AMA Votes on Transgender Rights, Capital Punishment

The AMA House of Delegates approved a report by its Board of Trustees that supports the right of transgender individuals to change the designation of their sex on their birth certificate without requiring sex-reassignment surgery.

The vote by the delegates at the AMA’s annual policymaking meeting in Chicago last month attracted publicity in lay publications. Many states require sex-reassignment surgery in order to change the designation on a birth certificate.

Some delegates opposed to the report argued that birth certificates were a matter for state regulation and that sex designations should be reserved for epidemiologic purposes. But the report was approved easily, with many physicians testifying that current best medical practice does not require sex-reassignment surgery for transgender patients and that appropriate gender identification can be achieved via psychological and hormonal treatment alone—a decision that is made between the patient and physician. It was further noted that a birth certificate is rarely, if ever, used for the determination of medical treatment for patients.

“Medically appropriate treatment for transgender individuals includes mental health care, social transition, hormone therapy, and—sometimes but not always—sex-reassignment surgery,” said Barry Wall, M.D., a member of the Section Council on Psychiatry, in testimony about the report during reference committee hearings.

“The correct course of treatment should consist of individualized decisions made between the treating physician and the patient. Such persons need to live authentically to achieve genuine and lasting comfort with their gender. To live in the real world, obtaining accurate birth certificates is a necessity,” he noted. “These days, they are used widely to determine employment eligibility, and for driver’s licenses, Social Security cards, passports, proving age, and enrolling in government programs, including medical insurance. It is therefore important for such persons to get an accurate birth certificate to live their lives, even when their journey does not require undergoing surgery or accepting sterilization as a part of transition.”

In other high-profile news, AMA reaffirmed already-adopted policies prohibiting a physician’s involvement in capital punishment. That action was taken by the House of Delegates after rejecting a resolution that would have requested all states to cease the execution of prisoners until problems with medicalized executions are solved or a nonmedical model of execution that is neither cruel nor unusual is adopted.

Those testifying against this resolution stated that the AMA already has policies prohibiting a physician’s involvement in capital punishment. “AMA has policies that address medical issues associated with the death penalty,” Wall said, testifying again. “We have a policy opposing physician participation in execution, and we have a policy against trying to make physicians participate in executions, as well as against attempts to hide the identity of physicians participating in execution. Psychiatrists involved in correctional mental health systems know the weaknesses of the current capital sentencing process, including for [people who are mentally ill or] developmentally disabled. Treating inmates on death row raises a number of complex issues, and the AMA already has a policy addressing ethical nuances pertaining to medical issues related to persons facing execution.”

Wall also noted that APA has a position statement supporting a moratorium on capital punishment, but that it is intended neither as an endorsement of the death penalty nor a statement of disapproval.

“The fair administration of the death penalty, and/or the decision to suspend or abolish it, is a moral, not a medical, issue,” Wall said. “It is important to have policy supporting the myriad medical issues associated with assessing and caring for persons on death row, and it is also important to not cross the line into social issues relating to the death penalty.” ■