Progress

Why the American Medical Association Opposes ‘Bathroom Bills’

The AMA supports transgender people’s right to access ‘basic human services and public facilities in line with one’s gender identity’ and opposes any restriction of that right.

On Monday, the American Medical Association broadened its support of transgender people, coming out against “bathroom bills” and supporting gender-neutral patient categorization in the Food and Drug Administration’s evaluation of drug risks.

AMA Wire, the official AMA news source, was first to report on these two actions, which came during the 2017 annual meeting of the AMA’s House of Delegates, the chief policy-making body for the large physicians’ association.

According to AMA Wire’s report, the House of Delegates adopted a policy supporting transgender people’s right to access “basic human services and public facilities in line with one’s gender identity” and opposing any restrictions of that right.

The American Medical Association already formally opposes discrimination based on sexual orientation and gender identity; this policy would only clarify and sharpen that opposition in the context of so-called “bathroom bills,” which seek to restrict restroom use based on birth certificate or birth-assigned gender.

According to AMA Wire, delegates also asked the AMA to coordinate with the FDA to create a gender-neutral way to categorize patients in Risk Evaluation and Mitigation Strategies (REMS)—the process through which drug manufacturers weigh a medication’s benefits and risks—in order to prioritize “reproductive potential” over “gender identity.”

In other words, because transgender and gender non-conforming patients may identify as male, female, or neither, a strict male/female categorization that assumes certain patient anatomy may not be adequate for drug risk evaluation.

As the delegates wrote, gender is “incompletely understood as a binary selection.”

AMA board member Dr. Jesse M. Ehrenfeld confirmed in a statement to The Daily Beast that the physicians’ association opposes anti-transgender restroom legislation.

“Laws and policies that restrict the use of public facilities based on biological gender can have immediate and lingering physical consequences, as well as severe mental health repercussions,” said Ehrenfeld. “To protect the public health and to promote social equality and safe access to public facilities and services, the American Medical Association is opposed to policies that prevent transgender individuals from accessing basic human services and public facilities in line with their gender identity.”

Harper Jean Tobin, policy director for the National Center for Transgender Equality, praised the AMA’s increased support for transgender people in a statement to The Daily Beast, noting that “the AMA and the country’s other leading medical associations have long supported inclusion and equal access to health care for transgender people, including access to medically necessary transition-related care.”

Indeed, the American Medical Association issued a resolution in support of transgender health care nearly a decade ago and virtually every major medical association now supports transition-related care. Tobin sees the AMA’s new actions as only furthering that broad base of support in the medical community.

“The AMA's most recent actions build on that support by taking a strong stand against discriminatory proposals (like Texas's SB6) that single out and exclude transgender people from public spaces,” Tobin continued, referring to recently proposed anti-transgender legislation in the Lone Star state. “The AMA's recognition that gender is not binary reflects today's medical consensus and underscores that all people deserve respect, including transgender men and women as well as those whose gender is not male or female.”

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The AMA’s adoption of a policy opposing “bathroom bills” comes about a month before the Texas state legislature is set to convene in special session to consider legislation which would bar school districts and local municipalities from instituting restroom protections for transgender students.

If it passes, Texas would follow North Carolina as the second state in the country to successfully pass an anti-transgender “bathroom bill.” Facing pressure from the NCAA, North Carolina rolled back some of the more controversial portions of its own “bathroom bill” this March.

North Carolina’s bathroom bill was notably opposed by the American Academy of Pediatrics, who recognized last year that anti-transgender restroom restrictions can have a negative impact on transgender student health.

“As pediatricians, we know first-hand how increasing burdens and barriers for youth who are lesbian, gay, bisexual or transgender (LGBT) can increase their risk of depression, substance abuse, dropping out of school, or suicide,” president of the AAP’s North Carolina Chapter said in a statement at the time.

Indeed, a 2016 study in The Journal of Homosexuality analyzed data from the National Transgender Discrimination Survey and found that “denial of access to either [bathrooms or campus housing] had a significant relationship to suicidality” among transgender college students, “even after controlling for interpersonal victimization.”

Other medical issues associated with anti-transgender restroom restrictions can include urinary tract infections and kidney problems.

The 2015 U.S. Transgender Survey found that nearly a third of respondents had “limited the amount they ate or drank to avoid using the restroom in the past year.” And as a result of restroom avoidance, eight percent of respondents said they had developed “a urinary tract infection, a kidney infection, or another kidney-related problem” over the last year.

The AMA’s new resolution also notes that there have been “statistically significant increases in mental health and psychiatric diagnoses” in states that have adopted anti-transgender policies, according to AMA Wire.

Transgender restroom access has become a heated political issue over the past few years; the AMA’s new policy confirms that it should be seen first as a medical one.