{"id":145939,"date":"2026-03-13T16:48:36","date_gmt":"2026-03-14T00:48:36","guid":{"rendered":"https:\/\/xira.com\/p\/2026\/03\/13\/fourth-circuit-removes-autonomy-from-adults-in-healthcare-ban-decision\/"},"modified":"2026-03-13T16:48:36","modified_gmt":"2026-03-14T00:48:36","slug":"fourth-circuit-removes-autonomy-from-adults-in-healthcare-ban-decision","status":"publish","type":"post","link":"https:\/\/xira.com\/p\/2026\/03\/13\/fourth-circuit-removes-autonomy-from-adults-in-healthcare-ban-decision\/","title":{"rendered":"Fourth Circuit Removes Autonomy From Adults In Healthcare Ban Decision"},"content":{"rendered":"

One of the best things about being an adult is that you\u2019re finally able to make decisions for yourself about what you\u2019d like to do with your life and your body. Unless, of course, you\u2019re an adult living in West Virginia and have a BL\u00c5HAJ somewhere in your room. <\/p>\n

The Supreme Court\u2019s decision in Skrmetti<\/a><\/em> held that children could be denied puberty blockers and hormone therapy without violating the Equal Protection Clause. The rationale for the decision was heavy with the law\u2019s majestic equality \u2014 cisgender children would still have those treatment options available even if trans children didn\u2019t. The silver lining appeared to be that trans kids denied care could just wait until they were adults to get the treatment they needed. Unfortunately, Sotomayor\u2019s prediction that the decision \u201cdo[es] irrevocable damage to the Equal Protection Clause and invite[s] legislatures to engage in discrimination by hiding blatant sex classifications in plain sight\u201d was spot on. Reuters<\/a> has coverage:<\/p>\n

\n

A U.S. appeals court on Tuesday upheld West Virginia\u2019s ban on Medicaid coverage for gender-affirming surgeries, the latest victory for Republican-led states seeking \u200bto curb the procedures amid an ongoing national battle over transgender rights.<\/p>\n

In a unanimous ruling, a three-judge panel of the 4th U.S. \u200cCircuit Court of Appeals in Richmond, Virginia, overturned a judge\u2019s decision that the 2004 statute violated anti-discrimination protections under two federal laws as well as the U.S. Constitution\u2019s promise of equal protection under the law.<\/p>\n<\/blockquote>\n

Following the same hate the sinner not the sin<\/s> specific procedures rather than specific individuals rationale, the decision extends coverage denial to adults. <\/p>\n

The strangest thing about the decision is that it, as Erin in the Morning<\/a> points out, turns the state\u2019s desire to \u201cencourag[e] citizens to appreciate their sex\u201d and \u201cnot become disdainful of it\u201d into a proper and constitutional aim. Anyone who actually gives a damn about personal liberty knows to be on high alert whenever a state tries to get away with with compelled \u201cenjoyment\u201d or \u201cappreciation.\u201d The practical question becomes what to do with the citizens who refuse \u201cencouragement.\u201d Erin runs through some of the practicalities:<\/p>\n

\n

If it is not unconstitutional to \u201cencourage citizens to appreciate their sex,\u201d the implications extend to virtually every area of transgender life. Are gender marker bans on IDs legal because carrying correct documents could \u201cdiscourage\u201d transgender people from \u201cappreciating their sex?\u201d Are drag bans and bans on cross-gender clothing legal because the state has an interest in encouraging the appreciation of sex? Could a state compel transgender people into conversion therapy, reasoning that it is not discriminatory because it targets a medical diagnosis rather than transgender status\u2014and that the goal is simply to \u201cencourage them to appreciate their sex?\u201d <\/p>\n<\/blockquote>\n

The ruling stands as proof of concept that autonomy and self-determination rights can be stripped away from adults. Right now it is West Virginia. How long will it take for Florida or Texas to adopt the \u201csex appreciation\u201d rationale? Or until the rationale gets applied to other protected groups? Rough time for liberty. <\/p>\n

West Virginia Can Ban Medicaid Coverage For Gender-Affirming Surgery, US Court Rules<\/a> [Reuters]<\/p>\n

4th Circuit Rules That States Can Compel Trans Adults To \u201cAppreciate Their Sex\u201d Via Care Bans<\/a> [Erin In The Morning]<\/p>\n

Earlier<\/strong>: Sam Alito Provides Breath Of Fresh Air In Transgender Care Case. Vile, Bigoted Fresh Air, But Fresh Air Nonetheless<\/a><\/p>\n

\n
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<\/figcaption><\/figure>\n

Chris Williams became a social media manager and assistant editor for Above the Law in June 2021. Prior to joining the staff, he moonlighted as a minor Memelord\u2122 in the Facebook group\u00a0Law School Memes for Edgy T14s . \u00a0He endured Missouri long enough to graduate from Washington University in St. Louis School of Law. He is a former boat builder who is learning to swim and is interested in rhetoric, Spinozists and humor. Getting back in to cycling wouldn\u2019t hurt either. You can reach him by email at\u00a0cwilliams@abovethelaw.com <\/a>and by tweet at\u00a0@WritesForRent<\/a>.<\/strong><\/p>\n

The post Fourth Circuit Removes Autonomy From Adults In Healthcare Ban Decision<\/a> appeared first on Above the Law<\/a>.<\/p>\n

One of the best things about being an adult is that you\u2019re finally able to make decisions for yourself about what you\u2019d like to do with your life and your body. Unless, of course, you\u2019re an adult living in West Virginia and have a BL\u00c5HAJ somewhere in your room. <\/p>\n

The Supreme Court\u2019s decision in Skrmetti<\/a><\/em> held that children could be denied puberty blockers and hormone therapy without violating the Equal Protection Clause. The rationale for the decision was heavy with the law\u2019s majestic equality \u2014 cisgender children would still have those treatment options available even if trans children didn\u2019t. The silver lining appeared to be that trans kids denied care could just wait until they were adults to get the treatment they needed. Unfortunately, Sotomayor\u2019s prediction that the decision \u201cdo[es] irrevocable damage to the Equal Protection Clause and invite[s] legislatures to engage in discrimination by hiding blatant sex classifications in plain sight\u201d was spot on. Reuters<\/a> has coverage:<\/p>\n

\n

A U.S. appeals court on Tuesday upheld West Virginia\u2019s ban on Medicaid coverage for gender-affirming surgeries, the latest victory for Republican-led states seeking \u200bto curb the procedures amid an ongoing national battle over transgender rights.<\/p>\n

In a unanimous ruling, a three-judge panel of the 4th U.S. \u200cCircuit Court of Appeals in Richmond, Virginia, overturned a judge\u2019s decision that the 2004 statute violated anti-discrimination protections under two federal laws as well as the U.S. Constitution\u2019s promise of equal protection under the law.<\/p>\n<\/blockquote>\n

Following the same hate the sinner not the sin<\/span> specific procedures rather than specific individuals rationale, the decision extends coverage denial to adults. <\/p>\n

The strangest thing about the decision is that it, as Erin in the Morning<\/a> points out, turns the state\u2019s desire to \u201cencourag[e] citizens to appreciate their sex\u201d and \u201cnot become disdainful of it\u201d into a proper and constitutional aim. Anyone who actually gives a damn about personal liberty knows to be on high alert whenever a state tries to get away with with compelled \u201cenjoyment\u201d or \u201cappreciation.\u201d The practical question becomes what to do with the citizens who refuse \u201cencouragement.\u201d Erin runs through some of the practicalities:<\/p>\n

\n

If it is not unconstitutional to \u201cencourage citizens to appreciate their sex,\u201d the implications extend to virtually every area of transgender life. Are gender marker bans on IDs legal because carrying correct documents could \u201cdiscourage\u201d transgender people from \u201cappreciating their sex?\u201d Are drag bans and bans on cross-gender clothing legal because the state has an interest in encouraging the appreciation of sex? Could a state compel transgender people into conversion therapy, reasoning that it is not discriminatory because it targets a medical diagnosis rather than transgender status\u2014and that the goal is simply to \u201cencourage them to appreciate their sex?\u201d <\/p>\n<\/blockquote>\n

The ruling stands as proof of concept that autonomy and self-determination rights can be stripped away from adults. Right now it is West Virginia. How long will it take for Florida or Texas to adopt the \u201csex appreciation\u201d rationale? Or until the rationale gets applied to other protected groups? Rough time for liberty. <\/p>\n

West Virginia Can Ban Medicaid Coverage For Gender-Affirming Surgery, US Court Rules<\/a> [Reuters]<\/p>\n

4th Circuit Rules That States Can Compel Trans Adults To \u201cAppreciate Their Sex\u201d Via Care Bans<\/a> [Erin In The Morning]<\/p>\n

Earlier<\/strong>: Sam Alito Provides Breath Of Fresh Air In Transgender Care Case. Vile, Bigoted Fresh Air, But Fresh Air Nonetheless<\/a><\/p>\n

\n
\"\"
<\/figcaption><\/figure>\n

Chris Williams became a social media manager and assistant editor for Above the Law in June 2021. Prior to joining the staff, he moonlighted as a minor Memelord\u2122 in the Facebook group\u00a0Law School Memes for Edgy T14s . \u00a0He endured Missouri long enough to graduate from Washington University in St. Louis School of Law. He is a former boat builder who is learning to swim and is interested in rhetoric, Spinozists and humor. Getting back in to cycling wouldn\u2019t hurt either. You can reach him by email at\u00a0[email\u00a0protected] <\/a>and by tweet at\u00a0@WritesForRent<\/a>.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

One of the best things about being an adult is that you\u2019re finally able to make decisions for yourself about what you\u2019d like to do with your life and your body. Unless, of course, you\u2019re an adult living in West Virginia and have a BL\u00c5HAJ somewhere in your room. The Supreme Court\u2019s decision in Skrmetti […]<\/p>\n","protected":false},"author":3,"featured_media":145940,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[16],"tags":[],"class_list":["post-145939","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-above_the_law"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/xira.com\/p\/wp-content\/uploads\/2026\/03\/Chris-Williams-2025-thm88r.jpg?fit=512%2C288&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/posts\/145939","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/comments?post=145939"}],"version-history":[{"count":0,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/posts\/145939\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/media\/145940"}],"wp:attachment":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/media?parent=145939"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/categories?post=145939"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/tags?post=145939"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}