Some great news for the taxpayers of California. A man convicted of murder and currently serving time in state prison has managed to convince a judge that the state will pay costs of at least $100k for gender reassignment surgery since he’s suffering from gender dysphoria.

A federal judge on Thursday ordered California’s corrections department to provide a transgender inmate with sex change surgery, the first time such an operation has been ordered in the state.

U.S. District Court Judge Jon Tigar in San Francisco ruled that denying sex reassignment surgery to 51-year-old Michelle-Lael Norsworthy violates her constitutional rights. Her birth name is Jeffrey Bryan Norsworthy…

Norsworthy, who was convicted of murder, has lived as a woman since the 1990s and has what Tigar termed severe gender dysphoria — a condition that occurs when people’s gender at birth is contrary to the way they identify themselves.

“The weight of the evidence demonstrates that for Norsworthy, the only adequate medical treatment for her gender dysphoria is SRS,” Tigar wrote, referring to sex reassignment surgery.

I only noticed this story because it was picked up by Dr. James Joyner at Outside the Beltway. He has some interesting thoughts on the topic.

Not much has changed in either my thinking or legal precedent since my August 2013 posting on “Chelsea Manning and the Law.”  In Manning’s case, the US taxpayer is paying for hormone treatment. On balance, that strikes me as reasonable. Gender dysphoria is a serious medical condition and, as a general rule, prisoners are entitled to proper medical care.

This case takes it quite a bit further. Sexual reassignment surgery is much more drastic a measure than hormone therapy and much more expensive. The AP story estimates that it “could run as high as $100,000 depending on the circumstances.”

This raises at least two issues. First, given that this is a state action, how do we assess the moral tradeoffs in authorizing the surgery? Second, presuming that this surgery is the ethical course of treatment, should the public pay for it?

Joyner goes on to make what I personally feel is a far too complicated argument over this case. Unfortunately, my rebuttal requires me to air what will certainly be seen as highly unpopular views on the subject. I’m not one of those people who falls in with the Scientology camp on the subject of mental illness. I think there are definitely people with mental problems which vary in severity just as physical maladies do. At the same time, we still know one heck of a lot less about the deepest inner workings of the human brain – when it comes to behavior, not broken blood vessels – than we do the rest of the organs in the body. Any competent doctor will admit as much.

It is equally obvious, though somewhat harder to prove, that our legal system runs into huge problems when it comes to dealing with the intersection of criminality and mental fitness. I would defy anyone reading this to claim that there has never been a criminal defendant in the United States legal system who claimed innocence by reason of insanity when the argument was essentially laughable. Yes, there’s something wrong with you if your natural inclination is to kill people, but that doesn’t mean we should let you off the hook or sympathize with you. And sometimes you are just flat out lying to avoid getting the chair because you lost your temper and killed someone you hated.

The point is that many aspects of mental problems are very hard to quantify. And the consequences are not nearly as clear as they generally are with physical maladies. If you have a prisoner who has been definitively diagnosed with stomach cancer and you provide them with no treatment, they’re probably going to die in a horrible fashion. If you are suffering from “gender dysphoria” (which Dr. Joyner describes as “a serious medical condition”) and you are not treated, what is the result? I’ve seen more than a few essays from people studying in this field which say that the “condition” has been with us forever, but in the old days, the victims had to suffer in silence for their entire lives. So I guess it didn’t kill them, but they were perpetually unhappy. Well, Mr. Norsworthy is serving time in prison for murder. I wasn’t expecting him to be terribly happy to begin with.

If Mr. Norsworthy, at 51 years of age, has made it this far in life with the genitalia that he was equipped with at birth, I’m guessing that he can make it a while longer. If he wants to wait until he gets out of prison and have the work done on his own dime (assuming he does get out, that is) then best of luck to him. The same goes for Chelsea Manning. But asking the public to fund any additional hormone therapy or expensive surgery for these conditions seems a bridge considerably too far.