Tuesday, May 15, 2012

Crossing Over: Treatment Rights of Transgendered Prisoners



Over on Clinical Psychiatry News I've put up a column on the evolving treatment rights for prisoners with gender identity disorder.

In the CPN post I cover about thirty years worth of changes in prison policies and standards, up to where we are today: individual inmates suing prisons to provide sex reassignment surgery. So far no inmate has ever been given surgery, but at this point it's just a matter of time.

I think the topic is interesting in part because it traces out how correctional standards of care develop: first the courts decide if a condition "counts" as a serious medical or mental health disorder that mandates treatment, then over time an accumulation of individual cases carve out the boundaries and limitations of that care.

So why aren't doctors the people deciding this instead of judges?

Well, they are to an extent. The institutional clinician assesses the condition and makes a determination of treatment needs. Outside clinicians acting as court consultants or correctional experts offer opinions about what the standard of care should be, and professional organizations also weigh in. Courts take in all of this information, weigh it against the interests of the facility, and issues an opinion about whether or not there is a constitutional right to treatment.

This is the same process that took place in the 90's when protease inhibitors were invented to treat HIV. Correctional facilities initially balked at giving the meds because of the cost, but now this is standard and accepted.

Feel free to post questions or comments in either place (CPN or Shrink Rap).