Comment by willurd | Hacker News Reader

Comment by willurd | Hacker News Reader

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While I agree in principal that people should have questioned Dani about his/her decision, it is hardly their responsibility to do so in this situation, and least of all the responsibility of the "medical folks" at any stage. The only exception would be a doctor you've asked for a consultation on whether it's a good idea medically, or a psychologist on whether it's a good idea psychologically (more relevant here).

I think one can assume that at the level of this type of irreversible decision, said decision maker has thought long and hard about whether to "reassign their gender" and come to the conclusion most suitable for their own lives. At this point, it's only appropriate for close friends and family to perform a last questioning of sorts before the decision is sought through. I mean, there is a point at which you must make the switch from being skeptical of a situation to being accepting of the situation, or you must exit the situation (burn the bridge, etc). The point of acceptance after healthy skepticism is due to the fact that everyone's life is different, and there is no one-size-fits-all solution to any problem. The real trick is figuring out when and how to make that switch.

it is hardly their responsibility to do so in this situation, and least of all the responsibility of the "medical folks" at any stage

It is always the responsibility of a doctor/nurse to ensure that a procedure is best for the recipient. That's the essence of the Hippocratic Oath.

"Gender reassignment" is an elective surgery. For a physician who performs such a surgery, how does she choose whether it's a good idea or a bad idea for a certain patient? And keep in mind this particular patient had no negative physical side effects. She only regretted it. This leads me to believe that a physician who performs such a surgery will unquestioningly perform it for all who ask, unless there are serious medical concerns, which there were not in this case.

Also, the Hippocratic Oath says nothing of elective surgery. For a normal surgery, sure, the onus is on the physician to decide whether it's best. For elective surgery, the physician's duty is to decide whether it's medically OK. Otherwise, we'd have physicians picking and choosing who gets what elective surgery for reasons unknown.

And note, I'm personally against elective surgery, but it exists and it's legal. Someone who wants it should be able to get it without being told NO by a physician who performs such surgeries because they don't think it's a good idea for that particular patient (unless, as I said, it's a medical concern). Leave the psychology to the psychologists.

> "Gender reassignment" is an elective surgery

Both the AMA and APA consider it medically indicated in certain cases. In these cases, the patient has the choice of whether or not to pursue these options as part of their treatment, but it is not considered an elective surgery for giggles, but rather a treatment option for medical reasons.

For liability reasons, most doctors do not perform the surgery on a walk in and have it happen basis. There's a set of guidelines that have been promulgated that are used by internationally by most doctors in their professional practice. These guidelines aren't binding on anyone, but have become accepted enough that most medical professionals working with people in this situation view them as standard practice for this procedure and follow them.

> Also, the Hippocratic Oath says nothing of elective surgery

There is no distinction as far as the Hippocratic Oath is concerned. Elective or not, a surgery is a doctor performing services as a doctor and I would find it odd to assume their oaths suddenly wouldn't apply.

> Leave the psychology to the psychologists.

Current practice mostly does, in that doctors generally only do these procedures after they've been recommended by a set of psychologists or psychiatrists after evaluation. (Usually two are required, at least one must be a doctoral level practitioner.) Almost every doctor also does their own brief check and conversation just to make sure they come to a similar conclusion and add their own confirmation.

Very interesting, thanks for the feedback/corrections. I find it especially interesting that gender reassignment surgery isn't always considered elective, but having your wisdom teeth removed is. Any links to information on how the decision, of whether it is considered elective or not for any given situation, is made?

> isn't always considered elective, but having your wisdom teeth removed is

Wisdom teeth removal isn't always considered elective either. Wisdom teeth removal is considered a medically necessary procedure by my insurance company and is covered.

> Any links to information on how the decision, of whether it is considered elective or not for any given situation, is made?

In the US system, generally each insurance company has their own policies on how they judge things and what they cover. Often depending on how your plan is written, slightly different sets of policies will kick in.

Insurance coverage in the US doesn't always directly correlate with what medical professionals in that field would declare as elective or not.

It is, of course, also extremely common for insurance companies to declare that genital reassignment surgery is elective, despite AMA and APA resolutions which declare otherwise.

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