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Identity or Behavior: A Moral and Medical Basis for LGBTQ Rights

Foreword to The Hastings Center Report special issue on LGBT Bioethics

The rainbow flag flies over San Francisco's Castro District. Photo: Benson Kua. Source: Wikimedia Commons.

The rainbow flag flies over San Francisco’s Castro District. Photo: Benson Kua. Source: Wikimedia Commons.

The progress of lesbian, gay, bisexual, transsexual, and queer rights entails the erosion of prejudice, and erosion is a slow process. Much press accrues to the dramatic advancement of gay marriage, but that progress reflects decades of committed activism that antedate the sea change. Social science, physical science, politics, philosophy, religion, and innumerable other fields have bearing on the emergence of healthy LGBTQ identities. The field of bioethics is implicated both in revolutionizing attitudes and in determining how best to utilize such ameliorated positions. For decades, the debate around homosexuality has centered on whether it is a choice or an inherent quality. A growing segment of the population believes that gay people are “made that way” and therefore do not deserve to be treated with the prejudice they might warrant if they had simply elected what others resisted. In effect, they are like disabled people, who can’t help the challenges they face, and unlike murderers, who could choose not to kill.

The disability model is a variant on the long-standing illness model. Bioethics must confront and correct the signal role of medicine in defining homosexuality as an illness and attempting to cure it through horrific interventions. Midcentury psychoanalysis visited a great deal of pain on gay people, but it is the tip of the iceberg. The case of Alan Turing — the brilliant, gay code-breaker who helped win World War II only to be chemically castrated with estrogen injections in the early 1950s, and who soon thereafter committed suicide — is a synecdoche for the millions of ruined lives that the illness model created. Even today, people continue to receive “treatment” for their homosexuality, and there are few more urgent issues in bioethics than the unmasking of such treatment as dangerous, humiliating, fraudulent, and ineffectual. The notion of sexuality as mutable does not serve truth; it does not serve the social interest; it does not serve individuals who experience an enormous sense of failure as their sexuality fails to shift. Anti-gay arguments tend to hinge on a view of gayness as a behavior; the liberatory ones, on gayness as an identity. A behavior can be avoided; an identity is integral and therefore warrants acceptance — or even celebration. People have a right to their identities, even if they have the capacity to act out other, different identities. Bioethics is the field in which this distinction between gay acts and a gay self may be argued most directly.

Even if sexual orientation is established as unresponsive to corrective interventions, the conversation remains tangled at several levels. First, the rights of minority groups should not be predicated on their lack of choice. We don’t allow freedom of religion because Jews can’t help being Jewish; we grant it because we believe in the value of self-determination. Second, the argument is very disenfranchising; it makes gay people out to be figures of pathos, helplessly caught in a condition so rife with disadvantages that no one would elect it. Third, it suggests that the dominant culture decides who warrants dignity, rather than acknowledging the universal reach of human rights. Hillary Clinton, as secretary of state, said in late 2011 that gay rights are human rights, a position that continues to evolve in jurisprudence and diplomacy. Her speech on the subject caused shock waves around the world; in many societies, gayness is still considered a crime, an illness, and a sin. Bioethics has an opportunity to address the question of sexual orientation as illness, which may in turn affect lawmakers who see it as a crime and theologians who argue that it is a sin.

In twenty-nine U.S. states, it’s still legal to fire someone for being gay. Some legislators are even now in the process of attempting to enshrine prejudice with law that allows anyone to refuse services to gay people. The Hobby Lobby decision has vast implications for gay people; if any corporation that has religious objections to homosexuality is allowed to enact prejudice against us, then even the minimal protections gay people now enjoy become etiolated. Contrary to much American media coverage, gay rights are not primarily marriage rights, and for the millions of gay people who don’t live in accepting places and don’t have resources, equality remains elusive.

Abroad, Russia is enforcing its law against “gay propaganda” with gay people being beaten in the streets on a regular basis. Twenty-seven African countries have passed antisodomy laws, many egged on by American evangelicals who see Africa as fertile ground for their oppression. In Nigeria, where people can be stoned to death for gay offences, lynchings have become commonplace. The president of Zimbabwe has referred to gay people as “filth” and threatened to behead them. In Saudi Arabia, two men caught in congress were sentenced to seven thousand lashes each, enough to leave them disabled; India’s highest court has upheld the country’s colonial-era antisodomy law.

Ethical issues tied to etiology and identity are even more urgent in the discourse about transgender rights. Are people with unusual gender expression acting on the basis of choice, asserting their true selves, or are they helpless victims, “trapped in the wrong body”? Most people can act the role of the gender suggested by birth physiology if they need to do so — but many trans people who attempt to do so are catapulted into despair, even suicide. Their conformity to social norms clearly does not benefit them, and there is no evidence that it benefits the larger society that has dictated those norms. Trans people face a level of prejudice unimaginable to most laymen who have not examined the issue. In 2009, the National Gay and Lesbian Task Force published a survey of transgender people from every U.S. state and territory, with ethnic distribution roughly comparable to that of the general population. The online distribution of the questionnaire meant that it was skewed toward somewhat privileged subjects. Four out of five people surveyed had been harassed or physically or sexually attacked in school, almost half by teachers. Although nearly 90 percent had completed at least some college, compared to less than half the general population, they were twice as likely to be unemployed. One out of ten had been sexually assaulted at work, and almost as many had been physically assaulted at work. One in four had been fired for gender nonconformity. They experienced poverty at twice the national rate. One in five had been homeless, and of that group, one in three had been refused entry to a shelter because of his or her gender expression. A third had postponed or avoided medical care because of disrespect or discrimination by providers. More than half of trans youth have made suicide attempts, as opposed to only 2 percent of the general population. The rates of substance abuse and depression are staggering. Between 20 and 40 percent of homeless youth are gay or trans, and more than half of trans people of color have supported themselves by prostitution.

The murders of trans people frequently go unreported; even when a murder is reported, the fact that it is a hate crime often remains unacknowledged. Since 1999, more than four hundred trans people have been murdered in the United States, and Transgender Day of Remembrance puts the rate of fatal transphobic hate crimes at more than one a month. Worldwide, a transgender person is murdered every three days. In the United States, the catalogue of murders specifically reported as transphobic for 2011 is alarming. Krissy Bates was stabbed to death at forty-five in Minneapolis on January 10. Tyra Trent was strangled at twenty-five in Baltimore on February 19. Marcal Camero Tye was shot and then dragged until dead at twenty-five in Forrest City, Arkansas, on March 8. Miss Nate Nate (or Née) Eugene Davis was shot at forty-four in Houston on June 13. Lashai Mclean was shot at twenty-three in Washington, DC, on July 20. Camila Guzman was stabbed repeatedly in the back and neck at thirty-eight in New York City on August 1. Gaurav Gopalan had a subarachnoid hemorrhage due to blunt-impact head trauma at thirty-five in Washington, DC, on September 10. Shelley Hilliard was decapitated, dismembered, and then burned at nineteen in Detroit on November 10. Her mother had to identify her by examining her charred torso at the medical examiner’s office. There is a need for bioethical examination of why this violence continues and for a consideration of how reframing the issue of trans rights might work to stem it.

Bioethics needs both to examine these current concerns and to anticipate prospective ones. We must consider what to do when we achieve increased knowledge about the biological mechanisms behind LGBTQ experiences, identities, and attractions. Historically, clarity about the origins of any stigmatized condition has been used to erase it, by either treating it or taking measures to prevent it. There is no immediate likelihood that we will understand the genetic, antenatal, structural, and hormonal agents of sexual preference and gender identity well enough to intervene to such ends in the immediate future. Nonetheless, bioethics ought to be contemplating the pros and cons of extirpating a community and an identity, work that will help build social consensus as to how and whether such potential knowledge should be exploited and by whom. As a gay person myself, I am troubled that LGBTQ rights are overly contingent on the growing consensus that we cannot change ourselves, which is an experientially strong but ethically weak position. We must be prepared to defend our right to exist even if science advances far enough so that we can, in fact, change ourselves — or so that others can change us.