NEJM backs transgender turn in US govt policy


On the evening of his inauguration President Joe Biden made it his business to send strong signals about the trans-friendly policies of his Administration. He signed an executive order to ban discrimination on the basis of gender identity and sexual orientation which wound back some of the trans-unfriendly policies of his predecessor.

Gender has clearly become a political battleground in the United States. How did this happen?

The New England Journal of Medicine this week gave Norwegian medical historian and bioethicist Ketil Slagstad a platform to help normalise transgenderism and to contest the notion of “naturalness” in medicine.

In the history of medicine Dr Slagstad sees five “‘anomalous’ forms of embodiment and identities” the hermaphrodite, the homosexual, the intersex body, the transsexual, and the transgender person. There never has been an uncontested binary notion of sex, he argues, even as far back as Hippocrates and Galen. And in the 19th and 20th centuries doctors and writers like Richard von Krafft-Ebing, Magnus Hirschfeld, John Money and Robert Stoller illuminated the idea that gender is a spectrum and that sex is plastic and malleable.

His underlying idea is that the idea of “naturalness” has been tossed into the dustbin of history:

These examples demonstrate how transgender rights trigger discussions about the nature of sex. But that effect is nothing new: repeatedly throughout the history of Western thought, “nature” has provided a rich resource for shaping norms, settling categories, and stabilizing concepts of normality. What counts as natural and what role nature plays in the order of things, however, are historically contingent.

The lesson for America is that its political battles over transgender issues are part of a painful historical evolution of understanding of sex and gender which began as far back as ancient Greece.

The history of medicine offers an antidote to the notion that we are simply looking at “nature” when we see sex and gender: what counts as sex and gender is historically changeable, morally infused, and politically loaded.

Ultimately, then, Dr Slagstad seems to argue, defining what is natural is a political, not an ontological, question.

The NEJM is probably the world’s most prestigious medical journal and this contribution nails the transgender flag to its mast. So the article is bound to be controversial. Not long ago Theodore Dalrymple published a scathing critique of the NEJM’s editorial policy, False Positive. No doubt its critics will quote his central complaint:

When it pronounces on social philosophy, as it often does, it reads like Pravda, not in the sense that it is Marxist-Leninist, of course, but in the sense that it takes its own attitudes so much for granted, as being so indisputably virtuous and true, that other viewpoints are rarely if ever expressed in its pages.

Michael Cook is editor of BioEdge




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