Man(ning) & Woman

A TransGender-Symbol Plain3

A TransGender-Symbol Plain3 (Photo credit: Wikipedia)

In a somewhat unusual turn of events, Private Bradley Manning claims that he identifies himself (or herself) as a woman named Chelsea Manning.  He has also expressed the desire to undergo gender re-assignment, beginning with hormone therapy. Given that I hold to a rather broad conception of liberty, I believe that Manning has the right to change his gender and that this is morally acceptable. In fact, if physically being a man is problematic for him, then he certainly should take steps to make his physicality match his conception of his identity. His body, his choice.

One rather obvious obstacle that Manning faces is a lengthy prison term for his role in leaking secrets to WikiLeaks. Being in prison, he most likely will lack the funds needed to pay for hormone therapy. Even if he had the funds, there is also the matter of whether or not the Army would provide such services. As it stands, the Army apparently does not provide such services.

Manning’s attorney, David Coombs, has asserted that if the state fails to provide Manning with the therapy, then he will try to force it to do so. Interestingly, Manning’s case is not unique. In Virginia, a prison refused to allow a prisoner to undergo gender reassignment surgery. In Massachusetts, a federal judge ordered the state to pay for a convicted murder’s sex change operation. These matters obviously raise some philosophical concerns.

As noted above, I believe that an individual should be free to change his or her sex. I base this on the principle that what concerns only the person is a matter in which the individual should have complete authority. So, if Manning wishes to change his sex to match his claimed gender, he should be allowed to do so. This is something I see as a negative liberty—that is, no one has the right to prevent Manning from exercising his liberty in this matter. However, I do not see this a positive liberty—that is, no one else has an obligation to provide Manning with the means of exercising this freedom. As such, if Manning has the funds to pay for the process, then the Army should allow him to do so. The same would also apply to civilian prisoners.

One obvious concern is that prisons are sex-segregated. As such a person who has a sex change would complicate matters. Obviously, a person with a sex change should not be kept locked up with those of his or her previous sex. However, there might be legitimate concerns about locking up the person with members of his/her new sex in terms of safety. However, it seems likely that such matters could be addressed with minimal problems. As such, as long as the prisoner can pay for her own operation, then this should be allowed.

The next point of concern is the matter of whether or not the state should pay for hormone therapy and sex-change operations. On the face of it, the answer would seem to be an obvious “no.” However, it does seem worth considering the matter a bit further.

In general, prisoners tend to lack financial resources to pay for their own medical treatment. After all, a typical prisoner will not have a significant source of legal income nor adequate savings to cover major medical expenses. Since letting a prisoner suffer or die simply because she lacks the means to pay for treatment would be wrong (the state has responsibility for those it incarcerates), it certainly seems acceptable for the state to pay for legitimate medical care for prisoners. As such, if a prisoner needs an appendix removed, it seems right for the state to take care of this rather than let the prisoner die. However, if a prisoner is displayed with her breast size and wants implants, then this is hardly a legitimate medical need and hence the state would not be obligated to pay for such surgery—even if the person’s self-image involved large breasts and the person was very upset about not having said breasts. Thus, the general principle would be that the state should provide legitimate and necessary medical care but is not obligated to provide all medical services that prisoners might want.

Assuming that the above is acceptable, the remaining question is whether or not hormone therapy and sex-change surgery are medically necessary procedures (on par with removing an infected appendix) or if they are not (on par with breast implants).

On the face of it, a person who believes that his gender does not match his physical sex is not in a dangerous medical situation. Being a man or a woman is not, it would certainly seem, a life or health threatening situation. Using the example of Private Manning, he will not become ill or die if he remains a man. As such, the state would seem to have no obligation to foot the bill for sex-change operations any more than it is obligated to pay for breast implants or tummy tucks. After all, one’s body not matching one’s self-image is not a serious medical condition.

However, it can be argued that such a situation is a legitimate and serious medical condition. That is, the person’s mental health depends on a sex-change as much as a person’s physical health might depend on having an infected appendix removed. As such, the state should pay for such procedures.

The obvious counter is that if the state is obligated to ensure that prisoners are not suffering from factors that would negatively impact their mental health, then it would seem to follow that the prisoners should not be in prison. After all, prison is intended to be a place of punishment and that is supposed to cause mental duress.

Another obvious counter is that a person who believes their gender does not match her physical sex might be suffering some duress, but it seems odd to claim that this suffering creates a medically necessary situation. That is, that the person must have her sex changed in order to be in good enough health to serve her punishment sentence in prison.

I will freely admit that I do not know the extent of the suffering a person who believes that her sex does not match her gender might experience. If it is the case that this is a medically serious situation that creates a medical necessity on par with other conditions that the state treats, then the state should treat that condition. However, this does not seem to be the case. Thus, while a person has every right to change his sex, there seems to be no legitimate reason why the state should pay the bill for a prisoner to get a sex-change.

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  1. You could at least refer to her by the correct pronoun for her chosen gender. Even the nasty old Daily Mail managed that:

    Second, if you ‘freely admit’ to not knowing the suffering involved, why do you then go on to assert that it doesn’t seem like enough of ‘a medically serious situation’ to generate a right? Surely a question this important should be decided on something more than your uneducated guess.

  2. Prison involves loss of liberty: that is the punishment, not any mental or physical suffering besides that associated with said loss of liberty.

    Prisoners should receive whatever is considered to be standard medical treatment in society as a whole.

    What is defined as “standard medical treatment” depends on historical and cultural circumstances and on the advance of medical technology, etc.

    Medical and surgical procedures and treatments which were unheard of 50 years ago are now considered standard.

    Given that, as far as I know, hormone therapy for transgender people is standard medical treatment in Western democratic societies, Chelsea Manning should be given that treatment during his time in prison.

  3. I’m wondering if this is at bottom some sort of legal subterfuge aimed at ameliorating, the sentence, or getting this, so-called Chelsea Manning, into such secure establishment where his/her desire to alter sex would be taken more seriously and sympathetically. For some reason I seem to smell a rat here.

  4. “I will freely admit that I do not know the extent of the suffering a person who believes that her sex does not match her gender might experience.”

    The comparisons you have made are relatively minor aesthetic alterations – big boobs are just bigger boobs. I think it would be fair to say, that the trauma experienced through not being allowed to have super sized boobs, and just make do with plain ones, is relatively minor. But it is all relative.

    It is generally accepted without controversy that prisons are obliged to provide adequate health care for their prisoners. And not to do so, would be an excessively cruel and unusual punishment. The relative degrees of suffering are significant in themselves. Denying a prisoner a medication, the absence of which will not result in death, but in great pain. Is different from denying the wishes of a prisoner to have bedtime stories read to him by a kind warden, because he says it’s the only way he can get a refreshing sleep. One demand is reasonable to dismiss, the other isn’t.

    As for boob jobs. If a female prisoner demands a boob job on the grounds she’s just not happy with what she’s got, and though there’s nothing particularly wrong with what she has, she’d just like them to be a little bigger. It is reasonable to dismiss her request. However, a slightly different scenario involving boobs. If a female prisoner contracts breast cancer. In the outside world, it is normal to consider nowadays, that the removal of the cancerous tissue, and then best the possible attempt at reconstruction, though two separate procedures, are both essential. If the prisoner contracts breast cancer, but the prison only pays for the first part of the procedure – the removal of cancerous tissue, but then doesn’t want to pay for the reconstruction, which is aesthetic, and the woman is left with horrifyingly disfigured breasts. We are in a completely different territory to the girl who is a little sad because her boobs are more petite than she’d like them to be. The woman who has had cancer, similarly has an aesthetic problem. But a reasonable person might agree that if it is possible to remedy her disfigurement, it is an excessive punishment to deny her this treatment. In this instance there is substance to the superficial.

    What is permissible as punishment for prisoners, has been historically problematic. But in most civilised jurisdictions, excessive punishment is considered a criminal act in itself. But the injustice initially occurs through a peculiar lack of enlightenment on the part of the public – that they engage in an activity that contradicts their own norms and values.

    If for instance, I’m out one evening, taking a walk around my ethnically and socially homogenized American suburb – let’s say I’m neighborhood patrolling, and I’m legally armed, ready to stand my ground. An I find a bunch of neighbourhood kids, in the bushes smoking marijuana, eating skittles and drinking ice tea. If I unholster my pistol and catch them by surprise before they have a chance to run. I don’t execute them on the spot, I decide they need to be taught a lesson. So I lead them back to my SUV, load them in the back, and take out the orange jump suits, chains and manacles I keep in my boot, just for occasions like this. I take them out to the dangerous median of a busy Interstate, and have them pick up pieces of trash for a few hours. When I think they’ve learned their lesson, from a little public humiliation, I get them back in my SUV, we go for some drive-thru as we’re all hungry, fries, burgers and ice cream, and then take each home, and drop them back at their parents’ houses. I bet before I even make it back to my house, the police will be waiting for me. They’ll take me in at gun point. The whole neighborhood will be stunned. They will see me as cruel, evil or insane. The judge will give me a sentence, if he doesn’t have me locked up in a mental asylum. But hey, I’m a nice guy, and I’m not crazy. I just had the kids out for a few hours, it’s not like I locked them up in a dungeon for months, and had them out in chains and manacles every week. Hey, I even bought them ice cream.

    But back to Mike and Chelsea. The parable of the foolish jogger and the wood nymph. One evening Mike is jogging through the woods of Maine. He spies a wood nymph sitting on a log with her back turned to him. He creeps up to her, with the stealth of cat, and lays his hand on her shoulder. She shrieks, leaps twenty feet in the air, and then gently flutters back down onto the log. She looks Mike in the eye, and says “Mike, you have seen me…Humans are not allowed see the nymphs…For my own carelessness I must grant you one wish, what will it be”. Mike ponders this for a moment, and says “You know I’ve always liked big boobs”….”Big boobs it is then” she says, with a smile and a wink, and within a puff of lavender scented fairy dust, she dematerialises, until only her grin remains and then that too is gone. Mike is alone in the forest again, a little puzzled, as to what all this could possibly mean…he feels growing tremours of anxiety as the possibility dawns on him. He peaks down, and behold, his wish has come true, attached to his chest, are two of the most fantastically biggest boobs he’s every seen his life. He checks them with his hands, and yes they are real. Any attempt to remove them leads to excruciating pain. He runs home, in great discomfort, as he has not had time yet to shop for a over sized sports bra. Calls his health insurance company and tells them the story. They check his policy, and what do you know, he’s not covered for boob jobs or acts of nymphs. Since his boobs are so huge, financing their removal out of his own pocket is beyond possible. He’s stuck with them. They’re too huge to conceal – he becomes a sad spectacle, drinking in bars alone – people point and stare….and whisper the tale of his foolishness with the wood nymph.

    Now Mike, you’re in XXX-Super D moccasins. Do you think it would be fair for your insurance company to pay for your boob removal? Even though your breast reduction it could be claimed is for aesthetic reasons – and there should be no direct health consequences should you go the rest of your life with those humongous hooters. Could make a living from them, couldn’t you. Quite a few people would be very happy to pay a dollar to touch em’, wouldn’t they.

    Would it be another sad and cruel twist to far, in the ballad of Chelsea Manning, to deny her what she needs.

  5. Alex Douglas,

    I did think about which pronoun to use, but I was unsure of how the system officially works. Does one use “he” or “she” based on physical sex or based on the person’s claimed gender? So, if Manning a he because Manning is still physically a male or is Manning a she because Manning claims to identity as a woman? As others have claimed, we need a generic gender free pronoun. Do the style and grammar books cover this now?

    I freely admit my ignorance of his internal states, but my argument is that remaining a man does not seem to impose a clear health risk. That is, it will not physically sicken/harm or kill Manning to remain a physical male. Manning was, after all, healthy enough to work his job. As such, there does not seem to be a clear need for the state to pick up the tab for Manning’s therapy. Even if Manning is under mental duress, there does not seem to be enough evidence that the condition is serious enough to count as a medical condition that would obligate other people to pay for Manning’s treatment. As I said, I am fine with Manning getting a sex change-that is Manning’s right. But we only have an obligation to pay for it if it is a matter of medical necessity.

    Now, if it can be shown that a Manning is in legitimate danger from remaining a man, then that would warrant the state paying for Manning’s treatment. As a related point, if this condition is classified as a medical disorder, that runs the risk that it will be taken as a mental disorder that requires Manning to be treated for being confused about Manning’s gender. That is, Manning is sick because Manning is a man who wants to be a physical woman and hence needs to be treated so that Manning accepts that Manning is a man. Treating Manning so that Manning accepts that Manning is a man would seem to be a legitimate treatment for the alleged medical condition. After all, successful treatment of that sort would fix the mental duress. Naturally, classifying such a gender matter as a mental illness that needs to be treated would seem to be rather insulting.

    It might be countered that the proper treatment is giving Manning what Manning wants, that is making Manning into a woman. However, if this is a medical condition it would have to be shown that said procedure is the best method of treatment for the medical defect in Manning. Again, I’m fine with Manning becoming a woman on Manning’s own dime-that is a life choice that Manning should be free to make. But, the state is not obligated to pay for life choices the way it is obligated to pay for legitimate medical treatment to ensure the health of a prisoner.

  6. JMRC,

    Nymphs can’t grant wishes. Plus, I’ve played the wishing game lots of times and know how to win. 🙂

    But you do point to the critical issue (which I raised in the post): is Manning’s need to be a woman a legitimate medical need? If the answer is “yes”, then the state is obligated to pick up the tab. If the answer is “no”, then the state is not obligated to pay the bill.

    Even if Manning has a legitimate medical need, there is still the question of what the treatment should be. In this case, it could be argued that Manning is suffering from some sort of gender confusion disorder that should be treated by leading Manning to accept that Manning is a man. It could also be argued that Manning should be treated by being made into a woman. Since I am not a medical expert on this matter, I cannot say with any authority which sort of treatment approach (“cure” the confusion by reconciliation or alteration) is the medically correct approach. Much would seem to hinge on whether Manning is a confused or mentally ill man in a man’s body or a “genuine” woman in a man’s body. In the first case, treatment would seem to require reconciliation. In the second, treatment would seem to require alteration.

  7. “is Manning’s need to be a woman a legitimate medical need?”
    I am still suspicious of what has been shown to be an untrustworthy person, notwithstanding the rights and wrongs of what he did.

  8. She does seem like an unstable person.

    For example, she joins the U.S. Army in 2007. By 2007 it was very clear that the invasion of Iraq was on false pretensions about non-existent weapons of mass destruction and so for any person who follows the media it was no novelty that it was not a just war.

    Yet Manning, after joining the Army, suddenly is illuminated with the insight that the war is not just and begins to filter sensitive material to Wikileaks. I would not have joined the Army in the first place, but if I had joined it, I suppose I would not have filtered sensitive material, out of (misplaced?) loyalty to the
    institution I belong to, that is, the Army.

    Then she discovers that she is a woman, Chelsea, not Bradley a man. I realize that gender identification is not written in stone and that most of us have masculine and feminine characteristics, if we consider the “normal” stereotypes about what constitutes masculinity and femininity.

    Still, if I were about to go to a male prison, the last thing that I would do is to declare myself a woman or tell people about my “feminine” side. I’d rather brush up on my karate. So it seems rather self-destructive for a “man” to declare him/herself a “woman” before serving time in a male prison.

    Probably, it was also self-destructive to leak the files, since Manning, being in the Army, was bound to be caught and be severely punished, while Assange has become a media star and is protected by the Ecuadorian government.

    So Assange will become a millionaire with book and movie royalties, while Manning digs his own grave several times.

    I feel sorry for her.

  9. Though some might see it as a minor detail in this horribly complex matter, I’m hugely distracted by the linguistic shambles we have got (‘gotten’ for US readers) into here with the sex/gender discussion. However, as encountered in every first-year philosophy class, and many other courses, we really do need to ‘define terms’. As ever, I hope that a diversion into this standard academic routine will help to illuminate the nature of the topic significantly.

    The now widespread blurring of the use – and thus the general understanding – of the words ‘sex’ and ‘gender’ has reached the point where we can no longer express ourselves accurately. (For many years now, even the biomedical research literature has reported on physiological ‘gender differences’ amongst such as the humble lab rat when, quite clearly, ‘sex differences’ were actually the issue.) What a shame it is (or was – the linguistic battle is probably long-since lost) that the very valuable distinction between these words has become so scrambled.

    It seems likely that Chelsea/Bradley Manning is ‘biologically’ (taken crudely) male. We can safely assume the Army entrance medical confirmed his ‘biological’ status as unequivocally male. If so his sex is male. However, for a variety of reasons, Manning now considers her/himself to be female, wishes to live as a female and that others will accept this status. Manning’s reasons could range all the way from major anatomical and hormonal abnormalities (by which I merely mean, having attributes well away from the normal male pattern, where ‘normal’ means merely common or typical) right through to entirely ‘psychological’ (again, taken crudely) determinants. Thus, Manning’s gender is female (assuming we can accept the assertion is honestly made).

    Enlightened cultures are increasingly content to accept that an individual may (is permitted to) assert his or her own gender and to live and act accordingly. Clearly, challenges enough arise in many aspects of the ‘intersex/transgender’ person’s everyday life. But where that person’s gender and sex do not match, interactions with legal processes and other societal formalities still pose an almost insurmountable problem. Manning’s case is at the extreme of such problems.

    At root, our legal and civil processes still assume – and thus insist upon – a binomial division whereby everyone (here one can’t say ‘everybody!) is either male or female. And that’s the problem. A very small percentage of the human race doesn’t fit this binomial description. This is entirely normal – it’s part of humankind’s standard biology, as it is of many other mammalian species. Perhaps the real tragedy is that, despite us by now being well aware of the variety of ‘interse/transgender’ physical and mental situations experienced by some humans, society hasn’t moved the definitions and requirements to match this awareness. Thus, the only ‘fix’ currently entertained for intersex/transgender individuals is to ‘move’ from one of the two two sex labels to the other, as their ‘gender’ is assumed to dictate. This is clearly ‘sexist’. This leaves a very real, yet impossibly difficult ‘middle ground’, for true intersex people. A veritable ‘no-man’s land’ indeed! The social pressures to conform to the societal male or female divide, even within gay-lesbian-transgender ‘communities’, are such that I suspect many intersex individuals feel pushed into a definite gender ‘role’.

    Against this background, the ‘medical’ and ‘psychological’ (taken crudely) issues that Manning faces could hardly be worse. A US Army Prison is surely not the ideal place to work through such matters and hope to reach a satisfactory resolution.

  10. JMRC,
    What a good story! And, of course, now that I know the story, I myself will never say ‘I like big boobs’. Instead I’ll say ‘I’ve always liked a hard body’… well maybe not exactly that word.

    In point of fact, that’s what Chelsie’s problem is: It’s time to man-up, Dearie. You did the crime now do the time unending.

    JMRC, since you’re the best story-teller in the group, do tell the story of Mike running along with Teiresias. How would that story go, if Mike, not Teiresias, happened to interrupt the coupling snakes???

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