July 20, 2019

Advancing the Rabbinic Prescription for Transgender Health Care

By Rabbi Mike Moskowitz and Joshua D. Safer, MD, FACP

Doctors and Rabbis are asked a lot of questions; it’s a big part of the job. We certainly don’t have all of the answers and so we continue to listen, research, and expand our understanding of the issues.  And, we have our own questions to help us get closer to the information that shapes our responses to the people who are asking for guidance. There can be no contradiction between science and religion when they both manifest the truth of the Divine intention. The struggle for that knowledge, and its application, is an ongoing and humbling process.

However, there are still many in both the medical and the Jewish communities who don’t yet understand gender identity and transgender experiences. They insist: “It can’t be that G-d put someone in the wrong body. G-d doesn’t make mistakes. It’s sacrilegious to change the body that G-d gave you,” and so on. No one would say this about a heart defect, deviated septum, or inflamed appendix – in part because the Torah teaches us in this week’s portion: “ורפא ירפא ” and be healed. The Talmud explains that this is the scriptural permission given to physicians offering treatment to change something that G-d has created.

Similarly, the wicked Turnus Rufus asked of Rabbi Akiva: If your G-d is a lover of the poor, why then does G-d not provide for them? R’ Akiva argues that the inequality experienced by many in this world doesn’t exist for us to sustain, but rather for us to change. G-d presents inequality as an opportunity for us to be in partnership, to heal the divide and emulate the Divine by supporting others.

Turnus Rufus replies that by changing the differential that G-d constructed, we are going against the Divine will and angering G-d. In response, R’ Akivah shares an interesting parable: To what is this similar? It is analogous to a king who, angry with his child, confines them to prison and orders that no one give them anything to eat or drink. Someone then disobeys and provides for the child’s needs and when the king hears about it, the king sends the person gifts in thankful recognition. R’ Akivah continues: We are all that child to G-d. When we improve the lives of those who are suffering, it brings pleasure and joy to G-d.

G-d, as our parent, wants us to support each other and make sure that we are all provided for.

We demonstrate to G-d that we see ourselves as G-d’s children when we take care of humanity as we would our immediate family. As a society, we have a responsibility to meet the needs of all, including our transgender siblings. We must make resources available, including all of the resources of modern medicine, whenever needed. It is not only permitted to provide transgender medical procedures, but we are obligated to do so when necessary.

The author of the Code of Jewish Law puts an additional responsibility on doctors to be available to help those in need of their services. He writes (Bais Yosef Y.D. 336): Any doctor who is competent in practicing medicine is obligated to heal and if they hold themselves back from providing treatment, it is considered as if they are a murderer.

Physicians are obligated to learn the optimal treatments for their patients and to continually extend their knowledge in the hope of ever greater good. Indeed, the scientific mission of the medical community is to develop an increasing appreciation of the complexity of life over time which can then result in better care of fellow human beings.

For many decades, physicians erroneously believed that transgender people suffered from a mental health disorder which required a mental health treatment. Over the past decade or so, the medical community has grown to recognize that gender identity contains a substantial biological component which cannot be altered by externally. There are simply some individuals for whom one part of their biology –  their gender identity – is not aligned with another part of their biology – their visible anatomy.

Although the specific biology of gender identity remains an unknown, the current medical approach that is most successful and the standard of good medical care for transgender individuals is to customize treatment to align their visible bodies with their gender identities. Failure to appropriately treat a transgender individual who seeks medical help would be a violation of a physician’s professional oath.

Jewish Law expects that rabbis rely on the medical opinions of doctors in order to accurately render a response to medical questions. The commentaries are also sensitive to concerns that some Jewish patients might have regarding constantly evolving and new perspectives in the medical profession. The rabbis teach “Don’t say that since medicine is just a vocation one shouldn’t listen to medical advice because perhaps it will only make the situation worse. It is in response to this that the Torah permits and mandates us to follow the guidance of doctors. One who is punctilious with this is praiseworthy” (Aruch HaShulchan 336.1).

We, rabbis and doctors, must continue to ask questions so that we may better answer the questions we are asked. Some may find it challenging and unfamiliar to respond to new understandings about gender identity, transgender experiences, and treatments.  But, it is our obligation, as the field of transgender medicine progresses, to also advance the rabbinic prescription for quality transgender health care.

 Rabbi Mike Moskowitz is a Scholar-in-Residence inTrans and Queer Jewish Studies at Congregation Beit Simchat Torah in New York. (Pronouns: He/Him)

 

 

 

 

Joshua D. Safer, MD, FACP is Executive Director, Center for Transgender Medicine and Surgery, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai

New York, NY

 

To learn more about God and Torah from a transgender perspective, join HBI on Thursday, Feb. 7 at 5 p.m. for a lecture and book talk by Joy Ladin. See details, here.

 

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