Underhill, K., & Nelson, K. M. (2025).
New England Journal of Medicine.
In recent years, state legislators in large portions of the United States have devised and enacted new legal strategies to limit access to health care for transgender people.1 To date, 26 states have enacted outright bans on gender-affirming care, which thus far apply only to minors. Other state laws create financial or procedural obstacles to this type of care, such as bans on insurance coverage, requirements to obtain opinions from multiple clinicians, or consent protocols that are stricter than thosefor other health care.
These laws target clinicians who provide gender-affirming care, but all clinicians — in every jurisdiction and specialty — should take note of the intrusive legal actions that are emerging in the regulation of health care for transgender people. Like the development of restrictive abortion laws, new legal tactics for attacking gender-affirming care are likely to guide legislative opposition to other politically contested
medical interventions. Here we consider one particular legal strategy that, if more widely adopted, could
challenge the legal infrastructure underlying U.S. health care.
The article is paywalled. :(
The author was kind and sent a copy to me.
Here are some thoughts.
The article discusses the increasing legal strategies employed by state legislators to restrict access to healthcare for transgender people, particularly minors. It focuses on a new legal technique in Utah that allows patients who received "hormonal transgender treatment" or surgery on "sex characteristics" as minors to retroactively revoke their consent until the age of 25, potentially exposing clinicians to legal claims. This law challenges the core of the clinician-patient relationship and the legal infrastructure of U.S. healthcare by undermining the principle of informed consent.
The authors argue that Utah's law places an unreasonable burden on clinicians, extending beyond gender-affirming care and potentially deterring them from providing necessary medical services to minors. They express concern that this legal strategy could spread to other states and be applied to other politically contested medical interventions, such as contraception or vaccination. The authors conclude that allowing patients to withdraw consent retroactively threatens the foundation of the U.S. health care system, as it undermines clinicians' ability to rely on informed consent at the time of care and could destabilize access to various healthcare services.
