21 August 2012

Military Healthcare Needs Reform

By Paula M. Neira RN, CEN, Esq.

Next month we celebrate the first anniversary of the end of “Don’t
Ask, Don’t Tell” (DADT). Amidst the joy, one group of patriots has
nothing to celebrate. Transgender Americans remain unwanted warriors.
Our military medical regulations pertaining to transgender
individuals, written almost a half-century ago and essentially
unchanged since, reflect the same narrow perspective that historically
excluded other unwanted groups from military service. Qualified
individuals, even those who may differ from the status quo, should be
allowed to serve the country they love and contribute to the
military’s mission.

As medicine is evolving in the 21st century, more emphasis is being
placed on medical care based on evidence and implementing the best
practices. Unfortunately, our current medical standards are not
evidence-based; there is no medical support for a permanent ban on
transgender individuals from ever being able to serve. To the
contrary, forty years of evidence show that gender reassignment
treatment provides positive benefits to individuals, improves their
quality of life, and reduces or eliminates their gender dysphoria.

The American Psychiatric Association (APA)
<http://www.sldn.org/page/-/News%20release-apa-position-statements-on-...>
last week stated that being transgender does not impair one’s
“judgment, stability, reliability, or general social or vocational
capabilities…” This is something that ten allies, including Great
Britain, Canada, Australia, and Israel, have already known for some
time. Perhaps more importantly, they also recognize that, in military
terms, transgender service members do not harm good order, discipline,
and morale simply by being themselves.

The only three articles in the medical literature that address
transsexuals in the US military in any manner were written during the
Reagan era by then-serving medical officers. They are instructive
because they show the true rationale behind the regulations: the real
reasons for barring transsexuals were “similar to those excluding
homosexuals (effects on unit morale).” George Brown, an Air Force
psychiatrist, writing in 1989 was also as stark in his assessment of
the situation:

[There] is a clear message that the military environment will not
tolerate identified transsexuals in its ranks, irrespective of the
quality of duty performance. [Emphasis added – Doesn’t this sound
familiar?] Transsexualism continues to be viewed as a nonmedical
defect requiring administrative separation, analogous to cases of
homosexuality . . . in spite of ample medical evidence to the
contrary. In 2012, nothing has changed in the military.

However the world is rapidly changing and it is time for the military
to catch up. There is a worldwide recognized standard of care
established by the World Professional Association for Transgender
Health (WPATH) – one the military refuses to accept despite its
acceptance in 2008 by the American Medical Association (AMA). (Dr.
Brown, mentioned above, serves on the WPATH board of directors.) The
recent statement by the APA condemning discrimination against
transgender and gender non-conforming individuals specifically cited
the military’s policy in justifying its stance.

Adding further momentum for change in the military’s medical standards
is the reported forthcoming change to the APA’s Diagnostic and
Statistics Manual (DSM). The fifth version will remove gender identity
disorder and remove the stigma of mental illness from those who are
gender non-conforming in a similar manner as it did in 1973 when it
removed homosexuality as a mental disease. Gender dysphoria, the
condition which is treated by gender reassignment, will remain. The
APA, AMA, and WPATH also call for the proper access to treatment for
gender dysphoria – now denied to military members and veterans. (The
law barring the VA from providing gender reassignment surgery is a
cynical basis for the military’s process of administratively
discharging transgender members with gender dysphoria rather than
medically discharging them.)

Admiral Mike Mullen, the former Chairman of the Joint Chiefs of Staff,
stated repeal of DADT was a matter of integrity. The military’s use of
medical regulations to bar transgender service, not for medical
reasons but for unsubstantiated concerns about good order and morale,
is no less an affront to the Core Values. It is time to admit that the
medical standards completely barring all transgender service are
nothing more than an echo of the same prejudices and pretextual
arguments familiar from the DADT fight. The APA’s welcome step forward
gives us an opportunity to review our standards, ensuring they are
evidence-based, reflecting the best medical practices, supporting the
health care our men and women in uniform deserve, and providing for
the best fighting force our nation can produce.

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Paula M. Neira was a Lieutenant, United States Navy / Naval Reserve
from 1985-1991.

© 2012 OutServe Magazine. All Rights Reserved.

http://outservemag.com/2012/08/military-healthcare-needs-reform/