http://downloads.frc.org/EF/EF16B28.pdf

跨性別運動和法律中的「性別認同」

Peter Sprigg

實際上所有人都有生理上的性別，出生時即可辨別，並且一生都不可改變，他們非男即女。跨性別運動代表了對這一身體事實的否定。

 

一種精神障礙

某人認為自己是或自己想成為不同於其生理性別的「性別認同」的想法，長期以來被公認為是一種精神障礙。[1]精神病學家Sander Breiner稱，「當一個外表和身體功能正常的成人以為自己外表某處很醜或有缺陷時，…他／她就有心理問題」。[2]另一位精神病學家Rick Fitzgibbons稱此種情況為「一種頑固的錯誤信念…確切來說是一種妄想」。[3]精神病學家Paul McHugh則稱，「這是一種心理的紊亂，而不是身體的紊亂」。[4]

那些選擇不按照生理性別對應的「性別認同」來生活的人被稱之為「變性」人。（注：極少數「雙性」人－生來具有混合男性和女性遺傳或生理特徵的人－屬於單獨的類別，不自認是「變性人」。）[5]）

經過跨性別運動積極分子的廣泛遊說後，美國精神病學會（American Psychiatric Association）在2013年將「性別認定障礙（Gender Identity Disorder）」診斷改為「性別認同障礙（Gender Dysphoria）」。不過，它還是保留在障礙（disorders）列，因為「若要獲得醫療的保險覆蓋，當事人需要先進行診斷」。[6]

 

「性別認同障礙」的成因和治療

「性別認同障礙」的成因很難斷定，那些自視為變性人的更可能曾是兒童性虐待的受害者，或者有過受創、喪親和家庭分裂的經歷。[7]

多倫多大學（University of Toronto）關於兒童性別認同障礙方面的頂尖專家Susan Bradley博士和Kenneth J. Zucker稱，「對於幫助兒童更堅定自己的性別認同，臨床醫生應該是更樂觀，而不是傾向虛無主義」。[8] 精神病學家曾報告說，性別認同障礙通常與成年人的其他精神健康問題併發，並且那些狀況會「隨著治療一同改善」。[9]

 

「性別重塑」手術

完全的變性涉及激素治療、乳房手術（移除或植入）、其他整容手術、生殖器重建和個人認同的改變。不過，不是每個尋求按另一種性別生活的人都會接受手術。[10]

這些手術過程並不總是成功的，可能會非常疼痛。[11]一生的激素治療也會帶來深刻的身體和心理影響。[12]精神病學家Jon Meyer總結說，「手術不是對精神疾病的合適治療方式，並且我很清楚，這些患者具有的嚴重精神問題不會在手術後消失」。[13]甚而在那些進行了性別重塑手術的人當中，自殺率非常高，這暗示了他們潛在的異常帶來自殺的傾向。[14]

 

跨性別運動的公共政策影響

政府認可

理想情況下，法律應當禁止政府以任何形式（無論是出生證明，[15]駕照，[16]護照，[17]或任何其他政府頒發的身份證明）認可人們生具生理性別的任何變化。或者，這種認可應限於清楚知道變化是永久和不可逆的情況－因為已經進行了性別重塑手術。[18]

「性別認同反歧視」法律

所有美國人在憲法下、他們的政府面前有同等的權利。然而，地方、州府和聯邦的法律或法令往往會基於所謂的「性別認同」，將雇傭、住房和公共收容中的一些「歧視」行為宣佈為非法，從而給予那些自認是變性人的人一份特殊的權利－只要他們覺得自己受到冒犯，就可以起訴，甚至私營公司也不能例外。這類的法律等於強迫人們肯定人可以改變自己性別的神話。因此它們原則上是錯的，也應當一直被反對。這些法案有時承認外觀、衣著和儀容標準在工作場所的重要性，但在文化上適合自身生理性別的穿著方式才是最基本的「外觀、儀容和衣著標準」。[19]

對「性別認同」法律原則的最極端應用當屬對男女廁、更衣室和淋浴間的使用。甚至自認同性戀者的前國會議員Barney Frank也承認，變性積極分子真正想要的，「是讓具有[男性身體構造]卻自認是女性的人可以與其他女性一同共浴」。[20]

以下是一些反對「性別認同反歧視」法律的其他原因：

• 它們增加了政府在自由市場的干預。
• 「性別認同」與民事權利法律保護的大多數其他特性不同。[21]
• 它們將導致對雇主的昂貴訴訟。[22]
• 它們強制批准雇傭那些自認是「變性人」的人，即便在明顯不合適的崗位，如教育崗位。[23]

學校裡的「性別認同」

雇傭自認是變性人的人作為老師或教職人員（在「反歧視」法規強制下）將會使孩子們困惑，並會破壞孩子們的性別認同意識發展，[24] 而他們在課程中教授「性別認同」可能會損害父母在這些問題上傳遞自己價值觀的權威。[25]如果自認是變性人的學生被允許使用異性的廁所、淋浴間和更衣室，安全和隱私方面的顧慮將更甚於成年變性人，[26]並且倘若學生可以任意選擇某種性別的群體來參與競賽，人們會問分男女進行的體育競技的公平性何在。[27]沒有學生應當受到恐嚇，不過在學校強加一種新的性別意識形態並不足以保證學生安全。

 

納稅人資助的「性別重塑」

納稅人不應被強迫來給公務員[28]、囚犯[29]的性別重塑買單，或通過《醫療保險和醫療補助》（Medicaid）[30]和《老年和殘障健康保險》（Medicare）[31]項目為性別重塑買單。這類治療－涉及健康肢體部分的切除，按理說是違反了醫學倫理。而且，它們是可選的手術，並不是必須的醫療保健，正如其他任何形式的美容或整形外科手術一樣。

 

政府強制的對「性別重塑」的醫療保險覆蓋

奧巴馬政府在《病者可支付醫療保護法》（Patient Protection and Affordable Care Act，又稱ObamaCare）下提出一條規定，禁止保險公司排除對性別重塑手術的覆蓋。[32]這干預了自由市場，並增加了所有購買健康保險的雇主及個人的費用。對於那些宗教上或道德上反對為這類手術買單的許多家族企業和宗教非盈利組織，該規定也違背了他們的信念。

決策者不應去為可選的整容性別重塑手術買單－或強迫他人為此買單，決策者應當考慮保證政府或已覆蓋精神健康服務的私人保險計畫能提供心理治療的覆蓋，來幫助人們克服（而非縱容）性別認同障礙和關聯的精神問題。

 

軍隊裡的變性服務

變性身份應繼續作為服兵役的不合格精神狀況，性別重塑手術應作為服兵役的不合格身體條件。[33]然而，奧巴馬政府可能很快改變這一點。[34]

美國自認是變性者的最著名服役人員Bradley Manning的故事加劇了這些擔憂。他是一位士兵，因為洩漏機密檔，在2013年被判定犯有間諜罪。[35]在其被判處監禁的第二天，他「變成了」變性人。[36]

For more information, see: Dale O’Leary and Peter Sprigg, “Understanding and Responding to the Transgender Movement,” Issue Analysis IS15F01 (Washington: Family Research Council, June 2015). Online at: http://www.frc.org/transgender

Peter Sprigg is a Senior Fellow for Policy Studies at Family Research Council in Washington, D.C.

 

參考文獻：

1 American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5 (Washington, DC: American Psychiatric Publishing, 2013), 451.

2 Sander Breiner, M.D., “Transsexuality Explained,” NARTH Bulletin, March 27, 2008.

3 Rick Fitzgibbons, M.D., “Gender Identity Disorder in Children: Will Jack Be Happier If We All Pretend He’s Jill?” Aleteia, January 12, 2015, accessed February 12, 2016, http://aleteia.org/2015/01/12/gender-identity-disorder-in-children-will-jack-be-happier-if-we-all-pretend-hesjill/.

4 Perry Chiaramonte, “Controversial Therapy for Pre-Teen Transgender Patient Raises Questions,” FoxNews.com, October 17, 2011, accessed February 12, 2016, http://www.foxnews.com/us/2011/10/17/controversial-therapyfor-young-transgender-patients-raises-questions/?test=latestnews.

5 A very tiny percentage of people, once known as “hermaphrodites,” suffer from “intersex” conditions—also known as “disorders of sexual development”—which involve a mix of male and female genetic or biological characteristics. However, this rare medical condition is not relevant to the transgender debate, because the vast majority of “transgender” individuals have only a psychological gender dysphoria and are not biologically 4 “intersexed.” See: Leonard Sax, “How Common is Intersex? A Response to Anne Fausto-Sterling,” The Journal of Sex Research, Vol. 39, No. 3 (August 2002): 175.

6 American Psychiatric Association, Gender Dysphoria, American Psychiatric Publishing, 2013, accessed February 12, 2016, http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf.

7 K. Zucker and S. Bradley, Gender Identity and Psychosexual Problems in Children and Adolescents, (New York: Guilford, 1995).

8 Ibid, 281.

9 Isaac Marks, Richard Green, David Mataix-Cols, “Adult Gender Identity Disorder Can Remit,” Comprehensive Psychiatry Vol. 41, No. 4 (July/August 2000): 273-275.

10 D. Schrock et al., “Transsexuals embodiment of womanhood,” Gender & Society, (2003) 20 (10): 149.

11 S. Krege et al., “Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients,” BJU International 88 (2001): 396-402, http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.2001.02323.x/epdf.

12 H. Asscheman, L. Gooren, P. Eklund, “Mortality and morbidity in transsexual patients with cross-gender hormone treatment,” Metabolism, vol. 38, Issue 9 (September 1989): 869-73, http://www.researchgate.net/profile/Louis_Gooren/publication/20628202_Mortality_and_morbidity_in_transse xual_patients_with_cross-gender_hormone_treatment/links/0c9605187a882bdc08000000.pdf.

13 Michael Fleming et al., “Methodological Problems in Assessing Sex-Reassignment Surgery: A Reply to Meyer and Reter,” Archives of Sexual Behavior, vol. 9 (5) (1980): 451, http://link.springer.com/article/10.1007%2FBF02115944?LI=true#page-2

14 Cecilia Dhejne, et al., “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLoS ONE, Vol. 6, Issue 2 (February 22, 2011), http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

15 “Changing Birth Certificate Sex Designations: State-By-State Guidelines,” Lambda Legal, updated February 3, 2015, accessed January 19, 2015, http://www.lambdalegal.org/publications/changing-birth-certificate-sexdesignations-state-by-state-guidelines. 16 “ID Documents Center,” National Center for Transgender Equality, updated February 1, 2016, accessed February 12, 2016, http://www.transequality.org/documents.

17 “New Policy on Gender Change in Passports Announced,” U.S. Department of State, June 9, 2010, accessed February 12, 2016, http://www.state.gov/r/pa/prs/ps/2010/06/142922.htm.

18 For example, in 2014, New Jersey Gov. Chris Christie vetoed Assembly Bill No. 4097, which would have liberalized rules for amending birth certificates by dropping the requirement for sex reassignment surgery. See veto message at: http://www.njleg.state.nj.us/2012/Bills/A4500/4097_V1.PDF.

19 Peter Sprigg, “Sexual Orientation and Gender Identity (SOGI) Laws: A Threat to Free Markets and Freedom of Conscience and Religion,” Family Research Council, October 2014, accessed February 12, 2016, http://www.frc.org/issuebrief/sexual-orientation-and-gender-identity-sogi-laws-a-threat-to-free-markets-andfreedom-of-conscience-and-religion.

20 Loren King, “Task Force Drops Support for Federal Anti-Bias Bill,” Bay Windows, June 10, 1999; no longer available online as of January 20, 2015.

21 For example, the Civil Rights Act of 1964 only bars discrimination based on “race, color, national origin, sex, and religion.” Public Law 88-352, “Civil Rights Act of 1964,” July 2, 1964, http://library.clerk.house.gov/reference-files/PPL_CivilRightsAct_1964.pdf.

22 For example, in 2009, a federal judge ordered the Library of Congress to pay $491,190 in back pay and damages to a transgender job applicant who had alleged discrimination. See: “White House not appealing transgender ruling,” Associated Press, July 1, 2009, accessed February 12, 2016, http://usatoday30.usatoday.com/news/washington/2009-07-01-transgender-ruling-appeal_N.htm.

23 Bernard Vaughan, “Gender-change teachers gets OK: Eagleswood board stands by decision to hire McBeth,” Press of Atlantic City, February 28, 2006.

24 Ibid.

25 Todd Starnes, “Call it ‘gender fluidity’: Schools to teach kids there’s no such thing as boys or girls,” FoxNews.com, May 15, 2015, accessed February 12, 2016, http://www.foxnews.com/opinion/2015/05/15/call-itgender-fluidity-schools-to-teach-kids-there-s-no-such-thing-as-boys-or-girls.html.

26 “ADF: No law requires Nebraska schools to open restrooms to opposite sex,” Alliance Defending Freedom, November 18, 2015, accessed February 12, 2016, http://www.adfmedia.org/News/PRDetail/9801.

27 Stella Morabito, “Minnesota Plans To Eliminate Gender Distinctions For High School Sports,” The Federalist, December 1, 2014, accessed February 12, 2016, http://thefederalist.com/2014/12/01/minnesota-plans-to-eliminate-gender-distinctions-for-high-school-sports/.

28 Chris Geidner, “Exclusive: Feds To Lift Ban On Federal Employee Insurance Coverage Of Sex-Reassignment Surgery,” Buzzfeed, June 13, 2014, accessed February 12, 2016, http://www.buzzfeed.com/chrisgeidner/feds-tolift-ban-on-federal-employee-insurance-coverage-of-s#.nkZYpvveV.

29 For example, a long-running lawsuit in Massachusetts claimed that it was “cruel and unusual punishment” for a Massachusetts prison to refuse to pay for gender reassignment surgery for a convicted murderer. In December 2014, the U.S. Court of Appeals for the First Circuit rejected that argument. See Michelle Kosilek v. Luis S. Spencer, No. 12-2194, U. S. Court of Appeals for the First Circuit, Opinion en banc (December 16, 2014), http://media.ca1.uscourts.gov/pdf.opinions/12-2194P2-01A.pdf.

30 Jeremy C. Fox, “Mass. to cover range of transgender medical care,” The Boston Globe, June 20, 2014, accessed February 12, 2016, http://www.bostonglobe.com/metro/2014/06/20/state-cover-gender-reassignment-surgeryand-hormone-treatment-for-transgender-patients/a9OPrvqdUPmRoiAQugVwEO/story.html.

31 “Medicare ban on sex reassignment surgery lifted,” USA Today, May 30, 2014, accessed February 12, 2016, http://www.usatoday.com/story/news/nation/2014/05/30/medicare-sex-reassignment/9789675/.

32 “Nondiscrimination in Health Programs and Activities; Proposed Rule,” Department of Health and Human Services, 45 CFR Part 92; Federal Register 80, No. 173 (September 8, 2015): 54172-54221, https://www.federalregister.gov/articles/2015/09/08/2015-22043/nondiscrimination-in-health-programs-andactivities.

33 “Medical Standards for Appointment, Enlistment, or Induction in the Military Services,” Department of Defense Instruction No. 6130.03 (April 28, 2010; Incorporating Change 1, September 13, 2011), http://www.dtic.mil/whs/directives/corres/pdf/613003p.pdf.

34 Kendall Breitman, “White House open to lifting transgender ban,” Politico, February 23, 2015, accessed February 12, 2016, http://www.politico.com/story/2015/02/white-house-open-to-lifting-transgender-ban115426.html?hp=l4_4.

35 Ed Pilkington, “Bradley Manning verdict: cleared of ‘aiding the enemy’ but guilty of other charges,” The Guardian, July 31, 2013, accessed February 12, 2016, http://www.theguardian.com/world/2013/jul/30/bradleymanning-wikileaks-judge-verdict.

36 Emmarie Huetteman, “‘I Am a Female,’ Manning Announces, Asking Army for Hormone Therapy,” The New York Times, August 22, 2013, accessed February 12, 2016, http://www.nytimes.com/2013/08/23/us/bradleymanning-says-he-is-female.html?_r=0.