Judge Rules In Favor of Taxpayer-Funded Sex Change for Massachusetts Inmate

A federal judge’s decision Tuesday to require that Massachusetts officials provide a taxpayer-funded sex change to an inmate is sure to ignite some controversy—not only is it the perfect issue to unite fiscal and social conservatives, but it also appears to be the first time a judge has ruled in favor of a transgender inmate making this request.

It isn’t the first time though that a transgender inmate has sued for the surgery, so we know a bit about how this debate plays out. U.S. District Court Chief Judge Mark Wolf ordered Tuesday that Michelle Kosilek, who has been in prison since 1993 for killing his (now her) wife, receive the surgery lest the state violate her 8th Amendment freedom from cruel and unusual punishment. Whether you’re outraged or encouraged by this probably has something to do with whether you view sex-reassignment surgeries as a medical necessity or a cosmetic request. In a nation that’s really only just beginning to grapple with trans issues, a lot of people intuitively trend toward the cosmetic end. But Judge Wolf noted in his ruling that more and more people are coming around to the former point of view: the idea that in some cases, it’s a medically necessary move. “This fact that sex reassignment surgery is for some people medically necessary has recently become more widely recognized,” Wolf writes in the decision. Lawyers for inmates in similar situations have argued that hormone therapy is, in some cases, insufficient to combat the emotional distress transgender people feel when suffering from gender identity disorder. To understand how deeply felt the disorder can be, consider Ophelia De’lonta, an inmate in a Virginia prison who was denied sex change surgery in 2011 and then tried to castrate herself with a disposable razor blade for three hours.

Others have seen shades of gray on the medical necessity debate. Inmates (including Kosilek) have already won court fights to gain hormone treatment therapy, but lost requests for surgery. In California, lawyers won a case to deny an inmate the surgery, arguing, “A prison is not required by law to give a prisoner medical care that is as good as he would receive if he were a free person, let alone an affluent free person.” In other words, we’ll treat you up to a point, but if you want the best care out there, don’t kill your wife.

Medical necessity aside, there’s a safety component, too. Prisons house inmates according to their genitalia and a UC Irvine study found that transgender inmates are 13 times more likely to be sexually assaulted than the average inmate. Sex reassignment surgery gets them out of an often treacherous situation.

We bet Judge Wolf’s decision won’t be a popular one, but then, that’s why we entrust these things to the judiciary. What will be most interesting in the long term is whether this big first remains an outlier decision or gives other judges cover to rule similarly.