Evidence, Equipoise, Expertise, and Trans Health

Abstract: Recent U.S. state and federal policymaking has taken aim at the health of transgender and gender diverse people and their social inclusion. This panel critically evaluates the ways that these policies draw upon antagonistic reinterpretations of familiar concepts in bioethics (such as informed consent) to legitimize radical change via the logic of “common sense.” The first panelist, a historian of medicine and bioethics, historicizes standards of care in transgender medicine, paying special attention to how these actions draw upon and call for supporting scientific evidence. The second panelist, a public health ethicist, situates these policies in an international context, offering the UK’s Cass Review as a comparative touchstone for interpreting the “evidence-based” turn against access to gender-affirming care in the U.S. The third panelist, a health services researcher, considers transgender community critiques of biomedical authority over identity and access to care, exploring the ways that community ambivalence about scientific medicine has led to the elevation of different kinds of evidence. The final panelist, an STS scholar and bioethicist, takes stock of the contrast between attacks on transgender rights and inclusion and the quotidian scientific methods by which they are carried out: literature reviews, calls for evidence development, and appeals to common understanding. Together, this panel surfaces the logics by which transgender exclusion has been legitimized in the public sphere. More broadly, we point to how bioethical analysis must carefully consider how seemingly common sensical appeals for further evidence can undermine health equity and social justice.

Keywords: Gender-affirming care, Health policy