New Rules being Developed by the Ohio Department of Health on Gender Affirming Care for Adults

Should mentally-ill adults be able to consent to life-altering care? Should Ohio protect the mentally ill from ideological and profit driven interest of licensed mental health professionals?

Photo: Mahoning County Jail - Nicholas "Sapphire" Cunningham - Nicholas Cunningham, also known as “Sapphire” or “Saphire,” was arrested in November in connection to the death of 44-year-old Gena Wade of Smith Township, Ohio. Cunningham a self identified trans man. Cunningham and Wade were known to each other, and that Wade had successfully filed for a restraining order against Cunningham in March of 2023. In the application for the order, Wade revealed that Cunningham had been stalking her 12-year-old niece and sending disturbing threats to both her and the girl’s mother via text and Facebook.

Gena Wade. Photo Courtesy of Dean’s Funeral Home. In the application for the protective order from Cunningham, Wade revealed that Cunningham had been stalking her 12-year-old niece and sending disturbing threats to both her and the girl’s mother via text and Facebook. Cunningham had reportedly become obsessed with the minor, and was determined to see her despite the objections of her family. At the time of the protection order, Cunningham was already known to authorities as a registered sex offender stemming from a 2015 conviction for the sexual abuse of a child under the age of 13. Currently, Cunningham is serving 3 years in Ohio’s penal system.

The referenced story is not unique around the country. There are a disproportionate amount of stories concerning trans-identifying individuals with converging mental disorders that are prone towards violence. We have a legitimate right to question the acceptance of mental illness as normative behavior - and that such an adherence to an erstwhile ideology may be producing a generation of violent criminals, murderers, pedophiles, and rapists.

The fear of being labeled a transphobic bigot in questioning mental health treatments and trans acceptance has silenced voices of reason - to the point that it is not possible to track crimes committed by trans identifying individuals to potentially reveal any correlations and causations with their mental illness.

For such statistics of trans-identifying individuals would undoubtedly find support that the normalization and acceptance of transvestitism has led to tremendous mental health failures in the form of violent crimes related to their mental health, psychosis, mania, or mental instability.

While Ohio has passed the SAFE act to protect Ohio’s children - shouldn’t we protect Ohio’s mentally ill?

Recently, Ohio’s department of health has drafted rules which seem to recognize gender affirming care for adults as an acceptable and viable treatment - yet, Ohioans are loathsome to find any evidence that gender affirming care is anything but compassionate care for the mentally ill - whether it be for children or adults. If the rules are good enough to protect mentally-ill children, why are they not acceptable for mentally ill adults?

In our legislators' deliberations concerning Ohio's approach to gender identity and mental health, we need to ensure they hear our voices concerning the timeless principle of "do-no-harm," a guiding beacon transcending partisan divides and should anchor our ethical compass as a society. While Republican and Conservative ideologies may emphasize prudence and respect for natural order in doing no harm, the ethos of "do-no-harm" resonates universally across political dogmas, compelling legislators to exercise both vigilance and skepticism when charting the course of mental health policies.

Grappling with the complexities of mental health policies, Ohio legislators must confront a stark reality: the field of mental health, unlike its pharmaceutical counterpart, often lacks the rigorous testing and empirical validation necessary to ensure the efficacy and safety of interventions. Indeed, therapies and treatments in mental health are susceptible to the ebb and flow of social movements and fads, rather than being anchored in sound scientific principles.

Consider the phenomenon of consensus within the mental health profession—a consensus that may arise not from robust empirical evidence, but rather from the sway of prevailing ideologies and cultural zeitgeists. Legislators must recognize that consensus does not equate to treatment based on fundamental principles; rather, it may reflect the prevailing winds of societal norms and political agendas.

Moreover, the principles of full disclosure and informed consent, sacrosanct in other medical disciplines, often languish in the realm of mental health. The mentally ill, grappling with irrational thoughts and self-destructive tendencies, may lack the capacity to provide genuine consent—a reality that demands heightened ethical scrutiny and oversight.

The analogy to children making life-altering decisions is apt: just as we shield minors from the consequences of their immature judgment, so too must we exercise caution in entrusting the mentally ill with decisions that may irrevocably alter their lives. It is incumbent upon legislators to safeguard the vulnerable from the potential exploitation of mental health professionals, ensuring that treatments are driven by genuine concern for patient welfare rather than ideological or financial motives.

To this end, an establishment of a robust framework of ethical inquiry—a matrix of moral questions designed to scrutinize the actions and decisions of mental health providers is essential to be established. An inspector general for Ohio’s licensed mental health professionals, charged with overseeing adherence to these ethical standards, would serve as a bulwark against abuses of power and conflicts of interest within the mental health profession.

Before embarking on any course of treatment, mental health providers should undergo rigorous scrutiny to ensure that their actions are guided by the best interests of their patients. A second opinion, untainted by ideological or financial considerations, should be sought to corroborate the proposed course of care. Only then can we reasonably be assured that the treatment plan is rooted in evidence-based practice, rather than illicit experimentation or ideological or profit-driven motives.

In the realm of mental health, where empirical certainties often yield to the nebulous contours of subjective experience, the imperative of "do-no-harm" should assume paramount significance to Ohio legislators. It enjoins legislators, as stewards of public welfare, to scrutinize with discernment any purported therapies or interventions lacking sound scientific foundation or consensus within the mental health community. A healthy skepticism is not born of ideological predispositions nor phobias, but rather of a sober acknowledgment of the vulnerability of those young and old grappling with mental illness and the potential for exploitation inherent in profit-driven and ideological ventures.

Ohio legislators entrusted with the solemn duty of shaping policies that intersect with the most intimate recesses of human experience, it is incumbent upon legislators to approach mental health policy with a judicious blend of empathy and skepticism. Legislators should remain ever vigilant against the siren call of quick fixes and profit-driven agendas, for the consequences of legislative decisions reverberate far beyond the hallowed halls of Ohio’s General Assembly.

In the context of gender dysphoria and related mental health conditions, where debates rage and consensus remains elusive, the maxim of "do-no-harm" should assume heightened relevance. Government has an obligation to those afflicted with such mental conditions - that transcends ideological affiliations, warning us to heed the call to tread cautiously and prioritize non-ideological evidence-based interventions over ideological dogmas or commercial interests.

Therefore, let us, as the watchful eye of public welfare and policy, encourage legislators to pledge allegiance not to any particular ideology concerning mental health but to the timeless principle of "do-no-harm." Let us all wield skepticism as a shield against the encroachment of unproven treatments and profit-driven ventures preying upon the vulnerabilities of the mentally ill - whether as a child or as an adult. “Trust, but verify” should become the maxim of the day. 

Ohio’s legislators must embark upon a difficult, and many times a heart wrenching, contemplative journey concerning the societal implications of Ohio's approach towards gender identity and its resonance with logic, truth, and ethics especially within the purview of mental health. Legislators should maintain a healthy distance from being assuaged by the passionate pleas of parents that have been convinced of gender affirming care and acceptance rather than attenuating delusional thinking of a mania or psychosis. It behooves all Ohioans to ensure that our legislators ensure guidance and active policing of the treatment of mental health with sobriety and intellectual rigor in developing policies and licensing because mental health treatment is fraught with fraud and abuse.

Central to the arguments of the day, transphobia Vs, compassionate and safe treatment, is the discernment between biological sex and gender identity—a fundamental dichotomy often conflated in contemporary discourse, yet one which carries profound implications for individual well-being and societal order. A mind of practicality and science is inclined towards anchoring societal structures in immutable truths, chief among them being the biological reality of sex. Indeed, it is upon this bedrock of biological reality that Ohioans have erected norms, laws, and protections, safeguarding the sanctity of intimate spaces and the vulnerable among us, notably women and children. The recognition of gender as being separate from biological sex provides a slippery slope for the recognition of all types of identities only limited by the imagination of the human mind.

In recognizing the primacy of biological sex, legislators  should espouse a stance upholding the necessity of discernment in an era awash with ideological currents. To affirm gender identities divorced from biological realities is to indulge in a departure from empirical truths—a perilous journey fraught with philosophical and practical quandaries - just where does it end?. To construct societal edifices upon the shifting sands of subjective identity is to court chaos and moral relativism, endangering the very fabric of our social cohesion. We see this in the contemporary division of society upon this topic.

Moreover, let us not overlook the solemn duty incumbent upon legislators as the ultimate custodians of public safety and mental health. The nexus between certain mental health conditions, such as gender dysphoria, and heightened propensities towards aberrant behaviors of violence, sexual abuse, and pedophilia demands our vigilant attention. It is a disservice to individuals and society at large to disregard these mental health realities in pursuit of a misguided notion of compassionate gender affirming care. We are not compassionate when we give a begging alcoholic a bottle of alcohol - nor are we compassionate when we exacerbate the delusions of the mentally ill by entertaining such behavior as normal and acceptable and as a civil right.

We extend genuine compassion, albeit difficult and arduous by facilitating avenues of treatment grounded in empirical evidence and therapeutic efficacy - not in trying to create acceptance of delusional thinking. It is incumbent upon us as a society to guide individuals grappling with gender dysphoria towards interventions that address the root causes of their distress, rather than acquiescing to transient affirmations detached from biological reality—a stance tantamount to enabling rather than healing.

Ohio legislators, would, in adopting a biological sex-only confirming policy for all state agencies would embody not only a steadfast commitment to conservative principles rooted in empirical reality - but also a conscientious embrace of our responsibility towards the mental health of children and adults and a consistent understanding that gender identities that do not conflate with biological sex are indeed delusions and should not be encouraged.