Paul Hruz is a doctor often hired to testify in support of political bans on health care for transgender youth. Such bans have been passed in 26 states. When the mother of a transgender teen asked Hruz what would happen if children like hers were denied access to health care, he said, "Some children are born into this world to suffer and die."
As a pediatrician—and a human being—I reject that brand of fatalism and my patients' parents do, too. So does my entire profession. That's why I worked with other health care providers and experts to submit an amicus brief in U.S. v. Skrmetti urging the Supreme Court to affirm unfettered access to best-practice health care for transgender youth and protect their parents' ability to pursue that care for their children.
Tennessee's law bars parents from making health care decisions for their minor children and with their doctors—but only if those children are transgender. The stories of two patients of mine make this ban's flaws and contradictions clear. Catherine was an infant who weighed less than two pounds when I cared for her in the neonatal ICU and Sarah was 12 years old when her parents sought a referral for hormone therapy.
Both girls received world-class medical care with their parents at the helm, but for very different reasons: Catherine was born 12 weeks early and Sarah is a transgender girl on the cusp of male puberty. Both families were charged with necessary, time-sensitive medical decisions. Both were supported by expert pediatricians.
Catherine's parents had to decide whether to pursue a blood transfusion, a trial off the ventilator, and donor human milk over calorie-dense formula. The blood transfusion could cause brain bleeding, the ventilator trial could set her back, and the donor milk could under-nourish her. Ultimately, her parents decided these treatments aligned with their values and would give Catherine the best chance at thriving in the years to come. Those choices weren't life or death, but they were critical and imbued with her parents' love.
At the critical juncture of puberty, Sarah's parents could passively let her enter a process that would permanently change her body and likely upend her life, or start a medication that would pause puberty for three months at a time. With her parents' support, Sarah lived authentically as a girl since pre-school. Most of her friends didn't know what her chromosomes were, or the sex listed on her birth certificate. Chest hair or a deep voice could be miserable for her. And while the medication was temporary, could there be side effects or unforeseen outcomes in the future? Ultimately, Sarah's parents found clarity because they knew her better than anyone. They knew what she needed to live a good life. So, they chose medical care.
It's not a tragedy that Catherine was born or that Sarah is a girl, but they met and meet tragic circumstances. Catherine endured invasive, even painful care. She lay in an incubator, often separated from her parents' touch, bathed in the sounds of stressful alarms. The trajectory of her life was far less certain than for a full-term infant who went straight home after delivery.
Sarah comes of age in a time riddled with toxic messages that her parents try to shield her from: that she is confused about who she is and a thief of her peers' success.
Catherine and Sarah drew short straws, but their parents never wanted different kids. What they want is what all my patients' parents want: to fulfill commitments they made to their children when they brought them into this world. It's my job—and my joy—to see these commitments through with parents. Catherine made it to kindergarten on time and has a laser-like fixation on dinosaurs. As a big sister, Sarah's parents describe her as the cornerstone of their family. Both sets of parents know that their families are only as strong as their children are healthy.
It may be hard to see how Catherine's parents face just as fragile of a role in their daughter's life as Sarah's, but transgender youth aren't the only political zeitgeist to overlap with health care. In U.S. v. Skrmetti, Tennessee is asking the Supreme Court to expand the Dobbs v. Jackson Women's Health ruling. This would open the door for political interference in all corners of private life.
The criminalization of birthing outcomes looms. In the year after Dobbs overturned the constitutional right to abortion, more than 200 mothers lost rights to parent their children. Many states now advance measures to police behavior during pregnancy. Under fetal personhood laws, which grant fetuses equal rights to a born person, Catherine's parents might not have been allowed to play such a central role in her care. A politician might seek to blame Catherine's mother for her early birth.
An avalanche starts small. I am deeply worried that criminalization of parental decision making in gender-affirming care is the beginning of something ominous for all my patients and their parents.
Sarah was not born to suffer and die. She deserves the same chance at a good life as Catherine. Tennessee and 25 other states have laws that bar her parents from securing that life for her. And yet, it's her parents' names on her birth certificate, not that of a governor or an attorney general. If the Supreme Court writes off any parent's ability to care for their kids, we may as well rewrite everyone's birth certificates. After all, I need to know who consents to my patients' care in the years to come.
Dr. Meredithe McNamara is a pediatrician at the Yale School of Medicine and the co-director of The Integrity Project for Child and Adolescent Health.
The views expressed in this article are the writer's own
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