A physician writes to the NYT Magazine‘s ethicist about a patient who used a racist slur (the N-word) to his Black nursing staff and a homophobic slur (probably the queer F-word, but maybe the queer D-word) to his receptionist, and contemplated ways to support these staff members as an outsider, explaining in the letter that he’s “a Hispanic, cisgender male”.
The first identifier, Hispanic, is a racial / ethnic identifier, counterposed to Black, White, API, Indigenous, etc. The second identifier, cisgender, is clearly intended to be counterposed to homosexual / gay / queer, terms that refer to same-sex (rather than other-sex) sexual orientation; but that looks like some kind of category mistake, since the standard usage of cisgender (with the prefix cis– ‘on this side of’, opposed to trans– ‘on the other side of’) is for a sexual identity that aligns with birth sex (and so is opposed to transgender) — a matter that’s orthogonal to sexuality / sexual orientation. Indeed, most same-sex-oriented people are cisgender; I myself am a cisgender queer, one of millions, though we’re hugely outnumbered by the cisgender straights, who are all over the place. And while some transgender people are sexually oriented towards their own sex, some are oriented towards the other sex.
The text. From “Can I Withhold Medical Care From a Bigot?: The magazine’s Ethicist columnist on a physician’s duties” by Kwame Anthony, Appiah on-line 6/7/22, in print 6/12/22, eliding the parts about the ethical issues to focus on the cisgender matter, with relevant bits bold-faced:
I am a physician, and last year, I took care of a white female patient in the hospital for a bacterial bloodstream infection. A few days into her stay, she began referring to Black staff members by the N-word and to our receptionist by an anti-gay slur. As the supervising physician, I made it clear that this was unacceptable. In general, with challenging patient behavior, I find it best to clearly lay out expectations and the consequences for violating them. So before talking to her, I discussed the situation with the nursing staff and hospital risk management, and we concluded that if she persisted in using this language, we would discharge her from the hospital, against her will if necessary.
I made all this clear to the patient. Thankfully, she stopped and completed the rest of her hospital treatment. But if she had continued using racist and homophobic slurs, would I have been wrong to force her to leave the hospital?
… Several Black nursing staff members felt strongly that this is what we needed to do, and I felt it was important to unequivocally support them. (I am a Hispanic, cisgender male.)
The cisgender usage issue. So, what’s up with the earnestly supportive doc?
At least two possibilities. One, which I’m very much hoping is not what’s going on, is that the doc subscribes to the deeply misguided theory that homosexuals are literally inverts, people of one sex in the bodies of the other — regardless of their feelings or beliefs about their sexual identities. In effect, unknowing or covert trans people.
If you genuinely believe in this idea — which has a long, sad, and complex history, complete with efforts to “treat” homosexuals by subjecting them to sex reassignment surgery — then you believe that saying you’re cisgender implies that you’re straight, so asserting cisgender status together with support for homosexuals would be expressing straight support for them.
Like I said, I really hope the doc isn’t an adherent of this crap.
Another possibility is that the doc has misapprehended the meaning of cisgender by abstracting, from the occasions where he’s heard or read it used, an extended meaning, a broader meaning than was intended by those who used it — fixing on something like ‘default for all of the SGO properties’ (sexual identity, gender identity, sexual orientation — elaboration below), or just ‘normal’ (in the SGO domain). In which case a cis sexual identity would come along with a sex-appropriate gender identity and an other-sex orientation.
SGO properties: the thumb-nail sketch. Three high-level categories and their primary subcategories (there are of course other subcategories; the subcategory structures can be quite complex):
— sexual identity, or SEX for short (sometimes, alas, referred to as gender): the primary subcategories of SEX are FEMALE and MALE
— gender identity, or GENDER for short: the primary subcategories of GENDER are FEMININE and MASCULINE
— sexuality, or sexual orientation, ORIENTATION for short: the primary subcategories of the category ORIENTATION are SAME-SEX and OTHER-SEX
The default settings:
— default SEX aligns with birth sex; cis(gender) means ‘having default SEX’
— default GENDER aligns with SEX (FEMININE with FEMALE, MASCULINE with MALE)
— ORIENTATION is, by default, OTHER-SEX