America First Legal (AFL) filed an amicus brief urging an appeals court to reverse a district court ruling that required states to provide inmates with transgender surgeries, the nonprofit law firm said in an April 1 statement.
AFL filed the brief in a case that sought to clarify whether prisons are obligated to provide such surgeries for inmates deemed to have gender dysphoria, a stance supported by the World Professional Association for Transgender Health (WPATH).
The District Court for the District of Alaska had accepted arguments that denying such procedures could amount to “deliberate indifference” from prison authorities. The “deliberate indifference” legal standard is invoked when prison officials intentionally ignore serious medical needs of an inmate, AFL said. The case then went to the U.S. Court of Appeals for the Ninth Circuit.
“AFL’s brief argues that prisons are not legally obligated to provide irreversible experimental procedures, particularly those with limited or no evidence of long-term benefits,” the statement said.
“Referencing past problematic prison practices permitting experimental medical interventions, such as lobotomies, sterilization, and shock therapy, AFL’s brief cautions that prisons must consider the lives these once-promoted treatments destroyed.”
According to a filing made by the Ethics and Public Policy Center, the case revolves around plaintiff Emalee Wagoner, a male serving a 60-year sentence for child sexual abuse, and diagnosed with “gender dysphoria.”
Since 2022, the Alaska Department of Corrections has addressed the issue by providing Wagoner with hormone therapy treatments. When Wagoner sought vaginoplasty, a surgical procedure to construct a vagina, his request was dismissed due to concerns that there was “insufficient evidence of long-term benefit” from the procedure, the filing said.
However, when the matter reached the district court, Alaska was ordered by the court to take “all actions reasonably necessary” to provide Wagoner with “gender-affirming genital surgery.”
AFL’s amicus brief, filed on March 25, argues that while vaginoplasty is advocated by groups such as WPATH as a treatment for gender dysphoria, the organization’s recommendations are “not tethered to evidence-based medicine and instead stem from its ideological viewpoints.”
“Evidence of purported benefits comes from badly designed studies that suffer significant risks of bias. And repeated studies suggest an elevated rate of suicide and other mental health harms after transitioning vaginoplasties,” AFL said in the brief.
“State officials who properly recognize this low-quality body of evidence—and the resulting impossibility of obtaining adequate informed consent from a vulnerable inmate—are not acting with deliberate indifference to the inmate’s health concerns. To the contrary, those officials are adhering to evidence-based medicine principles that medical elites have all too often ignored.”
The brief said states are not required to provide experimental medical treatments to prisoners, and that the court must not blindly follow recommendations made by WPATH.
The law firm asked the court of appeals to reverse the lower court’s decision and reaffirm that prison officials are not obligated to offer such treatments to inmates, the statement said.
Nick Barry, senior counsel at AFL, said that the U.S. prison system has a “fraught history of jumping at any new quick fix for psychiatric issues.”
“The Ninth Circuit Court of Appeals must not forget that damaged past. Courts must not paralyze officials from exercising sound judgment, forcing prisons to provide irreversible and experimental surgeries on the taxpayer’s dime. Courts should be cautious when an ‘expert’ promotes a financially lucrative medical intervention for a metaphysical injury.”
The Epoch Times reached out to the office of Wagoner’s legal representative for comment but did not receive a response by publication time.
WPATH Criticism
WPATH publishes Standards of Care (SOC) guidelines with regard to the health care of people identified as “transgender and gender diverse.”
The organization’s eighth and latest version of the guidelines, SOC-8, recommends that surgeons consider “gender-affirming” surgical procedures for eligible adolescents “when there is evidence that a multidisciplinary approach that includes mental health and medical professionals has been involved in the decision-making process.”
Among individuals born male, studies have reported “a consistent and direct improvement in patient satisfaction, including general satisfaction, body image satisfaction, and body image following surgery,” the guidelines said.
WPATH’s standards were criticized in a Feb. 19 study published in the Archives of Sexual Behavior journal.
Researchers in the study conducted a quality assessment of WPATH’s SOC-8 guidelines, recruiting several international health professionals as assessors.
“Our assessment revealed that WPATH’s SOC-8 guidelines have limitations in scientific and methodological rigor, applicability, and transparency in managing competing interests,” the study said. “On a scale of 1 to 7 (7 = highest quality), the median overall quality score was 3.5 to 4 for all chapters” in the guidelines.
“Evidence-based guidelines addressing the needs of transidentified children and adolescents are urgently needed, but the uncritical adoption or endorsement of WPATH’s guidelines may result in a disservice or even harm to this vulnerable population.”
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