Teachers are now to provide professional gender-affirming care for students without a required medical license, without parental approval or consent, without securing informed consent, and without conforming to professional standards of care.

Minnesota proposes to require teachers to “ensure” that student gender-identities are “affirmed.”  How would that work?  Let’s say 13-year-old Katie approaches a teacher and informs the teacher that she was born in the wrong body, that she is actually a boy, that she is to be called Ben, and that she needs to have her breasts removed in order to become her authentic self.  According to Item 4E of “The Proposed Standards of Effective Practice” for teachers in Minnesota, the teacher is required to ensure that Katie’s identity is affirmed.  The teacher, however, has no knowledge of Katie’s mental health history, whether she is under the care of licensed gender-care professionals, how Katie may have developed her beliefs as to her identity, the persons or causes instrumental in forming her gender identity, what Katie’s parents know, if anything, and how they feel about her gender identity, and what diagnoses and treatment recommendations Katie may have received from gender-care professionals, including recommendations that a wait and see protocol be adopted or that affirmation be delayed pending further evaluation and investigation.  The teacher is thus faced with a mandate from the state to affirm Katie’s gender identity in a one-size-fits-all protocol which clearly violates both the individualized treatment requirements of the 2012 Standards of Care Version 7 (page 7) published by the World Professional Association for Transgender Health (WPATH) and the individualized treatment recommendations of the American Psychiatric Association (APA).

Katie’s teacher would also be compelled to affirm a transition for which there is no medical consensus.  The 2012 APA Task Force Report (p.4) concludes that there is no consensus at all regarding treatment of children with gender identity disorder, now called Gender Dysphoria (GD), and identifies three approaches to working with children with GD. The first of these focuses on working with the child and caregivers to lessen GD and to decrease cross-gender behaviors and identification. A second approach makes no direct effort to lessen Gender Dysphoria or gender atypical behaviors. A third approach may entail affirmation of the child’s cross-gender identification by mental health professionals and family members. The APA also confirms that there is insufficient evidence to support guidelines for treatment of GD in adolescents. 

Katie’s teacher would also be compelled to wrongfully proceed with affirmation without completion of an assessment, evaluation, and investigation as required by the APA.  The report concludes that for “adolescents” the following evaluations should be undertaken:

“1) psychological and psychiatric assessment and diagnosis of adolescents presenting with a wish for sex reassignment, including assessment and diagnosis of co-occurring conditions and facilitation of appropriate management; 2) psychotherapy (including counseling and supportive therapy as indicated) with these adolescents, including enumeration of the issues that psychotherapy should address. These would include issues that arise with adolescents who are transitioning gender, including the real life experience; 3) assessment of indications and readiness for suspension of puberty and/or cross-sex hormones as well as provision of documentation to specialists in other disciplines involved in caring for the adolescent; 4) psychoeducation of family members and institutions regarding GV and GID; and 5) assessment of the safety of the family/school/community environment in terms of gender-atypicality-related bullying and stigmatization, and to address suitable protective measures.”

Similar evaluations are recommended for “children.” 

In short, teachers lack the experience, education, and training necessary for evaluation of GD patients in order to determine treatment recommendations for minors presenting with GD.

Katie’s teacher is also being compelled to wrongfully commence or continue participation in gender identity affirmation without securing the legally required consent of the minor’s parents or guardians.  The Supreme Court  has held that it is the parents’ constitutional right to make the decisions as to the care, custody, and control of their children. Further, even the WPATH Standards of Care (Version 8) confirm:

“We recommend when gender-affirming medical or surgical treatments are indicated for adolescents, health care professionals working with transgender and gender diverse adolescents... involve parent(s)/guardian(s) in the assessment and treatment process...  When there is an indication an adolescent might benefit from a gender-affirming medical or surgical treatment, involving the parent(s) or primary caregiver(s) in the assessment process is recommended in almost all situations...”

Teachers are also being compelled to participate in affirmation of a minor’s transition without securing legally and ethically required informed consent. For all minors presenting with gender identity issues, “informed consent” remains a prerequisite to treatment, whether that treatment is in the form of counseling, social transition (cross-dressing, use of opposite-sex names and pronouns, use of opposite-sex restrooms, or participation in opposite-sex sports,) or physical or other medical interventions.  Disclosure to and comprehension by the minor and his/her family is required both as to the wide divergence of professional opinion relating to treatment options and the reasons for such divergence and as to the overwhelming number of material adverse medical, social, and economic risks and consequences of transition. 

Katie’s teacher is also wrongfully being compelled to affirm a minor’s gender identity when doing so would cause the teacher to violate Minnesota state ethics regulations requiring teachers to make reasonable effort to protect the student from conditions harmful to health and safety.  Surely students need protection from what significant portions of the population and large numbers in the medical community deem to be child abuse.

If the state does not rescind or withdraw its “Proposed Standards for Effective Practice,” will anyone be surprised if litigation is immediately commenced by minors and their families against teachers, school boards, and the state?

Image: Ted Eytan