Population Care

AMA advises U.S. Supreme Court on transgender individuals’ rights

When the U.S. Supreme Court in 1994 decided a case involving a transgender individual’s rights, it looked to the American Medical Association to medically define the plaintiff who asked the court to protect her.

Dee Farmer was assigned at birth male, but identified as female. She wore women’s clothing, underwent estrogen therapy, received silicone breast implants and underwent an unsuccessful “black market” testicle-removal surgery. Farmer, who was serving a federal sentence for credit card fraud, sued federal prison officials for violating her Eighth Amendment rights to not be subjected to cruel and unusual punishment while in prison.

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Farmer had continued hormone therapy and presented as female in prison, according to court records. She was generally separated from the male population at the first prison she was housed, in part for behavior and in part for safety. After being transferred to another prison, she was placed in a general population where she said she was beaten and raped.

The Bureau of Prison’s medical personnel had diagnosed Farmer as transsexual and justices in their opinion turned to the AMA’s 1989 Encyclopedia of Medicine for the medical definition quoting that it was "[a] rare psychiatric disorder in which a person feels persistently uncomfortable about his or her anatomical sex," and who typically seeks medical treatment, including hormonal therapy and surgery, to bring about a permanent sex change.

The Litigation Center of the American Medical Association and State Medical Societies and 10 other medical organizations noted that this definition was out of date in an amicus brief they filed in a 2017 case, Adams v. School Board of St. Johns County, Florida.

“It is now understood that being transgender implies no impairment in a person’s judgment, stability, or general social or vocational capabilities,” the brief stated. “Gender dysphoria is a condition characterized by clinically significant distress and impairment of function resulting from the incongruence between one’s gender identity and the sex assigned at birth.”

The court in Farmer v. Brennan sent the case back to the lower court for further consideration of whether prison officials knew the risk, with the high court justices ruling that prison officials could be found liable for denying an inmate humane conditions if they knew of or disregarded an excessive risk to the inmate’s health or safety.

Farmer ultimately lost the case during the retrial, but the Supreme Court ruling was precedent-setting.

AMA Litigation Center gets involved

Since 1994, the AMA on numerous occasions has stood up for transgendered individuals’ rights in court, with the Litigation Center filing friend-of-the court briefs.

The AMA Litigation Center gets involved in cases when the AMA has policy on an issue. The Association has a number of policies involving LGBQT rights, including that public and private health insurers cover treatment of gender dysphoria as recommended by the patient’s physician. Policy the House of Delegates adopted at the 2018 AMA Interim Meeting calls on the Association to, among other things, oppose any efforts to deny an individual’s right to determine their stated sex marker or gender identity and to affirm that gender for many individuals may differ from the sex assigned at birth.

Advocating in Penn., Wisc.

In 2018, the AMA Litigation Center joined other health care organizations in filing an amicus brief asking the 3rd U.S. Circuit Court of Appeals to uphold a policy that allows Pennsylvania high school students to use a bathroom or locker room that matches their gender identity rather than their sex assigned at birth can be left in place.

The appellate court in its ruling in Doe v. Boyertown Area School District upheld the policy. The students who filed the lawsuit seeking to have the policy thrown out are now asking the U.S. Supreme Court to consider the case.

The AMA Litigation Center also advocated on behalf of transgender individuals’ rights in 2011 when it joined with other health care organizations in filing an amicus brief in the 7th U.S. Circuit Court of Appeals in a case that asked whether a Wisconsin law prohibiting prison doctors from using hormonal therapy or sex reassignment surgery to treat inmates with gender identity disorder was legal.

In Fields v. Smith, the 7th Circuit upheld a lower court decision that withholding treatment was cruel and unusual punishment under the Eighth Amendment and deprived inmates of equal protection guaranteed under the 14th Amendment.