Marisa Alder and Payden Alder: The thin line between paternalism and tyranny

Law banning care for transgender children is an affront to liberty.

(Trent Nelson | The Salt Lake Tribune) People gather at a rally in support of transgender youth at the Capitol building in Salt Lake City on Tuesday, Jan. 24, 2023.

In the state of Utah, minors can marry at 16 with parental permission. Parents can allow their children to play high-contact sports which can leave players with lifelong irreversible injuries. If the state prevented parents and their children from having the autonomy to make such decisions we would hear outcry about government overreach and arguments declaring our descent into a slippery slope would headline opinion pieces.

Yet when the state singles out a very small minority and strips those children and their parents of the autonomy to do what they believe is best for themselves those who claim to care the most about freedom are silent.

John Stuart Mill, one of history’s greatest defenders of freedom, argued the desire to police the morality of others until it encroaches on their liberty “is one of the most universal of all human propensities.” We are seeing that propensity carried out in the state of Utah.

The most common argument marshaled in favor of banning gender-affirming care is a desire to protect minors. We want to protect trans youth from choices they might regret. We all have paternalistic attitudes towards minors, but the line between good-willed paternalism and tyranny is thin. Mill feared the threat a tyrannical majority posed to liberty he warned, “There are many who consider as an injury to themselves any conduct which they have a distaste for.”

So, how do we know when those who claim to have someone’s best interests at heart are good-faith paternalists or tyrants in disguise?

One way to tell the difference is the scope of paternalistic laws. We should expect the good-willed paternalist to treat everyone equally under their laws. If they are worried about minors performing actions they might regret they should have such concern for all minors. Discrimination under the law is often tyranny under the law, and Utah’s new law smacks of tyranny.

This bill claims to ban gender-affirming care for all minors, but that’s not true. Utah’s new bill excludes breast implants for cis minors. This means cis minors who feel dysphoria regarding their body can legally seek out gender-affirming surgery, and yet transgender youth can’t even seek hormonal treatments. When you don’t want to protect all youth you can’t expect people to believe it’s not about policing particular youth.

People may construe our arguments as throwing caution to the wind, however, we are not against caution. Caution when making lifelong decisions is a virtue, but even before the bill was passed the process of being prescribed hormonal treatments required caution. Patients have to pass clinical evaluations assessing the severity of their gender dysphoria and show that they had already tried other forms of unsuccessful treatment. In these cases, both parents and their children have to be fully informed of the potential risks of the treatment and have the approval of both a therapist and a medical doctor before moving on to hormonal therapy.

These are not decisions parents and their children make idly. If both parents and minors are educated on the potential risks and benefits of a medical treatment why would we want a paternalistic nanny state preventing parents and their kids from weighing all the options available to them?

And the need to weigh all options is real. Utah has one of the highest trans teen suicide rates in the country. Transitioning can be lifesaving making it even more disheartening to see Utah restricting options for treatment. Particularly when the best research we have suggests the vast majority of trans youth will not regret the decisions they make with the help of parents and trained medical professionals.

Utah’s new nanny state not only limits freedom, it harms trans youth. It is good to advocate caution, but we, the majority, go too far when we strip a very small and politically powerless minority of rights we reserve for ourselves.

And for any lover of freedom who still feels the impulse towards paternalism Mill’s words should sting when he says “the only purpose for which power can be rightfully exercised over [another] … is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.”

Marisa Alder and Payden Alder

Payden Alder graduated from Utah Valley University with a bachelor’s degree in philosophy and is working toward a master’s in philosophy at Georgia State University.

Marisa Alder, LCSW, graduated from the University of Utah with a master of social work degree and works as a clinical therapist at Flourish Therapy Inc., a counseling center in Utah that provides behavioral and mental health services for LGBTQIA+ individuals, couples and families.