The effects of a newly amended law rolling back self-determination for transgender people in India have been documented in a survey of those caught between medical ethics and the conservative government’s anti-trans agenda: the doctors responsible for their trans patients’ care.
“If we go by the Act, then the role of the doctor has changed. You cannot be a doctor first. You have to be part of the administrative arm,” said Dr. Kavita Arora, senior psychiatrist and founding member of the Indian Mental Health Alliance, which launched the national survey to understand how the Trans Amendment Act has shaped trans peoples’ access to healthcare.
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“This becomes problematic for any healthcare provider,” she shared in an interview with Queerbeat.
The Trans Amendment Act was introduced in March by Bharatiya Janata (BJP), the right-wing nationalist governing party in India headed by Prime Minister Narendra Modi, a staunch ally of President Donald Trump.
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Opponents of the new bill, which ironically gutted some of the most progressive law addressing trans identity in any country, laid the blame at the feet of Trump and his crusade against trans identity, and Modi’s complicity in bringing it to India.
“This Bill is nothing but trashy colonial legislation,” Saket Gokhale, an Indian Parliament member with the opposition political party, All India Trinamool Congress, said when it was introduced in Parliament in March.
“If Donald Trump says there are two genders, our government will say there are two genders. We don’t mind if we are going back in time. This country has a glorious history allowing people to recognize their gender identity, but if now Trump has said it, he must have thought it through,” he said. “We have surrendered to Donald Trump.”
A landmark 2014 Supreme Court ruling affirmed the right of transgender people to self-identify, while the progressive 2019 law, which the new legislation amended, codified that right.
The new Trans Amendment Act became law in May, denying the right of trans people to self-identify and receive appropriate medical care. Now, trans people seeking gender-affirming care must go before a body of local medical “experts,” who will determine their gender identity.
The law also criminalizes and equates with “harm” any procedure or treatment by doctors for trans people not authorized by their local government; requires doctors to report any gender-affirming medical procedure to a district magistrate; and imposes a life sentence in prison for any “ally” who “allures” or coerces a child or adult to receive unauthorized gender-affirming care.
While the precise enforcement mechanisms have yet to be determined, and continuing care is still legally accessible, the law has already had a chilling effect, according to survey responses. The result is a “quiet withdrawal” of doctors from providing care for trans people, Dr. Arora said.
“From the responses to the survey, we find that medical practitioners are most concerned about the ethical conflict the Act causes and the impact on patients’ access to care. About 76% of the people said that the Amendment Act significantly reduces access to care for transgender individuals.”
“Most responded that the violation of medical ethics and patient confidentiality — requiring proof and the mandatory reporting part — was the most problematic,” the survey shows.
While the amended law hasn’t explicitly taken away the right of medical practitioners to provide gender-affirming care, “the general notion is that it has,” she said.
That “confusion” imposed by the new law, over when and if a trans individual can obtain gender-affirming care, has led many to simply stop providing it.
“With the Trans Amendment Act, they’ve said that you can’t self-identify. The entire confusion now is over who is trans. If somebody walks in and says, ‘I am a trans person,’ are we okay to provide gender-affirming care? Are we not? Do we first have to confirm their identity somewhere? This is against medical ethics, because what we are taught right from the beginning, and what is part of medical jurisprudence, is that you have to help and provide the best care to anybody who is standing in front of you and requires any kind of care, regardless of their caste, credentials, this, that, or the other,” Dr. Arora explained.
“A trans person will have to prove to the medical board that they are trans. Where does this leave a doctor in terms of providing gender-affirming care or providing the right kind of care to a trans person? In conflict with medical ethics,” Dr. Arora added.
“This is not just about transgender people,” Dr. Arora asserted. “This is not just about gender-affirming care. This is about saying, do we respect human diversity? Do we respect medical ethics? Do we respect that care comes above everything else when somebody enters the office of a doctor or a healthcare provider? Nothing else should matter except that the intention of the doctor is that of caring for the person. That person should have that assurance and trust, which right now, I think, is shaken.”
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