The 2022-23 and 2023-24 Editorial Boards of The Maneater see the recent emergency rule restricting access to gender affirming care as an unacceptable attack on the rights of transgender people in Missouri.
Missouri Attorney General Andrew Bailey recently instituted an emergency rule blocking gender affirming care for minors, and for the first time nationally, for adults. This rule will have dire consequences for MU students and many Missouri residents. This rule puts significant barriers between people seeking gender-affirming health care and any treatment that goes beyond the scope of psychotherapy. This emergency rule is a clear and unacceptable attack on the rights of all transgender people, prohibiting them from living full and safe lives.
The rule was originally scheduled to go into effect on April 27, and expire on Feb. 6, 2024. However, St. Louis County Circuit Judge Ellen Ribaudo temporarily halted the rule on Wednesday April 26, in response to lawsuits filed by the American Civil Liberties Union of Missouri. On Monday May 1, Ribaudo issued a temporary order blocking the rule until May 15 and scheduled a hearing for the lawsuit which challenges the rule. This temporary block could and should be extended beyond the set date.
What is an emergency rule?
In Missouri, an emergency rule is temporary legislation made, amended or rescinded by a state agency without following the provisions of section 536.021, which outlines the typical rule-making process. To constitute an emergency rule, legislation must adhere to a set of guidelines — the first being that the state believes there is an “immediate danger” to public health or safety. The secretary of state, Jay Ashcroft, must approve any emergency rule and publish it. Emergency rules may not be renewed and no consecutive emergency rules should be adopted that have the same effect. However, legislation similar to — or the same as — an emergency rule may be passed. An emergency rule can also be terminated by the filing agency and the Secretary of State.
What is this emergency rule?
The rule seeks to eradicate life-saving gender-affirming care such as hormone replacement therapy and surgical treatments by creating roadblocks for receiving such care.
This rule requires a patient to go through an 18-month period of psychotherapy, ‘resolve’ any existing mental health diagnoses and have medical documentation of three or more consecutive years experiencing gender dysphoria. This prolongs the treatment process, which can already take years to complete, depending on the extent. Medical providers and their patients should have discretion over when they need to receive care and what that care looks like. This emergency rule is another example of the state of Missouri unjustly interfering with citizens’ medical decisions.
Bailey’s emergency statement for the rule cites an allegation from a whistleblower who previously worked for the Washington University Transgender Youth Clinic in St. Louis, a provider of gender-affirming care in Missouri. The allegation states the clinic is failing to comply with a medical standard of care and has been disputed by a former colleague, patients and their parents. Washington University also issued a statement claiming the allegations are unsubstantiated. The claims are currently being investigated by the Department of Social Services, the Attorney General’s Office and the Division of Professional Registration.
Allegations against one clinic that have yet to be confirmed do not warrant a statewide order restricting health care.
The attorney general also cites advocacy against the use of gender-affirming health care due to a perceived lack of research on the treatments and their side effects. However, the FDA approved puberty blockers 30 years ago for children with precocious puberty. The American Medical Association, the largest and only national medical association in the U.S., also supports gender-affirming care. These forms of treatment are proven to be safe and effective for people experiencing gender dysphoria, yet the attorney general’s rule restricts access to this safe and often necessary healthcare.
Ribaudo, the judge who temporarily blocked the rule, said in her statement that patients, “are at high risk of having their medical care interrupted for an unknown length of time; once the Rule goes into effect, they may lose access to medical care through their current providers until such time as the provider can come into compliance with the Rule’s requirements.”
Restricting access to gender-affirming care is an unacceptable attack on the rights of transgender people.
According to the 2015 U.S. Trans Survey, 82% of transgender people have experienced suicidal ideation, and 40% have attempted suicide, a rate that is about nine times higher than the United States population average. Forty percent of all transgender people consider or attempt suicide during adolescence and young adulthood. With such a high rate of deaths by suicide and suicidal ideation, transgender individuals should be given additional resources, not stripped of their right to receive potentially life-saving care.
The AMA asserts that access to gender-affirming care can improve mental and physical health outcomes for transgender people.
“Gender-affirming care has been linked to dramatically reduced rates of suicide attempts, decreased rates of depression and anxiety, decreased substance use, improved HIV medication adherence and reduced rates of harmful self-prescribed hormone use,” the organization says on its website.
Restricting access to gender-affirming care will harm transgender people throughout Missouri and students at MU who need these treatments to survive and thrive.
A dangerous precedent.
Nationally, this is the first restriction that goes beyond the scope of transgender youth by also blocking adults from receiving treatment beyond physcotherapy. It follows a trend of anti-trans legislation and action by politicians as at least 13 states have now enacted laws restricting or banning gender-affirming care for minors. Even more states have one or more bills of this kind somewhere in their legislative process.
Now that Missouri has created this emergency rule, other states are taking notes on how they too could further restrict the rights of transgender citizens.
What can you do?
While the rule is temporarily halted, citizens have time to express their opinion. This rule was enacted by Missouri Attorney General Bailey, whose office can be contacted at (573)-751-3321, consumer.help@ago.mo.gov or nocall@ago.mo.gov. Tell him how the rule will negatively impact MU students and ask him to terminate the rule; let your voice be heard.
A rule that directly impacts citizens rights must be carefully considered and not rushed through as an emergency procedure.
The ACLU of Missouri in conjunction with Lambda Legal and Bryan Cave Leighton Paisner LLP filed a petition which is now Southampton Community Healthcare v. Bailey. This lawsuit is responsible for the current halt on the emergency rule. In a statement from the ACLU of Missouri Gillian Wilcox, Deputy Director of Litigation said, “Today’s ruling marks a win for transgender Missourians.” These groups will continue to fight the emergency rule on behalf of their plaintiffs and all affected Missouri residents.
Lambda Legal is a group focused on supporting LGBTQ+ people and causes in the American justice system. The ACLU of Missouri supports civil liberties and the principles of equality and justice. These organizations will continue to take necessary and warranted legal action against the restrictions. In a joint statement they assert, “This rule is a shocking attempt to exploit Missouri’s consumer protection laws in order to play politics with life-saving medical care.” Anyone affected by this rule can contact the Legal Help Desk at Lambda Legal or the ACLU of Missouri for information on available resources and their legal rights.
