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Open Access 01-06-2021 | Original Paper

Demand for Space: Elderly Transgender and Gender Nonconforming People, Healthcare, and Theological Ethics

Author: Mathias Wirth

Published in: Journal of Religion and Health | Issue 3/2021

Abstract

Visibility for transgender and gender nonconforming people and the elderly is growing; however, thus far the overlap of the two groups has rarely been considered. Trans persons therefore remain largely invisible in the context of older people’s care and medicine. The discrimination faced by this group is at least twofold: they are the targets of aggression incited by transphobia, and also by ageism. Although older trans and gender nonconforming people exist as a greatly marginalized group within another already marginalized group, even the field of theological ethics has neglected to grant them ethical attention. This leads to especially harsh consequences for elderly transgender and gender nonconforming people due to their specific vulnerabilities. There are reports from trans persons who have resolved never to make use of health services again due to regular experiences of transphobia in medical settings. There are religious components within transgender and gender nonconforming issues that should not be overlooked in this context. On the one hand, medical staff, in the name of their Christian beliefs, have refused to provide trans persons with basic medical care. On the other hand, demands for places of visibility, and spaces for the individual, are regularly made in trans-positive studies, and can be linked to discussions within theological ethics about giving space. Some ethical formulas within the Hebrew and Christian traditions focus on the creation of space in which other beings may exist, as found in concepts like brother–sisterhood, friendship, and Sabbath. By casting light on elderly trans and gender nonconforming people, and on their demands for space, via reflections on ethical concepts of space-making, this study develops a specific understanding of space for elderly trans persons. The paper aims to develop an understanding of trans-positive spaces within theological ethics and applied ethics. Spaces that assume a withdrawal or contraction by all those who have previously taken up trans spaces through ignorance, contempt, or violence, should not thereby become spaces of absence: indeed, elderly trans and gender nonconforming people might be in need of both kinds of spaces, those where otherness enables withdrawal, and those where the helping presence of others continues.

Admittedly, this point of view initially puts a broad focus on the disadvantages of being trans and older (Kimmel et al. 2006). In effect, this is a result of more deficient prospects of medical care. The study comes down to naming the necessary circumstances for older trans persons to develop in a positive way, and in no way doubts that successful older trans individuals exist (Fabbre 2015).

The fact that the program from 21st January 2018 provoked enormous criticism and an official complaint from the Transgender Network Switzerland (TGNS) who deemed the relevant statements during the program as defamatory or inappropriate (see: www.tgns.ch/wp-content/uploads/2018-Beanstandung_Antwort-Ombudsstelle-SRF.pdf) exemplifies how necessary a constructive dialogue between theology and the trans community is.

The German original quote goes as follows: “Queer-Sein ist für mich eine gesellschaftspolitische Haltung. Manchmal bezeichne ich meine Geschlechtsidentität als trans, manchmal als queer und manchmal einfach als männlich. Ich bin einfach ich, Ivan.”

Cisgender refers to the Latin cis, meaning “on this side”, as an antonym to the trans prefix (Sigusch 1991).

However, the concept of identity also draws criticism since it does not capture the element of fluidity and development prevalent in the individual lives of trans persons (Rubin 2003). Yet trans persons differ here only in a gradual way, but not a categorical way, from cis people, who do not express monolithic identities either, and can, for example, also suppress their feelings and desires to a considerable degree.

Of course the process varies a lot between jurisdictions, and psychological assessment is not required everywhere (Aizura 2011).

In this context, trans persons experience diminished autonomy, since they themselves are only considered “primary experts on their own lives” to a limited extent (Shelley 2008, p. 3).

This is related to the ongoing pathologization of being trans as a mental disorder, although initial steps toward depathologization are being made (Reed et al. 2016; Tinney et al. 2015).

This is also applicable to trans children and trans adolescents, although they differ from the focus group of older trans persons and often use medical treatments successfully (Drescher and Byne 2013; Shires et al. 2017).

Particularly in the field of psychiatry, historical review shows proof of the guild of psychiatric physicians’ guardedness against trans persons who were regarded not only as mentally ill, but also as “willfully annoying” (Cook-Daniels 2006, p. 27).

Zowie Davy quotes Raymond, a trans-person: “I had a doctor who struck me off because he couldn’t treat something like me because he was a good Catholic” (2010, p. 108). Another trans person cites a different case where no specialized medical help was offered: “I don’t work on people like you, you’ll have to go to see your GP” (quoted in Shelley 2008, p. 65).

Citing the following references on the meaning of Gen 1:27 in context is also a concern of theological ethics with its scope of orientation through differentiation (Fischer 2010). The following speak against a trans-negative interpretation of Genesis: (1) In Gen 1:26, the image of God is spoken of. As always, what is understood from this is that gender can have no determining significance, because God is not portrayed as having a gendered body in the Hebrew Bible. God’s face and other body parts such as the nose, eye, ear, arm, and hand are alluded to. For this reason alone, a normative assignment of the genitals must be retracted. If, however, God’s gender-specific qualities are named, then it shows that both female and male aspects shape each of the respective metaphors (Maier 2014). (2) The gender categories named in Gen 1:27 are not understood as exclusive categories in the exegesis. On the contrary, it could be interpreted that the masculine and feminine are understood as two different sides within each individual (Frettlöh 2009). Even more widespread is the interpretation according to which the two sides exist within each individual as a sign of equality among different people. The categories of male and female can or must be understood in the sense of a common merism in Hebrew rhetoric. There are two opposing pairs, as well as young and old, big and small, for a whole field (Wirth 2015). (3) What is particularly decisive for the trans issue, occasionally invasive gender reassignment interventions, and the notorious criticism referencing Genesis, is the separation of the blessing given to the person from the blessing given to the descendants, as can be taken from Gen 1:28. Here, firstly and unconditionally, a blessing of the person is carried out; the task of reproduction is secondary to this (Wirth 2015). Despite the indisputable significance of raising a family, being human does not forcibly involve procreation, and God’s blessing is not contingent on genital activity.

This form of discrimination exists most notably in the fact that people can fall under the rubric of “old” irrespective of their actual situation, leaving them at a disadvantage. In this respect, it is “unjust discrimination” that is particularly objectionable (Knell 2017, p.133).

For trans persons who are clearly in older age, experiences of loss also mean being able to be mindful of what remains. In a context particularly crucial to trans persons, the body can gain new importance since, after all, it is the body that remains until the final breath. Despite all these losses, and although the older body provides enough gnawing torment, its loyalty and servitude can lead to a new respect, perhaps even tenderness (Améry 2005; Bozzaro 2014). Contempt toward the trans body from a third party, which despite all resistance also becomes a refuge for fantasies and transitions, stands out from an ethical perspective as particularly negative in this context.

However, there are also positive developments in this area. In US care facilities, the first support groups for older trans persons are being established in addition to those for gay and lesbian residents (Krinsky and Cahill 2017).

One prominent exception is Emmanuel Lévinas, who in his ethics explicitly spoke of a “radical turn” (Lévinas 1995, p. 181) in the face of the Other and also of the problem of usurpation, the act of taking up space to the detriment of the Other (Lévinas 1995).

However, one danger of models based on spatial offering lies in the discernible emphasis of the character of offering. This implies an authority who may decide to bestow this gift, although there is no obligation for them to do so. An argument must consequently be made for a colonialist misunderstanding of spatial ethics. In the context of trans issues, it should not give off the impression that trans persons should wait for the benevolence of their colonial rulers who do still remain colonial rulers, even if they wield the power to liberate (Shelley 2008). Rather, a circumstance with spatial ethics should be described that can also be described from a Christian perspective as a type of right, since space in which a safe life can be led would have never been allowed to be taken away from people.

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Title: Demand for Space: Elderly Transgender and Gender Nonconforming People, Healthcare, and Theological Ethics
Author: Mathias Wirth
Publication date: 01-06-2021
Publisher: Springer US
Published in: Journal of Religion and Health / Issue 3/2021
Print ISSN: 0022-4197
Electronic ISSN: 1573-6571
DOI: https://doi.org/10.1007/s10943-020-01101-9

At a glance: The STEP trials

Springer Medicine

Demand for Space: Elderly Transgender and Gender Nonconforming People, Healthcare, and Theological Ethics

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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