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Set limits on sex change

THE MASSACHUSETTS Department of Correction has adopted a humane policy of providing hormones to inmates diagnosed with gender identity disorder, a psychiatric illness characterized by relentless anguish over one's sex. But requiring taxpayers to fund sex-change operations for inmates would push the policy to insupportable limits. Elsewhere, it has led to a backlash resulting in greater suffering for imprisoned transsexuals.

MCI-Norfolk inmate Robert Kosilek, 57, is asking US district Judge Mark Wolf to order the Department of Correction to pay for gender reassignment surgery. In 2002, Wolf ruled that Kosilek, who strangled his wifeto death in 1990, was entitled to treatment for the illness, but the judge did not mandate a specific treatment program. Kosilek's attorneys argue that failure to provide the surgery would result in depression so great asto pose a substantial risk of serious physical harm. A psychiatrist has even testified that Kosilek would likely kill himself if deniedthe sex-change operation. If so, how did Kosilek survive nearly a decade in prison without even the aid of female hormone treatment?

Kosilek's case is not compelling for reasons even beyond the obvious distastefulness of a wife killer angling to serve out his sentence of life without parole in a women's prison. Private insurers rarely pay for sex-change operations. MassHealth regulations deem both sex-change operations and hormone treatments as ``experimental." Medicaid recipients in Massachusetts, therefore, are not entitled to either form of treatment. Many respected psychiatrists who treat transsexuals see the surgery as the logical step after hormone treatment. But even they don't say surgery is backed by the unequivocal findings that characterize evidence-based medicine.

To even entertain the idea of publicly funded sex-change operations, one would need to know why such a procedure is required when hormone treatment and therapy are available. Advocates of surgery point to studies, including an oft-cited one from Belgrade, suggesting that transsexuals enjoy better relationships, more satisfying sex lives, and perform better at their jobs after surgery. It would be a stretch, to say the least, to use such factors in determining adequate medical care for a lifer.

In Wisconsin, an inmate filed a similar suit in 2003. Greater suffering and confusion resulted when the state Legislature responded by prohibiting the use of tax dollars for both surgery and hormone treatment.

Kosilek, like any inmate, deserves proper mental-health care, including hormone treatment and expert therapy. If he is at risk of suicide, he should be placed under constant observation. But that's sufficient.

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