When initially presented with the idea of being personally involved in sex-change surgery, I was too shocked to say anything immediately. I guess that proves I’m out of touch, since it happens enough to be fairly well-documented in the medical literature, and since none of the other members of my team (and I will state that I am not working on the west coast) seemed at all surprised or disturbed. Perhaps their statements implied the attitude that “I would never do that, myself,” but no judgment was implied concerning the individual’s choice, or their own decision to participate in that choice.

It has been suggested to me that a Christian in this situation is free to exercise God-given skills, without being responsible for the larger ethical scenario, rather as a painter might take a contract to paint a night-club, without being morally responsible for the use the owner then made of the building he had helped to put in working order. For one thing, I’m not completely sure the painter could do that. For another thing, I see two distinct actions there: the painter painting a neutral building, and the owner then making use of it for sinful purposes. To me, there’s more of a separation there than if I personally perform the [surgical] actions which enable another person to flagrantly violate God’s law.

(I should also state parenthetically that I am discussing the case of a sex-change operation undertaken for psychological reasons, not the far rarer case of a child being born either as hermaphrodite, or with ambiguous genitalia. That’s a different matter.)

It was also suggested to me that in my brief interaction with plastic surgery, I’ve already been involved in surgeries which I would consider wrong to seek for myself, ranging from liposuction to breast augmentation or face lifts. (I wouldn’t include breast reduction in there, because I recognize that there are often real medical considerations leading to this kind of procedure.) But the others don’t address any genuine medical need; they didn’t add to the patient’s physical health, and one could argue that no operation performed on the body can truly contribute to spiritual health, either. These patients were indeed rebelling against God’s design of their body. Nevertheless, they limited their rebellion to seeking to become more feminine (or masculine), rather than less feminine (or masculine). Perhaps I’m being inconsistent. Perhaps I should refuse to participate in any purely cosmetic procedure. Nevertheless, there seems to me to be a significant difference in degree, if not in kind, between trying to augment natural, God-given features, and trying to destroy or completely replace them.

Even setting aside what one could call religious-ethical objections, there are still medical-ethical objections to these procedures. The basic mandate for all physicians is, “First, do no harm;” which corresponds to the surgical principle, never to perform any invasive procedure unless it’s medically necessary. By no wild stretch of the imagination can these sex-change procedures be considered medically necessary. The patient was a healthy male or female to start with, and would have remained so, had we not interfered. Just because it has taken so many hormones that its identity is now ambiguous, does not constitute a medical need for surgery to match the hormones. Not only is there no need, the operation does positive harm, by exposing the patient to all the associated risks of anesthesia and surgery, as well as mutilating healthy tissue. On these grounds, even non-religious doctors ought to refuse to do these surgeries.

That’s what I wish I could tell my team. But it’s good enough that the fellow is accepting my recusal, and the attendings aren’t asking questions. I guess there’s still a limit to how much I want to rock the boat, even now that I’ve graduated.

(And all of this reasoning would not prevent me from treating such a patient if they presented with a plain problem, like appendicitis, or even a complication of this specific surgery, such as a wound infection. God’s sun rises on the just and on the unjust.)