The Benefits and Need of Defining through Exclusion

This blog article is in response to an article posted by Mercedes on her blog Dented Blue Mercedes, of which I am an avid follower. I was just going to respond in the comments section, but my post became more of an independent article,so I am posting it here with a link in the comments of Mercedes' article. The specific article I am responding to is titled Rocky Horror and the Holy Grail, or: The problem with Defining to Exclusion.

Mercedes has argued that when marginalized communities define themselves by exclusion it creates problems and as such, from my understanding, these newly emerging communities should instead define themselves through inclusion. While on the surface that solution sounds great and would prevent conflicts like the ones Mercedes mentioned from occurring, it also explicitly prevents a clear definition of the community itself, and thus perpetuates the marginalization of various groups within the community.

To define oneself is to distinguish and articulate how you are different from others. For example, I am a transsexual woman; I am not, and never have identified as, a crossdresser. This distinction is important because to understand who I am and thus understand the concerns and issues that are relevant to me, you must understand that I am not a crossdresser. To try and define the community of which I consider myself part of ,via inclusion to encompass me and crossdressers, is to marginalize the specific concerns of both me and crossdressers alike. We are different; to fail to recognize that difference is to fail to self-identify and thus continue the marginalization. Consider what defines the LGB community, particularly, that this community encompasses all those whose sexual attraction is not confined to the opposite-sex and is thus defined by the fact that they are not heterosexual.

This exclusion criteria is important because the only way a community can be recognized as one that was marginalized and whose rights and equality is something that needs to be safeguarded, is by saying "We are different than you and as such my concerns are not always the same as your concerns". By defining and clearly articulating that difference, or rather that exclusion criteria, the community itself draws attention to the specific needs and concerns that are unique to that community.

Defining yourself through exclusion is a fundamental and necessary fact of human existence. The real concern here is that, when defining yourself through the process of exclusion, these communities must acknowledge that that exclusion does not preclude some shared interests ,and that the exclusion itself does not necessitate conflict.

Having said all that, while defining yourself via exclusion is important in having your individual needs and rights recognized and protected, it is also important to recognize that the needs and rights of other such defined communities may coincide with some of the needs of your community. In those situations, by working together as a unit you can achieve more than you can by working independently. Translated into the specific GRS situation within the trans community, having GRS reinstated is a transsexual concern, not a crossdresser concern, and trying to say differently only creates problem; however the freedom of gender identity and expression is an issue that both transsexuals and crossdressers alike can join forces and fight for. I am not arguing that GRS reenlistment does not have ramifications on the freedom of gender identity and expression. I am simply arguing that enlisting crossdresser support for GRS reenlistment only serves to inflame the differences between the two distinct communities, and perhaps a better solution would be for the transsexual community to enlist the help of the crossdressing community to enshrine the freedom of gender identity and expression, without attaching GRS reenlistment to the agenda. Then the transsexual community, buoyed by the enshrinement of gender identity and expression can have better expected outcomes on the issue of GRS reenlistment.

Cosmetic or Not?

In Alberta, Gender Reassignment Surgery (GRS) has been talked about in most households across the province (and to a lesser extent) across Canada. Whether people are upset that it was funded in the first place, or upset that the Government removed funding, most everyone has an opinion on the matter.

Ultimately the decision on whether or not GRS should be funded will be resolved by the Human Rights Commission. Given the Hogan V. Ontario decision in 2006, the outcome is largely pre-determined, despite the fact that Lindsay Blackett's (Community and Culture Minister) opinion that "redneck" Albertans who are on the commission here will rule in the Governments favor. I have done my part to try and convince the Government the extreme foolishness of their actions and have been largely ignored, lied to, and misled, by the PC caucus. They refused to listen to sound reason, and logical arguments, so the Government, and by proxy the taxpayers of this province will pay a hefty price in legal costs along the way, fighting a battle they cannot win.

However, I feel I am digressing slightly. I am now talking to "Joe the Plumber" since that apparently represents the conservative mind in North America. An argument that is made time and time again is

"Why should cosmetic surgery be funded by the taxpayer? I can't get breast implants on the taxpayer dime, why should transsexuals get their surgery funded."

While this would be a perfectly sound argument, the premise on which it is founded is totally and completely false, and therefore, the argument is almost childlike. Since logic is not based on emotion, and opinion has no bearing on this matter, let me use facts that require little to no knowledge of GRS and are devoid of influence by my opinion, to completely debunk this argument and lay it to rest for the rest of eternity.

First of all, while all cosmetic surgery is plastic surgery, all plastic surgery is NOT cosmetic. Let me explain. According to Wiki, which we all know can NEVER be wrong **heavy sarcasm** but is fairly accurate in most cases, and unless proven false, we can proceed with it being an authoritative source on these fairly basic facts. Wiki says,

"Cosmetic Surgery and Reconstructive Surgery are two fields that comprise the medical specialty of Plastic Surgery."

Wiki further defines cosmetic surgery as,

"Aesthetic Cosmetic Surgery is defined as an autonomous and independent specialty of surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal."

http://en.wikipedia.org/wiki/Plastic_surgery#Cosmetic_surgery

So cosmetic surgery fits into one of three categories,

1. Maintaining normal appearance - GRS is clearly not this as the appearance was never normal to begin with and "Maintaining" is certainly not a word that would fit when describing what GRS is.
2. Restoring it (normal appearance) - GRS clearly does not "restore" normal appearance, again in order to "Restore" something, you must have "had" it in the first place. And for Transsexuals, they have never had the genitalia the surgery is creating. Clearly not restoring it.
3. Enhancing it beyond the average level toward some aesthetic ideal - GRS is clearly not about improving the appearance of our vagina's to some aesthetic ideal. Again in order to improve, transsexuals would had to have had one in the first place. Clearly not applicable.

Since regardless of what personal knowledge you may have about why GRS is performed, simple logic proves that GRS clearly does not fit into the definition of cosmetic surgery. To continue with this argument represents a fundamental lack of understanding of what cosmetic surgery is, and as such is childlike at best. Regardless of your opinion on GRS and any knowledge you may have as to why it is done, it is fairly easy to understand that taking a penis and creating a vagina (or vice versa) does not fit the definition of Cosmetic Surgery in any way shape or form.

So for those of you that actually would like to know what GRS is, let me continue. For those of you that want to hide from knowledge in order to justify your ignorance, thank you for your time, and please stop repeating the same argument over and over again. Consider it officially refuted.

So what is GRS then? Could it be Reconstructive Surgery? Wiki tells us

"Reconstructive Plastic Surgery is performed to correct functional impairments caused by: ... developmental abnormalities ... Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearace"

http://en.wikipedia.org/wiki/Plastic_surgery#Reconstructive_plastic_surgery

So with that knowledge, lets explore why GRS is performed. To correct gender impairment between the physical body and the brain caused by developmental abnormalities that resulted in the wrong genitalia being developed by the body. It is performed to improve the function of genitalia for the patient and to approximate a normal appearance of the genitalia. Clearly this fits into the reconstructive surgery branch of the the plastic surgery family.

While I understand that Wiki is not "gospel" and can be less then accurate at times, unless the definitions of cosmetic surgery, or reconstructive surgery are radically different then what is stated on Wiki, the arguments are still 100% valid. And as such the question on whether or not to fund the surgery needs to be based on the same criteria that guides the decision on whether or not to fund other reconstructive surgery. Since Alberta has had a long standing record of funding GRS, and most every other reconstructive surgery, to pick one particular surgery, that affects such a small number of people in such a life altering way for a mere 19 pennies per Albertan, is tantamount to cruel and unusual punishment.

Open letter to all MLA's in Alberta.

Hello, I have recently been informed that the budget for 2009 has removed funding for Gender Reassignment Surgery (GRS). I am writing this letter to have several questions answered. If you could please take the time to respond to each question it would greatly help.

First, the Alberta Government is required to fund medically necessary procedures. The general consensus in the medical community in North America is that this procedure is a medical necessity to promote the the long term mental, and physical health of a patient who has Gender Identity Disorder (GID) The Ontario Provincial Government was recently forced to re-list GRS as a covered procedure due to a class-action lawsuit. BC recently re-listed it a medical necessity as well.

• In light of the Alberta Government's duties as defined under the Canada Health Act, what is the justification you are using to deny funding for this surgery?

Second, the Calgary Herald reported that denying funding for transsexual patients for GRS will save $700,000 per year. Let me explain some of the medical ramifications of this before I get to my question. Transsexuals undergo Hormone Replacement Therapy as part of the treatment. This produces secondary characteristics to better align the patient appearance with their gender identity. With Male to Female patients, this allows a re-distribution of fat to the hips and buttocks, reduces the upper body muscles, starts breast development, reduces and softens overall body hair, prevents the progression of male pattern baldness, and many other items that in concert create a female image. Most of these changes will revert without Hormone Replacement Therapy (HRT) with the most notable exception being breast development. Before surgery a higher dosage of hormones are required because the natural production of testosterone needs to be suppressed and estrogen needs to be introduced. After surgery the testicles are removed with allows a much lower dosage due to the drastic reduction in the body's overall production of testosterone. Prolonged HRT without surgery will eventually lead to liver problems and other associated issue. Denying funding requires patients to spend much longer on HRT before surgery as they need to save up the minimum $20,000 required. This produces medical problems that Alberta Health Care will be paying for. The suicide rate among pre-operative transsexuals is documented at 3 times the national average. Due to the many failed attempts this would undoubtedly involve, it is common sense to see a drain on the Health Care System due to those attempts.

• What are the projections for the secondary expenses that Alberta Health Care will be encountering due to the denial of surgery funding?
• What is the ultimate savings/or cost with denying this surgery.
• If those projections have not been done, Why have they not been done?

Third, as I have already mentioned the suicide rate among pre-operative transsexuals is 3 times the national average, whereas the suicide rate among post-operative transsexuals is lower then the national average. The denial of funding will result in the deaths of Albertans.

• What studies has the Alberta Government done to examine the cost of human life this policy will create?
• If no such study has been done, how can you deny the funding for GRS when you don't even understand the ramifications for denying that funding. Why has no study been done?
• What dollar value is the Alberta Government willing to spend to save a single life? How many lives need to be saved per $100,000 in order to justify treatment?

Fourth, on or about November 19th, 2008, Mr. Blackett responded to a question by Ms. Notley with the following:

Mr. Blackett: Well, you know what, Mr. Speaker? In our party we have one native, we have four Sikhs, we have two Chinese, we have two Caribbean, and we have somebody from the Philippines. We understand diversity. We understand it for all. We have a multicultural education fund that goes out and helps educate. We fund organizations, including gay, lesbian, transsexual, transgendered individuals, on education of their rights and promoting equality for all Albertans.

If it is your governments stance that you wish to fund organizations that include gay, lesbian, transsexual, and transgendered individuals and wish to promote their rights and equality among all Albertans then

• How do you believe that denying this funding will impact your governments declared dedication to the promotion of equality for transsexual people?
• What message is being sent to Albertans about the basic rights of transsexuals?
• Many will see this as a justification to discriminate against transsexuals. What secondary impact has been considered as a result of this action by the government?
  

Fifth, transsexuals cannot change the gender marker on government issued ID without having the surgery performed. This includes Drivers License, Social Insurance Card, Birth Certificate to name a few. These items of identification are required to function within our society. Since your government requires that the surgery be performed to have your ID reflect your gender, does that not make the surgery a requirement imposed by this government?

• How can the government require that a medical procedure be performed and yet not fund that medical procedure?
• How can the government state that a medical procedure is elective, yet require it's completion?

Sixth, the total budget for Health Care in Alberta is Almost 13 billion. The $700,000 per year that is paid for GRS, amounts to 1/18000 of the budget, or approximately 0.00005% or a 200th of 1 percent. This represents 19 cents for every man woman and child in Alberta. I am including 19 pennies in this letter to show my commitment as an Albertan to shoulder the cost of this surgery for the betterment of our province.

• I want to know whether you intend on specifically fighting the de-list of GRS as a funded procedure.
  
• If you do intend on challenging it, I want to know what you specifically intend on doing.
• If you do not intend on challenging it, I want to know your specific reasons why you refuse to.

I as a resident of the province of Alberta I expect a personal response to each of these questions. I thank you in advance for you time and attention to this matter.