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PaperclipPerfector  2mo ago (text post)   29662 thread views

Culture War Roundup for the week of September 16, 2024

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Is plastic surgery an essential medical procedure that a Department of Corrections must pay for, if a prisoner is sufficiently distressed about it? And if a M-to-F transwoman undergoes full reassignment surgery, will that prisoner be transferred to women's prison in due course?

A federal judge ruled the Indiana Department of Correction's ban on gender-affirming care is likely unconstitutional, and an inmate from Evansville is at the center of the lawsuit.

Source, archived version.

The prisoner (neé Jonathan Richardson, now Autumn Cordellioné) is serving a 55-year sentence for almost two decades for killing one's baby stepdaughter. The prisoner was diagnosed with gender dysphoria four years ago and put on testosterone blocker and female hormone.

While the medicine has helped, the lawsuit states Cordellioné continues to experience symptoms of gender dysphoria including depression and anxiety. [...] Cordellioné was on a wait list for evaluation for the surgery, but a new Indiana statute does not allow the DOC to provide or facilitate "sexual reassignment surgery." The ACLU [representing Cordellioné] argues in its suit that for some, the surgery is a medical necessity. In this case, Cordellioné is seeking a orchiectomy, which removes the testicles, and vaginoplasty, which is the construction of the vagina.

"By prohibiting the surgery, regardless of medical need, the statute mandates deliberate indifference to a serious medical need and therefore violates the Eighth Amendment," the suit states. "Additionally, the statute discriminates against Plaintiff and other transgender prisoners in violation of the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution."

The judge agreed, issued a preliminary injunction against the Indiana statute in question.

Here's a summary of the statute (HEA 1569, passed in 2023) that perplexity.ai provided:

It prohibits the Indiana Department of Corrections from performing certain surgical procedures for the purpose of altering the appearance or affirming an inmate's gender identity if it's inconsistent with their sex assigned at birth. Specifically, the law bans the following procedures [gives a list including castration and vaginoplasty, and in general removing healthy tissue or non-diseased body part].: The law does not define "gender" or "sex" but appears to use "sex" to refer to an individual's sex assigned at birth.

The law doesn't prohibit hormone therapy (which the prisoner got) or social transitioning:

The lawsuit states Cordellioné has lived as a woman to the "extent possible" while in a prison housing only men. She has been permitted gender-affirming items such as makeup and "form fitting clothing."

I will put aside for now how utterly annoying I find the assumption that, to be a woman, one wears makeup and form-fitting clothes. By all means fellas, go all 17th-century Versailles. My main question is this: if the Indiana Department of Corrections is required accommodate "gender-affirming" transitions, including the extreme surgeries of removing testicles and shaping the penis to look like a vagina, wouldn't the reasonable next step be to affirm the prisoner's womanhood by placing the prisoner in women's correctional facilities?

(My husband said that if he ever had to go to prison and there was an option to go to women's prison rather than men's, his only question is: what needs to be chopped off and how soon?)

Let me end on a controversial (for The Motte) note: maybe I simply shouldn't care. Cordellioné has been in prison since early 2000, which makes the person at least 40. So even if I don't see this person as a woman, this is a middle-aged male on testosterone blockers with some serious surgeries between his legs. How dangerous would he really be to the female prisoners, compared to other female prisoners already serving there?

I wonder though, can the legislature categorically decide what medical care is given prisoners consistent with the 8th/14th amendments? Seems like the answer is no, at least not in an unlimited sense.

In the specific case, I think obviously the plaintiff isn't entitled to the specific care requested. But I think that's a fact-specific thing that is subject to constitutional minimums

Yeah, there's a long line of recent caselaw holding some medical care is constitutionally required, under the 8th Amendment for convicted prisoners and under the 14th for pretrial jailed people. Was one of several matters of controversy back in the early Sovaldi days, among others. Unlike the NYT's panicked reporting then, the legal standard isn't 'standard of care', but it is pretty messy and vague.

Indeed. So Indiana has to lose on the legislative issue.

In a sane world, the plaintiff would have an uphill case to prove that the care given was so lacking as to be unconstitutional.

The issue here is that the government had abdicated the role of deciding what counts as "medically necessary treatment" to doctors. This probably seemed like a good idea at the time, but now we have reams and reams of court precident citing professional standards generated by private doctor's associations as evidence of medical nessesity, such that it now overrules state laws attempting to regulate medical care.

I think that probably is a good idea going forwards, in the sense that the legislatures are probably not the right body to be making that determination.

It is sad that the professional bodies are beholden to nonsense, but at least they have the capacity to know what they are talking about and make the evidence-based call.

Ultimately, it seems like a choice between those that don't know and those that know better.

make the evidence-based call.

It isn't always evidence that is the deciding factor. To point to another hot-button issue, I don't trust doctors to decide "when is abortion murder?", because it is more a question of moral philosophy than medicine.

because it is more a question of moral philosophy than medicine.

This conflation of "expertise in a given field" and "ability to make complex moral judgements", already far too common in PMC spaces, became turbocharged during Covid. It's baffling the number of people who seem to think that simply being extremely knowledgeable about epidemiology automatically makes you qualified to judge which civil liberties can be indefinitely suspended.

(It's easy to expose how facile this reasoning is: no one thinks extensive training in firearms automatically makes you qualified to make a moral judgement on how easy it should be to buy a gun.)

Complicating that is that Covid revealed a lot of those "experts" weren't extremely knowledgable about epidemiology either -- e.g. the charts coming from the Canadian CDC showing predicted rapid exponential growth in deaths in the short term, which kept not happening. Either these people were lying, or they were failures even in their own field.

Absolutely. I don't believe that even one of Neil Ferguson's enormously pessimistic projections came to pass, but for some reason he's still held up as some kind of guru.

Agreed, that's quite a different thing though.

I personally find the very notion rather crass. We are going to spend millions in taxpayers’ money to transition convicted felons while the people who will be paying for it can end up owing thousands of dollars because their insurance doesn’t cover 100% of their frivolous cancer treatments and heart surgeries and so on. The state doesn’t have infinite money to do everything it wants to do, and it seems that doing essentially cosmetic procedures on prisoners while other much more pressing issues cannot be dealt with due to lack of funds? If hormones plus surgery cost (totally made up number) 75,000 dollars a person, what are we no longer going to provide to pay for this?

I do personally find it a bit odd that he didn't seem to be suffering from much dysphoria before he decided to murder someone, and in fact for the first 16-18 years, he wasn’t really saying or doing much that indicates dysphoria. I’m not sure that he isn’t faking to some degree either as a “fuck the system” thing or as a way to get better treatment that he imagines he’d get as a female prisoner. In short I suspect he is playing a game here, and he’s trying to be manipulative.

Being fair to him, I don’t think he’s the danger here. Female gang members and murderers are tough and they aren’t going to take this lying down. These aren’t nice polite PTA wine moms he’s going to be housed with. They are highly likely to try to hurt him before he could try anything stupid.

On the first point, prison is already quite expensive. Even if a substantial number of prisoners would take advantage of this, it would probably make up less than 1% of the price of prison. And offering violent prisoners better conditions in exchange for castration actually seems like a good deal for everyone involved.

On the second, remember, crime doesn't pay, especially not random murder, so the average murderer is stupid, insane or emotionally disturbed (probably a combination, in fact). So he might be trying to game the system in a stupid way, or he might just be fucked up enough to believe it.

On the first point, prison is already quite expensive. Even if a substantial number of prisoners would take advantage of this, it would probably make up less than 1% of the price of prison.

I notice that this reasoning could be used to justify almost any frivolous expense. "Let's give every inmate a PS5 when they're successfully paroled." "Why?" "Who cares? It'll make up less than 1% of the price of prison."

The difference between gender-affirming care and other prison expenses is that the taxpayer actually gets something back from most of the other costs associated with prisons. Most prison funding goes towards line items which will prevent convicts from escaping (walls, bars, COs), thereby protecting the taxpayer in the short-term; or which are designed to rehabilitate convicts, protecting the taxpayer in the long-term (education, shop classes, anger management training). Of course you can interrogate whether any given line item actually accomplishes its stated goal or passes a cost-benefit analysis (maybe if you're serving a life sentence without possibility of parole, any attempt at rehabilitation is a waste of time and resources, except to protect the COs and fellow inmates from you; maybe art classes to teach inmates how to get in touch with their inner child and express themselves visually actually increase recidivism rates, who knows?), but that's generally how they're justified.

Gender-affirming care for inmates meets neither criterion: it only "benefits" the inmate. At a push there's an ancillary benefit in that an inmate who undergoes a vaginoplasty can no longer rape taxpayers with the penis he no longer has, but not every inmate who requests gender-affirming care has a history of sexual violence: if Bob already was at zero risk of committing a sex crime after release and requests a vaginoplasty, we've just spent $75k of the taxpayer's money and gotten nothing back to show for it.

Perhaps a doctor will argue that the entire reason for the inmates' history of criminality or violent behaviour was unresolved distress due to their gender dysphoria, so providing them with gender-affirming care will actually have a rehabilitative effect in the long run. I haven't yet seen anyone try to justify the policy on those grounds, however.

I don't think we disagree as much as you think; I also care very little about making prisoner's life nicer. I'm not really in favor of this policy so much as thinking that among the crazy stupid stuff we're doing, this one is pretty low on my list of priorities, and might even have some unintended benefits.

Gender-affirming care for inmates meets neither criterion: it only "benefits" the inmate. At a push there's an ancillary benefit in that an inmate who undergoes a vaginoplasty can no longer rape taxpayers with the penis he no longer has, but not every inmate who requests gender-affirming care has a history of sexual violence: if Bob already was at zero risk of committing a sex crime after release and requests a vaginoplasty, we've just spent $75k of the taxpayer's money and gotten nothing back to show for it.

This is what we disagree on, I guess. Testosterone is the primary driver of violence in general, not just of sexual nature. And castration is by far the most reliable way of reducing T-levels. Even historically it was regularly noted how tepid and submissive eunuchs tended to be; But you don't need to take their word for it, modern studies on this topic consistently find a very strong relationship between violence and T-levels as well. It's not super advertised since it leads to some conclusions that most people don't like thinking about, but in a field were many things don't replicate, this one does reliably.

On the other hand, consider this report (I've been linking to it a lot lately) which found no statistically significant differences in the rates of violent offending between males who had undergone gender reassignment surgery and the general male population.

This is quite interesting. I find no obvious problems with the design except the unavoidable (large CI, now randomisation, etc.), so it does move the needle quite a bit for me. The only possible issues I can see is that I'm not entirely convinced that criteria i) strictly requires an actual surgery to take place, that the large CI can still hold some surprises (0..3-2.1 ranges from "almost female-pattern criminality" to "holy shit even higher than male-pattern criminality") and the usual troubles with selection effects.

It's very weird that somehow FtMs have male-pattern criminality, while MtFs ... also have male-pattern criminality.

FtMs have male-pattern criminality

Is that true? I wasn't aware.

According to the paper the report is based on, yes. See there under "Results:Gender Differences".

More comments

I didn't look at those numbers, but someone compiled some stats showing it's actually higher:

https://x.com/eyeslasho/status/1831735103082410239#m

Our own @ymeskhout wrote an article arguing that the stats on which this graph is based are being misinterpreted: https://www.ymeskhout.com/p/contra-dolly-on-trans-criminality

Jonathan Richardson, now Autumn Cordellioné

This is a bit of a derail, but why is that kind of "flamboyant" self-appelation so common in the MtF trans demographic?

I know three people from college who have transitioned in their 30s. Their self-chosen names are:

  • Maeve
  • Celeste
  • Pandora

At first I thought it was some kind of drag queen schtick, but no, they're all legal names.

I met one renamed "Lilith".

Edit: Someone below also mentions Liliths. I didn't know that was a thing.

Lilith is an extremely common name for trans women, for whatever reason. (I'm very supportive of trans people and have several trans friends, and "Lilith" is a common joke/punchline in trans communities when discussing names due to how common yet silly it is.)

I think for most of them the name is a reference to Neon Genesis Evangelion.

Abrahamaic noncanon esoterica holds that Lilith was the first wife of Adam who was rejected before the fall and became a demon. It's a common self-appellation among eg self-declared witches as well because of the misperception that she was some kind of slutty proto-feminist temptress figure instead of a demon who tries to kill newborns and their mamas out of jealousy, as the legend actually says.

It's just cultural appropriation. Not really worth getting offended over but also highly stupid.

In (non-canonical) Judeo-Christian mythology, Lilith was the first wife of Adam (before Eve). In many depictions she's very similar to a succubus.

The traditional view of Lilith in esoterica was as a scorned woman who became/made a pact with a demon to try to kill women in childbirth and young babies out of jealousy, not as a temptress.

Its a low-key cultural "fuck you" aimed at conservative Christians. The message being that I know that you know that this is some sort of weird sex/fetish thing but I'm going to scream bloody murder and accuse you of being uncharitable if you try to point it out.

Based of them.

Probably to do with changing your name in general.

Honestly, if I ever went for a name change, even keeping my gender, I'd absolutely go for something awesome. Why wouldn't I? And I might even make "Danger" my legal middle name, while I'm at it.

An army of Liliths and Reubens.

(Also just goes to show how relative these things are: "Maeve" has been an extremely common name in Ireland for decades, and was even the 44th most popular name for baby girls last year.)

I should probably do an effort post on this at some point but the distribution of trans patients in general medical care (which aligns closeish with real life), primary psychiatric settings, and correctional/forensic settings are all wildly different.

This causes a number of headaches, since political leadership inside the prison system often has minimal experience with prison (to say nothing of more general political leadership). You might be a well meaning left leaning person, primarily interact with well meaning and convincing trans people, and assume that the prisoners are the same. They are not.

"Real" trans people exist. In say, a locked psychiatric inpatient unit (where everyone is by definition mentally ill) most of the trans people are psychotic patients or those with borderline personality disorder or some other process causing identity instability. Correctional settings has those, and also people malingering. And yes you have people malingering so hard they'll cut their dick off if given the option.

For the usual reasons of wokeism activists can't really admit these other types of trans people exist and causes all kinds of problems, although it can be darkly funny when physicians are involved.

Wokeism does not typically survive very long with day to day contact with the prison population, so you'll find staff (even doctors and social workers) are much more clear eyed about all this but they don't make the decisions. People with strong ego defenses can stay woke but they almost uniformly end up on therapy to do it, which is...worrying.

In my state (redacted) the "worst" prison doesn't have functional climate control in the high security unit because too much of the budget has been redirected towards gender affirming care.

And yes you have people malingering so hard they'll cut their dick off if given the option.

Maybe that's a win, in a sense. If a male with sufficient propensity for violence or anti-social behavior chooses to castrate himself, I'd be happy if that procedure was paid for with taxes. I would be OK with the additional tax burden there.

Hard to research but - not necessarily a good outcome, once the identity instability clears or the secondary gain abates the patient may have increased rage at the system, violent urges, etc.

People in prison almost never have the ability to accurately assign blame "I can't believe specific person/the system let me do that, I need revenge on them specifically or people in general."

Holding out women's prison as an incentive for male prisoners to request castration is a good deal for everyone except the women. It would be ideal if prisoners worked jobs while in prison to pay for their own castration. But it makes sense for the government to cover the cost, since society benefits from the reduced secretion of testosterone.

“I can no longer sit back and allow Communist infiltration, Communist indoctrination, Communist subversion and the international Communist conspiracy to sap and impurify all of our precious bodily fluids.” - Gen. Ripper

If transferring a male convict to a women's prison was made conditional on their having undergone a penectomy/vaginoplasty, I imagine the policy would be much less controversial than it currently is, as it completely negates the possibility of the male in question raping a female inmate (possibly leading to pregnancy). In many jurisdictions, this isn't a condition of transfer at all: one must simply announce "I am a woman" and the transfer will be carried out, without even the most token effort at social transition.

However, even with his penis having been removed, if this convict is transferred to a women's prison, he will almost certainly be vastly stronger than all of his fellow inmates (even after having undergone hormone therapy). The female inmates might reasonably object to being placed in close proximity to a violent male who can overpower any of them with ease, even if the chances of him raping them are nil.

If transferring a male convict to a women's prison was made conditional on their having undergone a penectomy/vaginoplasty, I imagine the policy would be much less controversial than it currently is, as it completely negates the possibility of the male in question raping a female inmate (possibly leading to pregnancy)

This isn't true. It makes the possibility of pregnancy nil, though the hormone therapy probably already does this. They'd still have a strength advantage and could overpower and rape female inmates though. Just not with a penis, would have to use finger, fist, idk broomstick, etc. Honestly potentially more dangerous for the female.

Rape is generally defined as nonconsensual penetration with a penis. Forcibly penetrating someone with a finger or foreign object would fall under sexual assault.

Even the more strict definitions I'm familiar with usually just define it as forced penetration w/o a penis specifically mentioned. I still don't see why anyone would be relieved that male sexual deviants are forcibly fisting female inmates rather than traditional PIV though.

In the UK:

The legal definition of rape is when a person intentionally penetrates another's vagina, anus or mouth with a penis, without the other person's consent. Assault by penetration is when a person penetrates another person's vagina or anus with any part of the body other than a penis, or by using an object, without the person's consent.

Other jurisdictions use different definitions which include forcible penetration with a body part or object other than a penis.

I still don't see why anyone would be relieved that male sexual deviants are forcibly fisting female inmates rather than traditional PIV though.

While being forcibly penetrated with a fist is obviously intensely unpleasant, the chances of contracting an STD as a result are virtually nil and the chances of becoming pregnant are zero. This is why male-on-female sexual assault is qualitatively, categorically different to other kinds of sexual assault. Female inmates can and do sexually assault other female inmates, but the reduced risk of contracting an STD and the impossibility of being impregnated make it a very different risk calculus.

A male inmate who has undergone a penectomy absolutely can sexually assault (or rape, depending on definition) female inmates using objects or body parts other than the penis which he has had removed, and his physical strength will probably make it much easier for him to do so than a female inmate trying the same thing. But the impossibility of PiV changes the risk calculus significantly.

ah it's a US vs UK thing then

here its federally defined as:

Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.

if STDs were one of the main risks taken into consideration you'd think there would be more focus on male prison rape as male to male rape (anal) has a higher chance of spreading disease than PiV. Seems to me that here in the states the objections are more about putting people less able to defend themselves at risk of abuse.

I think the pregnancy thing is the main one, with STDs a distant second.

If transferring a male convict to a women's prison was made conditional on their having undergone a penectomy/vaginoplasty, I imagine the policy would be much less controversial than it currently is, as it completely negates the possibility of the male in question raping a female inmate (possibly leading to pregnancy).

I would support that. We already have various levels of security for male prisoners (minimum / maximum levels). We can adjust the women's prison to be the meek-and-weak prison. Women who demonstrate a history of attacking other inmates can be transferred to the minimum security prison.

Partially severing every muscle in the body should be an integral part of gender-affirming care.

Speak plainly, please.

Seems plain enough to me; he's saying that part of gender-affirming care for male-to-female transexuals in prison (which is the context here) should be to partially sever every muscle in the body, to make them weaker so they fit into the "meek-and-weak" prison.

I didn't find those caveats obvious. Perhaps they were intended, perhaps not. Either way, it makes for a convenient motte and bailey.

C.f. people who claim "kill all white men!" actually, in context, plainly means "politely ask a small subset of white men to voluntarily give up power."

Partial severing of every muscle in the body is just another way of saying "we should kill them" due to the combination of the hazards of the necessary surgeries and the fragility of a number of extremely important muscles (eg, the heart, diaphragm, and intestines).

Is that an oblique way to refer to the microtears that occur during hypertrophy (as an element of well-adjusted cis males’ and trans men’s “gender-affirming” lifestyle), or do you mean “severing” as part of a satirically proposed surgery to decrease over-all strength as part of an MtF transition — not as a genuine part of the personal expression project that is the medical sex/gender transition process, but as a security control, medical harm per se applied prophylactically to male prisoners seeking cross-sex asylum?

I assume they meant the latter, facetiously.

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