Our community seems sharply divided on the recent decision by U.S. District Judge Mark Wolf to allow convicted killer Michelle Kosilek to undergo transition surgery while in prison, paid for by the state of Massachusetts.
I understand the anger and frustration of those who have worked three jobs, sold their possessions, and still can’t afford to pay for this surgery. They think, “I have been a law-abiding citizen all my life and I can’t afford to have surgery, but a convicted murderer can get it for free? How fair is that?”
Probably not all that fair, actually. But, in my opinion, the Michelle Kosilek decision is about far more than one person – one murderer, even – getting her transition surgery covered by the state. I think there are some points that we have to look at with regard to this decision, all of which take Kosilek out of the equation entirely.
1. First of all, we have to examine whether or not federal, state, and local governments should pay for medical care for their prisoners. If the answer is yes, then the decision could go no other way. If transition is, in fact, medically necessary, and if, in fact, a civilized government provides health care to those who it incarcerates, then the government must provide medically necessary care to all its prisoners. It cannot discriminate on the basis of some false morality, or on the “worthiness” of the individual receiving the care.
We either treat our prisoners humanely or we don’t, and providing necessary health care is the humane thing to do. It’s not a matter of who “deserves” it and who doesn’t. It’s a matter of whether or not we are going to provide it to our prisoners – period.
2. Next, we have to look at legal decisions that work in our favor as trans people. Regardless of the unpopularity of this decision, among some in the trans community and among the general public, the fact is that any legal decision that determines that transition surgery is a medical necessity can only benefit us in the long run.
The more legal rulings that we have under our belt, the closer we get to eliminating this whole “choice” misconception, the closer we get to insurance coverage for transition procedures, and the closer we get to transition being seen as a medical, rather than a psychiatric, solution for a medical, rather than a psychiatric, condition.
3. And finally, we have to weigh the significance of this decision against the possible setback it represents for us in the minds of the general public. Certainly it can, and probably will, have some negative repercussions with regard to the “hearts and minds” that we hope to change. But hearts and minds are always slow to come around. And they can turn on a dime when something like this happens.
For these reasons, legal intervention must often come first. Then if hearts and minds don’t change, it doesn’t matter as much, because the law is working for us. And when the law recognizes us as legitimate human beings with legitimate legal rights, that often does serve to change hearts and minds over time. At the very least, it forces the hand of those hearts that are resistant.
So while I completely understand the arguments, anger, and animosity within our own community regarding this controversial decision, I think we have to put Kosilek as an individual aside and look at the larger picture with regard to what this means to us as trans people and what this means for a larger society that either will or will not provide necessary medical services to everyone in its care – no judgment calls and no exceptions.
Readers?
I understand what you’re saying about taking the murderer out of the picture, but surgery? Hormones I can understand, surgery I cannot.
Surgery, like hormones, is deemed medically necessary for transsexuals.
Then all law abiding citizens should sue their states for the same. Should I go to jail to get medically necessary treatment?!?
She’s nothing but a convict and shouldn’t have any rights beyond food and shelter.
“Then all law abiding citizens should sue their states for the same.” ABSOLUTELY!!!
in CA those on Medi-Cal are afforded SRS.
And hormones.
Convicts don’t have a right to healthcare? If I were locked up, I shouldn’t be given my insulin or other meds I need?
As I said to a friend yesterday who was curious about my take, “The fact that the state will pay for her transition, but my insurance would not pay for mine indicates a problem with my insurance, not with the prisons.” This is not “elective,” it’s not “cosmetic,” it’s as necessary to survival for some of us as a heart bypass. Once one accepts that fact, then the anger gets directed where it should–at the medical establishment.
Well said.
Matt, while I agree that this has the potential to give us legal protections and benefits, I also caution you and others from thinking that having laws that work in our favor is all that matters. More importantly is the enforcement of those laws. A good example of this is with New York City, with one of the oldest anti-discrimination laws on the books for us, but up until this year when they began training to do away with such behavior, the worst offender against us was the NYPD. Laws are nice, enforcement is what counts.
Caitlin
We have to be willing to file discrimination complaints, as I just did. If you have a non-discrimination law, use it. Luckily, my state (Washington) defines “accommodations” as including medical care, and the US EEOC defines “employment” as including “benefits”
Great post – Point 1 is unbeatable!
Reblogged this on Zander's Blog and commented:
Absolutely!!
absolutely, I concur.
I’m curious about why no mention of GID being referred to as a “major mental illness” more than once by the judge? This is not a victory rather one of the setbacks you speak of.
Good legal decision.
Terrible press coverage that suggests major news sites and sources still aren’t using the correct language when talking about trans people. I’ve scrolled through some of the reporting of this and the vast majority of them:
- refer to Kosilek as male and with male pronouns; AND
- headline the victory as one for “sex change” (not even sex reassingment surgery, let alone something more gender affirming).
We can celebrate the decision while realizing that a good part of the backlash is also from the fact that this is still being reported through a lens of misinformation and bias against trans people.
The coverage ALSO
- glosses over the issue of safety to trans people in prison by treating this case as the state caring about safety AFTER surgery vs. medical necessity (not mentioning safety issues for trans women housed in male prisons more generally; AND – describing the circumstances in which Kosilek committed the murder as being related to “cross-dressing” (which combined with use of male pronouns misstates what it means to be a trans woman
The corrections director’s claim of safety/security concerns following hormones, RLE, and GRS played a large role in the judge’s opinion, and there was strong evidence that the safety risk was minimal. After years on hormones and living as a woman, no incidents risking Michelle’s safety occurred.
I have often thought that choice versus medically necessary is a false dichotomy. The reality is that there is at least one additional option. I call it medically advisable. There is, for example no medical necessity that a flat chested woman requires breast augmentation however it may be medically advisable for many reasons including such hard to quantify things as self esteem and the ability to function well in society.
Here we are faced with a mature adult who did not commit suicide or die because of the person\’s condition but who did take the life of a spouse. Perhaps it is medically advisable that Kosilek transition, perhaps not. I am not in a position to make that call.
What I can say is that if a particular prison system is bound legally to provide medically advisable services and not simply medically necessary ones then Kosilek should receive the services as determined by those in a position to make a competent evaluation.
But, prison systems generally do not provide comprehensive health care for medically advisable conditions. For example they will pull infected teeth but generally are not obligated to provide replacement implants. They will provide medications and care but generally not transplant surgeries for failing organs such as heart conditions.
I\’m sure some will disagree with me on this. But consider that for FTM’s bottom surgery is now available. It is expensive but it is available. Does the record of the last 50 years indicate that it is medically necessary? The nature of a false dichotomy is to set up a yes/no or black versus white forced alignment when in fact many shades of gray exist.
Intersting points Matt. As a prison guard I expect that my co-workers will ask my me how I feel about this and I have struggled with what my response should be. I have to agree with what you have said on this and my response is now clearly formulated.
I spent my career in corrections/parole. You make very valid points and I don’t disagree, necessarily. I will, however, always have a problem with inmates receiving benefits that aren’t available to law-abiding citizens. Some have compared this to life saving surgery or treatment of other medical issues like cancer or diabetes. While I recognize that SRS is medically necessary, I don’t know that I can honestly say it is “life saving” in this case. I make this point purely based on the fact that there are numerous individuals with GID who can’t afford SRS. These individuals, myself included, have to struggle and survive without it, so why can’t she? Again, I see the good things that may come of this and I’m not saying she shouldn’t have the surgery. I just think that if it’s not available to others through insurance and such, then taxpayer’s certainly shouldn’t be paying for it. And, yes, I do recognize that some have taken their lives and most of us have contemplated it at some point. So, I recognize the importance of SRS and how it can be considered life saving.
But all of us are different, and the judge emphasized that “adequate medical care” requires individualization of treatment, and it is pretty clear that Michelle’s gender dysphoria was extremely severe, and every physician, counselor and social worker hired by the department of corrections agreed except for the one hired from Johns Hopkins.
Mark, the argument that there are law-abiding people that can’t afford surgery and so are forced to live with their condition is, unfortunately, an inaccurate comparison. Those who can’t live with it aren’t around to provide an example otherwise.
And, prisoners getting care that law-abiding citizens cannot afford doesn’t mean we value them more. It only serves to point out how badly we are failing everyone else. Out of thirty-three developed nations, thirty two had universal health care as of 2009. The United States being the lone exception.
I am sorry, but I must disagree. I am transgendered and would love to have surgery. I don’t have the money. I transitioned some 20 yrs ago and live just fin taking my hormones. I don’t think the taxpayer should be footing the bill for surgery. As someone who managed the medical facilities in two city prisons I know that inmates are entitled to life saving care, but SRS is not life saving.
I think the issue goes deeper – like it or not, we live in a very punitive society and we expect those incarcerated to suffer. So, let the trans woman suffer because she fucked up and killed someone. This is our society’s crappy attitude, not mine. Although, some people have to be segregated from society because they are a danger to others. But, they must be treated humanely and not society mimicking their actions.
What we need is to develope a more humane way of dealing with people who violate the law. It has been proven over and over that prison doesn’t deter crime and the death penalty doesn’t deter crime. And forcing a trans woman to have to live as a man is cruel. Who knows, maybe the murder was BECAUSE of her feelings of no other recourse. But, no matter how bad we feel about our situations, it doesn’t make it right to take someone’s life over it. there are other options – the same options we all take advantage of as trans people.
I agree with the judge to allow this woman to have her surgery and to be housed in a WOMEN’S facility AS a woman. I do hope that this eventually will lead to insurance and state medical programs will realize that SRS and hormones are necessary to us as trans people to enable us to live as we were meant to be. I would like to see our medical treatments be viewed just like any other medical procedure that anyone one would have. I didn’t have to hop through hoops to get my cornea transplant or my foot surgeries. My doctors said i needed these and Medicare and MediCal (Medicaid) paid, no questions asked. I look forward to the day when I can get top surgery the same way – no hoops or hassles. Yes, CA’s MediCal will pay but I’d have to join Kaiser first and that isn’t an option for me right now.
Lyn,
Here is a San Diego surgeon, who takes Medi-Cal, and performs trans surgeries. Call him!!
http://www.drchaffoo.com/surgery/transgender.cfm
Here’s another surgeon http://www.poustiplasticsurgery.com/Procedures/Procedure_genderReassignment.htm
Both advertise their MtF surgeries. So ask about their FtM surgeries.
The murder was committed after Michelle was discovered by her partner wearing her partner’s clothes. So, indeed, the murder may have been related to her dysphoria, self-loathing, and fear of discovery. She only married because her partner convinced her that love could cure her dysphoria.This doesn’t justify her crime or make it less heinous. But there is a lot of evidence that her gender dysphoria was extremely severe, so severe that even after hormone treatment and living as herself was not sufficient to quell her depression and her suicidality. Extreme fear doesn’t promote good judgment or constraint. This is one of the least discussed and most interesting aspects of the case. Can gender dysphoria be so severe that it is clearly a mental illness by itself? Or is it just collateral damage from not being able to completely transition?
I think people suggesting this isn’t life saving, like cancer drugs, should go read the 100+ page judge’s decision actually describing Kosilek’s attempts at self-castration and suicide.
This was not a question about whether surgery is generally life-saving for trans people. It was a question whether it was deemed necessary for HER, and in Kosilek’s case, it was well-documented that surgery would quite possibly be not only medically necessary, but literally life saving (depending on how good you think prison suicide prevention is).
I think people prefer not to know the facts of the case so they can feel more comfortable thinking that Kosilek should suffer because she is a murderer and because other people suffer, even though withholding treatment is known to jeopardize her life.
Let me think about this Sean. I kill my spouse because life is precious but hers is not and now I want mercy because this torment has plagued me since birth? Somehow I can’t wrap my head around that logic.
Giving life-saving medical care to someone who is serving the prison term that she received for her heinous act is not mercy, it’s called justice.
People who feel so strongly that this is wrong ought to be protesting every convicted killer who receives a life sentence, rather than execution, and protesting every suicide watch effort taken – we should be handing them guns to kill themselves if they want, right?
You are entitled to want the death penalty – or the functional equivalent (withholding care) – for anyone convicted of murder. And if that’s how you – or anyone else – feels, then I hope you’re as adamant in your protestation of our constitutional protections against cruel treatment for ALL prisoners, and I imagine you feel that all convicted killers should never be treated, not just biased against one who is a trans woman.
While our criminal justice system has many defects, showing too MUCH mercy is so very seldom a legitimate charge against it.
And I don’t know more about this case than has been shared in court, in public documents,and in the details throughout. However, I think we all have enough information to belive that Kosilek was not necessarily treated the same as anyone who killed a wife (on account of being trans), and we have enough information to know how much worse prison would be for Kosilek as a trans woman.
I don’t defend what she did, and I don’t think anyone should. I just see bloodlust, bigotry, and to some extent envy in many of the people who think she should suffer MORE than another convicted murderer would.
Sorry Sean. I do not think tax payers should be required to pay for SRS, breast implants, facial feminization, electrolysis and the rest. If she wanted and needed that she should have done it before she killed her wife.
I think I’m going to kill myself if I can’t live in a mansion in Beverly Hills and marry Brad Pitt….lol.
I agree, and feel Michelle Kosilek should have genital surgery. Instead of people getting upset that she is getting surgery, how about you put the same energy in to getting Masshealth (the state insurance where Kosilek is incarcerated) to pay for surgeries. Also keep in mind, it is not like she will have a free and easy life after her SRS. She will still be in prison for the rest of her life, which is fitting of the crime.
I just get the feeling a lot of this is “sour grapes”. Many feel they can’t “get theirs” so she should not “get her’s”. Like I stated previously, petition your insurance company to cover SRS.
Another thing I will add is I am really sick of trans people saying that just because they could manage to live without SRS, she can to. No. It does not work that way. Everyone is different.
“I am really sick of trans people saying that just because they could manage to live without SRS, she can to. No. It does not work that way. Everyone is different.”
Yes, exactly! This is not about you, people, it’s about her and we don’t know what she goes through or whether she can survive without surgery just because some of us can. We may have something in common, but are all different.
Don’t she should have considered the consequences of her crime if she wanted SRS? I know too many people have have to live without SRS because either they can’t afford it or they are not a candidate. I really have no sympathy for this person who chose t murder another human being. I think she’s lucky that she didn’t get the electric chair.
“I know too many people have have to live without SRS because either they can’t afford it or they are not a candidate.”
You’re not paying attention, honey, so let me say it again: this has nothing to do with other people and THEIR ability to live with or without SRS – we’re talking about one specific person and we don’t know enough about her situation to judge what she can live with – hopefully the judge does.
“I really have no sympathy for this person”
Yeah that’s pretty obvious. Let’s hope you’re never accused of a criminal act.
I frankly think she ought to be counting her lucky stars to still be alive and that she did not get the electric chair. I’m not buying that she needs SRS to survive. I do think she has mental issues but I don’t think SRS is going to cure them.
Massachusetts outlawed the death penalty years ago. Also, almost no states use the electric chair. They use lethal injection.
Nope – I don’t buy it. Rather, I don’t want to buy a convicted murderers SRS.
Normally I am a very compassionate person – but this is where I draw the line. I myself not only cannot afford SRS (ftm), I do not believe that any surgical option currently available is viable for me. Does this cause me dysphoria – yup. Is it a horrible feeling that I will have to suffer with probably for the next 40 years or so – yup. But that’s life – shit ain’t fair sometimes and we have to learn to suck it up.
This situation just feels like a magnification of everything wrong with our society right now; we reward those that have done nothing to deserve it and everyone else can go screw. I’m not saying withhold insulin or Lipitor here. Food, water, shelter and any medical intervention needed to live fine. But she can live without SRS – it won’t be a picnic but it’s PRISON for Pete’s sake no freaking club med.
I’m sorry but this ruling borders on lunacy. Someone who murdered their spouse and is serving life in prison does not deserve more rights to health care than law abiding citizens. I am a post-op TS and I’m the first to support access to health care for Transsexuals, including SRS. When you enter prison, you give up many rights that you had as a law abiding citizen. Tax payers should pay for medical nessesary procedures that maintain physical health of a prisoner. They should not be paying for cosmetic procedures to make the person feel more attractive or improve their self esteem. I do not believe SRS is necessary for physical survival. Look how many in our community wait years to afford it and many never will. You survive with or without SRS. Yes, it may relieve her depression temporarily but that’s not my concern. Next we will be paying for endless hours of electrolyiss, breast implants, facial feminization surgery if you follow the logic of the judge. This person obviously has more psychological issues than gender dysphoria. No telling how much the tax payers have already paid for psychiatric care for this goofball.
I think the negative repurcussions of this ruling will have very adverse consequences to the Trans community. It reinforces the idea that we are pushing an agenda which is out of the mainstream and irrational. That is exactly what we do not need.
Wow, are you a psychotherapist? If not, I do not think you are qualified to state she has “mental issues”. Both a judge and her doctor, a medical professional, ruled she needs SRS. Also, keep this in perspective. Massachusetts has paid $10,000 on curtains. The average MtF SRS costs $19,000. $19,000 is a drop in the bucket to the Commonwealth of Massachusetts.
She also needs this surgery because she has tried to kill herself twice and has tried to castrate herself. That to me, her doctor, and the judge was glaring proof she needs SRS. I personally know trans women who have either gone through with self castration or attempted it.
No, I am not a psychotherapist and I assume neither are you. I do have some common sense or at least I like to think I do. A mentally stable person, Trans or not, does not murder someone. This person has been allowed to transition, which seems very compassionate. Beyond that, I so no need for the State to do more. I’m not sure what sort of mental health counselling or psychiatric medication is available to prisoners. Certainly, she could benefit from that more than SRS. No one needs to know what gentialia she has beneath her prison uniform.
Next month she’ll be threatening to kill herself because her breasts are too small or she has facial hair or her bone structure is too masculine and she needs FFS. Seriously, this is insane. Her bill to transition will ultimately be well over $100,000.
We all know that you can get a doctor to say pretty much anything you want them to say. As far as the judge’s decision, I think it is wrong and will have a very negative impact of Trans people in general.
This is not about what others will think about her. I will probably live a life of celibacy being as I am too socially awkward to date, but genital surgery is still very important to me. Just like chest surgery was and a hysterectomy. No one has xray vision but getting a hysterectomy was very important to me and one of the best things I have done. I also had chest surgery even though I only had A-cup breasts that could easily be concealed under a shirt. You see, none of my surgeries had to do with others, but strictly had to do with my well being. I think it is the same for Michelle.
Like Matt said, we’re “sharply divided” on this issue…
Just curious, but it seems that one obvious split, in opinion on this matter, is occurring between trans men and trans women (not 100%). I wonder why? Pre-transition ideologies, values & socialization influence? Interesting to read men advocating for “mercy” and women for “justice,” opposite of what I read on non-trans blogs.
Interesting point. I have noticed this also. It seems that mostly trans women don’t feel she should have SRS while trans men seem to support the decision. Though, for me personally, I don’t think it has to do much with socialization based on birth sex. My mom was very hardline. She was a big supporter of the death penalty. My dad was the opposite. While I am not 100% sure his position on the death penalty, I know he was less judgmental about people than my mom. Due to the way my parents were, when I was a little kid, I thought men were the understanding,sensitive ones, while the women were the mean, strict ones. I did not realize the opposite was true until grade school.
I view life saving measures as justice, not mercy – see above.
We provide health care for prisoners (and in general, prison-level health care is *not* something you’d aspire to deliver as a universal plan) the same as we feed them. They can’t work on their own or go buy food. We feed them. They can’t work on their own or go buy insurance or go see a doctor. So we provide some level of medical care.
The fact that our country has children who are food insecure doesn’t change the fact that we feed prisoners. Same here: the fact that ordinary people lack adequate health care doesn’t mean we let prisoners die for lack of medical care.
It’s hardly a statistical sample, but yes, the most vocal people in trans communities do appear to be trans women bashing Kosilek and this decision and trans men supporting it.
I’m sure it’s a combination of factors, including:
- trans women feeling the need to reject one of “their own” who is a murderer
- trans women reacting at the injustice that deserving people don’t get surgeries and medical care they need
- the judgement that Kosilek shouldn’t receive medical care because she is undeserving of it
- trans women fearing that this will be used in the public more generally as reason to deny trans women rights and care
- trans women substituting their own personal need for certain procedures (or that of friends) for Kosilek’s
I have some sympathy for those who have suffered as much or more and do not receive the care they need.
I do worry about the extent that this decision will create a backlash against trans rights in general, esp with regard to health care.
However, I see the best way to overcome these concerns as spinning the Kosilek case to mean that if EVEN the worst of trans people are entitled to life-saving, medically necessary treatment, then how much MORE should we be advocating for the rights of everyone else.
As troubling as Kosilek’s case may be, I don’t see the advantage in bsahing her or denigrating the decision or worse, acting like SRS is NOT medically necessary and quite possibly even life-saving for many people. This is what the most recent WPATH Standards of Care say, this is trans rights advocates are relying on, and its damaging to the whole community to pretend it isn’t so, just because OTHER people can cope or have suffered.
“it seems that one obvious split, in opinion on this matter, is occurring between trans men and trans women”
Hmm . . . I hadn’t noticed that.
You wrote:
Absolutely. Matt, you’ve nailed it.
[...] http://tranifesto.com/2012/09/06/the-michelle-kosilek-decision/ [...]
I totally agree with Matt. The issue here is that the judge supported Michelle Kosilek’s human right to gender expression which shouldn’t be confused with healthcare providers not supporting those human rights.
I’m not surprised some MTFs are unaware of their masculine habit patterns left over from an earlier life but shocked at their knee-jerk naivety. To be fair FTMs can have a problem with standing up for themselves and disappearing off into FTM only groups behind the scenes which robs the public sphere of their input but even so the way MTFs have leapt on this issue like marines going “Hut, hut, hut. Yessir” is a wakeup call if ever I saw one.
On a more positive note the US position on the right of transgenders to access healthcare is now similar to where the UK has been for some time. However, funding of healthcare stops short of what many leading US corporations now fund via their healthcare programs so surgery like FFS and the quality of breast reduction surgery for FTMs falls short.
I like to encourage both MTFs and FTMs to mingle and work together more as I think we have a lot to offer each other on many levels, and would like to throw the thought out there that maybe closer transatlantic cooperation may help both US and UK transgenders fill in weaknesses in their respective campaigns for healthcare providing quality outcomes available to everyone.
Lastly, I wouldn’t want to forget transgenders in Asia and worldwide who are denied even the most basic healthcare due to the legacy of history, law, and in some cases grinding poverty.
I am a transsexual male. The reason why I choose to be “behind the scenes” has nothing to do with socialization. The reason why I am “behind the scenes” is because I do not want the public to know of my transsexualism.
When asked “are you out?” I tell people that choosing to disclose my trans status is a personal decision regarding private and confidential (medical) information that I take into consideration. Usually, I do not disclose, but it has nothing to do with female socialization, especially since I was raised by liberal parents, in Los Angeles in the 1970s, who did not balk at my athleticism, outspokenness and assertiveness. As a matter of fact, those attributes were encouraged!!
@ Summer Day. Sweetie there is no Hut Hut going on here nor masculine habit patterns. The problem that I see is that there is a myth that going through changes including surgeries is either a choice or a medical necessity. This false dichotomy has caused tremendous harm for decades. Think of it this way. Fixing a cleft palate is not medically necessary but medically desirable for those born with that deformity. It is a gray area between choice and medically necessary. You could call it a choice but no one born with that condition would view it as choice simply because it is devastating to living a normal life.
What I call medically desirable includes procedures that have proven successful in treating a condition that is not required because the condition is life threatening nor is it really a choice because a person suffering the condition would almost universally desire the procedure.
There is a scary potential to accepting the false dichotomy. That is the potential for the huge majority of people not having such a condition to say surgeries are obviously not medically necessary as in life threatening so therefore they must be a choice. I think that potential escalates when tax dollars are at stake. The prison/industrial complex is gobbling up a larger and larger share of local and state tax dollars.
So please spare me the little barbs. I accept that most men discount my thoughts on complex topics but I see trouble ahead if we scream it is medically necessary so so it. The proverbial fat lady may show up and start singing the final song and she may be a far right winger.
[...] is a part of the responsibility that a society takes on when it incarcerates people. Matt Kailey summed it up well: “First of all, we have to examine whether or not federal, state, and local governments [...]