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Dec. 31st, 2018 02:40 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
chhotiiI work at a major teaching hospital in a very liberal state. Note, ironically, this is the major teaching hospital that has been putting big rainbow-flag ads on the sides of busses, touting how welcoming it is to the LBGTQI+ community. To be a patient or a research subject at this hospital, you have to be registered by Registration, and get a medical record number. When Registration registers someone, they either ask "what is your sex?" or they guess the answer to this question based on your name or gender presentation. "Sex" is a non-optional field in the database, and there are precisely two possible answers the Registration Department staff can choose from: M, or F.
This came up as an issue in our lab. To enroll in one of our studies, one has to fill out an on-line screening form, which includes not only questions designed to determine people's eligibility for our studies, but also to gather the required information so that we can call Registration and get medical record numbers for our subjects. The typical college student is not willing to jump through the hoops of calling and getting a medical record number themselves just to participate in a research study. So the screening surveys ask for "Sex" and offer 3 radio buttons for responses: M, F, and Other. Someone filled out a form and choose Other. When the research assistant went to register this person and get an MRN, Registration literally told them "you cannot register this person. You have to know what sex they are." The research assistant concluded (falsely, in my opinion) that we should ONLY offer the binary M or F choices for the sex question.
Whoa, whoa, whoa! I said. Insisting that everyone choose only either M or F, otherwise they are just not able to fill out our form, erases the identity of a lot of people. Let's not do that, I said.
Trying to COMPLETELY leave aside the issue of GENDER for the moment, it's biologically false to claim that all people fit neatly into either the "male" or "female" category. It may be true that a very large majority of the population either have the XY chromosomes and a penis, or have the XX chromosomes and no penis. But it's biology, anything can happen, so there are many interesting edge cases. What about people with weird karyotypes: X, XXY, XYY, and maybe a few other variants are compatible with survival. What about people with XY chromosomes, but a mutation that knocks out their testosterone receptors. What about people born with ambiguous genitalia.
I suspect that society has gotten along this far offering only two radio buttons because intersex people are used to having their identity erased. Generally, in unusual edge cases, the doctors confer, and try to decide at the birth what sex a person "really" is; and often they do "corrective" surgery to make the anatomy more typically male or female. Parents are told "raise the baby as a boy" or "raise the baby as a girl" and forever afterwards the fact that anything was different from the norm of the assigned sex is buried as a deep, dark, shameful secret. I suspect that throughout history, most intersex people are not out as such, denying that they might be some third category for fear of being treated as freaks. I have heard that some are now tired of having their identities erased, though.
Along came the transsexual people, then the transgender people and now the genderqueer and genderfluid, insisting that their biological sex is not their identity, and therefore they are leaving the concept of biological sex completely behind. So completely behind, in fact, that apparently the existence of biological sex at all is controversial?... Here is where I'm floundering over swampy ground. Try explaining why there's a separation between men's and women's tennis (as I tried to explain last night) to someone who regards the concept of biological sex as having zero ontological validity (as Vic does). "So," I said, "there are some physical characteristics, such as height, or the angle of the hip bones, that make a difference in tennis, and while there's a lot of variation and overlap, the averages for people with XY chromosomes are different from the averages for people with XX chromosomes..." At this point Vic accused me of spouting "TERF propaganda". But I continued on: "So where would Serena Williams rank if she had to compete with Federer, Djokovic, Andy Murray? I don't know. If they lumped everyone together, we might never see anyone with tits playing tennis on television. Maybe not even Serena Williams. Maybe some people want to sometimes see someone with tits playing tennis on television?" Vic was amused at the idea of "tittie tennis", but not willing to retrieve the concept of sex from the dustbin for anything so frivolous as sports.
Frivolity aside, society's insistence on knowing everyone's sex could be a real barrier to anyone with dysphoria. I've mentioned before that Vic does not want to get a learner's permit for driving, because the state insists that one check off M or F on the application (and your response should probably match your birth certificate). (Let's try to get that changed; those of you who are Pat Jehlin's constituents, I'm going to bug you again to bug her to put that on the to-do list for the progressive flank in the State Legislature.)
Even more worrisome than whether Vic learns to drive-- I told Vic about my workplace's insistence on checking off either M or F when registering patients. "Ugh, I never want to go to that hospital!" said Vic. I said "what if you were right there, on the corner of Riverway and Brookline Avenue, right next to their emergency room, and there was a gang shooting from a car, and you got hit in the arm-- imagine, you're spouting blood, but you don't die because the doctors come running out..." "Just let me bleed out," said Vic. I didn't tell Vic that the reason they have no trouble getting medical care everywhere they've been seen before is that they are already in the database, as "F".
Is this just the melodrama of a teenager? Or is insisting that we categorize people potentially a real barrier for people getting care? I don't know. Perhaps we should allow people to opt out of being categorized, in case it might be a barrier?
Anyway, I've suggested that my lab ask two different questions on the screening surveys, each with three possible responses:
Sex: _M _F _Other _Prefer not to say
Gender: _M _F _Other _Prefer not to say
How we use this information, given that the possible responses doesn't map on to what the hospital's registration system expects, I don't know. But at least our screening surveys shouldn't perpetuate the oppressive notion that all people are in one box or the other.
This came up as an issue in our lab. To enroll in one of our studies, one has to fill out an on-line screening form, which includes not only questions designed to determine people's eligibility for our studies, but also to gather the required information so that we can call Registration and get medical record numbers for our subjects. The typical college student is not willing to jump through the hoops of calling and getting a medical record number themselves just to participate in a research study. So the screening surveys ask for "Sex" and offer 3 radio buttons for responses: M, F, and Other. Someone filled out a form and choose Other. When the research assistant went to register this person and get an MRN, Registration literally told them "you cannot register this person. You have to know what sex they are." The research assistant concluded (falsely, in my opinion) that we should ONLY offer the binary M or F choices for the sex question.
Whoa, whoa, whoa! I said. Insisting that everyone choose only either M or F, otherwise they are just not able to fill out our form, erases the identity of a lot of people. Let's not do that, I said.
Trying to COMPLETELY leave aside the issue of GENDER for the moment, it's biologically false to claim that all people fit neatly into either the "male" or "female" category. It may be true that a very large majority of the population either have the XY chromosomes and a penis, or have the XX chromosomes and no penis. But it's biology, anything can happen, so there are many interesting edge cases. What about people with weird karyotypes: X, XXY, XYY, and maybe a few other variants are compatible with survival. What about people with XY chromosomes, but a mutation that knocks out their testosterone receptors. What about people born with ambiguous genitalia.
I suspect that society has gotten along this far offering only two radio buttons because intersex people are used to having their identity erased. Generally, in unusual edge cases, the doctors confer, and try to decide at the birth what sex a person "really" is; and often they do "corrective" surgery to make the anatomy more typically male or female. Parents are told "raise the baby as a boy" or "raise the baby as a girl" and forever afterwards the fact that anything was different from the norm of the assigned sex is buried as a deep, dark, shameful secret. I suspect that throughout history, most intersex people are not out as such, denying that they might be some third category for fear of being treated as freaks. I have heard that some are now tired of having their identities erased, though.
Along came the transsexual people, then the transgender people and now the genderqueer and genderfluid, insisting that their biological sex is not their identity, and therefore they are leaving the concept of biological sex completely behind. So completely behind, in fact, that apparently the existence of biological sex at all is controversial?... Here is where I'm floundering over swampy ground. Try explaining why there's a separation between men's and women's tennis (as I tried to explain last night) to someone who regards the concept of biological sex as having zero ontological validity (as Vic does). "So," I said, "there are some physical characteristics, such as height, or the angle of the hip bones, that make a difference in tennis, and while there's a lot of variation and overlap, the averages for people with XY chromosomes are different from the averages for people with XX chromosomes..." At this point Vic accused me of spouting "TERF propaganda". But I continued on: "So where would Serena Williams rank if she had to compete with Federer, Djokovic, Andy Murray? I don't know. If they lumped everyone together, we might never see anyone with tits playing tennis on television. Maybe not even Serena Williams. Maybe some people want to sometimes see someone with tits playing tennis on television?" Vic was amused at the idea of "tittie tennis", but not willing to retrieve the concept of sex from the dustbin for anything so frivolous as sports.
Frivolity aside, society's insistence on knowing everyone's sex could be a real barrier to anyone with dysphoria. I've mentioned before that Vic does not want to get a learner's permit for driving, because the state insists that one check off M or F on the application (and your response should probably match your birth certificate). (Let's try to get that changed; those of you who are Pat Jehlin's constituents, I'm going to bug you again to bug her to put that on the to-do list for the progressive flank in the State Legislature.)
Even more worrisome than whether Vic learns to drive-- I told Vic about my workplace's insistence on checking off either M or F when registering patients. "Ugh, I never want to go to that hospital!" said Vic. I said "what if you were right there, on the corner of Riverway and Brookline Avenue, right next to their emergency room, and there was a gang shooting from a car, and you got hit in the arm-- imagine, you're spouting blood, but you don't die because the doctors come running out..." "Just let me bleed out," said Vic. I didn't tell Vic that the reason they have no trouble getting medical care everywhere they've been seen before is that they are already in the database, as "F".
Is this just the melodrama of a teenager? Or is insisting that we categorize people potentially a real barrier for people getting care? I don't know. Perhaps we should allow people to opt out of being categorized, in case it might be a barrier?
Anyway, I've suggested that my lab ask two different questions on the screening surveys, each with three possible responses:
Sex: _M _F _Other _Prefer not to say
Gender: _M _F _Other _Prefer not to say
How we use this information, given that the possible responses doesn't map on to what the hospital's registration system expects, I don't know. But at least our screening surveys shouldn't perpetuate the oppressive notion that all people are in one box or the other.
no subject
Date: 2019-01-02 02:51 pm (UTC)no subject
Date: 2019-01-02 04:15 pm (UTC)Inevitably I think it's going to happen somewhere someday that some F2M person who passes as male really really well is going to get sent for an X-ray in an emergency, blithely ignore the signs that say "PLEASE TELL THE TECHNICIAN IF THERE IS ANY POSSIBILITY THAT YOU MIGHT BE PREGNANT", and get X-ray'd without pregnant person precautions. (But, how often does it already happen that a woman, when asked "any possibility that you might be pregnant?" says "nope, absolutely no way"? I'll bet THAT happens all the time.) I would guess, though, that X-ray technicians do not study the registration information before deciding whether to ask the question. I'll bet they guess whether that question is necessary based on someone's appearance. So, I don't feel like our lab, when we register people, have a huge responsibility for guaranteeing the 100% biological truth of the database.
I gather from Vic that in the trans community, it's considered extremely rude and non-PC to label a trans man a "woman" in any context or capacity. But I now (thanks to your response) anticipate that if we push for allowing people to be registered as "other", the push-back from the establishment is going to be "but we must know you are a woman, my dear, because BABIES!!!!"
no subject
Date: 2019-01-02 03:57 pm (UTC)NOT! OK!
(thank you for trying to do something about this.)
I'm fighting binary catagorization on multiple fronts...
Date: 2019-01-02 04:22 pm (UTC)Today our new, possibly more progressive State Legislature is being sworn in. It's on my to-do list to try to get S.2377 re-introduced. You think the word could go out to the Yes on 3 people to lobby for this?
Re: I'm fighting binary catagorization on multiple fronts...
Date: 2019-01-02 04:36 pm (UTC)They have not yet started the application for the learner's permit. I suspect there will be much teeth-gnashing when that happens.
When they first started this, I talked to them about how long civil rights fights take and that this one likely would be going on for some time. They still have all the impatience of a teenager but they're also going to have to learn that sometimes you just suck it up and deal.
You think the word could go out to the Yes on 3 people to lobby for this?
It certainly could, but I'm not connected to the leadership there in any way.