Standards of Care

The Health Law Standards of Care of Transsexualism International Conference on Transgender Law and Employment Policy

The Health Law Standards of Care of Transsexualism were developed and adopted by the Health Law Project of the International Conference on Transgender Law and Employment Policy (ICTLEP). The Health Law Standards of Care were developed in the wake of widespread dissatisfaction by many in the transgender community with the Harry Benjamin Standards of Care. The Health Law Standards of Care for Transsexualism include the following principles: Persons have the right to express their gender identity through changes to their physical appearance, including the use of surgery. Persons denied the ability to exercise control over their own bodies in terms of gender expression, through informed access to medical services, may experience significant distress and suffer diminished capacity to function socially, economically, and sexually.

The Health Law Standards of Care for Transsexualism also include the following standards: Surgeons participating in Male to Female (MTF) or Female to Male (FTM) transsexual health care shall provide sex reassignment surgery to patients requesting a change in their physical appearance subject only to the surgeons reasonable determination that the surgery will allow the patient to more fully and successfully live as a man (FTM) or woman (MTF).

PRINCIPLES

PRINCIPLE 1.
Transsexualism is an ancient and persistent part of the human experience and is not in itself a medical illness or mental disorder. Transsexualism is a desire to change the expression of ones gender identity.

PRINCIPLE 2.
Persons have the right to express their gender identity through changes to their physical appearance, including the use of hormones and reconstructive surgery.

PRINCIPLE 3.
Persons denied the ability to exercise control over their bodies in terms of gender expression, through informed access to medical services, may experience significant distress and suffer diminished capacity to function socially, economically and sexually.

PRINCIPLE 4.
Providers of health care (including surgical) services to transsexuals have a right to charge reasonable fees for their services, to be paid in advance, and to require a waiver of all tort liability except negligence.

PRINCIPLE 5.
It is unethical to discriminate in the provision of sex reassignment services based on the sexual orientation (actual or perceived) , marital status, HIV status, or physical appearance of the patient.

STANDARDS

STANDARD 1.
Physicians participating in transsexual health care shall provide hormonal sex reassignment therapy to patients requesting a change in their sexual appearance subject only to: (1) the physicians reasonable belief that the therapy will not aggravate a patients health conditions, (2) the patients compliance with periodic blood chemistry checks to ensure a continued healthy condition, and (3) the patients signature of an informed consent and waiver of liability form. If the patient is married, the physician may not require divorce, but may also require the spouse to sigh a waiver of liability form.

STANDARD 2.
Physicians providing hormonal sex reassignment therapy shall collect and publish on an annual basis the number of hormone prescriptions they have issued, and the number and general nature of any complications and complaints involved. The publication requirement of this Standard shall be satisfied by providing the collected statistics in writing, together with other current information on the potential risks and complications of sex hormone therapy, to all prospective patients inquiring into the physicians hormone therapy services.

STANDARD 3.
Male to Female (MTF) Standards: Surgeons participating in MTF transsexual health care shall provide sex reassignment surgery to patients requesting a change in their sexual appearance subject only to: (1) the surgeons reasonable belief that the surgery will not aggravate pre-existing health conditions, (2) the surgeons reasonable determination that the patient has been under hormonal sex reassignment for at least one year, and (3) the patients signature of an informed consent and waiver of liability form. If the patient is married, the surgeon may not require divorce, but may also require the spouse to sigh a waiver of liability form.

STANDARD 3.
Female to Male (FTM) Standards: Surgeons participating in FTM transsexual health care shall provide sex reassignment surgery to patients requesting a change in their sexual appearance subject only to: (1) the surgeons reasonable belief that the surgery will not aggravate pre-existing health conditions, (2a) in the case of chest reconstructive surgery, the surgeons reasonable determination that the surgery will allow the patient to more fully and successfully live as a man. The patient need not have been under any hormonal treatment for this surgery, (2b) in the case of genital surgery, the surgeons reasonable determination that the patient has been under hormonal sex reassignment for at least one year, or that the surgery is otherwise medically necessary for the health and safety of the patient, and (3) the patients signature of an informed consent and waiver of liability form. If the patient is married, the surgeon may not require divorce, but may also require the spouse to sign a waiver of liability form.

STANDARD 4.
Physicians providing sex reassignment surgery shall collect and publish on an annual basis the number of sex reassignment surgeries they have performed, and the number and general nature of any complications and complaints involved. The publication requirement of this Standard shall be satisfied by providing the collected statistics in writing, together with other current information on the potential risks and complications of sex reassignment surgery, to all prospective patients inquiring into the physicians sex reassignment services.

STANDARD 5.
Physicians and surgeons shall not divulge the name or identity of any patient requesting or receiving sex reassignment services except as explicitly directed in a notarized written request by the patient.