I read an article back in the 80’s about the death of a female impersonator. She died in a plane crash, and as her estranged mother was the next of kin, the mother got control of the decedent’s body. The mother instructed the mortuary to remove her child’s breast implants, cut her child’s long hair to a short mannish style, and dress her child in a man’s style suit. I was offended then, and remain offended now. While funerary rites are often said to be more for the living than for the deceased, it remains that acts like those mentioned above can also function to erase or invalidate the true person who died.
Flash forward to earlier this year, 2010. I am now a Forensic Pathologist (a physician trained in determining the cause of death, think of the doctor doing an autopsy in a movie or on TV). I work in southern California, and a few months ago a case came to the office where I work that reminded me of the aforementioned article. A woman died in her home. Her name reflected her preferred name (over her birth name) on both her driver’s license and her Social Security card. Her sex was indicated as female on her driver’s license. Because she retained male genitalia, when she arrived at the office she was classified as “Male”. Some people have fake ID’s, so this initial classification was understandable if not completely agreeable to me. I asked the administrative arm of my office as to the guidelines for recording gender/sex on a Death Certificate. I was informed that there really are not any hard and fast rules, and that it is the discretion of the office how to record such data.
I would like to digress for a moment. In the United States, most jurisdictions fall into either a Medical Examiner system (an appointed physician, usually trained in forensic pathology) or a Coroner system (an elected official, often affiliated with law enforcement, most commonly a Sheriff’s office). Let that sink in. The people who determine gender/sex on a Death Certificate are most commonly either a physician (who may have no training/understanding of gender variance) or a sheriff (who also may have no training/understanding of gender variance).
So while this death gave me an opportunity to educate some of the investigators and administrators in my office on the topic of gender variance, it did not establish any hard and fast rules. When a transsexual/transgender/gender-variant individual dies, someone may label their remains’ gender/sex as they see fit. An individual’s identity can be erased by bureaucracy. While the dead may or may not be past caring, their friends and family are not. That someone who has had to fight society to establish the validity of their identity can have that identity erased so callously is offensive to me.
Transsexuals/transgenders/gender-variants have had much conflict with both the medical and law enforcement communities. These are the communities empowered to classify gender/sex in death. Death certificates are public records, so newspapers and others will continue to look upon the “Sex” as labeled on the death certificate as authoritative.
Until something changes, the Trans community will continued to be treated in death as poorly as it is often treated in life.
Sean E. Enloe. M.D.