|Abstract: ||Tiriamajame darbe nagrinėjant plastikos chirurgo teisę atsisakyti suteikti paslaugą, motyvuojant tuo, jog tai yra dalis medicininės lyties keitimo procedūros, kurios tvarka Lietuvoje nėra reglamentuota buvo analizuojama medicininė ir teisinė lyties keitimo samprata, asmenų lygybės ir nediskriminavimo dėl lyties teisinis reglamentavimas nacionaliniu ir tarptautiniu lygmeniu, kurių analizė parodė, kad lyties samprata plečiasi ir pamažu socialiniai bei psichiniai kriterijai įgauna tokią pat svarbą kaip ir biologiniai, o tai lemia dar didesnį situacijos dviprasmiškumą. Tą taip pat patvirtina lyties keitimo teisinio reglamentavimo Lietuvoje ir kitose Europos Sąjungos valstybėse analizė. Siekiant atsakyti į klausimą buvo nagrinėjamas gydytojo-chirurgo veiklos teisinis reglamentavimas ir galimi pagrindai atsisakyti suteikti sveikatos priežiūros paslaugą. Neatsiejama to dalis yra paciento teisės ir autonomijos principo reikšmė sveikatos priežiūros sistemoje. Nesant aiškaus teisinio apibrėžtumo ir valstybės pozicijos šiuo probleminiu klausimu buvo analizuojama sveikatos priežiūros reglamentavimo problematika Lietuvos tesinėje sistemoje.
Išanalizavus ir įvertinus tiriamą problemą, darytina išvada, kad iškelta hipotezė, jog atsisakymas transseksualiems ir translyčiams asmenims suteikti plastinės chirurgijos paslaugas, motyvuojant tuo, kad tai yra dalis lyties keitimo procedūros, pasitvirtino iš dalies. Atlikus tyrimą galima teigti, kad chirurgo atsisakymas suteikti paslaugą vien dėl šios priežasties nėra teisėtas, kai asmeniui, kuris kreipiasi dėl paslaugos yra diagnozuotas lyties tapatumo sutrikimas – transseksualumas. Transseksualumas, kaip lyties tapatumo sutrikimas, laikomas liga, kuriai taikomas kompleksinis gydymas susidedantis iš psichoterapijos, medikamentinio ir chirurginio gydymo. Lietuvoje iki šiol vyrauja praktika, kad teisę keisti lytį turi tik šią diagnozę turintys asmenys. Atsižvelgiant į šiuo klausimu nagrinėtas sveikatos priežiūros reglamentavimo problemas Lietuvos teismų praktikoje – Lietuvoje transseksualumas yra gydomas kaip ir visos kitos ligos, kurios yra įtrauktos į Tarptautinę ligų ir sveikatos problemų klasifikaciją, todėl galima teigti, kad realus parindas atsisakyti suteikti tokią paslaugą yra tik chirurgo kompetencijos stoka ar kitų būtinų salygų suteikti paslaugą nebuvimas.|
Gender reassignment procedure is the totality of interrelated legal and medical procedures. Legally it means a change of personal documents by identifying the person of opposite gender, while medically it means a long process that may cover psychological help, hormone therapy and plastic surgeries.
Although not all the persons, who want to change their gender, endeavour full medical gender reassignment procedure, but the majority of them need single services of plastic surgery. Due to the lack of legal regulation of gender reassignment procedure in Lithuania, the availability of such services is becoming an especially relevant problem.
The novelty of this work is reflected by the fact that the Equal Opportunities Ombudsman has already had to consider the complaint of Romanian citizen, which was based on the ground that one of the Lithuanian Aesthetic Surgery Centres had deprived the claimant of the breast augmentation surgery. This was done due to the fact that after the ultrasound, the surgeon realized the customer was a transgender woman. Moreover, "[i]t was explained that the Lithuanian legislation does not regulate the treatment of transgender people, and male breast augmentation surgery is not carried out because the legislation prohibits such operations. Attention is drawn to the fact that in a number of breast augmentation surgeries for transsexual woman, the operation of gender reassignment has already been carried out earlier, and personal documents were already replaced, but they are still referred to as a male. After this event, she said that if she had known that Lithuania discriminates against transgender people, she would never have chosen to come here.” It reveals the ambiguity of the situation and the fact that publicly known transsexual A. Landau had the same operation done in Lithuania. This implies the assumption that the provisions of such services in Lithuania are potentially subjected to double standards.
Legal issue raised in this work is: Can a surgeon refuse providing services on the ground of them being a part of gender reassignment procedure?
The object of this work: the rights of transsexual and transgender individuals to have surgical services in Lithuania.
The aim of this work: by analysing of the legislation, literature sources and cases, to investigate and determine whether the refusal to provide surgical services for transsexuals and transgender persons in Lithuania, on the grounds that it is part of a gender reassignment procedure, is legal. The following tasks were set for this work:
1. To perform a theoretical analysis on the equality of persons and the principle of non-discrimination and to provide the aspects of gender reassignment;
2. To analyse legal regulation regarding the gender reassignment in Lithuania and other EU countries;
3. To analyse the rights of both the doctor - surgeon and the patient, in relation to health care services;
4. To investigate the regulation of health care problems in the process of gender reassignment in the Lithuanian legal system.
The research work is analysing the right of plastic surgeon to refuse to operate, rendering his services on the ground of them being a part of gender reassignment procedure, which is not legally regulated in Lithuania. The medical and legal concept of gender reassignment and legal regulation of equality and non-discrimination of persons due to gender were examined on the national and international levels. The analysis revealed that the concept of gender is rapidly expanding and social and mental criteria are receiving gradually the same importance as the biological ones, which lead to even bigger ambiguity of the situation. The same is confirmed by the analysis of legal regulation of gender reassignment in Lithuania and other States of the European Union. In order to answer the raised question, the legal regulation of the surgeon’s activities and possible grounds for refusal to render health care service were analysed. The integral part of this issue is meaning of the patient’s right and principle of autonomy in the health care system. In absence of clear legal definition and the State’s position regarding this problematic issue, the regulation problems of health care in the Lithuanian legal system were analysed.
Having analysed and assessed the researched problem, the conclusion should be made that the raised hypothesis that the refusal to provide services of plastic surgery to transsexual and transgender persons on the ground of them being a part of gender reassignment procedure has been partially confirmed. The carried-out research allows stating that the surgeon’s refusal only due to this reason is not lawful when the disorder of gender identity – transsexuality – has been diagnosed to the applicant. Transsexuality as a disorder of gender identity is considered a disease that needs complex treatment consisting from psychotherapy, medicament and surgical treatment. The predominant practice of Lithuania is that only the persons with such a diagnosis have a right to reassign their gender. With reference to the regulation problems of health care on that matter in the Lithuanian case law, the treatment for transsexuality is applied in Lithuania in the same way as any other diseases included into the International classification of diseases and health problems. Therefore, it is possible to state that the real ground to provide such a service is only the lack of surgeon’s competence or absence of the necessary conditions for such a service.