While Transgender Day of Visibility happens annually on March 31, this year it’s happening against a backdrop of state officials legislating transgender people out of public life. Right now, more than 140,000 transgender adolescents have lost or are at risk of losing access to best-practice medical care due to bans in 23 states. Health care providers in Washington have a chance to help save transgender lives.
As a family medicine physician specializing in care for transgender people, I was relieved when Washington passed a shield law last year. This law protects clinicians from police and legal action if the charges are related to providing lawful reproductive or transgender medical care in Washington. In accordance with the law, our Attorney General has already taken action to protect Seattle Children’s Hospital from the gross overreach of the Texas Attorney General who requested records for any Texas adolescent who had traveled to Seattle for care. This law protects providers with multi-state licenses from many of the risks of providing medical care for transgender and gender diverse (TGD) people. In this way, health care providers in Washington have a unique opportunity to save lives through civil disobedience while risking very little personal loss.
I refuse to let unconstitutional and discriminatory state laws affect my practice in other states. The American Medical Association's Code of Ethics states, “Ethical responsibilities usually exceed legal duties... In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties.”
Across history, we can see several examples of physicians choosing ethics over state law. For example, some physicians refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War. Dutch physicians chose collectively to turn in their licenses rather than practice under Nazi rule. There are also individuals I look to such as Dr. Rudolf Weigl and Dr. Gisella Perl, who saved lives during Nazi rule.
Unfortunately, there are even more examples of providers conforming with bad laws and policies, even horrific ones. Physicians authorized forced-sterilization programs in the United States. Physicians in the Soviet Union used psychiatric hospitals as political prisons. Most physicians have not reported police brutality under apartheid in South Africa. More than half the physicians of Germany participated in the murder of people in concentration camps in Nazi Germany. I want to fulfill my ethical obligation and be on the right side of history. Washington state law makes it very safe for me to do that.
While Christian Nationals and the media have intentionally questioned the validity of medical care for transgender people, citing a lack of history or research, these claims are patently false. Over 150 precolonial cultures honored a third gender. The first Western medical clinic for transgender people was opened in 1919, and over 2,000 peer-reviewed publications about transgender medical care have been published since 1975. Every major medical association, which includes over 700,000 clinician members, in the United States supports essential health care for transgender people.
In my work with transgender youth, I’ve seen how necessary this care is. So many of the adolescents I support participate in the first few telehealth visits with their body only half in frame or their hair covering most of their face. But after months of us working together, they blossom as they feel affirmed and confident in who they are. They center their body in the frame, their hair is out of their face, they smile. I recently met one of my patients who I had supported for years, and she thanked me for saving her life. I also hear from parents, who commonly tell me they feel like they got their young person back after we start medical care.
Bans against essential health care threaten not only TGD lives but all lives. Allowing politicians to make medical decisions threatens bodily autonomy and health care access for everyone. Everyone deserves timely, affordable, essential health care in the community where they live. Washington health care providers are uniquely positioned to help save lives. We must uphold our ethical obligations to our patients and not let politicians get in the way of medical practice. Washington providers with licenses in other states must utilize telemedicine to stop the genocide of transgender and gender diverse people.
For those who are not health care providers, I encourage you to:
● Not assume someone’s gender or pronouns based on appearance
● Donate to A4TE, Abortion Defense Network, STYEP
● Get involved in legislative action
Taking these steps and more like them will help save trans lives. These actions make the world a safer place to be human- cis or trans!
Crystal Beal, MD, (they/themme) is a board certified family medicine physician and founder and CEO of QueerDoc and QueerCME. They’re also a clinical instructor at the University of Washington School of Medicine, and a field instructor for the University of Washington School of Public Health’s community oriented public health practice. Their opinions are their own and not representative of the University of Washington.
