 1) using language that compares politically sensitive health services that many of his coworkers or their families may have used and/or may feel defensive about to atrocities and 2) accusing his coworkers of supporting atrocities. That feels quite disruptive and inappropriate in the work environment IMO.

[frollogaston]

That all assumes it's a medically necessary procedure, which is exactly what people disagree about. And again, no mention of coworkers in that quote at least, not said in a work setting either.

[wk_end]

What's medically necessary is for a person and their own doctors to decide on, not for you or some AI engineer or anyone else to disagree about.

[frollogaston]

Not when public money is involved, which pro-trans voices absolutely want it to be. And even without it, society does have reasons to concern itself with how parents treat their children. There's no side that separates the responsibilities, it's just a matter of who thinks this is socially right.

[wk_end]

I actually don't know how much of that's especially true where doctors are involved. We as a society strictly regulate who can call themselves a doctor and the credentials that are required to do so, and then in doing so entrust them as a class to be reliable arbiters of what constitutes what's medically necessary, how public medical funds should be spent (which, even if that's something activists agitate for, is still a separate issue), and so on. We also entrust them to help monitor how parents are treating their children.

Anyway, to double back once, it actually doesn't really "assume it's a medically necessary procedure"; we can soften it to something like a "medically desired procedure" and the point in fact still stands that Shazeer's wording - which really should be the point here, not re-enacting the tired trans healthcare debate - is deliberately incendiary and manipulative. Broadly, no one is advocating for parents to be sterilizing their children as an end to itself, so it shouldn't be characterized as such.

[frollogaston]

Doctors are allowed to make judgement calls within whatever rules the insurance providers and laws give. The status quo before all this was that gender-affirming care was never covered, which changed to always covered in discrete steps across the 2000s and 2010s. Doctors didn't get to decide that on their own. Before that even, medical schools instill rules and values that come mostly from the outside, while the medical knowledge and experience is from the inside.

Another controversy is physician-assisted s–... euthanasia. Some doctors would consider it medically necessary, but they can't legally perform or even recommend it, as it's considered murder. They can in Canada. Abortion of a viable fetus not threatening the mother is illegal in all 50 US states, but legal in many states in earlier stages, again based on what the states consider murder (but the doctor judges what is viable or a threat to the mother).

Anyway if gender-affirming care is just medically desired but not medically necessary, the sterilization is accepted but not necessary. I agree with the spirit of the wording, even though it's imprecise, because it highlights that children are taking on an irreversible side effect. It's a short quote and not a whole essay where he gets to clarify.

[gen220]

I’m curious, do you personally know anybody who’s gone through gender-affirming-care?

For me it was a really confusing issue until I became close friends with someone whose childhood best friend is trans.

If he was born a decade earlier, he probably would have killed himself (this was the path he was on, which is incredibly tragic and all too common); the gender dysphoria invoked depression was unbearable.

Instead, he was able to work through therapy and medical care to understand his gender dysphoria and receive gender affirming care in his late teens.

Now (over a decade post treatment) he’s among the most cheerful people I’ve ever met. He inspires joy as a band teacher, is inspiringly happily married, and is raising a beautiful baby girl.

I often think about him when people talk about the issue in the abstract. The hundreds of children whose lives he’s impacted for the better, let alone the lives of his friends and family. Removing gender affirming care is implicitly saying you don’t want any of that to happen, because the logical conclusion of removing is people like him in a pit of depression and despair that often ends in suicide, all over an affliction that they did not choose.

This is where the “medically necessary” part of gender affirming care comes from.

I didn’t understand it before I knew him and his story so I don’t begrudge people who are in shows I used to walk in. But I’d encourage people to try to understand and lead with empathy and meet people where they are.

[zozozk]

That's analogous to how frontal lobotomies were justified as a medical procedure. But it still caused significant, lifelong harm to tens of thousands of people, most of them children and young women.