Yesterday, Private Manning was sentenced to serve 35 years in military prison. After sentencing, Manning issued a statement, in which she bravely called for a more just society and stated that if she is not pardoned, she “will serve [her] time knowing that sometimes you have to pay a heavy price to live in a free society.” Today Ms. Manning again spoke her truth and bravely came out as transgender: “I am Chelsea Manning,” she announced. “I am a female. Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible.” The Army responded by stating that it does “not provide hormone therapy or sex-reassignment surgery for gender identity disorder.” Not only should Chelsea Manning not have to pay the price of a 35-year prison term for sharing information with the press in the public interest, but she should also not have to experience the added punishment of going without necessary medical care.
With Manning’s announcement this morning and widespread buzz about Laverne Cox’s portrayal of Sophia Burset, a transgender woman serving prison time at a federal women’s prison, on Netflix’s Orange is the New Black, the struggle of transgender people to access medically necessary care in prison has captured public attention.
Policies, like the one the Army announced this morning, that categorically withhold hormone therapy violate clearly established standards of care for the treatment of Gender Dysphoria as well as clear constitutional proscriptions against deliberate indifference to the serious medical needs of individuals in government custody. Gender Dysphoria (formerly known as gender identity disorder or GID) is a serious medical condition, and hormone therapy is part of the accepted medical protocol for treating this condition. Without the necessary treatment, Gender Dysphoria can cause severe psychological distress, anxiety and suicidal ideation. According to the World Professional Association for Transgender Health (WPATH), the leading medical authority on the proper standards of treatment for people with GID, “hormone therapy…is a medically necessary intervention for many transsexual, transgender, and gender nonconforming individuals with Gender Dysphoria.”
When the government holds people in its custody, it takes on a duty to provide them medically necessary care. The National Commission on Correctional Healthcare advises against “blanket administrative or other policies that restrict specific medical treatment for transgender people,” particularly where such policies either: (1) “make treatments available only to those who received them prior to incarceration or that limit GID treatment to psychotherapy;” or (2) “attempt to ‘freeze’ gender transition at the stage reached prior to incarceration.” Federal courts that have considered the issue in the last several years have consistently found that the blanket denial of treatment for Gender Dysphoria violates the Eighth Amendment of the Constitution.
The ACLU supports Ms. Manning and the many transgender people who have preceded her, including Ophelia De’lonta, Michelle Kosilek, Andrea Fields, Jessica Davison, and Vankemah Moaton, in the fight for medically necessary treatment while in custody.