Convicted murderer wants taxpayer-financed sex change.
February 3, 2002 11:53 AM   Subscribe

Convicted murderer wants taxpayer-financed sex change. "Hill & Barlow, the law firm appointed by the court to represent Kosilek, said in a statement: 'The case raises important constitutional issues about medical treatment for prisoners.'" When fourteen percent of the population doesn't have health insurance at all, is there any legitimate reason to expect the government to pay for this?
posted by mr_crash_davis (24 comments total)
"Bias - which is not based on medical information - should not trump a prisoner's access to appropriate health care"

Oh, Lord. Hand me an axe and I'll take care of this pathetic loser's "problem" real quick and easy like.
posted by owillis at 11:58 AM on February 3, 2002

owillis - I couldn't agree with you more.

"The universal prescribed treatment involves psychotherapy, hormone therapy, and surgical correction of the offending genitalia," he said in court documents.

I know an arborist that can handle this correction. Then again, he strangled his wife. Maybe we could just strangle it off.
posted by treywhit at 12:13 PM on February 3, 2002

these are the kinds of things that make me sad transexuals have slipped into what some people consider the "gay community"

they are almost opposites. gay people only want liberty to act as they want to, not hurting other people, we see ourselves as just fine as we are. transexuals on the other hand feel they are broken, or in the wrong body and need to be changed. they say they need "treatment" this idea should be abhorrent to the gay community, we are too inclusive.
posted by rhyax at 12:26 PM on February 3, 2002

I'd be more concerned by the fact that 14% of Americans are not covered by medical insurance. For the richest country in the world, this is a disgrace.
posted by salmacis at 12:30 PM on February 3, 2002

rhyax - why should this idea be *abhorrent*? accepting other people is abhorrent? yeah, that's the idea, completely disenfranchise people who already feel like they are broken simply because they don't feel the same way about their sexuality that you do. that'd be very productive.

saying "the gay community has become too inclusive" is abhorrent to *me*.
posted by pikachulolita at 12:44 PM on February 3, 2002

For the sake of discussion, let's seperate out the strands of any potential discussion:

1. Should criminals have access to health care greater than that of many law abiding tax paying citizens? Why or why not?

2. Is sex reassignment surgery a form of health care? If so, why should it be denied to those who would "require" it under accepted standards of medical treatment?

3. Why are 45 million Americans (a common figure quoted in many news reports on the issue) without health insurance? How can this be remedied? And how would the considerable health care lobby be dealt with?

4. Are transgender individuals part of the gay community? Why or why not?

While 4 was brought up in a couple of posts, I would argue that 1, 2 and 3 are the real issues in the posting, but each on its own is a potential maelstrom of discussion.
posted by ltracey at 12:56 PM on February 3, 2002

Ridiculous. If people want to practice the self-mutilation that 'sex-change' (gelding) entails, then they are free to do so if they have the means.

But under no circumstances should public monies be used to fund said act. Medical treatment should only be provided if the prisoner's life or health is in duress. It sounds as if this prisoner needs psychological treatment rather than expensive emasculation. But I don't want to pay for that, either, when I can't even afford therapy for myself.

As for the 'gay community' thing:

I do not want to be, and am not, any part of any 'gay community'. Or, for that matter, any 'G/L/B/TS/TG...' community. I will accept no community affiliation save the human community, the American community, and the local community where I reside, expecting all the rights and privileges thereof.
posted by evanizer at 1:05 PM on February 3, 2002

According to an (unrelated) article in the SF Chronicle, California prisons are currently providing "feminization hormones for 35 transsexuals."
posted by G_Ask at 1:56 PM on February 3, 2002

Following ltracey’s suggestion:

I don’t believe that criminals should have access to better health care but it appears that they do.

What is the definition of health? How about freedom from physical disease? That seems fair to me and excludes physical alterations such as sex reassignment, breast/penis enlargement, and liposuction.

I’ve been with and without health insurance. I’ve had insurance while employed. And didn’t when unemployed and without access to affordable coverage and a means maintain payments. The remedy from my experience? 100% employment or national health care.

I would think that transgender individuals would only be part of the gay community should their lifestyle dictate. For example, this prisoner gets a sex change from male to female and then takes a female lover.
posted by treywhit at 1:59 PM on February 3, 2002

Playing Devil's Advocate....well, just for the hell of it.

I'd just point out there is an argument to be made for the individual's position. As the state is, for better of for worse, denying his (insofar as this is the proper pronoun) freedom to have any sort of health care on his own, and bears an element of responsible in the general health care of its inmates.

Now, certainly the first assumption (mine as well) is that prisoners have rights to "legitimate" health care, but that this is a luxury/choice/deviance/takeyourpick and thus should not be covered. But I see nothing wrong with, at the least, identifying his situation as a legitimate medical condition, and under consideration for coverage. It (to my knowledge) stems from a disconnect between the brain and the body as to which gender "they" are. Which doesn't fall under the heading of conscious choice, necessarily, nor under the heading of lifestyle (which I assume is what sets it apart from L/G/B: the necessity of medical intervention).

(Lifestyle has become a bit of a loaded term, but I couldn't think of a better one)

The question becomes, then, what about transsexualism disqualifies it from coverage?

I think I would point to two issues that set it apart from many or most medical conditions. An argument might be made that this was not something that popped up in prison, and as he could've done it before committing a crime, he loses claim to state-funded intervention. There is a further argument to be made that this is an inherent condition that poses no immediate threat to his health, and the state should not be in the business of, to put it rather bluntly, "fixing" the human body beyond its "natural" limitation. It should engage its energies only when the body begins to "break down", to continue to mechanistic analogy.

As for the fourteen percent with no insurance, that's a tragedy to be sure, but I'm not sure it's terribly relevant.

I will personally plead ignorant to the whole thing, and go back to watching the Cambria list be trod upon.
posted by apostasy at 2:08 PM on February 3, 2002

No, I don't think we should be paying for this. The way I see it, she's basically asking for cosmetic surgery. If gender dissonance is a disease, then she's being treated for it with therapy and hormone replacement. Sex reassignment surgery is an elective part of that process- especially for someone who is constrained by the penal system from having normal sexual relations. We don't give prisoners nose jobs or breast implants to make them feel better, why should we pay for sex reassignment?

Aside from that, we're talking about someone who (even with surgery and hormones) has the same muscle mass and strength of a man- a man who committed a violent crime against a woman. If she has this surgery, then she can't very well stay in the general population of a men's penitentiary, but it also doesn't make sense to send her to a women's penitentiary. So where do we put her?
posted by headspace at 2:12 PM on February 3, 2002

I can't see how people can have a problem with prison healthcare in general. I guess there's two ways to think about it, split the populace into two groups criminals and non-criminals. Assume the former to be the personification of everything you hate. Now form an opinion about them.

A more pragmatic approach would be to realize that there's a chance that something you do in the future may land you in prison. That means you're not working, and that the health services you can get are the ones handed to you by the state. I'd rather not come out of jail sick or spend my time there suffering from an illness because the popular assumption is to have a vengeful attitude toward all prisoners regardless of what they've done wrong. Everyone is a child molester or a murderer to them.

Worse, its pretty shameful to pick a major failing in the world's richest country, lack of national health insurance, and use it as a reasonable defense against anything.
posted by skallas at 2:34 PM on February 3, 2002

What if he wasn't a convicted felon and he wanted Medicaid (Medicare?) to cover this? Personally, I have no problem with my tax cents including this coverage. We already provide hormonal treatment/drugs, psychological counseling and (for lack of better/correct term) appendage alteration to people without private insurance. I don't see the combination of these when used for gender reassignment as any less worthy.
Of course, he is a convicted felon. Although he doesn't deserve better treatment for being incarcerated, if these procedures were made available to those who warranted it (non-prisoners, that is), then yes, I think it's a valid argument for him to request it, as well.
posted by G_Ask at 2:34 PM on February 3, 2002

As the state is, for better of for worse, denying his (insofar as this is the proper pronoun) freedom to have any sort of health care on his own,

Uh, lets be accurate -- the state may be holding the key, but the state is not the reason that the prison is denied freedom to seek their own health care. The prisoner made that choice when s/he committed the crime for which s/he is currently incarcerated.

I'd be in favour of state-paid gender reassignments for convicts if it were something typically covered by state-provided health coverage, aka medicaid. Convicts should not be allowed a higher standard of care than the impoverished. But to my knowledge, there isn't a state anywhere which gives sex changes to the poor for free, so I think Mr. Kosilek will just have to wait.

According to an (unrelated) article in the SF Chronicle, California prisons are currently providing "feminization hormones for 35 transsexuals."

I wonder if the state of California is also providing hormone replacement therapy for the thousands of menopausal women who are currently incarcerated in the state.
posted by Dreama at 2:37 PM on February 3, 2002

Uh, lets be accurate -- the state may be holding the key, but the state is not the reason that the prison is denied freedom to seek their own health care.

This is what "for better or for worse" was aimed at. While the state has a perfectly legitimate reason for keeping him locked up, he couldn't head to the local wellness center to, say, get that pesky femoral artery patched up before he's deflates. Which puts on the state at least some responsibility for his health. Certainly no implication of his "oppression by the state" or something of the sort was intended.
posted by apostasy at 2:46 PM on February 3, 2002

My beef with this whole lawsuit can be boiled down to one point. I pay two-hundred dollars (give or take) for health care coverage for my family per month (and that's a bargain in today's market), and "gender reassignment" is specifically excluded from coverage, as is birth control, facelifts and other "cosmetic" surgery, liposuction, and a host of other surgeries deemed "elective". I'm a law-abiding, taxpaying citizen, and if I, for whatever reason, came to realize that I was actually a woman I would have to raise the money for my sex-change operation because my insurance would deny it.

This person murdered another human being for "spilling boiling tea" in his lap, and yet he wants the taxpayers of his state to pay for something that I, a person whose most egregious trespasses against the law are speeding tickets, cannot have unless I can come up with the money on my own.

I have no problem with providing basic health care to inmates. I believe it should be a fundamental right in our society, and it sickens me that so many of our citizens are going without. However, I think that under the current structure of our system, gender reassignment is a luxury, and should be denied to incarcerated criminals. I don't feel it's right to ask the taxpayers of Massachusetts for sex changes, orthodontics, tattoo removal, nose jobs, or anything else beyond what's necessary to keep a prisoner alive and physically healthy.

posted by mr_crash_davis at 3:05 PM on February 3, 2002

i should clarify my position more. i would certainly not curtail anyone's desire to get a sex change, and (although i don't really know) i would be willing to accept that there are people who this procedure would actually help. what i do have a problem with is all the people being piled into the GBILT umbrella. we are fighting for something and it confuses the point to have so many, not very similiar views expressed together.

An example, i support election reform, and i support public sex education. I don't think these two things should be organized together because they are not similiar, it just doesn't make sense. if there is a fiasco in the election reform community it should not adversly affect the sex education community. also to join them confuses the point to people that may be either anti-sex edu, or anti-election reform.

As a more direct example, do i think intersexed people have issues that should be addressed? yes i do. but i think these are almost completely non-overlapping issues than those that face the gay community, yet they are piled together. gay people face mainly social problems while intersexed people need a change in the medical community, and in how the medical condition is treated and/or viewed.

To lump them all together to me seems to me like we have accepted an outside sterotypical view, "all "sexual-deviants' will line up here please" we're not all the same, and people need to see that diversity. It feels to me like we're allowing people outside to group us, like calling all hispanic people mexicans, or asians chinese. it's innaccurate. there are fundamental differences that i think grouping into GBILT obscures.
posted by rhyax at 3:41 PM on February 3, 2002

Good points rhyax. A parallel can be drawn between the current trend to lump all 'sexual minorities' together and the 'anti-globalization' movement. Whenever I see one of these protests, everyone seems to be against everything. There are all manner of 'causes' there, and as a result, it becomes an irritating and ineffectual cacophony of gripes and petty grievances. All real, reasoned dissent and opinion is lost in the shuffle to diversify. It becomes a big smear of 'NotocorporationsscrewtheWTOfreeMumiawehateStarbuckssavethewhalesstoppthewar' silliness, and encourages people, who may otherwise be interested in hearing about a specific issue, to just ignore it.

Thus the similarity to the 'gay community': any serious consideration of the issues affecting us is lost in the diversity shuffle.

I see the case of this prisoner as nothing to do with gay rights or even 'transgender' rights. It is an issue of prisoner's rights. And prisoners, having willfully broken our social contract, have relinquished their rights as citizens. They have not relinquished their rights as humans (usually), but they do not deserve subsidies that the average citizen does not have, or would dream of asking for.
posted by evanizer at 4:15 PM on February 3, 2002

"or would not dream of asking for." should read the last line.
posted by evanizer at 4:18 PM on February 3, 2002

I don't feel it's right to ask the taxpayers of Massachusetts for...anything else beyond what's necessary to keep a prisoner alive and physically healthy.

So the crux seems to be the definition of "alive and physically healthy." Is mental health included? If so, does severe depression with gender issues at root count? If not, why?

My gut certainly tells me this request is nonsense. Just want to be sure it's not the bean dip talking.

but they do not deserve subsidies that the average citizen does not have

The problem with this is the criminal has had certain basic rights taken away (justly), and by definition the state has to provide a certain level of subsidies. I'm pretty average, and the state doesn't give me free room and board, but the situation demands that the criminals receive a subsidy that I don't have (at the cost of their liberty, of course).

Shoud the criminal be entitled only to that which any citizen could get, regardless of their economic situation (emergency medical care, basic nourishment)? Are they entitled to a basic "quality of life", regardless of what citizens w/out health care can receive? Where is the cut-off? As above, "alive and physically healthy" is pretty ambiguous.
posted by apostasy at 5:21 PM on February 3, 2002

"''alive and physically healthy' is pretty ambiguous."

I respectfully disagree. Alive and physically healthy is a clear and concise description. Any second-year medical student could examine a person and determine whether he meets this standard.

As for mental health care, those inmates who need it should have access to counseling and whatever medications are proscribed for their conditions, which is a damn sight more than the average citizen can hope to receive. If an inmate afflicted with "depression due to gender issues" feels it's necessary for his personal well-being to have a sex-change, let him do it when he gets out, on his own dime, the same as any law-abiding taxpayer.

Oh, that's right, this person is in for life. Tough. He gave up his right to the pursuit of happiness (and that's what this is all about, isn't it?) when he strangled his wife. The approximately $37,000 that belongs to the taxpayers of the commonwealth of Massachusetts would be better spent elsewhere. This person has forfeited his claim to any of it, beyond what it takes to keep him alive and healthy for the duration of his sentence.

However, should the majority of insurance carriers reverse their policies and begin to provide gender reassignment as basic coverage, I would have no problem with revisiting this debate. But until it's a commonly-accepted practice to provide this service to law-abiding taxpayers (there's that phrase again), then I believe it should be off-limits to prisoners. I'm simply annoyed that prison inmates somehow believe they're entitled to more than Joe Sixpack is.
posted by mr_crash_davis at 8:00 PM on February 3, 2002

Any second-year medical student could examine a person and determine whether he meets this standard

Granted (mostly). The sentence should have read something more like "what is a criminal entitled to beyond life and the very basics of health". Should mental health be included, and to what extent? And where is the threshold set between issues of necessary physical health and luxury physical health? Should they be eligible for organ transplantation, which is often necessary to remain alive, or is this a luxury they don't deserve?

Just to reiterate, I don't support his request, I just want to see these issues fleshed out. If it turns out to be necessary for his mental health (and not his pursuit of happiness), would we consider it acceptable? I suspect not. Personally, as above, I don't think the state should be in the business of subsidizing what amounts to a "correction"; at least not for criminals. Even if it were commonly accepted by HMOs, etc., I don't think I'd support it.

(Note: I've used "broken" and "correction" to describe the condition so far. Not really the tone I want; just not sure how better to get my point across.)
posted by apostasy at 8:40 PM on February 3, 2002

I hear you, apostasy. I'm having a hard time coming up with the terms I'm looking for, as well.

You mention organ transplants, and I have a really hard time with that. On one hand, I consider the fate of an inmate who will, at some point, be released back into society, and I feel like that person deserves every chance to reintegrate, and they can't very well have that chance if they die of a preventable disease before reaching that point. On the other hand, there's the person who's going to spend every second of the rest of his life behind bars. What are we as a society gaining by prolonging that person's life? Indeed, what are we giving that person by keeping him alive to be locked up for another ten, twenty, or fifty years?

I'm afraid these kinds of questions are for people with a greater capacity for ethical reasoning than I possess. I feel like the greater good of our social fabric is advanced by giving that organ to a person who has a chance at becoming a productive citizen, and not to a person who will live out their days within the walls of a prison. It's my feeling that anyone serving a life sentence has lost their opportunity to be a member of a civilized nation and all the benefits that go with that status. I could be wrong, but dammit, I have to draw a line somewhere, and for me this is that place.
posted by mr_crash_davis at 8:59 PM on February 3, 2002

I'm afraid these kinds of questions are for people with a greater capacity for ethical reasoning than I possess.

Myself as well. Part of the reasoning I'm drawn to questions of ethics, actually. On a scale of mind-bending complexity it falls slightly below quantum physics and above Britney's Boobs. It's also why I'm drawn to philosophy in general. In philosophy all we really have to do is come up with the questions. The answers, the implementations, we'll leave those to those sciencey guys. They're good with their hands; they'll know what to do.

This is the problem with this case: for all my poking and proding at unanswered questions, a decision still has to be made and we don't have the luxury of waiting until all of ethics fits into a neat framework that satisfies everyone. I think that I don't think that inmates should get transplantations unless there are enough to go around. And yet, do we want to be a culture that decides who gets a life-saving procedure based on how much they have to offer to society? Certainly if we applied that principle outside of the prison we'd be real uncomfortable with it. It's enough to drive a man to drink...

I do love it when I formulate groundbreakingly great ideas.

"If you're studying geology, which is all facts, as soon as you get out of school you forget it all... but philosophy, you remember just enough to screw you up for the rest of your life."
--Steve Martin
posted by apostasy at 9:20 PM on February 3, 2002

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