do you think GRS should be done by Informed consent

[stephaniec]

Do you think you should be able to walk into  a surgeons office and sign a form saying that you are well informed and knowledgeable about the treatment you are asking for and accept all responsibility and are of sound mind and then be scheduled  for GRS  or should you be required by the medical community to fulfill certain requirements to ensure a successful outcome for the kind of treatment your asking for ie. GRS.

[Lady Smith]

Informed consent all the way.  And when I say 'informed consent' I mean acknowledging that yes you really do understand what it is you're committing to and not treating it like a free pass to ride the train and complaining afterwards should you fall off through your own carelessness.

[iKate]

You can probably get it informed consent if you pay cash.

However, it is the insurance companies who put requirements for SRS and apparently it is stricter than WPATH SOC. Dr Bowers explains it as follows:

"Despite our absolute support of the new SOC, nearly all insurance companies still adhere to the requirements below, and your pre-authorization will likely not be successful if you can't provide the letters of recommendation to their satisfaction.  We continue to pressure insurance companies to update their requirements."

So, blame the insurers.

[Jenna Marie]

Informed consent.

I know more than one person who jumped through all the hoops, dealt with *serious* gatekeepers... and still regretted GRS. So I don't think the gatekeeping prevents regret, and I KNOW it causes anguish in many people who have to wait and struggle (and pay money and waste time) in order to comply with the requirements invented by cis people.

Besides, cis people are allowed to make stupid mistakes with their lives, even ones involving surgery. No reason why trans people should be treated as less capable of making life-changing decisions.

[Lady Smith]

You can probably get it informed consent if you pay cash.

However, it is the insurance companies who put requirements for SRS and apparently it is stricter than WPATH SOC. Dr Bowers explains it as follows:

"Despite our absolute support of the new SOC, nearly all insurance companies still adhere to the requirements below, and your pre-authorization will likely not be successful if you can't provide the letters of recommendation to their satisfaction.  We continue to pressure insurance companies to update their requirements."

So, blame the insurers.

Here in New Zealand you haven't got a hope in hell of getting private medical insurance to pay for GRS so I never considered the insurance angle.

[AnonyMs]

Yes, but not the way you put it.

I believe in Wikipedia's definition of informed consent, and the appropriate person to determine adequate reasoning facilities is a psychiatrist, not a surgeon. Firstly because surgeons are not qualified to evaluate a persons mind, and second due to financial conflict of of interest.

"An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications, and consequences of an action. To give informed consent, the individual concerned must have adequate reasoning faculties and be in possession of all relevant facts. Impairments to reasoning and judgment that may prevent informed consent include basic intellectual or emotional immaturity, high levels of stress such as PTSD or a severe intellectual disability, severe mental illness, intoxication, severe sleep deprivation, Alzheimer's disease, or being in a coma."
https://en.wikipedia.org/wiki/Informed_consent

[suzifrommd]

I lack the psychological and medical insight to know exactly what would make it less likely that a patient has surgical regret.

I don't think the medical community has that insight either. In the absence of a proven way of reducing regret, I'd err on the side of personal liberty.

In any event, SRS should be treated as any other permanent life altering elective surgery. I.e. tubal ligation, breast augmentation, rhinoplasty, hair transplantation, abortion etc. If you can get any one of these by informed consent but you can't get SRS, than that is DISCRIMINATION AGAINST THE TRANS COMMUNITY.

[BunnyBee]

HRT, yes.  GRS, no.

[Jessica Merriman]

Let me get this straight. A topic just like this in controversial nature was just locked so we just start it again? Seriously?

[Mariah]

As has been pointed out, This topic looks a lot like a topic I just locked, but this one was started many hours before that topic was locked. Which is why though, I'm going to remind people to keep it civil and stay inside the TOS. I will lock it at the first sign of trouble this time. Thanks
Mariah

[Jessica Merriman]

I believe in Wikipedia's definition of informed consent

You are going to base health care off of Wikipedia? You would really trust your health to armchair quarterback scholars? Do you have any idea how far off some of those are that enter information? Look up the Spartan battle of Thermopylae. Whoever entered the info got it wrong if you study real history from knowledgeable professors. Trust Wikipedia for my health care, no! 

[CrysC]

Informed consent should be enough to be sure. 
I can see where RLE is maybe recommended but sad and annoying to have it required.  I can even see where they keep psych eval just to make sure that people going this route are doing it for the right reasons. 

What we need is a health insurance option in the US that caters to trans folks and our needs.

[stephaniec]

honestly, I'm quite confused on this matter myself. When I started to transition I was really for whatever the medical community thought was right for the individual which meant I year and psych letters. Now.  after being on hormones(which are great) I'm at a loss on this subject. I personally love therapy maybe because I've been alone for so long so therapy does not bother me at all. I am concerned about someone else deciding my need, I know who I am and I've lived this condition since 4 years old , so I consider myself incredibly knowledgeable about my need , more so than any doctor on this planet. Personally the year doesn't bother me whatsoever because I've been doing it for 60 years , but that's me I love dresses can't help it I've tried, but totally impossible not to wear a dress. As far as informed consent without any other requirements I'm not sure how I feel. I know at one point I was all ready to go , but after thinking about it through therapy I'm not sure anymore because of my own particular circumstances , My need for assistance for those few months of healing and my physical problem with rheumatoid arthritis would make it impossible for me to deal with the healing after surgery without help. I never thought about the details before. If I would of just been able to do it without therapy I would of found myself in deep do do. I think there needs to be some level of therapy but this is my opinion only.

[Obfuskatie]

If you want available surgeons to be able to do the surgery, two letters helps absolve them and those who wrote the letters after evaluating. Otherwise, malpractice premiums would rise for the surgeons who will perform the surgery and the cost of the increase would inevitably raise the price of GRS and lower availability of surgeons willing.
Informed consent is best used when the effects are gradual over time, hence why many places accept it for HRT. Surgery requirements are there because of the Hippocratic oath, since they aren't reversible. Basic routinely performed cosmetic procedures always involve consultations to weed out bad candidates, and have so many available surgeons that if someone wants the surgery enough they can nearly always find someone despite any ethical issues involved.
Yes there should be reform. Yes we in our community should be able to address complaints to a guiding body about incompetence or disingenuous behavior from Gatekeepers. Yes there needs to be advancement and increased availability and insurance coverage for transition surgeries including top and bottom surgeries, FFS, and FMS. There's a mountain of change that is needed, but in our current system with the current selection of surgeries, opening them all to informed consent will break the rickety piecemeal system we've cobbled together in spite of violence and bigotry. I would hate to see transition surgeries performed in clinics treated similarly to ones that provide abortive procedures.


     Hugs,
- Katie
Sent from my iPhone using Tapatalk

[Lady Smith]

I'm keeping silent because I don't want to start a flame war.

[warlockmaker]

Hi Stephanie, been meaning to thank you for your kind comment on my pic. This is a contentious question! I feel that informed consent is an absolute necessity. I am not a fan of rules that dictate what I choose in my life choices yet, I understand that to protect the few we all clumped into the same group for simplicity. I question if that would be democratic. The rules need so many exceptiobs to meet our different situations to be fair, look at the US  tax code and the exceptions. I also feel that age is a major issue. It's essential to fully understand and be sure, therapy is essential for all age groups but even more important when you are younger and a wrong decision means no children. Yes informed consent with a lot of exceptions.

[suzifrommd]

If you want available surgeons to be able to do the surgery, two letters helps absolve them and those who wrote the letters after evaluating.

You make a good point Katie.

I'm comfortable with surgeons wanting letters from therapists attesting to whether they're patients are of competent enough mind to make this decisions.

There is a BIG difference between determining whether a patient is competent to make a decisions and deciding whether they're a suitable candidate for SRS. Doing that is abhorrent, gatekeeping, and patronizing. RLE is an example of the latter.

[Jean24]

As opposed to having several years of RLE forced on me? Yes. That way I can choose my surgeon when I feel that I'm ready. At this point in time, I'm not ready. Sometimes I think about the different surgeries and feel overwhelmed by the thought of waking up and having drastic changes. RLE isn't going to change that, only I can know when I'm ready.