I am a transgender person researching transgender data justice in healthcare. I actively look for presentations surrounding trans health in bioethics conferences. So far, the dominant bioethics literature about transgender people focuses on reacting to the anti-trans movement without centering trans experience. More specifically, it is oriented to fight the anti-trans legislative acts. Such focus fails to ask how a transgender person might argue or see these laws. Forgets the preferences of transgender people. In medical ethics, there is no difference either. The main focus is to react to the anti-trans atmosphere to show how trans experience is “normal.” For example, ASBH 2023, had three sessions on transgender people but two of them were reactionary. HHCC 2024 also only has one session on transgender issues, with a focus on policies. While this reactionary bioethics research is necessary, it only scratches the surface of trans bioethics.
By focusing on the trans-experience, bioethicists will come closer to capturing the core of trans bioethics. Doing so does not mean that they should avoid research on policies or medical bias. It means that even when they want to do such research, the starting core of that research is transgender people’s testimony.
Centering Anti-Trans Rhetoric Objectifies Trans People
American lawmakers have already introduced forty-three anti-trans bills in 2024. Most of these laws aim to curb or ban medical transition. These attacks raise significant concerns for bioethicists, some of whom are transgender or allies of the trans community. Arguing against these harmful policies is necessary, yet not enough to create an environment where trans people may thrive.
When we focus on refuting bigoted ideas, we continue to center them. When we busy ourselves reacting in a limited fashion to anti-trans legislation, we remain distracted from the wholeness and integrity of trans people themselves.
In centering anti-trans rhetoric, we objectify trans people in bioethics. A focus on explaining the trans experience to a cisgender audience fails to recognize that the audience that matters most is trans people themselves.
Centering Trans Narratives
Transgender people are looking for high-quality, expert care that benefits and supports their lived experiences. They are not wondering if medical professionals are “doing the right thing” by prescribing hormone replacement therapy. Trans people, through their own lives, know that HRT is an important option to consider. Instead, they wonder if they should choose medical transition and how to do so safely, especially in a hostile political atmosphere. They wonder if they do desire a medical transition, will they be able to find a medical provider who treats them with dignity and respect? Will they have to educate every provider on current standards for transgender care?
A trans person does not need to be told there is systemic oppression in the medical system. The experience of trans people in the system exemplifies this oppression. Trans people are more interested in sense-making questions, namely the whyand the how questions.
Why do I have to be the medical expert on everything related to being trans, yet my doctor treats me unequally when I ask medical questions? Why are there only two gender options in the medical intake form? Why does hormone replacement therapy (HRT) impact my body in certain way? How should I decide about getting a gender affirming surgery that suits me well. How does HRT affect my body in long term? How many times should I get check-ups for breast cancer? Why is HRT is not affecting my body the same way it affects other trans folks?
Trans Philosophy to Trans Bioethics
Philosopher Talia Betcher introduces trans philosophy as a valuable field of study. Betcher is disinterested in defending that trans philosophy is philosophy. In “What is Trans Philosophy”, Betcher argues that trans philosophy always centers trans people and focuses on trans experiences. We should make sense of transgender people’s existential concerns.
Betcher contrasts this view with approaches that use transgender people as objects of study. Objectification uses transgender people as tools. It aims to think about different philosophical questions using them. For example, objectification focuses on gender as binary, then attempts to include trans people. However, trans philosophy focuses on why trans people are not typically included when talking about gender. Why are trans people used as counter-examples or examples?
Trans People Are Not Tools: Their Testimony has Value
Like Betcher, I argue that while any reactionary trans bioethics is an important surface issue, trans experiences are at its core. In bioethics, the objectification of trans people remains the unexamined default. If we focus on those most affected, we should assume our main audience is transgender people. For doing that, we should rely on transgender people’s testimony.
Seeing the surface of the problem might happen because people are mostly aware of legislative news and there are less narratives about transgender people outside their community. They argue how lifesaving this medical procedure is for trans people. Yet, they do not see that sometimes a transgender person might need to explore using HRT. They need it to see if they want to continue medical transition. This means that gender-affirming care goes beyond its ability to save lives. We also want to think about the transgender people who are living in an unsafe area. Some transgender folks want to discuss re-transitioning even though it is stigmatized and abused by anti-trans legislators. We want to think about ways they can live a safer life while using an unsafe medical system. This approach should not be limited to institutional solutions, which are often slow. Instead, we should refer to their testimonies when researching their interests. For example, a term for the trans experience might help navigate the system. It is harmful not to have a term for a discriminatory experience. If we pay attention to the testimony of transgender people, we will be able to approach their problems better.
Centering Trans Narratives: Trans Broken Arm Syndrome
Naith Payton coined the term “trans broken arm syndrome” to describe the significant medical discrimination trans people experience for being trans. In Payton’s version, a doctor attributes a transgender person’s broken arm to HRT instead of focusing on the main cause. Naming and claiming “trans broken arm syndrome” helps transgender people defend and confirm this experience. Secondarily, they can more effectively advocate during medical examinations. This centers trans narratives rather than a cisgender default.
Holistic Transgender Bioethics
Holistic transgender bioethics centers on trans experiences by paying close attention to trans peoples’ testimonies. Trans bioethics should mainly focus on and benefit transgender folks, helping them to navigate medical, social, and political systems. We should figure out ways to end the causes of the horrible experiences that often negatively impact trans people’s lives. We need actionable policies to eliminate discrimination, but never by neglecting the central importance of trans people themselves. We should not use any possible arguments only to win these battles. We cannot tell transgender folks to wait for policymakers to win the legislative battles.
As bioethicists, we must focus on serving trans people directly by centering their voices in our research.
Rebecca Sanaeikia, BA is a Philosophy Ph.D. student at University of Rochester.