A 65-year-old woman sits in Massachusetts, writhing in emotional and psychological pain. For years, she has been in medicinal and therapeutic treatment that has not cured her suffering; she has self-injured and attempted committing suicide multiple times. Recently, her caretakers and doctors have recommended a surgery that would entirely fix her mental disorder--a surgery many say she shouldn’t have.

Michelle Kosilek, born Robert Kosilek, brutally murdered her own wife 25 years ago, and is serving a life sentence in a Massachusetts prison. She has a long history of hard drug use and sexual abuse. Similar to Laverne Cox’s character in Orange is the New Black, doctors have diagnosed Kosilek with Gender Identity Disorder (GID), a condition where the body is incongruent with the mind’s gender. To treat it, she has been in hormonal therapy, laser hair treatment and psychological therapy, but is still chronically distressed; they now recommend gender reassignment surgery which would fully alter Kosilek’s genitals to a woman’s. On May 30, a federal board ruled Medicare can no longer automatically deny coverage requests for gender reassignment procedures. Given that she is doing life in prison, it is taxpayers who would foot the bill for her gender reassignment surgery.

Is the way we look such a hindrance to our qualities of life that it becomes a medical need requiring expensive and dangerous surgery?

Jessica Pettitt, a transgender activist, says the surgery is no different than a cosmetic surgery.

“It isn’t (different.) Cosmetic surgery can also be using technology and science to help anyone be and appear as they wish,” she says.

Department of Corrections Attorney Richard McFarland told Newsday that only 5 percent of people diagnosed with GID undergo gender reassignment surgery.

"The clinician [in Kosilek’s case] didn't say you must have this surgery, but that if you want it you can get it,” McFarland says.

Ian Thompson, a legislative representative for the American Civil Liberties Union, says that prisoners are not currently allowed to leave prison grounds to receive medical treatment, nor are they allowed to demand a certain medical procedure. They do have a right, though, to receive treatment that is adequate to address the seriousness of their medical needs, and that in Kosilek’s case, gender reassignment surgery is “medically necessary and the only adequate treatment for her severe gender dysphoria.”

According to the American Medical Association, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, GID is a serious medical condition where there is a persistent discomfort with one’s assigned sex and with one’s primary or secondary sex characteristics, which causes intense emotional pain and suffering. They recommend gender reassignment surgery, and assert that “the denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient’s gender identity.” According to the ACLU, for inmates, the denial of treatment constitutes a violation of the 8th Amendment protection against cruel and unusual punishment.

“This is about health care,” says Loren Cannon, PhD in Philosophy from Humboldt State University. “All prisoners should receive necessary health care – when they are incarcerated their health is the responsibility of the state.”

Cannon says the question of whether or not the taxpayer should pay for gender reassignment surgery assumes the procedures are unnecessary.

Withholding medical care for wards of the state is “not a topic for which counting pennies is even appropriate,” she says. “It is important for society to be just – that means justice for all, not just the most privileged.”

Thompson, from the ACLU, says the surgery will have a significant impact on the role of the individual in the prison community because at present, transgender people are at especially high risk of abuse in prisons because they are often assigned to cells based on their genital characteristics instead of the gender they identify with. Kosilek is in a men’s prison, and hopes to be moved to a women’s prison upon gender reassignment surgery. The Prison Rape Elimination Act requires prisons create individualized housing placements for all transgender people, which is ostracizing and non-inclusive.

Cannon says trans people are routinely sent to solitary confinement because of the presence and threat of violence. Gender reassignment allows officials to assign the prisoner a more appropriate space.

Kylar Broadus, Founder of Trans People of Color Coalition and Senior Policy Counsel for the Transgender Civil Rights Project, agrees, and says it should be called gender correction surgery rather than gender reassignment.

“I think [in Kosilek’s case] you’d deal with a person that’s much more functioning because they’re happier in their body as to who they are,” Broadus says. “I think that people become much more productive because they’re much more themselves, they’re willing to engage in a more positive way.”

He says the surgery is an 8th Amendment right for Kosilek, “like any other prisoner with medical needs” and that it doesn’t have anything to do with cosmetics. He says he has “tons of things that are on my face that need to be done, and other areas of my body that are not done, and those… have nothing to do with confirming my gender.”

About his transition, he says “I never felt like I transitioned into anything but to me.”

“With regard to gender reassignment,” Cannon says, “the harms that result from not getting this kind of care are well documented – the only thing holding back so many folks from getting adequate care is ignorance and bias.”

Author Bio:

Stephanie Stark, a contributing writer at Highbrow Magazine, is a freelance writer and web producer out of New York City. Her work focuses on social, religious and gender issues in the US. Follow her at @stephanie_stark.