“Gender-affirming” and “transgender” medical care are part of a broader transformation in medical ethics. The injunction that governed medical practice for 2,400 years to do no harm has, in our time, given way to the edict to improve social wellbeing. “Gender-affirming” and “transgender” medical care are not the whole of this transformation, but are perhaps its most distinguishing features.

The Constitution of the World Health Organization (1946) declares that “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” The World Health Organization’s (WHO) Constitution, with its emphasis on mental and social wellbeing, has helped shift medical ethics away from the Hippocratic Oath and toward a broader, and often vague, project of social transformation led by physicians.

The aspiration articulated in the WHO Constitution toward “complete physical, mental and social wellbeing” has become institutionalized in the medical wing of the therapeutic-managerial state. Doctors, nurses, and sundry associated medical professionals now pursue the triune aspects of wellbeing by means of therapist-managers who can and conflate their political agenda with social wellness. A 2022 article provides in one long sentence this sprawling agenda:

Students are encouraged to identify activities to promote their mental and physical wellbeing (through interventions to increase positive affect and/or positive health through, for example, physical activity); community wellbeing (e.g. orientation to promote good) and planetary wellbeing (e.g. nature-based mindfulness) while reflecting on how they might work towards overcoming the many sociostructural constraints to wellbeing through, for example, contributions to social change (e.g. volunteering; civic engagement; activism) through commitment to something greater than oneself (i.e. self-transcendence).

That agenda, which lives up to Hannah Arendt’s analysis about the effects of conflating politics and society, is also totalitarian in aspiration.

Mental and social wellbeing justifies “medical” interventions that previous generations would have found nightmarish. Yet the grant of power and duty to medical professionals subordinates the individual self to the needs of the medical regime.

The philosophical roots of transgenderism, along with transhumanism, have been described, acutely, as a form of Gnosticism: medicine, surgery, cybernetic engineering, all are ways to liberate the true self from the body’s delusions and chains. This is a war on both the human body and the human mind. Long ago, Augustine wrote of the inextricable fusion of mind and body. His view proved central to Western thought over the millennia, though there was always a counter-tradition that deprecated the body in favor of the primacy of the mind. That counter-tradition, best remembered as Gnosticism, achieved a strange resurgence in the latter half of the 20^th century, initially at the prompting of teachers of Eastern spiritual traditions. 

Eventually, it took the form of the delusion that we can will ourselves away from the encumbrances that nature gives us, including the encumbrance of being, by nature, either male or female. 

To oppose the contemporary transgender movement is not to deny that many people—perhaps all of us—feel discomfort in our physical selves. We experience pain, illness, aging, and the prospect of death. We may dislike our appearance, and some few harbor a dislike of their biological sex. Medicine, rightly understood, has a role to play in reconciling people to those aspects of their physical selves that are fixed. That means that our minds must adapt to the realities of our bodies.

But if we conclude, as do our new Gnostics, that the body is merely an encumbrance, the role of medicine becomes carving the body into whatever form the mind desires. 

Medicine, of course, is not alone in pampering these desires. Humanity has always sought to improve on nature by dress, adornment, cosmetics, and exercise. The fashion industry exists in a way to align our minds with our bodies in a pleasing way. And medicine can play a relatively innocent part in repairing the damages of accidents and age. But medicine crosses a line when, instead of repairing—or incidentally improving—the body, it becomes an accomplice in attempting to erase essential qualities. 

The Gnostic hope of radical self-improvement by radical surgery, however, is futile. Every cell and thought contributes to our individuality. Each pulse of sensation, consciously and unconsciously perceived, is a word in the continuous dialogue of mind and body. Health requires, although it is not guaranteed by, the unaltered conversations of mind and body.

We are, in some sense, different beings just by wearing corrective lenses. But modern medicine allows far more drastic changes: drugs, hormones, surgeries, which aim to change by physical means the perceiving self. Any medical intervention changes the conversation of body and soul that makes us ourselves, but we can now do so with targeted and powerful effect.

The great justification for these radical interventions, of course, is the assertion that our sex is not natural but is “socially constructed.” And what is socially constructed can be surgically or pharmacologically deconstructed.

The reality is that our sex is both natural and social. We shouldn’t be bullied into thinking it is just one or the other. But the social side has to build from the materials supplied by nature. The effort to make nature buckle to the demands of transgenderism produces, at most, a person determined to sustain a theatrical performance.

To the extent that contemporary medicine has become an accomplice of such performances, it has betrayed the principle of do no harm. The doctors may think themselves as ameliorating the deep unhappiness of patients who think they were born in the wrong bodies, but they are really abetting an illness that manifests itself in a delusion. Medical ethics ought to presume against intervening in the body in ways that will change the self that is constituted of mind and body in internal and continuous conversation.

The vastly increased power of medical personnel to conduct such interventions indeed makes this ethical imperative even more vital than it was in previous generations. Do no harm should be revived and strengthened as a guiding principle: do not seek to influence a patient to refashion himself by medical means and refrain wherever possible from such procedures.

Medical education must rise to this level. Radical activists have embedded their Gnostic trainings throughout America—in the University of Michigan’s Transgender Healthcare Curriculum, in Johns Hopkins University’s Center for Transgender and Gender Expansive Health and Transgender Primary Care Elective, in the American College of Obstetricians & Gynecologists’ Gender Affirming Care curriculum, and an ever-lengthening list of similar programs and curricula. Accrediting organizations such as the American Medical Association are leaning ever more heavily toward requiring “gender-affirming” and “transgender” medical care in medical education. We cannot restore medical ethics unless we remove these Gnostic structures from medical education. It is vital to do so to shape properly the professional and moral character of the next generation of medical professionals.

And of course, the radical activists in the medical academy now produce a host of pseudo-research to justify their new dispensation. The slightest pushback against their conduct requires the assemblage of a great deal of real research to justify saying the obvious: that the “research” justifying Gnostic reshaping of mind and body is so much quackery. The attrition warfare of modern politics consists not least in assembling a congeries of peer-reviewed publications to attack or support common sense. The activists’ new strongholds in the medical academy provide them the ability to prep the political battlefield with a constant supply of weaponized footnotes. We will greatly strengthen the campaign to restore medical ethics if we remove public subsidies for tenure-track lines, programs, and centers dedicated to Gnostic butchery.

We may fight this battle on the ground of removing public subsidy, of removing all public support for Gnostic medicine. Even if we grant that medical professionals are free to argue for such ends, that does not mean we are required to pay their salaries. The government’s regulatory and financial support provides a rationale and a practical means for public intervention to override the medical fields’ commitments to medicalized refashioning of their patients’ bodies and souls. We may fight first to prevent medical educational institutions—accrediting organizations and schools—from requiring assent to such medicalized refashioning. If that campaign is successful, we may fight further to prevent these institutions from allowing such medicalized refashioning at all.

Accrediting organizations, professional associations, schools of medicine and nursing, and teaching hospitals now face no consequences for facilitating such misconduct. If they were to pay for their misbehavior, they would be more likely to change it.

We can and should tell medical professionals, thou shalt not. But it is at least as important to tell them that you should not.

Follow the National Association of Scholars and David Randall on X.