Commentary

Bill Siksay: Sex reassignment surgery deserves full coverage across Canada

by The Georgia Straight Staff on June 29th, 2009 at 4:03 PM

By Bill Siksay

What are the limits of medicare coverage? Does prejudice against an identifiable minority affect decisions about who gets covered? Does “medically necessity” not apply to minority communities?

These questions are raised when members of the transsexual and transgender community are denied medical coverage for sex reassignment surgery (SRS) and related therapies, including hormone therapy, hair removal, and breast augmentation.

Transsexual and transgender folks have a different experience of gender than many Canadians. Some trans folks experience their gender opposite to their physical sexual characteristics, a feeling of being in the wrong body. To correct this, they look to SRS. Others experience their gender in ways that are different to the accepted binary theory of gender that says you are either male or female. These folks find their gender on a continuum between or beyond male and female. Some trans folks feel no need to change their physical sex, and may live out their lives as neither traditionally male or female.

Members of the trans community face discrimination as any conversation with them will definitively establish. Trans Canadians experience increased violence because of their gender identity and its expression. Job discrimination is far too common. Often trans folks are passed over when trying to rent an apartment. Obtaining appropriate identity documents can be a frustrating hurdle, exacerbated by misunderstanding. Many trans youth are thrown out of their family homes, ending up homeless and on the street. And getting appropriate health care is sometimes impossible.

We need explicit legal protection for trans Canadians. That means adding gender identity and expression to the list of grounds on which discrimination is prohibited in the Canadian Human Rights Act. It also means adding gender identity and expression to the hate crimes and sentencing provisions of the Criminal Code of Canada, so hate crimes against trans people can be considered by police, prosecutors, and judges.

Protections are in place allowing successful human-rights complaints to be made by trans folks using the “sex” and “disability” categories of existing law. Specifically adding gender identity and expression to the law would make it absolutely clear that such discrimination is wrong in a society that seeks equality and fairness. Changing the law will also raise awareness about the life experience and situation of trans Canadians.

Medical coverage varies across Canada. Some provinces fully cover SRS. Some provinces don’t. Some offer only partial coverage. Some provinces cover related therapies. Some don’t. This is unacceptable. The Canada Health Act was meant to ensure that individuals are not burdened with the cost of medically necessary procedures. It is also supposed to ensure medical treatment is accessible and comprehensive. Forcing individuals to pay out of their own pockets for medically necessary treatment is wrong. Canadians decided some time ago to share the expense of medical care so we all get the care we need and don’t go bankrupt obtaining it.

SRS is not a frill. It’s not cosmetic. It’s not elective. It’s a necessary procedure that some trans people pursue in consultation with their doctors. It’s necessary medical treatment which helps some trans people lead healthy, happy, productive lives.

The federal government does not make decisions about which specific services are covered by medicare. Those decisions are up to provincial governments. But the federal government does fund medicare and set the standards which govern it. Those standards must recognize the medical necessities of trans Canadians’ medical requirements that must be funded collectively through our tax dollars. Decisions must be based in fact, not determined by prejudice.

For all these reasons, I’ve tabled a private member’s bill, Bill C-389, in the House of Commons to add gender identity and expression to the Canadian Human Rights Act, ensuring full protection for transsexual and transgender Canadians. My bill is likely to be debated and voted on this fall. And I’ve put a motion before the House to call on the federal government to ensure appropriate health care is accessible across Canada to transsexual and transgender people. Anything less than explicit, full, and comprehensive protection of trans Canadians diminishes Canada’s commitment to equality and diversity. And the failure to fully cover SRS within medicare diminishes the fundamental Canadian vision of public health care.

Bill Siksay is the member of Parliament for Burnaby-Douglas and the federal New Democrat critic for gay, lesbian, bisexual, transgender, and transsexual issues.

Comments

14 Comments

Congratulations

Jun 29, 2009 at 6:40pm

Everyone deserves equal access to public health care across provinces, and this means the health care system is responsible for its trans patients and their needs. Thank you, Mr. Siksay, for standing up for this principle. Your summary, "SRS is not a frill. It’s not cosmetic. It’s not elective. It’s a necessary procedure that some trans people pursue in consultation with their doctors," is excellent.

In British Columbia, the Medical Services Plan was unable for years to provide publicly-funded SRS options for some trans patients because there were no qualified surgeons. It created an indefinite waiting list. Then, there were only a few state-endorsed psychiatrists who could approve people for SRS, and for years they didn't take new patients. This created a second indefinite waiting list. So, those who can save up for the very, very expensive private system out-of-province and poor people are left with waiting as the only option – no health care at all.

Julie Bleheim

Jun 29, 2009 at 11:44pm

I have very poor eyesight, and cannot function without optical aids (glasses, contacts); because my sight is so poor, fixing it costs more than it does for the average glasses wearer. I have to buy glasses, though - I'd probably get hit by a car crossing a road without them, and can't read anything unless it's so close that I go cross-eyed. But BC won't fund my glasses or contacts either. It's frustrating when people selfishly single out their own preferred group instead of fighting for real justice - why not demand that the Canada Health Act be applied fairly to everyone - not just to those who are getting coverage, "plus" one extra group?

As an aside, Bill, in your article, it would be worth explaining to those who may not know (including me, at this point in time - and you had a chance to convince me), why it is that SRS is so imperative for those who want it, and how a person wanting it differs from a woman who sincerely believes her breasts are too small and wants implants (I'm guessing that they're not covered) - that is where, and how, does the line get drawn? And, if you really believe that SRS is a more important issue than (e.g.) visually impaired people being helped to see, why is that so?

Lastly, you want hair removal to be covered - so, should women who have naturally hairy bodies be ashamed of their hair and get it removed (it's implied)? Should they then also be covered - free laser removal for all hairy women? What, only SRS people qualify? But, but... that would be discrimination, wouldn't it?

Danica

Jun 30, 2009 at 7:44am

I agree and THANK Bill Siksay for ayyempting to help us Trans people , God Bless him , his party is getting my votes.

Alison

Jun 30, 2009 at 10:21am

Julie Bleheim, as someone who doesn't know as much as I should about trans issues, I can somewhat understand why you'd think questions like that. But, it isn't Siksay's job or anyone elses to educate you and me about, for example, why "SRS is so imperative" etc. etc. etc. There is so much information available for us to read and it is a display of privilage to demend to be educated, without first being willing to search out information. And, it's also potentially offensive to a lot of people to ask such ignorant and transphobic questions.

So, please consider some reading recomendations. I've personally found these very helpful as I try to learn about these issues:

http://questioningtransphobia.wordpress.com/category/trans-101/

http://juliaserano.livejournal.com/14700.html

http://drakyn.blogspot.com/2008/01/definitions-and-explanations_22.html

http://nnhs-gsa.org/transwhat/

The book Whipping Girl, by Julia Serano

Dani

Jun 30, 2009 at 10:36am

In response to Julie, You are correct there should not be discrimination for ANY medically necessary procedure. To answer your question regarding those of us Trans people who need SRS/GRS: We reach a point in our lives where the anxiety and depression of trying to live the life everyone expects us to overwhelms the coping techniques. Our lives fall apart and we crash hard. After years of therapy and embarking on correcting the issue, of which SRS/GRS is the final step, we can put back together productive happy lives. Lives where we don't go to bed at night praying we don't wake up. It is very hard to explain to anyone that has not felt the emotional pain involved.

The problem is that 1 in 1500 children are born with an intersex condition. Only 4 or 5 of the 170 known conditions are visible at birth. Where do these people fit in the artificial gender binary? Where do I?

I am not a Canadian. I am spending $600 US per month on my transition just in therapy, hormones, and electrolysis. I still have to save $15,000 to $30,000 to cover my SRS. I also wear glasses and spend $800 every two or three years for new eye glasses. It would be nice if they were all covered. However, the things I need to live are therapy, hormones, and eventual SRS when I get to that step. While it would not be pleasant I could learn to live blind but I already know that without hormones I won't make it a month.

I hope that answers your questions. :)

goldorak

Jun 30, 2009 at 2:47pm

And since I do not feel the urge to change my sex, my glasses prescription has not changed for years and that I already enjoyed the sub par maternities of this country, I feel somehow the prejudice of being asked over and over again to fund everyone elses' little or big bobos should be compensated by taxpayers too.

Heather1415

Jun 30, 2009 at 6:10pm

The comparison to a normal woman getting implants is completely ludicrous. Ask yourself if a normal 20-year-old man at 150 lbs who has DD breasts should be able to get a double mastectomy. If you were this man, would you still think it was strictly a cosmetic issue? Would you be able to face a world that treats you as a total freak, but won’t pay for the surgery to fix your body, even though you can’t afford to pay for it yourself? Would you put up with employers laughing in you face and refusing to hire you because of them?

This is why many trans people commit suicide. It’s better than knowing that you will spend the rest of your life being laughed at, discriminated against and treated like a freak because of a medical problem over which you have no control.

If you want to find out more about this issue you should look at this YouTube channel:
http://Youtube.com/TransInsight

Diane_K

Jul 1, 2009 at 3:55pm

I do wish that the distinction would be made that a person who wishes to trans their sex is a true transsexual and born that way according to the BSTc and other research studies that show it to be a congenital anomaly.

On the other hand a person who moves in and out of gender moods or urges is doing just what trans-gender indicates.

The former is a condition inherent in the womb and natural unlike that of those who might be gender confused as many of the latter who seem rather nurtured toward a gender awkwardness often as a result of 'friendly' enablers who are doing a disservice to those of the transgender community who would be better suited never to consider surgery whether it be sex reassignment or genital reassignment. No such thing as changing ones gender through a surgical process so therefore no such thing a 'gender change' through a surgical result.

Jack Webster

Jul 2, 2009 at 12:50am

Who dreams up all this silliness and where does it end up taking us? If you don't like something about your self, get a job and pay for it yourself! You aren't going to drop dead tomorrow if you don't get sex change operation, and we don't to overload our medical facilities with your in your head conditions.

Is it fair for somebody else to get up every day to work as a garbage truck driver, receptionist, engineer ... to cover the costs for you? What is wrong with you freeloading basket cases!