Skirmetti vs US Amicus Brief - Healthcare is Inherently Discriminatory For A Good Reason

Section IB read in the Supreme Court Case

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Dec 21, 2024

The debate around transgender healthcare often involves complex ethical, medical, and legal considerations. For the most part, people’s embrace of the principles and practices associated with transgender rights and healthcare has been disastrous.

Daily Wire podcast host Michael Knowles recently explained, “It’s not just that transgenderism endangers children. It does. It’s not just that transgenderism infringes on the legitimate rights of women to have their own spaces and associations — though it does.”

Transgenderism is manifestly absurd, and almost everyone knows it. The realization of sex is so fundamental that it’s engrained throughout species. It’s more fundamental than what we perceive to be up or down, black or white, and good or evil. Most everyone knows that men and women are different, and men cannot become women and vice-versa. When people insist that they can, it makes people question their judgment.

For example, I came away from the supreme court hearings with a feeling that the nine justices didn’t have a firm grasp of the fundamental harms of transgenderism in children, such as the potential psychological, medical, and physical risks of early gender transition. But again, their goal was to argue the topic from a legal standpoint. Please refer to my previous article.

Healthcare is Inherently Discriminatory For A Good Reason

The discourse surrounding healthcare equality often overlooks a fundamental reality: men and women possess distinctly different biology and anatomy, necessitating unique medical skills and approaches for adequate care. This essay underscores the vital role of tailored medical skills and approaches, emphasizing that healthcare should differentiate based on sex not out of bias but out of necessity driven by these physiological differences. This approach is about efficiency and compassion and the essence of safe and effective medical practice.

Biological and Anatomical Distinctions

Understanding and acknowledging the biological and anatomical differences between men and women is not just a matter of fact but a crucial aspect of healthcare. This knowledge is vital for healthcare practitioners, as these differences significantly influence health in every aspect, from disease susceptibility to treatment efficacy. This underscores the necessity of tailored medical skills and approaches in healthcare, ensuring that all patients receive the best possible care.

Reproductive Health: The most evident distinction lies in reproductive systems. Women require specific care concerning menstruation, pregnancy, childbirth, and menopause, which have no male equivalents. Conversely, men’s health concerns include prostate issues and different forms of sexual health complications. In the operating room, healthcare practitioners must consider genitalia to practice safe and effective medicine. Before the start of surgery, everyone must pause before starting the operation and state the operation, the side being operated on, the name, and other identifying factors. In the case of a trans-identifying individual, the person is named by their preferred pronoun, and nothing is ever said about their biological status or genitalia. (personal experience).

A strong example is that trans individuals often request that medical professionals not ask about their biological genitalia and use alternative terms such as “front hole” as opposed to vagina (Harding, 2023). This is an impossibility and unsafe. For example, the urethra of males and females differ vastly and require specific skills and materials to place a catheter safely in the urethra. We are being asked not to inquire about a patient’s anatomy and essentially guess, all not to exacerbate or trigger their underlying mental illness.

Cardiovascular Health: Women might present with atypical symptoms during heart attacks, often leading to misdiagnosis when not considered (Lichtman, 2015). The hormonal differences also affect how heart disease manifests and progresses (Callabhajosyula, 2015). How can medical professionals be asked not to inquire about a person’s biological makeup when dealing with heart attacks, which remain the biggest killer in today’s society?

Mental Health: Sex hormones play a role in mental health, with conditions like postpartum depression or hormonal mood swings in women (Payne, 2019). At the same time, men might experience different patterns of mental health issues influenced by testosterone levels (Hauger, 2022). For example, healthcare practitioners who are asked not to inquire about a person’s biological status in order not to exacerbate their mental illness and increase the risk of suicide is based on shoddy science.

During the oral arguments of a case involving transgender rights, Justice Samuel Alito referenced a study often associated with discussions around transgender healthcare outcomes. He cited 2024 BMJ Mental Health article that analyzed the all-cause and suicide mortalities among adolescents and young adults who contacted specialized gender identity services in Finland. There was no statistically significant difference in suicide mortality rates after controlling for psychiatric morbidity. This suggests that gender dysphoria itself does not predict suicide or all-cause mortality when psychiatric treatment history is accounted for.

Another study by researchers at the Karolinska Institute, which has been widely discussed concerning transgender health outcomes, particularly suicide rates post-transition. This study, published in 2011, followed 324 Swedish transgender individuals who had undergone sex reassignment surgery between 1973 and 2003 and compared their mortality, morbidity, and criminal rate with matched controls from the general population. The findings showed that individuals who had undergone sex reassignment had a significantly higher risk of suicide, with the suicide mortality rate being about 19 times higher than the non-transgender population. Gender-affirming surgeries may alleviate gender dysphoria, but they don’t address the underlying mental health issues or societal factors contributing to suicide risk among transgender individuals.

Pharmacokinetics: Drugs can be metabolized differently depending on the sex, affecting dosage and effectiveness (Mauvais-Jarvis, 2021). Women might require lower doses of certain medications due to differences in body composition and metabolism rates (Mauvais-Jarvis, 2021). For example, in the operating room or intensive care unit, the anesthesiologist must know if a person is a biological male or female based on the pharmacokinetics of the medications being administered.

Medical Skills and Training

Given the profound impact of biological and anatomical differences on health, medical education, and practice must evolve to incorporate sex-specific knowledge. This evolution is not just a suggestion but necessary to ensure the best possible care for all patients, regardless of their sex. By emphasizing the need for sex-specific training, we can reassure the audience about the quality and effectiveness of healthcare.

Training: Medical schools should ensure that training encompasses sex-specific pathophysiology, diagnostic methods, and treatment protocols. For example, gynecology and obstetrics are specialized fields that almost exclusively cater to female biology. Similarly, urologists specialize in male biology and male-specific health issues like testicular cancer or male-pattern baldness. However, medical schools are promoting gender ideology, which is a dangerous direction, especially in children.

Technology and diagnostic tools are often designed predominantly for males. There’s a growing need for devices that consider female anatomy, improving diagnostic accuracy and patient comfort. Historically, clinical trials have often underrepresented women, leading to treatments that may not be as effective or could even be harmful due to biological differences. Therefore, the inclusion of sex-specific data from trials is not just important but crucial for the development of personalized medicine and the creation of treatments that are effective for both men and women. This emphasis on sex-specific data can instill confidence in the audience about the future of healthcare.

Societal and Ethical Considerations

The argument extends beyond biology into societal roles and ethics:

Resource Allocation: Health systems might need to allocate resources differently to treat trans-identifying patients. This would result in changes in healthcare funding and allocations, which would be based on political decisions, not what’s best for the patient. For example, this could lead to changes in funding for breast cancer research due to its prevalence in women or more for male-specific health screenings like prostate exams.

Healthcare must also consider cultural aspects where sex discrimination might be necessary for respectful care. This consideration is a formality and a way to ensure that all patients feel respected and included in their healthcare journey.

Conclusion

The notion of sex-based discrimination in healthcare, when framed through the lens of biological necessity, medical skill adaptation, and societal roles, transforms into a nuanced argument for differentiation rather than discrimination. Being discriminatory is caring for the individual in the sense that if we care enough about the person in front of us, discrimination is necessary for making decisions that will improve the life of that person in front of us. This approach recognizes and respects the inherent differences between men and women, not to segregate or disadvantage, but to enhance health outcomes through personalized, scientifically informed care. By advocating for medical practices that are sensitive to sex differences, healthcare can move closer to true equality by providing the most appropriate care for each individual based on their sex. This is not about lessening care for one sex over the other but optimizing care for all.

Johnathan Edwards MD Substack

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