The Sovereign Body

(TRIGGER WARNINGS: DISCUSSION OF SUICIDE AND SELF-HARM)

Who has the right to determine what you may, or may not, do to yourself? Although many people associate this question with the issues of birth control and abortion it is often key to other issues/concerns.

For example, recently in the United Kingdom a judge ruled that doctors could force feed a woman who did not want to eat (Anorexic woman should be fed against her wishes, judge rules, The Guardian, June 15 2012) while in Canada the British Columbia Supreme Court ruled in that laws against physician assisted suicide were unconstitutional since they infringed on the right to bodily autonomy of physically disabled British Columbians (A good day for Civil Liberties, The Globe and Mail, June 16 2012).

What do you think? To what degree do we (should we) have sovereignty over our own bodies? When (if ever) should the state step in?

Note #1: This is a complex ethical issue without easy answers, about which many people have strong feelings. Please keep the discussion civil and respectful.

Note #2: The trigger warnings at the top of the post also apply to all comments on this thread.

--mmy

---

 

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Comments

[kisekileia]

I would say that the state should step in if and only if the person 1) is too mentally ill to know what they're doing, and 2) will seriously endanger him/herself or others without intervention. I agree with force-feeding in severe anorexia nervosa, especially since research has shown that a lot of the psychological symptoms of anorexia result from starvation rather than just the other way around, and with forced hospitalization of people who are suicidal, homicidal, or unable to keep themselves safe due to mental illness. I don't agree with banning assisted suicide for people who are incurably ill and in their right minds, or with legal restrictions on birth control or on elective abortion in the first half of pregnancy (probably with the exception of sex-selective abortions).

[hapax]

TW: Child abuse, self-harm and suicidal ideation

Gaaah, this is a complicated one for me.

On the one hand, all my progressive instincts, all my human instincts, kick in automatically and say, "Well, of course a person has a right to absolute bodily sovereignty!"

But then I have second, and third, and fourth thoughts...

We already acknowledge society as a whole ((which is represented by the government) occasionally has interests that trump the right to absolute bodily sovereignty. An obvious case is that of vaccination.

There are more complicated cases. Most people would agree that minor children do not have the right to absolute bodily sovereignty. We generally assign that authority to their parents or legal guardians, but very few people (and no-one I respect) would assert that society as a whole has not only a right but a duty to make sure that authority is not abused.

We say so because there is general agreement that children do not have the cognitive ability to fully understand the consequences of their choices.

Well, what about those with suicidal inclinations? It is arguable that they are not fully capable of making such a decision, either.

I wouldn't dream of arguing that in every case. I do believe that there are people who have freely and rationally chosen to self-terminate.

But (and here we get into serious TMI territory be warned) I can't recall ever having a single day in my life without seriously considering suicide. Not just when I'm depressed (by which I mean not just sad, but experiencing the disease of depression) but ever.

I don't know why; perhaps it's a side effect of medication; maybe it's just some glitch in the mental wiring. The desire is just THERE, in a way that's both as persuasive and as casual as the desire to eat another potato chip.

Obviously I have resisted the inclination so far. But it's an act of conscious will each time, just like turning down salty crunchy greasy yumminess.

If it became clear to those who knew me well (family and close friends) that I no longer had the ability to resist that impulse, I would hope that they would resort to whatever authority -- moral, social, or in the final resort legal -- they could obtain to take away my ability to exercise that choice.

And I hope that because, when I really think about it, I do NOT believe that I (speaking only for myself here) have an absolute right to treat my body as I wish. My body is a ... hmm, not a "gift", precisely ... but a responsibility? I do not own my body, but am the steward of my body, with the right and duty to treat it in such a way that benefits others as well as myself.

That means not eating too many potato chips, so I stay healthy to do my job, to provide companionship to my near ones, to exercise my talents, and to serve others as myself. And that means not destroying that body likewise.

Tl; dr -- In my ethical framework, we live not ONLY for ourselves, but also for others. The question is, is there a way to translate that understanding into a legal framework that neither violates *my* ethics, nor unfairly imposes them on those who do not share them?

(Note -- all legal systems, to some extent or other, rely upon the impositions of someone's ethics upon those who do not share them. We can't get away from that. How do we do this in a manner that is both just and beneficial? How do we decide who gets to decide?)

[Izzy]

Hm.

On the one hand, my gut reaction to things like severe anorexia, bodily mutilation, and suicide that isn't the result of terminal illness is that wanting to do those things to yourself is proof that you're not in a state of mind where you should be responsible for your own well-being.

On the other hand, I *don't*, intellectually, think that everyone has a duty to their bodies or even necessarily their communities*. I do, but that's because I've taken certain oaths; if the guy down the street really doesn't feel that he can live with physical or mental pain any more, that's not something I think the law should interfere with, and I don't think it's morally wrong.

As a friend, I'm pretty sure I'd at least get verbally pushy about suicide, anorexia, or extreme mutilation: I love my friends and I don't want them to go away, or to do something that has a pretty good chance of making them miserable later. On the other hand, I know I do things that some people wouldn't consider good for me, and where do you draw the line?

Maybe a legal moratorium might work if we're going to apply force? Assuming that the situation won't become worse or more urgent in that time**, you have to wait three days or three weeks or whatever before you can continue on a sufficiently harmful path, and you have to go to therapy during that time.

Which is not going to help everyone, and it still has some issues re: autonomy, but I think that buying time and showing different perspectives might be the best compromise we can get here.

*Well, not one that involves keeping themselves healthy or alive. I think benefiting from the world obligates you to give back in some way, but if you opt out of some of those benefits, that's your choice.
**Which is my main problem with anti-abortion "mandatory counseling". I mean, also that it's emotionally manipulative and based on entirely wrong premises, but mostly that mandatory counseling turns a three-week abortion into a six-week one, increasing the likelihood of physical and emotional trauma.

[kisekileia]

(Trigger warning: starvation.)

The other factor that comes into play with anorexia specifically is: Starvation alters the brain in ways that exacerbate the psychological symptoms of anorexia and diminish the person's ability to make rational choices. Looking up the Minnesota Starvation Experiment is very enlightening about this. Basically, starvation in itself can cause obsession with food and depression, and anorexia nervosa involves a feedback loop in which the psychological symptoms and the starvation feed off each other. Force-feeding an anorexic person has the potential to reduce the biologically driven side of the person's depression and fixation on food, making it possible for psychotherapy to take effect enough for the person to begin eating voluntarily. Force-feeding someone who is severely anorexic is often necessary to enable them to make free choices about how to handle their illness, rather than a way of obstructing their free choices, because their thoughts and desires are altered by the biological effects of starvation.

If you look at the comments, you'll see a few recovered anorexics agreeing that force-feeding is necessary in a case like this--and you'll also see how anorexia clouds the mind, because two of these recovered anorexics state that despite being recovered, they honestly didn't realize how dangerous their very low BMIs were until they saw what BMI this article described as leading to imminent death.

[Mmy]

This is an incredibly complex issue for me. Somewhat like hapax I have lived for long periods of time when the thought of suicide crossed my mind at least once a day. (In my case it was due to chronic high levels of pain.) And my mother chose not to have surgery that might have extended her life for a couple of years (or she could easily have died on the table due to her fragility) and consequently she starved to death. (She had a total bowel shutdown -- she could not eat or drink.--No extraordinary measures meant that she had no feeding tubes.)

Force-feeding someone who is severely anorexic is often necessary to enable them to make free choices about how to handle their illness, rather than a way of obstructing their free choices, because their thoughts and desires are altered by the biological effects of starvation.

I actually knew someone who was force-fed because of their anorexia. It may have saved her life but it left her in a strange indeterminate state in which she never ate enough to be healthy--she just ate enough to keep them from hospitalizing her again. The loss of bodily autonomy she experienced when they forced her to eat just drove her to never trust anyone again about food or her health and she spent much of her time mapping out ways that she could get away with *just* starving herself so slowly that by the time she was far gone enough to be institutionalized again it would be too late for anyone to do anything for her.

[Hummingwolf]

I'm reminded of another news story: North Carolina's Senate recently decided against compensating surviving victims of the state's forced sterilization program. That link is to Wonkette's version of the story, which I think has the right amount of sarcasm as well as a photo of an awesome protest sign; other, soberer reports can of course be found elsewhere.

Anyone interested in U.S. Supreme Court decisions relevant to the above? Buck v. Bell and Skinner v. Oklahoma are morbidly fascinating.

[MercuryBlue]

By the logic of the North Carolina Senate, if I steal something and apologize (and I'm not entirely sure that, by North Carolina Senate logic, the apology is necessary), I need not return the item or the cash value thereof.

[Firedrake]

TW suicide, starvation

I think anyone should have the right to commit suicide painlessly. Refusal-to-feed is extremely unpleasant for the victim, and the fact that people are still choosing this even though it's one of the nastiest ways to die is evidence that reform is needed.

As a safeguard, I think there should be a waiting period - perhaps a week, perhaps a month, something of that order. So you register your intent to die (with some sort of coercion test to make sure you haven't been bullied into it), make an appointment, then come back that week or month later and take your lethal pill. Change your mind at any point, then just don't turn up, and you have to start again. No mystique, no compulsory counselling, no stigma, no glamour of the forbidden.

Trickier with people unable to make the assertion for themselves. I can't see a way round that one.

Yes, there are some people it would be a shame to lose. If you are more benevolent towards humanity than I am, every death can be considered a shame. But I reckon it's their choice, not mine, even if they are of what I regard as an unsound mind.

The problem with the law as it stands is that it still assumes one cannot wish to die if one is of sound mind.

[Mmy]

@Firedrake: TW suicide, starvation, pain

I think anyone should have the right to commit suicide painlessly. Refusal-to-feed is extremely unpleasant for the victim, and the fact that people are still choosing this even though it's one of the nastiest ways to die is evidence that reform is needed.

The palliative care team at my mother's hospital were amazing--their aim was to prevent mom from feeling any pain. That took a while (a complicated regimen of drugs was required.) Nothing like being on the palliative care ward in order to be disabused of the idea that, as some people like to say, we never get sent a burden that we cannot bear. Mom's pain was brought under control but there were people on the floor for whom the only escape from horrific pain was their eventual death.

[Kirala]

@Firedrake:

The problem with the law as it stands is that it still assumes one cannot wish to die if one is of sound mind.

That's the question, isn't it? I don't know if I know the answer. I'd say that if a person is facing a debilitating irreversible disease or is in deep, chronic pain, they might be of sound mind and wish to die. But is it sound mind when a person is in deep temporary or treatable pain and wishes to die? Should we just say, "Sucks to be you" to any person who is temporarily unable to see that life will get better, that there is life worth living still?

It's much more complicated than that in practice, given our inability to tell the difference between temporary and permanent pain in most cases. But I can't simply write off the issue with "let everyone choose for hirself, sound or 'unsound' mind" if it means jettisoning some people who would want the help if they could be what they regard as themselves.

I would agree, though, that the law errs too far on the other side. If I'm far enough gone with Alzheimer's that I can't recognize my loved ones, any part of me that I care about is already dead; why can't I have a living will to let the rest of me follow?

[MercuryBlue]

tw, suicide, rape

So you register your intent to die (with some sort of coercion test to make sure you haven't been bullied into it)

Suppose you've got a young woman from a culture that does honor killings. She's a rape survivor. I presume this coercion test would screen her out if her dying were her father's idea, but what happens if she's internalized the concepts behind honor killings and she therefore decides to kill herself? She wouldn't be making a free choice, I think, but nobody'd be coercing her.

[Nick Kiddle]

//As a friend, I'm pretty sure I'd at least get verbally pushy about suicide, anorexia, or extreme mutilation: I love my friends and I don't want them to go away, or to do something that has a pretty good chance of making them miserable later. On the other hand, I know I do things that some people wouldn't consider good for me, and where do you draw the line?//

That is a big question, especially in conjunction with the word "mutilation". I read some windbag the other day saying that tattooing is self-mutilation, and I immediately made the connection to all the concern trolls who say the same thing about transition-related surgeries. One person's mutilation is another person's lifesaving body fix, so unless you let everyone decide what to do to their own body, whose standards do you apply?

//Suppose you've got a young woman from a culture that does honor killings. She's a rape survivor. I presume this coercion test would screen her out if her dying were her father's idea, but what happens if she's internalized the concepts behind honor killings and she therefore decides to kill herself? She wouldn't be making a free choice, I think, but nobody'd be coercing her.//

I wonder how many cases of assisted suicide by severely disabled people who aren't terminally ill fall into a similar category. Certain disabilities are talked about as a fate worse than death, and I can't imagine it not working on someone's mind at least to a degree when they make that decision.

[Mmy]

@Nick Kiddle: I wonder how many cases of assisted suicide by severely disabled people who aren't terminally ill fall into a similar category. Certain disabilities are talked about as a fate worse than death,

At least some of the discussion around the British Columbia ruling was that by promising physician-assisted suicide if the physically disabled ever wished, in the future, to end their own life it would prevent people from prematurely ending their lives while they were still physically able. In effect the argument is that by allowing the physically disabled the future option of suicide fewer of them would resort to it now and at least some would find that at a later time it wasn't a fate worse than death.

I think that it is also important that decisions such as these (should I live, should I die) must be made without worries of penury or privation. Or shaming. Or exile from one's community.

[hapax]

Yes, there are some people it would be a shame to lose. If you are more benevolent towards humanity than I am, every death can be considered a shame.

Well, that's part of it, true. "Any man's death diminishes me", and all that.

And please understand that I do believe that a person may be in a situation of physical, emotional, or spiritual pain that self-termination is the least bad solution. I also believe that suicide can, in conditions of extreme injustice, be an effective and moral form of protest and resistance.

But I come from a family with, shall we say, a statistically anomalous number of suicides in the past few generations, and it's that more than anything that forms my understanding.

(After some consideration, ROT13 for graphic discussion of of the after effects of suicide)

Nsgre lbh'ir pnyyrq gbb znal nzohynaprf, tbar guebhtu gbb znal cbyvpr pbairefngvbaf, qrnyg jvgu gbb znal fcbhfrf naq cneragf naq sevraqf jub unir qvfpbirerq gur obqvrf, frra rabhtu pnecrgf naq onguebbzf pbirerq va oybbq, naq qrnyg jvgu gur nsgrefubpxf gung erireorengr sbe qnlf naq zbaguf naq lrnef, bsgra phyzvangvat va gurve bja nggrzcgf ng frys unez... jryy, vg'f uneq gb xrrc guvaxvat gung fhvpvqr vf n cevingr qrpvfvba.

Once again "hard cases make bad law", etc. and I don't know the appropriate policy response.

[victoria]

this is an issue i have a lot of strong feelings about, but right now i don't have the spoons to participate fully so i apologize for not reading all the comments so far. i just want to say that (barring an imminent and plausible threat of violence to another person) i am and will always STRONGLY be on the side of maintaining a patient's autonomy, even if family and loved ones and medical staff feel otherwise, even if it may lead to the patient's death. Because so, so, so often it's not a case of "the patient isn't capable of making an informed decision at this time," it's a case of "the patient has made a decision, and we do not like the decision the patient has made, and so we are going to intervene and we are going to pretend that we know what the patient wants, better than the patient does."

[hapax]

Responding to myself:

Actually, mulling it over, some sort of legalized process (registration, waiting period, discussion with trained professionals, painless and supervised medication) might indeed greatly reduce many of the societal harms I discuss in the post above.

It's worth thinking about, at least.

[kisekileia]

I have to say, I DO very very much support physician-assisted suicide in cases of incurable physical illness (maybe also VERY rare mental illness cases where all possible avenues for treatment have failed, yet the person is of sufficiently sound mind to make an informed decision) where the symptoms cannot be reduced to a level that the patient feels they can live with. I also think that people should be able to write living wills saying "When my symptoms get to X state, euthanize me, unless I am then of sound mind and do not want to die."

My family has a history of terminal cancer + lots of morphine = psychosis, and in 2/3 cases the psychosis has been very distressing to the person and their caregivers. It's not clear whether the cause of the psychosis has been high morphine doses, brain metastasis, or both, but it's happened to three different people in the past 25 years on one side of my family. I told my boyfriend today that if I ever go the same way and physician-assisted suicide is legal at the time, when I can no longer have reasonable pain relief and be lucid at the same time, I want to die. I also decided some time ago that if I ever develop dementia, I want to die if/when I stop recognizing close relatives (e.g. grandchildren). I absolutely think that people should be able to make choices like that, either when the intolerable situation arises or before, and have their wishes carried out without anyone getting into trouble with the law.

[Froth]

On mental capacity to choose not to live:

When I was seriously suicidal last year, the problem was not just that I was in unbearable pain. It was that I was in unbearable pain and nobody would help me. It's all mental - the broken leg that the world keeps making me run on is metaphorical - but that doesn't make it less painful. And in some ways, my consideration of suicide was very rational.
I was in unbearable pain. I was unable to perform basic self-care tasks. I could see no prospect of my pain being reduced or of receiving the support I needed to take care of myself. In that circumstance, it made a great deal of sense to escape the situation through the only means available.
I had nowhere else to run. My pain and diability were all in my head, but the part of me that knew whether I could stand to live like that any more was working just fine.

I worry that in defining people as not of sound mind because they wish to escape from mental pain by any means possible, we are ignoring that mental health is not an all-or-nothing thing.

On the right to bodily autonomy:

It's important to me that I am not alive as a default state. I am alive because I have chosen to be alive. Because I have fought and endured and struggled to remain alive. It makes a cruel mockery of all my fighting if, when someday I choose otherwise, I am not allowed to put my burden down.

For less final matters, it's the difference between a rented house and an owned one. The world is a shared resource, and what I can do in it is limited by the needs of all the others who are in it. But this body is mine. It's the only one I have. It's where I have to live, and it is my right to alter it to suit my wishes. I choose to wear this body with its hair long, its ears unpierced, its face unpainted. I clothe it in sober colours, in waistcoats and work boots. I was issued with a body at birth, but bodies don't come with guarantees that they'll fit without alterations.

If the house is rented from a landlord, then I can only do do it what the landlord permits. I can't repaint the walls or change the carpets or hang pictures without their agreement. I certainly can't remodel the kitchen and knock some walls through and put a partition in to make an office. But if I own it, I need no consent but my own to change it. Since my body will go back to the earth when I am done with it, I needn't even leave it in a good state for the next tenant.

[Nick Kiddle]

TW: quoting of ableist rhetoric

//In effect the argument is that by allowing the physically disabled the future option of suicide fewer of them would resort to it now and at least some would find that at a later time it wasn't a fate worse than death.//

That's an argument that makes a lot of sense. The idea that abled people are permitted to end their lives and disabled people should have the same right is an interesting angle - it's not the way it's usually approached. Usually the attitude is that if an abled person wants to die that's a sign of mental illness and they must be stopped, whereas if a disabled person wants to die they should be allowed because who wants to live like that anyway. Hopefully BC's angle will make for a more nuanced and less ableist discussion.

//I think that it is also important that decisions such as these (should I live, should I die) must be made without worries of penury or privation. Or shaming. Or exile from one's community.//

Or the feeling that one is a "burden" on one's loved ones :(

//It's important to me that I am not alive as a default state. I am alive because I have chosen to be alive. Because I have fought and endured and struggled to remain alive.//

For me, it's the opposite. If I'd ever had to make a positive choice to live, I'd be dead by now. It's only the fact that I'd need to take positive action in order to die that's keeping me alive some days. And I don't know how I feel about that. On my better days, I'm glad that I'm still around to give life a chance. On my worse days, I feel trapped, and I hate the things that make me keep trying.

TW: Emotional pain, self-blame, miscarriage

I have times when I feel that I'm fundamentally not viable, that I'm not capable of doing the basic things that a human has to do in order to survive, that my existence is either a joke or a massive cock-up depending which way you look at it. I sometimes say that it would have been better if my mother had just miscarried, the way the body often does with non-viable fetuses, except my non-viability didn't become obvious until much later. I don't know what to do with any of these feelings. The possibility of dying terrifies me, but sometimes the prospect of living is no better.

[alsafi]

I'm going to have to say that I strongly disagree with victoria, above, though I respect that her spoon supply is not such as to allow her to participate--and I do respect her position. But from my perspective, and it includes having dealt with some serious mental health issues, both my own and in my family (both birth and choice), we are none of us an island. We don't make choices in a vacuum, and our interconnected web of being means that choices we make affect those we love and that love us. Like hapax, I think it's cruel to pretend that those who are left behind aren't affected by suicide. And thus, I think that it's much too complicated to ever say that complete and total patient autonomy is always the highest good. This article in the NYT recently really resonated with me (my partner and I went through some similar experiences with her mother, and found out then how heartbreaking, terrifying, and problematical an unswerving commitment to absolute patient autonomy can sometimes be). The article deals with bipolar disorder, rather than more physical disorders, but I think the principle is very similar.

[RodeoBob]

If someone identifies as transgender (and I apologize if I'm using incorrect terminology) we accept that their self-perception is accurate, and allow them bodily autonomy to alter themselves physically to match their internal self-image, yes?

But if someone identifies a profound internal wrongness with having both legs or both hands, this is termed Body integrity identity disorder and is viewed as, well, a disorder that requires treatment, not voluntary amputation.

Now, decades and decades ago, transgender folks were seen as disordered. So what are the key, relevant distinctions between transgender and BIID? I'm not aiming to offend, but to try and tease out what makes one an issue of personal autonomy, and the other disordered thinking.

[lonespark]

Hmmm. I can think of situations where massively altering your body, in ways that mainstream society might view as mutilation, could be a religious freedom issue. Of course, mainstream society gets twitchy about animal sacrifice, and a million other issues of "doing religion in a way that we deem strange and therefore BAD..."

[MercuryBlue]

Scratch 'massively' from that, Lonespark: infant male circumcision.

RodeoBob: Upon contemplation, I'm not sure BIID would be disordered thinking. It's something one would want to think really long and hard about before acting on, because amputation cannot be undone, but I'm not sure there's anything inherently wrong with the idea that one's body is shaped wrong, and calling that idea a disorder implies that there is something wrong with the idea.

[lonespark]

Ohhh. Yeah, but, that's doing something to someone else's body, which isn't what I meant.

[Darlington County]

tw: Rape, suicide, religion

> Suppose you've got a young woman from a culture that does
> honor killings. She's a rape survivor. I presume this
> coercion test would screen her out if her dying were
> her father's idea, but what happens if she's internalized
> the concepts behind honor killings and she therefore decides
> to kill herself? She wouldn't be making a free choice,
> I think, but nobody'd be coercing her.

This is a fascinating topic in general and this post really goes to the heart of the problem - the tension between what society believes a person should do and the right of the person to make up his or her own mind - and the question of whether one can really even "make up ones mind" given how dependent we are on society in general for our cues.

For example, if someone is ill and wants to end their life because they believe that they will be welcomed into rainbow land by thousands of chocolate unicorns, one might wonder whether the person is really competent to make decisions about their life.

Yet if the person believes that they will go to heaven and be united with their long deceased relatives for eternity, American society wouldn't consider that a sign that the person was incompetent.

I know I am just talking around the subject. I really don't have any metric for determining where that line should be drawn - or even if the line should be drawn at all

[MercuryBlue]

Fair.

[Ross]

@RodeoBob: This is related to something i've been trying to work out how to approach.

A few years ago, an unfortunate turn of the internet caused me to find out that there is in fact a movement that believes that anorexia is not a disorder, but a lifestyle (one they will admit carries health risks, but this being no different from smoking, overeating, or certain sexual habits), and should be respected as such, and who hope for the day when it's removed from the DSM-IV and recognized as a valid alternative lifestyle.

And as absolutely certain as I am that suchgroups are wrong and a day will never come when mental health professionals stop classing anorexia as a disorder, I know that if you go back 50 years, you'll find scores of people just as intelligent as I am who would say exactly the same thing about homosexuality.

[kisekileia]

Ross, homosexuality doesn't kill people. Anorexia does. Hence the difference. :P

BIID is a difficult issue. I think the research has found that the only real way to resolve things psychologically for the people affected is amputation, and that there are real brain differences indicating that the person's brain genuinely does not recognize the affected limb as part of the body. I think it would be ideal to find a way to retrain the brain to recognize all of its parts, but in the meantime, I'm not really sure whether there's a better option than amputation.

[Dan Audy]

TW: Absolutism, suicide, equation of transgenderism to mental illness

Like most rational people I have a lot of trouble with this issue because the lines are blurred and different people draw them at different places but we still have to respect each others choices. Ultimately my stance is that people have the right to ABSOLUTE bodily autonomy provided it doesn't directly harm others. That means that people have the right to abortion, suicide, surgical alterations, refusal of medical procedures, carry a terminal pregnancy to term, self starvation, consensual sexual activity, or any other issue regarding control over themselves for any and all reasons regardless of whether it is deemed appropriate or acceptable by society at large. Different segments of society believe that different variations of those options are acceptable and attempt to use the force of law to cause others who don't adhere to those beliefs to follow their requirements. When we start forcing others to accept our standards as an absolute truth it often causes as much or more damage as allowing the disallowed act to take place. The exact same attitudes and 'we know better than you' approach characterise opposition to abortion, opposition to gender reassignment surgery, and opposition to BIID amputation. The fact that people may make suboptimal or actively self harming choices is unfortunate but evolving attitudes just within our own generation should show us how something like transgenderism can go from being treated as a profound mental illness that should be treated with drugs and electrical shocks to being considered a unusual place of the continuum of gender and sex. Personally I believe that transgenderism is within the spectrum of mental illness but that gender reassignment surgery is a viable means of coping with that while still respecting bodily autonomy.

I want lots of counselling available to anorexics, women seeking abortions, and people contemplating suicide along with social supports that alleviate the stresses that often lead to this but not that anyone be forced to access them or prevented from pursuing their desired outcome. Fundamentally, I see no real difference between preventing someone from exercising their bodily autonomy and proactively invading it to adhere to societal standards - they both cause true harm to the individual and deny their personhood and control over themselves.

[Prell]

Hey, hapax, comparing suicide to eating too many potato chips, especially with the current virulent fat shaming and eating policing rhetoric, is perhaps not the greatest analogy, even if it's an apt one personally.

I think I'd like to hear from current and recovering anorexics before making policy decisions. It's true, as noted upthread, that starving to death is excruciating - but force feeding someone is also not exactly fun and games. From a personal perspective, it's vital to me and most of my close family that we preserve quality of life.

It's a tough issue, but I don't think we have the right to keep loved ones around purely on the basis of our love for them, and I don't think the side effects of banning suicide - including often horrific deaths that could have been avoided with pharmaceutical help - make things better for the suicidal or their families. But making that a policy decision means it's vital to help those who need it, in as many ways as we can - both on an individual basis and in terms of structural/value changes.

[FIredrake]

TW for BIID, amputation, coercion, mental illness, homophobia, transphobia. Phew!

Here's another hypothetical. Let's say you have - or you are - someone who genuinely believes that hir left hand is in some way wrong and should be removed. Let's further say that you have two options: amputation, or a change in the layout of your mind (via surgery, therapy, or whatever) that would remove the belief. (Yes, I know this doesn't exist yet.)

Can you make a rational decision as to which is a better option? Probably not. If the mind alteration worked, you'd be happy and not have to go through life with one fewer hand than most people. But it's your mind!

Now ditto homosexuality (e.g. if the "ex-gay" thing were actually real), or transsexuality.

Now ditto paedophilia.

Some of these things don't hurt other people. Some of them are considered "wrong" at the moment. These groups are not the same. Is there an overarching principle that can be applied to determine when treatment should be given without the consent of the potential patient?

I earlier advocated a pretty extreme view. That's one valid approach: set up an absolute principle and stick to its implications, however strange. Another is to set up guidelines and rely heavily on human decision-making - which unfortunately needs a constant supply of really good human decision-makers, who don't bring their own preconceptions. Every trans person I know has come up against people in positions of medical authority whose basic approach is "being trans is a weird and wrong thing, and I'm going to try to stop you being it".

No easy answers.

[lonespark]

I feel like in the real world the relevant question is a bit less about how you view the issue and more about who you feel is the right person/group to make the decision. Which I suppose is the whole point of the thread and I'm just being redundant...

[Froth]

Show me a way to rewrite my mind so that I'm okay with being called "she", and I will run away. I would not be me if I were not masculine, and I cannot imagine being masculine and content to have that go unrecognised by everyone around me.

Most of the people who object to me do so on the grounds that I am abnormal, and this a. matters very much and b. is a privilege I am granted by the normal folks, who could revoke it and make me be normal if they weren't being so generous.
I wonder if it's a fundamental difference in understanding of what people are? Sovereign agents, who have the right to do anything they wish with their life and to their body, or units of the collective who must be kept on script.

[Ross]

But it's your mind!

It's also your hand.

As a culture, we have a tendency to give the mind preferential treatment, as if we were, as Descartes thought, "really" this disembodied consciousness that is piloting around a COTS body, and the "real you" ought therefore to be utterly free to mod that body however you see fit.

That may be a useful analogy. It may be the best one we can come up with for avoiding imposing harmful policies on the bodily soverignty of others. But it's not some kind of inherent truth scribed on the nature of reality.

I have a sense of "I" being "me" that is separate from "my body", as if there's a "me" that is utterly separate from my body, but of course medical science increasingly suggests that this is an illusion: my sense of self is an emergent property of the chemistry going on in my body. That far from "I" being the intangible ghost who pilots this body-machine, my sense of self, my "I" is a thing my body *makes up* in order to cope with the disparity among all the processing going on in that big old lump of gray stuff in my head.

(And it's particularly hard for me to stand firm in the conviction that my sense of self is the "real me", when, however much that sense of self feels like the real me, I can remember when it happened -- as I mentioned back in the open thread about first memories, I do remember the moment when my brain assembled all those disparate senses and sensibilities into an "I").

I don't know that this line of thought leads to something useful and actionable, but I am wary of priviliging the mind over the body without some reflection on in. And I wonder if the way we tend to privilege the mind over the body as the "real self" is the common root of why we are so bad, culturally, at treating mental illness like we do illnesses of the body.

[FIredrake]

Ross, a very good point. (Particularly with the experiments suggesting that conscious thought actually lags a second or two behind reality, but lies to itself to make it appear that that's not the case. Sorry, haven't got a reference on that.) But - as apparently with Froth, and as with transpeople I've met (I do not know Froth's status and wish to make no assumptions) - that is very much the way that many people seem currently to think: that the mind is master, and the body should be changed to follow it.

Partly of course this is because extant mind-altering techniques are very primitive compared with what one can do to alter a body. If someone offers mind-alteration for homosexuals right now, for example, we know that that's simply a lie. If that were to change... I don't know.

I know that there are things I like about me which I don't want to change; nobody's going to claim they should medicate me to change them. (Though I'm very glad I was born before the Ritalin-for-bored-children era.) I imagine homosexuals and transpeople usually feel that way about their sexual identities; these days neither position is generally considered something that should be prevented. Off the edge of the "acceptable" cliff for now are the non-sexually dysmorphic, and the people whose illnesses cause them to harm others - they too, I imagine, privilege their thoughts over (in one case) their bodies and (in the other case) other people. But that cliff has moved in my lifetime, and I think it's likely to move again. Not betting on which way, though...

[Mira]

Lonespark makes a good point - I fall somewhere between "no man is an island," valuing total autonomy also seems like undervaluing mutual dependence, etc., and "how can 'the state' make abstract universal rules that accurately reflect people's unique realities?" It seems like jumping from the smallest possible scale to the largest, and I'm not sure that's where the decisions should lie. But families aren't perfect either, and we don't live in a society that makes "community" in the sense of mutual support and dependence particularly easy to work.

Also, sometimes when we talk about "rational decisions," aren't we overvaluing rationality in some way? Isn't there some more holistic way we can think about it? "Total bodily autonomy" implies your mind ruling over your body...and I don't think that's really how it works, of course your body influences your mind and makes you less abstractly "rational." Doesn't it sound different to say, "should people have the rights to complete autonomy over their current and future selves?" And doesn't it sound different to say that they shouldn't? I'm not sure how but I think there's something bigger at stake than the body and something more involved in decisions than the mind.

[Froth]

"...that is very much the way that many people seem currently to think: that the mind is master, and the body should be changed to follow it."

The alternative is to force someone to conform to our perception of what their body should be like, instead of their own.

Fundamentally, I think people don't come with a guarantee that their mind and their body will develop to fit smoothly together, and that it's up to the individual person how they want to adjust the fit.

[Ross]

(Particularly with the experiments suggesting that conscious thought actually lags a second or two behind reality, but lies to itself to make it appear that that's not the case. Sorry, haven't got a reference on that.)

That was real? The reference I'm thinking of was a Dilbert cartoon.

[Froborr]

Same trigger warnings as the OP.

Long, semicoherent post below.

Show me a way to rewrite my mind so that I'm okay with being called "she", and I will run away.

Is it reversible? I see anything that makes me more protean as a good thing; the ideal, for me, would be to become a complete physical and mental shapeshifter, able to change attitudes and moods and identities and body types as easily as changing clothes.

But that's me; I would never, ever want to change another person's identity against their will. Except...

------

This is an upsetting topic. Not triggery per se--I can put it aside and stop thinking about it if I need to, and then I stop feeling upset, while a trigger lingers for hours or days and I can't get rid of it--but upsetting.

But I think it should be upsetting, because it's about a difficult and important question, and one where how people feel matters.

"Rational" is the wrong word; a person can do things for irrational reasons that are nonetheless good reasons. Art and charity are the first two completely irrational good ideas I can think of; I'm sure there are others.

Unfortunately, our language doesn't have a good non-judgmental word for "behavior that results from brain* malfunction," and we're still struggling to define what is a malfunction, as opposed to a brain that simply functions differently from the norm. For that matter, we're still trying to define the norm.

As for the actual question of the OP... well, that's where it gets tough. I do think, in general, people should be able to do whatever they want to themselves. However, my father had atypical bipolar disorder. He would be fine for months, sometimes years, and then he would go off his meds and become temperamental, wasteful, and prone to paranoid fantasies.

When he was doing well, he wanted to stay well, but when he was sick he didn't know he was sick. At those times, he thought he was the victim of a vast conspiracy, and that any attempts to medicate or hospitalize him were actually attempts to brainwash him. The only way to help him was to get a court order declaring him a danger to himself or others; then he would go into the hospital for a couple of weeks and come out stable and medicated again. Until the next time it happened.

My father needed a legal mechanism for forcing him to accept help, and when he was well, he was grateful such a mechanism existed. But the exact same mechanism could easily be abused. To give an example related to the OP, I had a friend (we've lost touch) who was misdiagnosed with anorexia and forcefed as a teenager, when the problem was actually with her stomach. The doctors refused to believe that she wasn't throwing up on purpose. Now she has to eat tiny snacks continually because feeling full is a trigger for her.

I think this is something that *has* to be decided on a case-by-case basis. There is no one-size-fits-all solution. I think we definitely need legal mechanisms in place to ensure that people who need help for reasons that make them reject help still get help, but we also need to make sure such systems aren't abused.

This also reminds me, I need to give my fiancee medical POA and make sure she knows what my wishes are...

*I am intentionally avoiding the word "mind" because, as pointed out by several commenters before me, mind-body duality only serves to muddy the issue further. And yes, I know, there's also glands and the whole rest of the nervous system and various feedback mechanisms with the body's other systems, let's just assume "brain" is folding all that in because it's a pain to type out. Also because there is a qualitative difference between a chronic stomach disorder and anorexia, and it's a little too easy to overemphasize a holistic approach and forget the human body contains quite a few separate-yet-interdependent organs and isn't just a big sack of undifferentiated magic goo.

**There's also almost sexism at work there. I also had a condition as a teenager that caused me to throw up a lot and lose weight extremely rapidly, and I was under treatment for depression at the time. While the doctors mentioned anorexia, they checked for causes in my digestive tract first--and sure enough, they found them. Whereas she had no history of psychological disorder (AFIAK) and they immediately assumed a psychological cause.

[Ross]

(Though I'm very glad I was born before the Ritalin-for-bored-children era.)

Please try to avoid saying things which sound like you're characterizing ADHD as a made-up excuse for drugging unruly kids.

[Froborr]

Please try to avoid saying things which sound like you're characterizing ADHD as a made-up excuse for drugging unruly kids.

This has always struck me as a particularly uninformed claim, because Ritalin makes kids who *don't* have ADHD more, not less, unruly. It is a small dose of speed, after all.

[Ross]

@Froborr: Tell me about it. So damned many depictions of it in the media acting like a tranquilizer, but what I remember was the summer when my sister gave up sleeping until they got the dosage properly tuned.

[DavidTC]

I think the system we need to set up is that any voluntary, _irreversible_ change to the body requires some sort of 'waiting period'. (And, no, tattoos and piercing are not irreversible, and abortion is not really a 'change', it's just undoing a medical condition. Let's not quibble over what I'm trying to include here.) For the extremely irreversible 'suicide', I'd require at least a few hours counseling session plus a month waiting period, although note that I'm not saying they need doctor's _approval_ at the end to do it, just that they sit there and listen to a doctor.

We somewhat have such a system with transsexuals, but that, IIRC, is a voluntary doctor-created system, they simply won't do the surgery without it. And that, wrongly, includes the doctor's approval. (To the point that, I hear, SRS patients routinely lie, because apparently doctors sometimes want to hear that the patient will become a _straight_ member of the opposite sex. Or do I have that backwards? I forget.)

We could try to expand that system, but it doesn't really help when the change doesn't require going through a doctor, like with suicide or anorexia.

For that matter, at what point does anorexia become 'irreversible'? Sure, it's dangerous, but so is overeating, and we let people do that. One of those is caused by psychological issues, whereas the other is usually just caused by society and general apathy to health, but I'm a little baffled as to how we can make any sort of distinction under _body autonomy_. We either have to say 'There are some valid, and some invalid, reasons for risking your health, and we only allow valid ones.', or we can't do anything about anorexia.

And then, even after all that, half the anorexics will just nod along for one session and keep doing the same thing, unless we can figure out some magical way of stopping that very insidious behavior in a short amount of time.

..although, frankly, the real issue with eating disorders like anorexia and bulimia is that they are _contagious_. If it was just some random thing that affected one person at a time, like BIID, I think we'd just shrug and say 'If they want to harm themselves, whatever.'. Or even alcoholism, which we as a society tend to just let the sufferer deal with, unless they do dangerous stuff like drive on the roads.

But the problem is that eating disorders infects entire groups of people, usually young people. A few hours of therapy can't fix it, and letting them keep doing it means that they will pull others along with them. So we can't ignore it, we can't let people just do it unchallenged, unless we fix the screwed up body image society has decided on. (And good luck with solving that this decade.)

(And, wow, if you replaced 'anorexia' with 'homosexuality' in that two last paragraphs, it sounds exactly like the horrible arguments made against homosexuality. But the difference is that anorexia is very self destructive, whereas if in Hypothetical World hanging out with a bunch of gay people actually made straight people occasionally have sex with their own gender, it is, or should be, a 'Who cares?' situation. The problem, even in Hypotherical World where gayness is contagious, only arises there if gay sex is some sort of problem in the first place.)

[Andrea]

David, I hope you aren't trying to suggest that alcoholism harms only the sufferer.

[Izzy]

Yeah, ADHD drugs--Ritalin, Adderall, etc--were one of the main sources of extra Finals Week cram time back in high school.

@David: Yeah, and also, with alcoholism and anorexia and so forth you *also* get the subjectivity of diagnosis. The more severe cases are easy to spot, but by that point they've often done themselves and others serious damage.

And before that point, you get a lot of argument. Are you anorexic if you always count calories? If you try a whole lot of fad diets? Are you an alcoholic if you need a martini after work to relax, or if you go through a six-pack of wine coolers while watching Buffy reruns? I'm inclined to say that the first two are problematic and the second two aren't, but that might just be my point of view.

[Mmy]

@DavidTC: I think the system we need to set up is that any voluntary, _irreversible_ change to the body requires some sort of 'waiting period'.

Including, I presume, deciding to get pregnant? To have cataract surgery? To have root canal surgery? To get one's teeth filled?

For that matter, at what point does anorexia become 'irreversible'?

Death?

But more seriously, it is quite possible to be use exercise as a "tool" to be anorexic.

[DavidTC]

No, I'm saying we _treat_ it as if it harms only the sufferer. (Unless they do stuff that is obviously dangerous to random people, like drive drunk.)

Obviously, almost all self-destructive behaviors cause harm to people who care about the person.

However, neither society in general, or I specifically, think it would be useful for society to step in with laws stopping such behavior. It seems a very slippery slope to me, as there's a lot of self-destructive behavior that is, frankly, with our rights as owners of ourselves. (And our rights as owners of ourselves are not trumped by people who care about us.) And additionally there's a lot of behavior that seems self-destructive when others see it, that is not.

Perhaps some people disagree, I don't know.

But anorexia, in my mind, is rather akin to alcoholism when combined with a cult that encourages it. It's not really the drinking/eating disorder that's the issue...it's the fact it's been combined with a self-replicated meme that seems designed to pray on vulnerable people, mostly insecure teenagers. (If 'insecure teenagers' is not redundant.) Especially since the act itself makes people think less clearly.

[Froborr]

And additionally there's a lot of behavior that seems self-destructive when others see it, that is not.

This.

If the only way in which something harms others is that it upsets people who care about the person doing it, it has to be allowed. Otherwise your fundamentalist parents can prevent you from getting a same-sex marriage or a sex change or, heck, even a tattoo. I'm not saying that alcoholism is comparable to any of those things, I'm saying that the pain of the person who believes that their loved one is harming themselves is comparable.

[cjmr]

Everywhere I've ever lived requires a parental signature for kids under 16 (or 18, depending on the state) to get a tattoo or piercing, actually.

[Mmy]

Trigger Warning: Discussion of Anorexia

@DavidTC: But anorexia, in my mind, is rather akin to alcoholism when combined with a cult that encourages it. It's not really the drinking/eating disorder that's the issue...it's the fact it's been combined with a self-replicated meme that seems designed to pray on vulnerable people, mostly insecure teenagers.

While this is true of some people who are anorexics it is by no means a good (or adequate) generalization. Anorexia is by no means uncommon at graduate school† and I know a number of PhDs who had or have it. Graduate school is not only a stressful time in one's life it is also a stretch of time when one has very little control of oneself.

† Indeed, I still have some of the clothes I wore at graduate school -- and I am amazed that legs thin enough to fit into those jeans could actually hold a person up. And of course I was amenorrheic.

[Izzy]

@Froborr: Right.

My grandfather died of lung cancer. I have friends who smoke. I myself think they're making a bad choice--but it's not my right to prevent them. It's not even my right to harp about the issue; if I did, I would fully understand them ceasing to be friends with me.

Likewise, I'm sure that there are people out there who feel that my lifestyle choices are harmful in the long-term, what with the drinking and the sex and the lack of desire for children or husband and I don't put nearly enough in my 401K and the red meat and the dairy and so on. I'm not gonna have much patience with anyone telling me as much. (Well, except for the 401K thing.)

Even with actual cults, there's a certain point at which, if my friend wants to become a Scientologist, my friend wants to become a Scientologist, and I've just got to deal with that one way or another.

It's possible that we really have to say "Well, it's up to you," and then work on the issues at the root of the behavior: better diagnosis and treatment of mental illness, more reasonable societal beauty standards, better education about various kinds of health risks, and so on.

[Froborr]

I myself think they're making a bad choice--but it's not my right to prevent them. It's not even my right to harp about the issue; if I did, I would fully understand them ceasing to be friends with me.

If one of my friends smoked, I wouldn't harp, but at the same time, I'm not hanging around people who are currently smoking, because that harms me. If it's a space that belongs to me (my apartment, in other words), they can leave; otherwise I'm leaving.

[DavidTC]

@mmy
Including, I presume, deciding to get pregnant?

If becoming pregnant causes an irreversible change in someone's body, I must suggest that they have forgotten to give birth. And, yes, they should probably see a doctor, although not for therapy. And, I must point out, pregnancy is also reversible without giving birth.

Somehow I get the idea you think I meant, by 'irreversible', I mean 'not perfectly reversible'.

Nothing's perfectly reversible. Unused piercings, laser-removed tattoos, after effects from pregnancy, those are not what I am talking about.

To have cataract surgery? To have root canal surgery? To get one's teeth filled?

I don't understand when dental and eye care somehow became 'voluntary', unless you're trying to make the argument that _all_ medical care is voluntary. Which, strictly speaking, it is. And not what I was talking about, because, with the dental examples at least, the choice is 'become ill and possible die' or 'have medical care'.

So not having medical care, as that would cause the largest change (death), is the thing that would apply to what I was talking about. (And you generally can't have a waiting period to not do something, so a 'waiting period' wouldn't even apply. However, for example, a waiting period would apply to people being removed from respirators. Although it should be very short, a few hours or so.(1)

But even without the risk of death, there is an obvious difference between medical procedures designed to fix illness or disability, intended to return people to how they used to be, and voluntary medical procedures. There's a difference in transsexuals with perfectly functional (if wrong) bodies, and people with dysfunctional eyes. One of them is changing something that works to something else that can't do, and can never do, the same things it did before (So needs careful consideration), and one of them is fixing something broken. (Which doesn't really need any consideration at all, as no one ever regrets removing their cataracts.)

And perhaps more relevant, I'm saying everyone has the right to change anything about themselves. Or even deliberately break them. The thing I want is a waiting period, not any sort of approval. So even if somehow the premise gets extremely screwed up somehow and people with cataracts have to wait a month to have surgery...I must point out that, yeah, they pretty much already do that. Most people with cataracts wait years to have them fixed. No one just randomly decides to have cataract surgery and runs into the optometrist suddenly demanding it right then, and if they did that the optometrist would just laugh and schedule an appointment.

1) I have a sort of general idea that waiting periods, in addition to being relevant to the severity of the change, should also be related to the expected amount of time in the future that the change persists over. (That is, the amount of time they have to 'live with it', except that phrase doesn't really work for suicide.) E.g., someone who is going to die of cancer in a month needs only a few days, and someone who is on a respirator only needs a few hours. Whereas a perfectly health 20 year old who wants to kill themselves need to wait a month. This idea is rather vague, though.

[MercuryBlue]

Everywhere I've ever lived requires a parental signature for kids under 16 (or 18, depending on the state) to get a tattoo or piercing, actually.

I can't remember who or where, but not too long ago there was a news story where a kid decided he wanted a tattoo--I think it was in honor of his dead brother--and his mom took him to get the tattoo and as a result somebody got arrested. Forget if it was the mom or the tattoo artist, though it might have been both.

[hapax]

TW: Side effects of pregnancy

If becoming pregnant causes an irreversible change in someone's body, I must suggest that they have forgotten to give birth.

With all due courtesy, that suggestion implies that you have never been pregnant, and have zero medical knowledge of the irreversible changes that pregnancy does, in fact, cause in the body.

And not all of them are immediately obvious. (E.g., there is some evidence that some cases of fibromyalgia are caused by an autoimmune reaction to pregnancy).

[Mmy]

@DavidTC: If becoming pregnant causes an irreversible change in someone's body, I must suggest that they have forgotten to give birth. And, yes, they should probably see a doctor, although not for therapy. And, I must point out, pregnancy is also reversible without giving birth.

David, I suggest that you poll the women in this community who have been pregnant and ask them about what pregnancy does to a woman's body. There are a raft of irreversible consequences that can follow pregnancy. And don't try and thread the needle with "not perfectly reversible." Pregnancy is hard on a woman's body.

I don't understand when dental and eye care somehow became 'voluntary', unless you're trying to make the argument that _all_ medical care is voluntary.

What is the difference between someone getting surgery to reduce the pain in their jaw than surgery to reduce the pain they experience from being in the wrong type of body?

And there is a dreadfully long history in medicine of having authorities decide that certain types of pain is "real" and needs to be taken seriously and other types of pain are things that one should get over and should be dissuaded from through waiting periods. No one (where I live) gets told that they don't really "need" cataract surgery since they don't use their eyesight that much and it isn't important and they should wait longer.

Waiting periods are classically used to dissuade people from getting treatments they want. Such time delays can be used to make procedures too expensive and difficult for working class people to get (see the moving goalposts for "getting an abortion" in the US.)

[DavidTC]

mmy:
While this is true of some people who are anorexics it is by no means a good (or adequate) generalization. Anorexia is by no means uncommon at graduate school† and I know a number of PhDs who had or have it. Graduate school is not only a stressful time in one's life it is also a stretch of time when one has very little control of oneself.

Ah, that's my bad, or rather whoever brought anorexia up. Or I misunderstood what they were talking about.

Apparently, according to teh Wikipedia, 'anorexia' is technically just 'not having a normal appetite for any reason'. That is not even a disorder, that's just a symptom of many different things, and is not what I was thinking of. (Heck, everyone's had that at some point when sick.)

What I was thinking of is the eating disorder called, specifically, 'Anorexia nervosa'. To quote Wikipedia: 'Outside of medical literature, the terms anorexia nervosa and anorexia are often used interchangeably; however, anorexia is simply a medical term for lack of appetite. However, people with anorexia nervosa do not lose their appetites.'

People who have a long-term symptom of lack of appetite should obviously (as with most medical issues) see some sort of medical specialist, and I would suggest that people refrain from that level of stress if that's what's causing it. But that just affects them.

Eating disorders, be it anorexia nervosa or bulemia, OTOH, are a whole nother kettle of lack of fish. And, actually, thinking of it, we can handwave most body autonomy issues by the simple fact that often such people are underaged.

[Mmy]

@DavidTC: Rather than fall back on Wikipedia I just checked out the (American) National Institutes of Health as to what, exactly, anorexia nervosa was. The "definition/description" refers to it as both "anorexia" and "anorexia nervosa" (on the same page.)

The behaviour of teenagers that you mention was anorexia is not about losing appetite. If you talk to teenagers who have gone through it (in my experience) they talk little about not having an appetite rather they talk about controlling their bodies.

If you are an adult with anorexia/anorexia nervosa (which I was) you don't really lose your appetite rather you become used to being hungry. Which is an entirely different thing.

And, as I said, anorexia (and bulemia) are not exclusive to people who are underage. Both are more common in teenagers and young women than in the general population but "young women" includes a large number of people who are anything but underaged.

[lonespark]

If becoming pregnant causes an irreversible change in someone's body, I must suggest that they have forgotten to give birth.

WTF. Your lack of basic medical knowledge is astounding.

[Mmy]

@lonespark: The first example that sprang to my mind when I read that comment was "pelvic prolapse."

[cjmr]

"If becoming pregnant causes an irreversible change in someone's body, I must suggest that they have forgotten to give birth."

I'm not going to post any horrific pictures but this comment is just inane. Two of my acquaintances have just undergone horribly invasive surgery to correct damage that their pregnancies did to their body. Reversible, yes, but at the cost of complete hysterectomy and surgical pelvic reconstruction.

[Nick Kiddle]

//Somehow I get the idea you think I meant, by 'irreversible', I mean 'not perfectly reversible'.

Nothing's perfectly reversible. Unused piercings, laser-removed tattoos, after effects from pregnancy, those are not what I am talking about.//

So what do you mean by "irreversible" then? Transition is imperfectly reversible (stop hormones, take other hormones, have voice therapy and possibly surgery if necessary) and you're still including it in the category of irreversible.

[Ross]

But more seriously, it is quite possible to be use exercise as a "tool" to be anorexic.

Or bulimia. It can get quite bad without many of the usual signs presenting.

[Mmy]

@Ross: Yup. I knew someone who had a treadmill set up with a "standing desk" on the top so zie could grade and jog at the same time. Wouldn't sleep or eat until X number of miles were clocked. And then no more could be eaten than the number of calories burned off in the evening's jogging. Also wouldn't eat in front on anyone else (including spouse.) Zie was always completely exhausted because anything eaten had to be "paid for" upfront with exercise.

[DavidTC]

@mmy
David, I suggest that you poll the women in this community who have been pregnant and ask them about what pregnancy does to a woman's body. There are a raft of irreversible consequences that can follow pregnancy. And don't try and thread the needle with "not perfectly reversible." Pregnancy is hard on a woman's body.

This is getting a bit pointless. I've already explained that pregnancy is not one of the things I'm talking about, mainly because it's not even a medical procedure so a waiting period would be impossible to actually deal with. I don't know why you think I might want a waiting period for it, or how I would be proposing to deal with it.

I also have to point out that a lot of people have missed the context of 'irreversible', which was talking about _voluntary_ changes. Yes, pregnancy can involve a lot of horror stories...which _no one_ choose to do to themselves, they just happened. Pregnant women do not voluntarily have serious problems with their pregnancy. Other people, please read this from the start and don't assume that Mmy is presenting what I said correctly.

What I did, if readers don't want to go back, is suggested a waiting period for people who want irreversible voluntary changes made to their body. Mmy decided to parse my words to include pregnancy, and I pointed out that pregnancy is not actually irreversible, by which I mean it's not _supposed_ to be irreversible, because I was talking about it in the context of what people _choose_ to happen to them.

Women who choose to become pregnant choose to undertake a process for nine months that will result in their body basically returning to how it started. And then a bit of lactation, which stops later. _That_ is the body changes they signed up for. That is all they signed up for. They didn't sign up for any sort of permanent change to their body.

The fact this does not always work out that way does not mean it would be included under what I'm talking about, anymore than the driving a car would be covered by a waiting period because it sometimes results in serious medical problems due to accidents.

I'm sorry that I didn't make it clear I was talking about the _intended_ result of pregnancy in my last post. And I didn't intend to cause anyone to dwell on any issues they might have had to deal with.

I don't even want to be talking about pregnancy at all. Pregnancy is not one of the things covered under what I'm talking about, no matter what Mmy has decided, despite the fact I've explained it's not. If it is bothering people, I'll just stop responding to that part of the discussion after this.

What is the difference between someone getting surgery to reduce the pain in their jaw than surgery to reduce the pain they experience from being in the wrong type of body?

Yes. We all know there's no such thing as actual pain, it is all psychological, and that it can't possibly be worse than someone who is in the wrong body and is mentally distressed from that.

And are you really arguing that people should be able to have SRS without _any_ waiting period? Just walk in, lay down, a few snips and tucks and it's over? Or did you miss the part where I suggested suicide would require a month-long waiting period, and other things would require less...whereas SRS currently requires a year in most places? (And not just a 'declare and wait' year, but actually living as the opposite gender for a year. And is subject to a doctor's okay, which I want to do away with.)

Yes, I think that people with pain in their jaw should be able to get surgery _now_, whereas people who have been living in the wrong body their entire life can perhaps _declare_ that to a doctor at least two weeks before surgery to fix that.

This is one of those arguments where either you seriously misunderstood me, or you hold very baffling positions.

And there is a dreadfully long history in medicine of having authorities decide that certain types of pain is "real" and needs to be taken seriously and other types of pain are things that one should get over and should be dissuaded from through waiting periods. No one (where I live) gets told that they don't really "need" cataract surgery since they don't use their eyesight that much and it isn't important and they should wait longer.

Meanwhile, I say doctors shouldn't have any say in that, and the waiting period should be much shorter than it currently is. Your argument with me is...?

Incidentally, although I didn't make it clear, this flows into 'giving people whatever pain killers they want'. (After about one day waiting period or whatever.)

Waiting periods are classically used to dissuade people from getting treatments they want. Such time delays can be used to make procedures too expensive and difficult for working class people to get (see the moving goalposts for "getting an abortion" in the US.)

Yes, I am aware of that. The entire point of this, in fact, is to 'dissuade people from getting treatments they want', because often people temporarily want things they do not actually want. Like to be _dead_. So if they want to be dead, they should have to want that now, and then want it a month later, then they can do it.

Likewise, people think they're a gender other than their biological sex should perhaps have to hold that opinion for a few weeks.

You appear to be somewhat worried about people who need _emergency_ sex changes. I have to suggest this is not a reasonable concern.

As for making things more expensive, well, I would be, except I'm talking about things that are either currently illegal or have much longer waiting periods currently. So not really.

[DavidTC]

@Nick Kiddle
So what do you mean by "irreversible" then? Transition is imperfectly reversible (stop hormones, take other hormones, have voice therapy and possibly surgery if necessary) and you're still including it in the category of irreversible.

Erm, no, actually, I was just including the final surgery in the irreversible category. Most of the other stuff is reversible, AFAIK. And, as at this point I suspect everyone responding is just responding to my latest post and not reading my original premise, let me restate:

Yes, I am proposing that people who actually have SRS should have to fill out a form two weeks in advance they intend to do so! And perhaps talk to someone for an hour or so who has no say over their final decision! Oh noes!

If you really have an issue with that, I'll follow up, but I suspect you were thinking I was saying something else.

[Mmy]

@DavidTC: This is getting a bit pointless. I've already explained that pregnancy is not one of the things I'm talking about, mainly because it's not even a medical procedure so a waiting period would be impossible to actually deal with. I don't know why you think I might want a waiting period for it, or how I would be proposing to deal with it

In your original statement you said: I think the system we need to set up is that any voluntary, _irreversible_ change to the body requires some sort of 'waiting period'.

You did not, note, say "and voluntary medical procedure.

I then asked you: Including, I presume, deciding to get pregnant?

And you responded If becoming pregnant causes an irreversible change in someone's body, I must suggest that they have forgotten to give birth. And, yes, they should probably see a doctor, although not for therapy. And, I must point out, pregnancy is also reversible without giving birth.

Note that you did not say that pregnancy wasn't included in your proscription because it wasn't a voluntary change (or even a medical procedure) you said it didn't count because it wasn't an irreversible change.

Since then you have been trying to climb out of the hole you dug for yourself.

I don't even want to be talking about pregnancy at all. Pregnancy is not one of the things covered under what I'm talking about, no matter what Mmy has decided,

I decided nothing. I asked a question "does that include pregnancy" and it was your answer to my question that created the problem you are now in.

Additionally it you really think: Women who choose to become pregnant choose to undertake a process for nine months that will result in their body basically returning to how it started. And then a bit of lactation, which stops later. _That_ is the body changes they signed up for. That is all they signed up for. They didn't sign up for any sort of permanent change to their body.

Then you are woefully ignorant of the facts of life on the ground for women.

Finally: You appear to be somewhat worried about people who need _emergency_ sex changes. I have to suggest this is not a reasonable concern..

Huh? I spoke to pregnancy, root canals, dentistry and abortions. I was merely pointing out that your ill thought out initial stance could force waiting periods on people who need medical treatments related to those things as well as other procedures that we had been discussing.

[Nick Kiddle]

TW: transphobia, dysphoria, medical mistreatment, cancer reference

//You appear to be somewhat worried about people who need _emergency_ sex changes. I have to suggest this is not a reasonable concern.//

This really, really, REALLY comes across as minimising what trans people go through. To use myself as an example, I didn't summon up the courage to try to access hormones until the estrogen in my system was making me suicidally dysphoric on a regular basis. If I'd been able to find a doctor willing to give me low-dose testosterone cream on an informed-consent basis, I would be MASSIVELY more stable now. As it was, I had to endure a doctor telling me that it has irrevesible effects, will automatically cause fatal cancer of the ovaries and basically a catalogue of lies and patronising garbage. I am STILL running on estrogen and I am STILL incredibly prone to suicidal ideation. And I am only one of far, far too many.

There's a horrible trend where cis people talk about transition where they suggest that trans people should be protected from ourselves just in case we magically change our minds and become cis. But in real life, it doesn't work like that. Trans people who aren't allowed to transition are still trans, we're just miserable and dysfunctional a whole lot of the time. And if a misguided cis person transitions and then realises their mistake, they have the option to detransition. They'll be in a similar situation to a trans person who's transitioned, and if you think that's such a terrible thing that says a lot about how you think of trans people.

[hapax]

DavidTC, I suspect that the problem people are having with your proposal is that the categories you are mapping out -- "voluntary", "irreversible", "change to the body", "medical procedure", etc. -- are not as cut and dried as you apparently think they are.

This is the problem with the entire issue of the OP. We, as a society, are pretty much forced to apply strict legal categories to individual needs and desires that don't neatly conform to any blanket definition.

Yet it seems that we (most of us, at least) are also reluctant to throw up our hands and say, "Well, then, anything goes!"

Pointing out the likely unintended ramifications of the policy you suggest is not a personal attack. It's a restatement of the motto on our masthead.

[Nick Kiddle]

//Erm, no, actually, I was just including the final surgery in the irreversible category.//

What final surgery? Chest reconstruction? Facial feminisation? Metaoidoplasty? Orchidectomy? I think you need to have a better idea what you're talking about before you get into discussions like this.

//Huh? I spoke to pregnancy, root canals, dentistry and abortions. I was merely pointing out that your ill thought out initial stance could force waiting periods on people who need medical treatments related to those things as well as other procedures that we had been discussing.//

"Ill thought out" gets to the heart of it, I think. DavidTC has built this theoretical edifice that he really likes the look of, but it doesn't fit with anyone else's practical experience of life and there are dozens of edge cases that make it really problematic. And instead of being willing to engage with the points we're raising, he's complaining that we don't appreciate his pretty theory properly.

[Nick Kiddle]

And while I was writing that comment, hapax put it so much better. What she said.

[DavidTC]

Mmy:
I asked a question "does that include pregnancy" and it was your answer to my question that created the problem you are now in.

No, you didn't. You asked if it included that, and I responded out it didn't.

Then you decided to argue that it _did_, despite me saying it didn't, because I didn't exclude it in a way you liked. What's more, you decided to make the way I excluded it about something else entirely, problems with pregnancy, which is a pretty triggery and random topic to leap to.

Huh? I spoke to pregnancy, root canals, dentistry and abortions.

Did I misunderstand 'What is the difference between someone getting surgery to reduce the pain in their jaw than surgery to reduce the pain they experience from being in the wrong type of body?'?

@Nick Kiddle
"Ill thought out" gets to the heart of it, I think. DavidTC has built this theoretical edifice that he really likes the look of, but it doesn't fit with anyone else's practical experience of life and there are dozens of edge cases that make it really problematic. And instead of being willing to engage with the points we're raising, he's complaining that we don't appreciate his pretty theory properly.

I quickly cleared all the 'edge cases' up in the next post I made, after Mmy thought I was talking about something we should start applying to random things, instead of as a way to _add_ body autonomy to things that are currently very difficult to convince doctors to do or even illegal. (Namely, BIID surgery, gender transitions, and suicide, which I all mentioned in my original post, and what we were talking about. There might be other things, also.)

I understand that original confusion. My post did not, by itself, have the context of the discussion. So I did addressed that and explain that I was actually talking about voluntary medical procedures in my very next post, not things like pregnancy (Which is not even a static condition, much less an irreversible one.) or corrective medical procedures.

And then people just kept trying to argue what I must have meant.

@hapax
Pointing out the likely unintended ramifications of the policy you suggest is not a personal attack. It's a restatement of the motto on our masthead.

No, but continuing to point them out after I've explained the context of what I suggested (voluntary medical procedures) is hard to take any other way.

[DavidTC]

@Nick Kiddle
//You appear to be somewhat worried about people who need _emergency_ sex changes. I have to suggest this is not a reasonable concern.//

This really, really, REALLY comes across as minimising what trans people go through. To use myself as an example, I didn't summon up the courage to try to access hormones until the estrogen in my system was making me suicidally dysphoric on a regular basis. If I'd been able to find a doctor willing to give me low-dose testosterone cream on an informed-consent basis, I would be MASSIVELY more stable now. As it was, I had to endure a doctor telling me that it has irrevesible effects, will automatically cause fatal cancer of the ovaries and basically a catalogue of lies and patronising garbage. I am STILL running on estrogen and I am STILL incredibly prone to suicidal ideation. And I am only one of far, far too many.

Yes, the idea that trans people don't have at least two weeks before surgery is rather minimizing what trans people go through, as the process often takes years.

Of course, that comment is my mockery of Mmy's position, where 'two weeks' are going to get in the way of people transitioning. Because there are apparently gender transitions that are quicker than that, where a man is happy with his gender one day, and then, less then a foresight later, she's not only realized her gender identity is female but is now ready for some surgery, which will be, darn it, foiled by my new waiting period.

Or something like that. I'm having trouble figuring out this objection, because in actual fact people transitioning have to wait quite a long time for surgery. Much longer than two weeks. And have to have other people sign off on it.

I vaguely understand the misunderstanding about how I might be adding waiting periods to root canals or other random things, although that requires people not reading my response to that.

But I don't understand how someone who is transitioning can think my idea will make it harder. You're standing there talking about how complicated and hard transitioning is, and don't seem to notice what I actually said was 'Trans people shouldn't have to put up with that shit, they (and everyone else) should be able to do _anything_ to their body they want, at all, without anyone's permission, as long as they're willing to wait a very short amount of time (much much much shorter than currently demanded by doctors) to confirm it for the few things they can't undo.'

That is my _entire_ premise.

And I'll point out that you wouldn't have to 'find a doctor' to get hormones. You'd just _do_ it. Want to take hormones? Well, those are reversible (or at least the first few days are so there's a waiting period built in), so go right ahead.

There's a horrible trend where cis people talk about transition where they suggest that trans people should be protected from ourselves just in case we magically change our minds and become cis.

You mean like the doctors you currently have to fight your way past and I wish to remove? Yes, that is fairly horrible.

But in real life, it doesn't work like that. Trans people who aren't allowed to transition are still trans, we're just miserable and dysfunctional a whole lot of the time.

Also in real life, you have to have policies that actually can exist in the real world, even if they are forced, for fairly pointless reasons, to deal with non-existent hypothetical issues.

Alternately, you can argue against a trivial roadblock on moral grounds (A roadblock that trans people would not actually hit, because they know well in advance they wish to change), and prefer instead to remain in a universe where doctors control your fate and can keep you from transitioning _at all_.

[Mmy]

@DavidTC:

You made a statement based on overly broad (or ill judged) categories. I asked if something (pregnancy) fell into one of those categories. You stated it did not--on the basis of a serious misunderstanding/misapprehension of physical impact of pregnancy.

Note the order (you are the person who is worried about who brought things up.)
1) You made the statement.
2) I asked a question and
3) you demonstrated that you had little understanding of the medical impact of pregnancy.

Then you went on to make statement about a number of other things which indicated that you also had a minimal understanding of number of other things that would be affected by your original overly broad categorization.

This is your pattern:

You make an overly broad simplistic statement. Someone else on the board asks a question/makes a comment that demonstrates the problem with your position. You then make the statement that they claimed something that they never claimed.

Either you are arguing in bad faith or you have incredibly poor reading comprehension skills. Or a combination of the two.

[Kit Whitfield]

Higs to Nick Kiddle.

DavidTC: if you do not understand pregnancy, you need to shut up about pregnancy. And you clearly do not understand pregnancy.

[DavidTC]

@Kit Whitfield
DavidTC: if you do not understand pregnancy, you need to shut up about pregnancy. And you clearly do not understand pregnancy.

Me: People should fill out a change of address before they move so their mail follows them.
Mmy: What about when they go to the store? Or sleep on the couch.
Me: I have to suggest if going to the store has caused a problem with their mail reaching them, they have forgotten to come back home. And also by move I meant 'relocation their home', so sleeping on the couch isn't really relevant.
Mmy: You know nothing about driving. People die in car accidents on the way home from the store all the time. You should talk to some people who've driven.
Me: WTF? Car accidents are not 'moving'.
Mmy: Car accidents involve the movement of people. You don't know anything about car accidents.
Others: Yeah! How insensitive of you! If you don't know anything about car accidents, you shouldn't even talk about people driving cars!
Me: I _wasn't_ talking about that!

I was not talking about pregnancy. _At all_. I did not bring it up, and when I was asked about it, I explained that pregnancy did not fall under my definition of 'irreversible', as it lasts at most a certain amount of time and then ends, which I explained in a joking manner. That _should_ have ended it. (Actually, that specific question shouldn't have been asked, considering I explicitly said I wasn't talking about abortion, and it's nearly impossible to come up with a logical way that pregnancy is considered irreversible but abortion is not.)

And Mmy then continued to argue that I was wrong about what I had proposed, because for some reason I must have been including involuntary changes to a body during pregnancy, despite me not saying anything of the sort, and it in fact being excluded by the entire premise of voluntary changes.

[Froborr]

DavidTC: Learn to read. Pregnancy? Causes permanent changes to the body. And is (for now, sometimes, and we're trying to make it always and forever) voluntary. Therefore, pregnancy falls into the category of voluntary permanent changes to the body, so when you talk about voluntary permanent changes to the body, readers naturally assume you are including pregnancy.

In response to readers asking about pregnancy, rather than saying "Oops, I didn't mean pregnancy," you said readers should have known you didn't mean pregnancy because of a reason that only makes sense if you know nothing about pregnancy. Then you made another excuse that only makes sense if pregnancy isn't voluntary.

I recommend following the first law of holes.

[Mmy]

@DavidTC: You are mischaracterizing the entire sequence of conversation. You can argue up and down until the cows come home.

I simply asked you a question (what about pregnancy) because it was clear to me that you hadn't thought through the implications of your scheme.

You decided to blither about how pregnancy didn't count for all sorts of reasons that were medically incorrect.

At this point you are just feeling put upon because you weren't willing to simply say "good point, I hadn't thought about that." At which point the conversation might have gone on.

[Froth]

"Yes. We all know there's no such thing as actual pain, it is all psychological, and that it can't possibly be worse than someone who is in the wrong body and is mentally distressed from that."

This sounds an awful lot like you're saying that dysphoria doesn't hurt.

Do you believe that "actual pain" must be a matter of damage to the body, and anything else somehow doesn't count?

Though, since you apparently believe it's reasonable to expect someone to wait a full day for pain relief, you might just not understand what pain is.*

*If you mean non-emergency pain relief, it's a fuzzy and not hugely meaningful distinction. What counts as an emergency? If I get appendicitis and have surgery for it, do I have to be unmedicated for a day after I wake up so I can decide if it's bad enough to need numbing? Does it have to be life-threatening? Can I only have my migraine reliever if it goes on for more than twenty-four hours and I go to the doctor every time?

[DavidTC]

@Froborr:
In response to readers asking about pregnancy, rather than saying "Oops, I didn't mean pregnancy," you said readers should have known you didn't mean pregnancy because of a reason that only makes sense if you know nothing about pregnancy.

I had proposed a line in the sand, and it was unclear where I had drawn it. Fair enough. So in my _first_ response, I *did* said I didn't mean pregnancy, because I didn't consider the amount of changes that happen during pregnancy (To the woman) to qualify.

I said specifically 'Nothing's perfectly reversible. [...] after effects from pregnancy, those are not what I am talking about.'

Interestingly, that line got cut out when Mmy quoted the flippant part of reply, which got everyone thinking I had actually said pregnancy didn't _have_ any irreversible effects, despite the fact I had _explicitly_ said there were some. (Instead everyone saw the joke that there was really only one part of that I would consider a 'body change', carrying a baby...except that wasn't irreversible.)

And it just snowballed from there, because everyone decided to read what Mmy had said instead of what I actually said.

@Mmy
You decided to blither about how pregnancy didn't count for all sorts of reasons that were medically incorrect.

I have said nothing about pregnancy that is medically incorrect, because I have said almost _nothing_ about pregnancy. The only medical statements I've made about pregnancy are, as far as I can see: 1) There is such thing as abortion, 2) Pregnancy does not last forever, and 3) Pregnancy can result in a child.

If you have some other medical statements of mine, perhaps you'd care to quote them.

What has happened, Mmy, is you thought I was talking about something much broader than I was, which, like I said, was fair enough, as I didn't explain it well.

And because you already thought the line was somewhere else, you completely misunderstood my reply when I said 'Pregnancy is not irreversible in the sense I was talking about.' to mean 'He thinks pregnancy causes no changes at all!', instead of reading it and saying 'Oh, so the 'irreversible' concept is on the other side of that. Okay, that clears things up a bit.'. (And you also irrelevantly brought in medical complications, which confused things more.)

I have been pointing out this misunderstanding the entire time. You imagining that the line _I_ drew is in the wrong place so you are standing there and arguing placed pregnancy on the wrong side of it. Please stop. The line that I invented is where I said it was.

If you want to take issue with the phrasing, feel free, I don't like it either, but I've _repeatedly_ explained where I was intending to draw the line.

At this point you are just feeling put upon because you weren't willing to simply say "good point, I hadn't thought about that." At which point the conversation might have gone on.

_I'm_ extending this by failing to give _you_ props?

If so, let's pretend I edit my second post to start with 'Good point, Mmy! My phrase 'voluntary, irreversible change to the body' is indeed unclear, and I guess the exclusions I gave were not as helpful as I thought! I shall clarify what I was talking about now:'.

[Mmy]

@DavidTC: To quote you Women who choose to become pregnant choose to undertake a process for nine months that will result in their body basically returning to how it started. And then a bit of lactation, which stops later. _That_ is the body changes they signed up for. That is all they signed up for. They didn't sign up for any sort of permanent change to their body.

Memo: Women in general are quite aware that there is a good chance of long term bodily changes after pregnancy. Very long term.

You are in a hole. You had no idea that pregnancy involves for most women a long term permanent change to their bodies.

It does.

[DavidTC]

Froth:
This sounds an awful lot like you're saying that dysphoria doesn't hurt.

Do you believe that "actual pain" must be a matter of damage to the body, and anything else somehow doesn't count?

I was responding to someone who thinks that waiting two weeks to deal with an infected jaw and waiting two weeks to have gender reassignment surgery are somehow comparable.

But I apologize for saying 'actual pain', I see how that seems dismissive of emotional pain. I'm sure that dysphoria is indeed painful.

However, it is also a long-term, low-level pain, one that people take a rather long time to even _realize_ is wrong. So I have to suggest that, perhaps, a few weeks is not really a major issue. I further have to suggest that two weeks is much shorter than the time it took for the anyone reach the point of surgery, and thus the waiting period would be completely moot.

Again, I repeat, I'm rather baffled about people taking issues with this. I keep getting faced with people who seem upset I suggested that 'People should only have to sign a form and wait two weeks, they they can get anything they want altered about their body. This replaces the thousands of little hassles and hoops and authorizations they have to jump though now where it takes years and doctors can block them.'.

People do realize that the entire point of my waiting period is to allow people to do things that are current difficult or illegal, right? It doesn't make _anything_ harder. (Technically, it might physician-assisted suicide slightly more time consuming, making it last a month, where it's already legal, but I already stated a way around that involving life-expectancy shortening the waiting period.)

Though, since you apparently believe it's reasonable to expect someone to wait a full day for pain relief, you might just not understand what pain is.*

No. I was proposing that doctors get to prescribe pain medication, just like now....and if that pain medication doesn't work and your doctor won't listen you can override your damn doctor with a single day's effort. Because it is _your_ body and you have the right to alter it, including becoming addicted to painkillers or whatever the rational is for not giving actual pain medication.

[Froth]

My issue was purely with what looked like dismissing dysphoria; if that's not what you meant, shiny.

I'm all in favour of removing barriers to voluntary body-alteration.

On pain relief: I think you're talking primarily about chronic pain that's being inadequately medicated, yes? Because if you're including acute trauma, surgical recovery and so forth, twenty-four hours is a really long time.

[MercuryBlue]

My understanding is that the drugs that work best for chronic pain are also the expensive drugs. So I can entirely understand the mindset of 'let's make sure you need this drug before we let you have a ninety-day supply', and it makes sense that that process would take longer than a day. I don't know how to apply that mindset without excluding too many people in genuine pain, though. And also a chronic-pain patient of my acquaintance assures me that it would be cheaper and more effective to give her marijuana than to give her whatever she hasn't yet built up a tolerance to, and that she is not alone in this, but somehow marijuana is not yet legal.

[Nick Kiddle]

//I have been pointing out this misunderstanding the entire time. You imagining that the line _I_ drew is in the wrong place so you are standing there and arguing placed pregnancy on the wrong side of it. Please stop. The line that I invented is where I said it was.//

I don't think you've been nearly as clear on where this line is than you think you have. My guess would be that, for example, orchidectomy would be on the irreversible side, while facial feminisation would be classed as imperfectly reversible. But that's just me attempting to read between the lines of your answers, because you haven't actually explained how you're defining irreversible beyond telling us what does and doesn't count.

Maybe your actual proposal would be beneficial to trans people - although it's so far-reaching that it doesn't stand the faintest chance of coming to pass. But the way you're expressing it, and the way you continue to express it after I tried to explain the problem, is coming across as massively condescending and trivialising.

You also keep talking very flippantly about things you don't understand well. Remarks about pregnancy only being irreversible if you forget to give birth, and everything you've said about "emergency sex changes" make it sound like you don't care how things work in practice. That doesn't make for a productive discussion.

[hapax]

DavidTC -- I don't think anybody is opposed to the idea of making various body alterations *on* *principle*.

But you (as I understood it) weren't proposing a principle; you were proposing a *policy*.

And policy proposals depend on a pretty technical precision with language, which a lot of us were unclear about.

"Voluntary", "irreversible", and "medical procedure" simply aren't as clear as you seem to think they are.

Others have talked about "irreversible", and how that might include things you want to exclude, and vice-versa, so I won't bring that up again.

"Medical procedure" is also a tricky one; does it include medication, or just surgery? Remedial or transformative? What about therapeutic non-invasive procedures? (If you think intensive psychiatric counselling is "reversible", for good or for ill, I suspect you've never had any.) What about refusing medical intervention -- is that also a "medical procedure"?

Finally, the big sticky wicket -- "voluntary". That implies an ability to "consent". This is something that we have traditionally said minors are unable to do, although the "age of majority" varies greatly depending upon what they are consenting to (In my state for example, it is legal to consent to sexual activity and even marriage YEARS before it is legal to be allowed to even carry an unopened can of beer).

More importantly, it depends upon the person being judged "of sound mind", capable of informed consent. Unfortunately (or fortunately, depending on your point of view), in the judgment of many persons in our society, the very request for some of these body modifications would be considered prima facie evidence that the person desiring them was not rationally capable of consenting to them.

This is what I'm talking about when I bring up unintended consequences. It would be simple to say, "Hmmm, I was just tossing a general idea out there. How would y'all refine it to make it work better?"

But, you see, it is just those edges and fuzzy areas that cause the concerns that prompted this entire discussion in the first place. And now we're back to where we started.

[Mmy]

@hapax: Finally, the big sticky wicket -- "voluntary".

Indeed. For example, just how voluntary is a procedure when the patient sees that procedure as the only way to reduce agonizing pain? If in the throes of such extreme pain a patient is asked "are you willing to have this surgery performed?" can one really say that patient voluntarily consented to all of the "side effects" of the surgery?

When I agreed to have surgery to remove a very large tumour was I really volunteering for the permanent irreversible side effects of that surgery? I wanted the surgery--I didn't want some of the consequences of that surgery.

[cjmr, on her son's netbook]

"For example, just how voluntary is a procedure when the patient sees that procedure as the only way to reduce agonizing pain? If in the throes of such extreme pain a patient is asked "are you willing to have this surgery performed?" can one really say that patient voluntarily consented to all of the "side effects" of the surgery?"

TW: suicidal ideation, sort of

This. I have had painful migraines that have lasted so long that if someone had offered trepanning or decapitation as a pain relief surgery, I might have taken them up on it.

[hapax]

@cjmr -- Oh, I hear that. I actually tried to talk my doctor into killing the trigeminal nerve on the right side of my face, but she point-blank refused.

(Rightly, as I later conceded. Not that it might not have been worth it, if it had worked, but the procedure doesn't have statistically good outcomes.)

[Kirala]

I actually tried to talk my doctor into killing the trigeminal nerve on the right side of my face, but she point-blank refused.

That's a related point - to what extent do doctors have the right to refuse to administer treatments they find wrong? Where's the line between professional integrity and being an interfering busybody?

[cjmr]

@hapax -- is that the Botox procedure you are talking about? I had one doctor recommend that and another warn me off.

[hapax]

No, this wasn't Botox. This was injecting alcohol directly into the nerve to kill it.

The problem is that it's a very technically difficult procedure to get right, the side effects are horrible, and the outcome is only still about fifty-fifty pain relief; that's why the the medical associations (I forget the proper name of the one for neurologists) no longer recommend it.

Temporary "blocks" of various kinds, including Botox, are still approved under certain circumstances, but the likelihood of positive outcomes still ranges from 25 - 75 %, depending on lots of factors.

I was lucky to have a physician who stood on her professional integrity. On the other hand, a person who was in a different situation than me could equally well have seen this, as Kirala notes, as meddlesome prejudice.

[Izzy]

Right.

I mean, I pretty well resent the fact that I can't get sterilized until I'm thirty. Not the doctors themselves--mine seems nice enough, and I know he's just covering his ass legally, which is understandable--but there's something just wrong about it being common practice to deny an adult a procedure they want on the grounds that "well, you might change your mind someday."

I'd be fine with a mandatory waiting period of anywhere from six months to a year, but the standard procedure at the moment bugs the hell out of me.

[MercuryBlue]

Izzy: No comprendo. If someone gets sterilized and later wants to be a parent, there's always kids needing to be adopted. To safeguard against the possibility of someone getting sterilized and later wanting to be a parent and nothing but that person's genetic child will do, the sterilization procedure could be preceded by the procedure to donate gametes. Then, should the person being sterilized have second thoughts, all that'd be needed would be a second set of chromosomes and possibly a surrogate mother (who wouldn't necessarily be easy to find but wouldn't be impossible either), and if the frozen gametes are never used then they're never used, no harm done. And meanwhile the person in question is not capable of producing an unwanted child. This seems like a thing to encourage.

[hapax]

TW: Misogynistic slurs

Well, you have to understand the mindset that equates "voluntary sterilization" with, I dunno, "genetic suicide". Or possibly some sort of, umm not TRANSgenderization, but DEgenderization, because our femininity (or masculinity) is determined by our ability to reproduce. Or something.

And that's the charitable assumption.

I suspect that it's more along the lines of "voluntary sterilization" equals "medically endorsed sluttiness."

[MercuryBlue]

Most days I'm agender. I'm not seeing how 'degenderization' is an inherently bad thing.

And society really needs to get over the idea that sex is bad. (Assuming all parties to the sex are consenting, anyway.) Also the idea that women having sex should be punished by having babies.

[hapax]

Sorry, I should have added "sarcasm" tags or something like that to my last comment.

But the internalized patriarchy relies on strict gender binaries and the virgin / whore dichotomy.

As you know as well as (or better than) I!

[DavidTC]

@hapax
But you (as I understood it) weren't proposing a principle; you were proposing a *policy*.

Well, now I see where some of the confusion is. I was indeed proposing that we (Well, society. Or lawmakers.) make a system. I was not proposing that my specific wording _was_ the system. I'm pretty certain there's never been a six word public policy, and I'm also certain there is no process by which a post on this site can become a law. (Someone check with Schoolhouse Rock.)

"Voluntary", "irreversible", and "medical procedure" simply aren't as clear as you seem to think they are.

I knew my original sentence wasn't clear, at the time I made it. Which is why I said 'Let's not quibble over what I'm trying to include here.' right after it!

And as the original post I made was even more confusing than I thought (I assumed people would read that idea in the context of the discussion we were having about body sovereignty, and not attempt to apply it outside BIID surgery, gender transitioning, and suicide.), I posted a followup where I clarified several things, namely that I was only talking about medical procedures, and that I didn't consider the after effects to pregnancy to reach what I was talking about...and then people disputed my clarification.

I have, at this point, spent 24 hours saying 'No, I repeat, that's not what I meant by that word.', to the general disbelief of people who are _sure_ that's what I meant.

It would be one thing to say, after my clarification, 'Irreversible is not the best word for what you're talking about then, how about this word:'. It's another to say 'By irreversible you mean this, despite what you just said you didn't. Which also means, by the definition I've foisted on your vague word, that you are wrong about this other thing, as it is included under that definition.'.

Anyway, do you have any better words, so we can actually get past this? Again, I'm trying to cover BIID surgery, gender transitioning, and suicide, and things somewhat close to them. Major alterations of the body that are basically one way. (Sterilization, which was just mentioned, might or might not require a waiting period, depending on how it was done. Either way it _does_ happen, despite doctors not approving.)

And, as I don't think people understand this, I'm trying to cover things happening outside of actual medical recommendation. (Which I called 'voluntary'.) There are no waiting periods when doctors say something should happen. There are no waiting periods for doctors giving out drugs.

This is for when doctors say that something _shouldn't_ happen, and the patient says 'I'm signing this form, and in a few days it will anyway.'.

I didn't bother to make this clear for gender transitioning. (I was trying to simplify. The medical profession already has much longer waiting periods for that already, so whether or not the medical profession has waiting periods under this is rather moot. Such waiting periods would just be folded into the existing ones.) This confused a lot of people. To be clear: Transitioning under a doctor: Normal medical procedures, no waiting period. Transitioning without doctor, or against doctor's recommendation: Voluntary medical procedures possibly subject to waiting period.

So, anyway, what's a better word for 'Choosing to have surgery or drugs without a medical professional signing off on it.' instead of 'voluntary'?

And what's a better word to mean 'And not surgery or drugs that can be undone easily.' instead of 'irreversible'?

And there should be something in there about not including trivial changes...something like a pierced ear shouldn't count. (I don't think piercing would anyway as it undoes itself for the first few days if you simply remove it, so it has a built in 'waiting period' if you change your mind.) But something like a piercing, aka, punching a very small hole in your body, shouldn't count anyway, even if it could not be undone.

[Froborr]

Except there's something weird going on here, because society has no expectation that I (being male) should get pregnant as a punishment for sex, and yet I also can't get sterilized until I'm at least 30, and most doctors won't do it at all unless I have biospawn first. Which kinda defeats the point of sterilization.

And yeah, the whole point is that I already know I am never going to want to reproduce biologically; if I ever get to the point where I want to raise a child, I'll adopt one.

Also, what if I *want* to commit genetic suicide? I don't even like being photographed, why would I want a half-clone running around? (Okay, more like 1/6 to 1/3, since uterine environment is so significant in development and I'm not providing any of that, but still.)

Pisses me off. Part of that is privilege, I'm sure--I'm not used to people telling me what I can do to my own body--but part of it is that it's a violation of bodily autonomy. Worst case scenario is that I regret it afterwards, but that's the *entire point* of something like this--trapping my future self to ensure they do not make decisions my current self thinks are wrong. See also every contract ever signed, every oath ever sworn, and every public commitment ever made.

[Froborr]

TW: Suicide, Cancer, Euthanasia

I don't see what the point of a waiting period is. It took a hell of a lot more than a month to get me consistently non-suicidal after my attempt, more on the order of five years.

On the other hand, if I've got a fast-acting cancer like killed my father (two days to go from odd aches to coma, another two weeks to death, death a near-certainty from the start), I want my lethal morphine overdose within two days, not a month.

You mentioned adjusting the waiting period by degree of change, so if it was shortening your lifespan by a small amount it would be shorter, but that just seems like it would get ridiculously complicated very quickly, and require all kinds of assumptions and calculations of subjective value that no one should be making that isn't the person themselves.

I really don't think this is a question that can be resolved with a policy of finite complexity; better to have a vague policy and leave it up to the person who's actually going to be affected by it.