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Tag: Crumbling

  • Health care access for trans youth is crumbling — and not just in red states

    Health care access for trans youth is crumbling — and not just in red states

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    aptopix anti transgender healthcare bills missouri 77689

    The impact of gender-affirming care bans — inflamed by the rhetoric on the right about “child grooming” — is rippling beyond Republican-controlled states, making it harder everywhere for transgender youth to receive care and physicians to provide it, eight doctors who provide gender-affirming care to transgender youth told POLITICO. The Human Rights Campaign and the Southern Poverty Law Center, which have been tracking attacks against doctors, report similar findings.

    Even in states without bans, providers said death threats, harassment, fears of litigation and, in some cases, a lack of support from institutions have created a chilling effect that undermines their ability to provide care.

    “I got an email telling me that I’m evil, I’m foolish, my work is opposing God, that I harm children, that I’m going to hell, and that I should die,” said Meredithe McNamara, an assistant professor of pediatrics who specializes in adolescent medicine at Yale University. “The threats, the harassment, the constant fear of, ‘Did I say that right? Is that OK? Should I have said that differently? Did I present my position in a public space as effectively as possible, and also did I say anything that is going to get my family targeted in some way?’”

    Physicians in states where gender-affirming care remains legal said they now spend significant chunks of patient visits either batting down misinformation from parents or talking through kids’ mental health concerns related to the new laws. The bans outlawing therapies in nearly a third of the country threaten to overwhelm clinics in blue states, like Minnesota, that already have waiting lists of anywhere from several months to more than a year and have left red-state providers grappling with how to care for their young transgender patients under the bans.

    “We think about this affecting kids who live in [ban] states, but it’s affecting kids everywhere and it’s affecting care everywhere,” said Angela Kade Goepferd, medical director of the Gender Health Program at Children’s Minnesota. “It affects the families in the states where care is banned, and it affects the families in the states where the care is not.”’

    And the bans keep coming: North Dakota Gov. Doug Burgum on Wednesday signed a law banning gender-affirming care for transgender youth. Nebraska lawmakers are poised to enact a similar ban after legislation passed a second round of debate earlier this month. Missouri Attorney General Andrew Bailey’s emergency regulation requiring transgender youth and adults complete a long checklist before receiving gender-affirming care is scheduled to take effect this week. And Montana Gov. Greg Gianforte is expected to soon sign a ban after legislators adopted his proposed amendments last week over the pleas of their transgender colleague.

    “I’ve sat down and met with transgender youth and adults. I understand their struggles are real, and my heart goes out to them. I firmly believe that, as with all of God’s children, Montanans who struggle with their gender identity deserve love, compassion, and respect,” Gianforte wrote in a letter to Montana’s Republican legislative leadership last week. But, he argued, it is “right and appropriate” to restrict access to hormones and surgery to adults.

    Gianforte and other conservatives argue that kids aren’t mature enough to make serious, life-altering medical decisions, even with parental consent, and have expressed concerns about the long-term outcomes of such interventions.

    While some doctors, especially those early in their careers, said the bans have inspired them to work harder and continue providing this kind of care, others who are older said they have considered quitting or retiring early — though they acknowledge doing so would make it even harder for their patients to receive care. There are an estimated 300,000 transgender youth in the U.S. and about 60 comprehensive gender clinics for children and adolescents, though care can also be provided outside of those settings, according to the Human Rights Campaign and the Williams Institute, a think tank that researches sexual orientation and gender identity law at the UCLA School of Law.

    The pediatricians told POLITICO that part of their ethos is being an advocate for children, but the threats have left them worried about their personal safety, and the safety of their families, patients and hospitals. Four of the doctors interviewed were granted anonymity because of fears about threats to their safety, their clinic, their patients or their own family, or because they were not authorized to speak by their institution, in some cases because of the threats.

    But some of the doctors said they feel that by staying quiet they are protecting their institution’s safety but letting down their patients.

    “I know many of my colleagues feel like when we’re doing what they need us to do for our protection and our institution’s protection, many of us also feel like we’re letting the community who needs us the most down,” a blue state pediatrician said.

    Those willing to speak on the record said they were doing so either because they had no family, had talked through the possible risks with their spouses and children, or because they felt protected and supported to speak publicly by their hospital or clinic.

    “As our legislature also votes to advance constitutional carry, and as AR-15s are incredibly easy to get, there’s a non-zero chance somebody might kill me, and I know that. I don’t like it. At least I would die standing up for my values, but I’ve had to make peace with that,” said Alex Dworak, associate medical director of family medicine at OneWorld and assistant professor of family medicine at University of Nebraska Medical Center.

    Targeting physicians is not new: The ’70s and ’80s saw a wave of attacks against abortion clinics, including 110 cases of arson, firebombing or bombing. Three people were killed inside a Colorado Planned Parenthood in 2015. And just last year, an under-construction abortion clinic in Casper, Wyo. was set on fire.

    While Arkansas was the first state to enact a gender-affirming care ban in 2021 — after the legislature overrode then-Republican Gov. Asa Hutchinson’s veto — doctors told POLITICO that the threats didn’t begin in earnest until the following year when Boston Children’s was targeted on social media and received several bomb threats over the summer and fall.

    In 2023, those threats have continued as more red states approve bans as part of a broader agenda that includes preventing transgender people from participating in sports or using bathrooms in accordance with their gender identity and restricting access to drag shows.

    According to the Southern Poverty Law Center, which tracks hate speech, 24 hospitals and clinics that provide gender-affirming care to transgender youth have been targeted on social media over the last year, resulting in bomb threats, death threats to medical staff and temporary suspensions of services. And the Human Rights Campaign said the attacks have steadily increased.

    “We launched our gender health program at Children’s Minnesota in 2019 — the front page of our Star Tribune here in Minneapolis — and barely a peep,” Goepferd said. “We have really been, up until recently, able to provide good, high-quality care in a way that we would all want to, regardless of what speciality in pediatrics we were in.”

    Every major medical association, including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association, supports the use of gender-affirming care to treat transgender people with gender dysphoria, or the feelings of discomfort or distress some transgender people experience when their bodies don’t align with their gender identity. For transgender youth, that typically includes social support, mental health help, puberty blockers, hormone therapy and, very rarely, gender-affirming surgery.

    Those who oppose gender-affirming care argue that kids should wait until they are adults to make the decision to take hormones or undergo surgery, and that the science around such treatments is unsettled.

    “Children suffering discomfort with their sex are best served by compassionate mental health care that enables them to live comfortably in their bodies and with their true identities as male or female,” Matt Sharp, senior counsel and director of the Center for Legislative Advocacy at the conservative legal powerhouse Alliance Defending Freedom, which has helped conservative lawmakers draft trans-focused bills, said in a statement. He added that the organization will “continue to protect children from harmful, irreversible, and unnecessary medical procedures.”

    The American Medical Association, the American Academy of Pediatrics and the American Psychological Association have released statements, published op-eds and documents in support of gender-affirming care and provided coaching and technical assistance to state-level affiliates that they say are closer to the legislative process and better suited to testifying at hearings. But several providers said they need more support.

    “Right now, individual providers show up in public spaces and we feel like we get seen as lone actors, and that we don’t have the backing of large credible institutions, and that’s a really scary reality,” McNamara said. “It’s no longer like, so-and-so who speaks for the American Medical Association says this. It’s this person who you’ve never heard of is here — and it makes us much easier to target.”

    Jack Resneck Jr., president of the American Medical Association, said that the association “stands in vehement opposition to governmental attempts to criminalize or otherwise impede on clinical decision-making.” Resneck added that the AMA has worked with state medical associations to oppose gender-affirming care bans since legislation first emerged in 2020 and has also been involved in legal challenges.

    Mark Del Monte, the American Academy of Pediatrics’ chief executive officer and executive vice president, called gender-affirming care “vital to the health and wellbeing of our gender-diverse patients.”

    Doctors in blue states also said they are happy to see legislatures enact so-called shield laws protecting access to gender-affirming care — as California, Colorado, Illinois, Massachusetts, New Mexico and Washington have done — but some worry those policies will not hold up in court.

    These doctors said they’re also worried about whether they will have the capacity to provide care to out-of-state patients given that most have waitlists that are several months long.

    “It makes me worried about how we can adequately meet the needs of patients and families both here in Washington who have been on our waiting list for many months, but also so many patients and families that are uprooting their lives to be able to continue care,” said Gina Sequeira, co-director of Seattle Children’s Gender Clinic.

    Broadly, the doctors worry about the future practice of gender-affirming care. They say that not only is the chilling effect from the bans stymieing research and collaboration, but also they fear that it will dissuade future doctors from going into an already small field and prevent doctors from receiving training.

    “I am hopeful that I can be a quiet country doc and not have this be a part of my life. That is my hope, that this is not forever,” a red state pediatrician said. “But it’s hard to see that. It’s hard to see that future.”

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    ( With inputs from : www.politico.com )

  • Israelis Fear Their Democracy Is Crumbling — and the U.S. Isn’t Coming to Help

    Israelis Fear Their Democracy Is Crumbling — and the U.S. Isn’t Coming to Help

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    Some 130,000 demonstrators swarmed the streets that night last month to rally against the country’s new far-right government — arguably the most extreme in Israel’s history — and an agenda that even centrist politicians say threatens Israel’s democracy. The protest wasn’t a one-off. Pro-democracy demonstrations have taken place every Saturday since the start of January, bringing in some of the largest crowds in recent memory (though smaller than the 2011 social justice protests that, at their height, brought approximately a quarter million people to the streets).

    The new government is led by a familiar face, Prime Minister Benjamin Netanyahu, who has been in and out of office since 1996 and is still on trial for corruption charges.

    But the coalition he cobbled together to regain power includes elements that once composed the fringe of Israeli politics. That includes Itamar Ben Gvir, a far-right religious nationalist who heads a political party named “Jewish Power.” Previously, he was a member of Kach, a party that was outlawed in Israel and that spent 25 years on the U.S. State Department’s list of terror organizations; in a twist of irony, Ben Gvir is now serving as the country’s national security minister. Since taking the helm, he has visited the Al Aqsa compound in Israeli-occupied East Jerusalem, home to the third holiest site in Islam. Al Aqsa is sacred to Jews as well, but such visits are viewed by Palestinians as a huge provocation — an act so contentious that Ariel Sharon’s September 2000 visit is widely credited with sparking the Second Intifada, or Palestinian uprising.

    Another controversial figure in the new government is Bezalel Smotrich, a settler and the leader of an ultra-nationalist religious Zionist party. Smotrich is now serving as a finance minister; it is widely believed that, in this role, he will ensure West Bank settlements get the money they need to continue to grow, threatening what little possibility remains of a territorially contiguous Palestinian state.

    Already, this new government is making moves to chip away at the country’s democratic space. A proposed overhaul to the judiciary would render the High Court’s judgments toothless and would destroy its independence, upending the country’s system of checks and balances. The government also announced an intent to shut down Kan — the country’s only publicly funded broadcast news service — with Communications Minister Shlomo Karhi “calling public broadcasting unnecessary.” Outrage was so intense that it’s been put on ice for now as the government focuses instead on pushing through its controversial judicial reforms. Netanyahu defends the reshuffling of the judiciary, dismissively calling them a “minor correction.”

    But even Israel’s own president, Isaac Herzog, is sounding the alarm. In a speech given on Sunday — the day before a massive nationwide strike that brought 100,000 Israelis to protest outside of the Knesset on Monday — Herzog warned that the country is “on the brink of constitutional and social collapse.”

    “I feel, we all feel, that we are in the moment before a clash, even a violent clash,” Herzog said. “The gunpowder barrel is about to explode.”

    When I wade into the crowd on that Saturday night, just after Shabbat has ended, there’s another consistent fear I hear from Israelis: that this new government will undermine its standing in the world, including with its most important ally, the United States. But while there are fears about losing American support, some Israelis also voice concern that American backing will continue regardless of what this new government does — a scenario they view as enabling and dangerous. Because what would an Israel — held accountable to no one, left entirely to its own devices — look like?

    Avi, who works in high-tech, a key Israeli industry, says he is particularly worried about the government targeting the rights of secular Israelis, women and LGBTQ individuals — which could also prove to open rifts between America’s Democratic Party and the Israeli government. (Just a few days later, hundreds of Israeli high-tech employees would take to the streets, leaving their desks abruptly at midday to march on Rothschild Boulevard as they carried signs that read, “No democracy, no high-tech.”)

    Asked if Israel’s relationship with the United States is a concern, Hila replies, “It’s always a concern. We’re supposed to be the only democracy in the Middle East and that doesn’t seem like where we’re going with the latest changes.”

    Maya Lavie-Ajayi, a 48-year-old professor at Ben Gurion University, says she hopes to see some sort of intervention from the Biden administration and the European Union. “We see Hungary and we see Russia and we know you get to a point where [citizens] can’t fight back anymore.” She added that while Israel isn’t there yet, “I think that we need support to keep the democratic nature that was problematic in the first place.”

    Lavie-Ajayi notes the withdrawal of American support would be a powerful lesson to Netanyahu: “Bibi would understand that he can’t just do whatever he wants, that he doesn’t have an open ticket to chip away at the democratic nature of this country.”

    It’s not just people in the streets who see the prospect of pressure from abroad. In December, over 100 former Israeli diplomats and retired foreign ministry officials sent an open letter to Netanyahu expressing concern about the new government’s impact on the country’s international standing, warning that there could be “political and economic ramifications.”

    Indeed, senior American officials seem to share at least some of protesters’ worries about the direction Israel is taking. U.S. National Security Adviser Jake Sullivan visited Israel last month reportedly in hopes of “syncing up” with the new government. Then came Secretary of State Antony Blinken’s trip, during which he said he had a “candid” talk with Netanyahu, with Blinken touting the need for a two-state solution with Palestinians and the importance of democratic institutions.

    Still, it seems unlikely Israel will lose American support — including billions in military aid — anytime soon.

    “This administration will go to great lengths to avoid a public confrontation with the new Netanyahu government,” says Aaron David Miller, a longtime State Department official who worked on Middle East negotiations and is now a senior fellow at the Carnegie Endowment for International Peace.

    At the same time, Israel’s shifting politics — particularly with a government that’s now more religious right than secular right — could have unintended reverberations. It’s taken for granted that American liberals are likely to grow ever more skittish with an ultra-conservative Israel. But some in conservative corners are also worried, according to Yossi Shain, a political science professor at Tel Aviv University, professor emeritus at Georgetown University and former Knesset Member from Yisrael Beiteinu, a secular nationalist party on the right. He says he’s constantly on the phone with American counterparts who are deeply concerned about how the new government will impact the country’s security and economy.

    “The Israeli right pretends to reflect American conservative values, but in fact distorts them,” he adds. “It builds on clericalism and religious orthodoxy that negates liberties, the core of American conservative creed.”

    Now, Shain says, some of the same political actors who helped foster the circumstances that enabled this government to rise are wringing their hands.

    To which Israel’s pro-democracy protesters would likely respond, “Told you so.”

    Back on the street in Tel Aviv, many in the crowd, though not all, link the decades of Palestinian occupation with the decline of Israel’s democracy.

    “Rights for Jews only is not a democracy,” reads one poster. A massive black sign — made out of cloth and held up by half a dozen protesters — depicts the separation barrier, guard towers and barbed wire that contain the West Bank; in the middle, a dove bearing an olive branch bursts through the structure. “A nation that occupies another nation will never be free,” says the sign in Arabic, Hebrew and English.

    Nearby, a woman calls through a bullhorn, “Democracy?”

    “Yes!” the crowd responds.

    “Occupation?”

    “No!” they cry.

    “I’m terrified of a situation where [Israel’s new government] doesn’t reduce American support,” says Rony HaCohen, an economist, pointing to the way the military occupation of the Palestinian territories has become normalized amid a lack of American censure.

    But one protester questions even the United States’ ability to rein in its closest ally in the Middle East. Jesse Fox, a 41-year-old doctoral candidate at Tel Aviv University, says that while he’d like to see the Biden administration raise some pressure, he believes Israel is already headed down “the path of Hungary” and other countries that have abandoned democratic principles.

    “It starts with the court reforms,” he says. “After that, they have plans to try to bring the media under government control. And then, who knows?”

    And as an American Jewish immigrant who has lived in Israel for the better part of 20 years, Fox adds, “I want Americans to realize that, right now, being ‘pro-Israel’ means opposing the Israeli government.”

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    ( With inputs from : www.politico.com )