Gender Affirming Care: Should it be Publicly Funded?
Friends,
One of the great debates facing countries with public healthcare systems is: gender-affirming care. Today, even countries like Canada and its public healthcare systems are questioning some of these medical interventions as ‘experimental’.
While eye care and dental care require most all Canadians to pay out of pocket, gender-affirming care is free of charge. Hormone therapies, psychological assessments and surgeries all come under the purview of the public healthcare system.
The rapid pace of this development may leave Canadians with questions. After all, it was only in 2016 that the Province of Ontario adopted Gender Affirming Care. The answer may be strictly economical. According to Statistics Canada, 0.33 percent of the population identify as transgender. Those needing eyecare after 50? Probably 80 percent.
This is not meant to divide Canadians along the lines of supporting the LGBTQ+ community or not. But it’s the pace at which this acceptance and approval have some perplexed. Such procedures are steeped in morality, ethics and cultural values. And, some may not have statistically relevant and reliable data for participants to make the most informed choice.
Let’s examine the current process for obtaining Gender Affirming Care in Canada.
What’s the current process in Canada?
The process can vary by province and territory, reflecting differences in healthcare systems, resources, and policies. However, there are some common steps and requirements:
Initial Steps
A primary care provider (nurse practitioner or family physician) may provide initial consultations and referrals.
While not mandatory, a mental health assessment may be recommended.
In 2016, the Ontario Health Insurance Plan (OHIP) aligned funding criteria for transition-related surgery to align with the World Professional Association for Transgender Health (WPATH) - specifically it’s standards of care for Gender Dysphoria. Requirements for Upper surgery include an assessment from one Physician or Nurse Practitioner. For Lower surgery an assessment is required from a physician/nurse practitioner, and a second assessment from a qualified Physician, Nurse Practitioner, Psychologist or Registered Social Worker with a Masters Degree.
And then there’s the case of K.S.
K.S. v. Ontario
An individual identified as K.S., a non-binary individual sought gender-affirming care in Ontario. Specifically, K.S. initially requested funding from OHIP for lower surgery, arguing without the operation it would pose risks of dysfunction and urinary incontinence. OHIP rejected the claim, stating the procedure was not part of the benefits in the public health system. So, K.S. went to Texas to receive the operation - and billed Ontario.
OHIP refused again. K.S. appealed to the Health Services Appeal and Review Board. The Board agreed with K.S. OHIP was wrong. OHIP took it to the courts. The courts agreed with K.S.
The rationale the courts provided was simple: Ontario recognizes WPATH as the standard of medical care for transgender individuals. As a result, the standard recognizes the need for individualized treatment plans that affirm a person’s gender experience - explicitly mentioning the procedure K.S. sought. Denying K.S. this violated bodily autonomy, protected by the Charter of Rights and Freedoms.
Should Canadians Have a Say?
When it comes to public health care, should Canadians have a say in what is covered? Perhaps there’s good reason why we don’t. There are entire segments of the population who may not agree with assisting those with drug habits, alcoholism or smokers.
Ontarians in particular however, may be perplexed to know that for certain surgeries as part of Gender Affirming Care, a patient requires only two assessments. Some may wonder whether or not subsequent examinations of both mental and emotional health may be needed. And, while unknown for now - it is my assumption that most all surgeries are happening on young adults, or those near the age of majority. What role do parents play in these types of decisions?
A Pragmatic Approach to Gender-Affirming Care?
It goes without saying a nuanced approach to this issue is absolutely necessary. Providing more assessments and rigour in approving Gender Affirming Care cannot be twisted into slogans popularized by interest groups and organizations as “denying Trans people rights”. No. It means fully accepting these are life-altering decisions and the Provincial governments will need to ensure due diligence is undertaken with proper consultations with parents and guardians.
As well, Ontario and other Provinces should provide, free of charge, consultations on known and unknown risks with Gender Affirming Care. Similar to other prescription drugs, mandate experts walk through patients these risks will serve to benefit the patient.
Finally, WPATH should explicitly state what types of surgeries are indeed lacking reliable data on success rates and side effects so patients are informed about the risks involved with proceeding.
Pragmatism has to return to our policy-making on this and many other issues - it’s too important for the future of Canadians accessing Gender Affirming Care.