Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery (GRS) is a procedure that can change the transgender person’s physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice. This paper will be divided in four key sections: First, the state of transgender health will be outlined, including the role of GRS and common objections to it. Second, a number of common objections to GRS will be analysed at the outset and shown to be unconvincing. Third, a constructive argument will be advanced, arguing that publicly funded GRS is clinically necessary, cost-effective, and demanded by principles of justice. Fourth, the paper will briefly discuss moralistic biases and why we demand a higher burden of justification for funding GRS compared with other analogous procedures.

No abstract

The world is undeniably full of injustice. Many feel that much political philosophy is practically impotent and engaged instead in overly abstract theorising insufficiently sensitive to the realities of the world. One response to this concern is David Miller's influential model of evidence-based political philosophy, which claims to be sensitive to empirical evidence from the social sciences, takes seriously people's opinions, and defends the role of facts in grounding normative principles. Using various examples from the field of global justice, one of Miller's key areas of work, I show that Miller's method is unconvincing on two-levels. His theoretical argument for fact-dependence is flawed, and his practical argument for an opinion-sensitive political theory is either guilty of status quo bias or, in an attempt to escape it, becomes self-defeating. While the paper is primarily critical, I endeavour also to draw out the implications of my critiques for the role of the 'real world' in theorising.