A Response to "Philosophical Malpractice"

Or: How to Spot Philosophers Who Should Maybe Stick to Trolley Problems

Look, I get it. Philosophy can be hard. You spend years pondering whether chairs exist, arguing about zombies, and trying to figure out if a ship is still the same ship after you replace all its parts. So when you venture into the real world of medical ethics and constitutional law, things can get a bit... confused.

Which brings us to Daniel Kodsi and John Maier's "Philosophical Malpractice" - an essay that proves sometimes the real philosophical malpractice is the philosophy we practice along the way.

These distinguished thinkers have discovered, and hold onto your hats folks, that if you cut off a hawk's wings, not only can it not fly, but it is no closer to becoming a cheetah! Revolutionary stuff. Even more groundbreaking: they've decided this is somehow analogous to providing medical care to trans youth. Because nothing says "rigorous philosophical analysis" like comparing evidence-based medical treatment to animal mutilation.

But hey, let's give them the benefit of the doubt. Maybe there's a sophisticated argument hiding under all those tortured metaphors and selective outrage. Let's examine their claims with the seriousness they deserve...

Examining the Hawk Metaphor

Kodsi and Maier open their essay with a striking metaphor: cutting off a hawk's wings to make it more like a cheetah. They argue this creates disability rather than similarity, establishing a framework where medical interventions that alter typical development are inherently harmful. However, this metaphor fundamentally mischaracterizes gender-affirming care and reveals a misunderstanding of both medical ethics and the lived experiences of transgender individuals.

The metaphor fails on multiple levels. First, it assumes that all deviations from species-typical development constitute harm, a claim that medical practice routinely contradicts. Second, it frames transgender identity as an arbitrary desire to "become" something else, rather than recognizing it as an aspect of human diversity. Third, and most critically, it ignores the extensive evidence that gender-affirming care, when medically indicated, improves rather than harms functioning and well-being.[1]

[1]: See Coleman, E., et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1-S259. https://pubmed.ncbi.nlm.nih.gov/36238954/

Natural Function and Medical Intervention

The authors invoke evolutionary biology to argue that disrupting "normal sexual development" constitutes harm by definition. They write: "animals of either sex that lack the means characteristic of their sex to reproduce are only like animals of the other sex by an artificial and myopic standard." This argument commits the naturalistic fallacy, wherein one is conflating what is natural with what is good or desirable. Natural does not always mean good or desirable.

Medical practice routinely intervenes in "natural" processes to improve health and well-being. We correct vision with glasses, regulate insulin in diabetics, replace calcified heart valves, repair cleft palates, and provide growth hormones to children with deficiencies. The authors themselves acknowledge that blocking puberty is acceptable for precocious puberty, thereby revealing that their objection isn't to interfering with natural development per se, but specifically to interventions that support transgender individuals.

Furthermore, their evolutionary argument ignores that human well-being extends far beyond reproductive capacity. Many individuals choose not to reproduce, use contraception, or undergo sterilization procedures for various reasons. The reduction of human flourishing to reproductive function represents a narrow and contestable view of human life. The fact that they concede that puberty blockers are acceptable for precocious puberty, but not for a trans child, is the loose thread that unravels their entire argument.

The Gamete Fallacy: Confusing Function with Personhood

Perhaps the most fundamental flaw in Kodsi and Maier's analysis is their reduction of human identity and well-being to reproductive function. Their entire argument rests on the premise that trans people are trying to "become" the opposite sex in some complete biological sense, and failing because they cannot produce different gametes. This is a strawman of goliath proportions.

The authors write that "a male without functioning testes may be like a female in that very respect, it is crucially unlike a healthy female in lacking a functioning gonad." But this completely misses the point of gender-affirming care. Trans people aren't seeking treatment under the delusion that they'll develop the ability to produce different gametes. They're seeking to:

• Alleviate gender dysphoria
• Align their physical characteristics with their gender identity
• Improve their mental health and overall functioning
• Exercise autonomy over their own bodies
• Live authentically in society

If trans people had access to some magical intervention that could completely transform every cell in their body, many would likely choose it, some may not. Non-binary individuals might choose various points between or outside the binary. But that's not the world we live in. In reality, we work with the medical tools available to help people live their best lives.

The authors' obsession with reproductive function reveals a worldview that places biological capability over personhood, agency, and well-being. By this logic, post-menopausal women or men with vasectomies have somehow diminished their sex-based essence. It's an impoverished view of human life that reduces us to our reproductive organs.

They may try to overlap this point by retreating to their naturalistic fallacy, but as we already know, that is not defensible position they think it is due to their own contradiction of it. “But there is nuance there you are obviating” will be their rebuttal, I am sure; and a reasonable one. The problem is that no matter how nuanced a view you take on that premise, the fallacy still holds. To cling to that waving the flag of ‘nuance’ is to contradict your own principles and values.

Moreover, their framing implies that trans people are confused about biological reality. This is demonstrably false. Trans individuals are typically acutely aware of their biology than most others, and that is often the source of their dysphoria. Medical transition isn't about denying biological reality; it's about modifying what can be modified to improve quality of life.

The real question isn't "Can medical intervention make a male into a 'complete' and ‘healthy’ or ‘functional’ female in every way?" but rather "Can medical intervention help this person live a healthier, more authentic life?" The answer, supported by extensive research, is yes.[2] And as we know, a woman without uterus, ovaries, and/or breasts is still a woman. Just as we know that a man without testicles or even any reproductive organs at all, is still as much a man as any other. Because our bodies do not determine how much of a woman or man or human being we are - we do.

[2]: See van de Grift, T. C., et al. (2017). Effects of medical interventions on gender dysphoria and body image: A follow-up study. Psychosomatic Medicine, 79(7), 815-823. https://pubmed.ncbi.nlm.nih.gov/28319558/

The Skrmetti Case and Constitutional Analysis

The authors' discussion of United States v. Skrmetti misrepresents both the legal arguments and the medical facts at issue. They claim the Supreme Court correctly held that Tennessee's SB1 does not classify based on sex. However, this interpretation ignores how the law explicitly creates different treatment regimes based on the sex assigned at birth.

When the authors state that "American states are free to stop doctors from putting psychologically distressed children on a path to sterility and anorgasmia," they engage in several misrepresentations:

First, they frame all transgender youth as merely "psychologically distressed," ignoring diagnostic criteria for gender dysphoria. Second, they present sterility as an inevitable outcome, when fertility preservation options exist and not all treatments affect fertility. Finally, they ignore the extensive evaluation process required before any medical interventions.

The reality is that SB1 permits identical medical treatments for cisgender youth while banning them for transgender youth, a distinction based explicitly on sex assigned at birth. The majority justices did quite some tap dancing and decorated their ruling quite a bit to distract from this fundamental point.

The primary fallacy here is loaded language (also called "poisoning the well" or "appeal to emotion"). By framing transgender youth as merely "psychologically distressed children" and gender-affirming care as putting them "on a path to sterility and anorgasmia," Kodsi and Maier are using emotionally charged language to prejudice the reader against the treatment before any actual argument is made.

This is combined with a strawman fallacy - they're misrepresenting what gender-affirming care actually involves and ignoring all the evidence and data surrounding it that inconveniently contradicts their strawman.

There's also an element of cherry-picking or selective evidence - focusing exclusively on potential negative outcomes while completely ignoring the documented benefits of treatment.

By using emotionally loaded language like 'psychologically distressed children' and 'path to sterility,' the authors engage in poisoning the well—prejudicing readers against the treatment through word choice rather than argument. This rhetorical manipulation substitutes fear for factual analysis.

Analyzing the Yale Philosophers' Brief

Kodsi and Maier spend considerable effort attacking the amicus brief filed by Yale philosophers, particularly their "decompositional strategy." The Yale philosophers argued that Tennessee's law can be reformulated to show its sex-based classification: "Female minors may not access medical interventions to masculinize their features, even though male minors can use those same treatments."

The authors counter with examples like "Don't kill anyone" or "Don't commit incest," arguing these could similarly be decomposed into person-specific rules. However, this response reveals a fundamental misunderstanding of constitutional law.

Here Kodsi and Maier made a category error while missing the point (probably intentionally so), and responded as if this were a general philosophical claim about the nature of all laws, which is fundamentally the wrong framework. This is specifically a legal argument about Equal Protection analysis, not the nature of all laws. It's like if someone said "This key opens this specific lock" and they responded "Well, any piece of metal could theoretically be called a key!" Technically correct but misses the point, and any piece of metal is not necessarily a key.

Second, they commit a false equivalence fallacy. Their examples actually undermine their point. Laws against murder or incest are "generally applicable," meaning they apply to everyone equally regardless of protected characteristics like race, sex, or religion. Tennessee's SB1, by contrast, explicitly treats individuals differently based on their sex assigned at birth. This is precisely the type of classification that Equal Protection analysis is designed to identify. By treating these fundamentally different types of laws as equivalent, Kodsi and Maier reveal they either don't understand or are deliberately ignoring how constitutional analysis works.

Third, the authors misleadingly characterize the Yale philosophers' argument as claiming the classification is "illicit" or automatically unconstitutional. In reality, the amici merely argued that the law classifies on the basis of sex and therefore requires heightened scrutiny, which is a higher level of judicial review. This is basic constitutional law: certain classifications trigger stricter review, but aren't necessarily invalid. By misrepresenting this nuanced legal argument as an absolutist claim, Kodsi and Maier reveal either their misunderstanding of constitutional doctrine or their willingness to distort their opponents' positions.

It's a bit like criticizing a cardiac surgeon's use of a scalpel by pointing out that butter knives also cut things. Sure, that's technically true, but it completely misses the specific purpose and context of the tool being used.

The False Dichotomy of Medical Treatments

Though this may be the shortest section, it is perhaps the most revealing section as it addresses why treating gender dysphoria differs from treating conditions like precocious puberty or hirsutism. The authors claim that only gender dysphoria treatment involves "indulging" a "serious mistake" and making children "lifelong medical patients." I hope you can see where this is going already, as they prefaced their entire argument here with value-laden judgments.

This characterization is both inaccurate and revealing of bias:

1. Medical necessity: Gender dysphoria is a recognized medical condition with established treatment protocols. Characterizing evidence-based treatment as "indulging" an error reveals prejudice, not philosophical rigor.
2. Lifelong treatment: Many medical conditions require ongoing treatment: diabetes, thyroid conditions, and yes, precocious puberty. Singling out transgender care as problematic for requiring continued treatment is arbitrary.
3. "Error" claim: The authors assert that transgender identity is based on "error" without evidence. This contradicts extensive research on gender identity development and the persistence of transgender identity.[3]

[3]: See Steensma, T. D., et al. (2013). Factors associated with desistence and persistence of childhood gender dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582-590. https://pubmed.ncbi.nlm.nih.gov/23702447/

Addressing Academic Freedom and Intellectual Integrity

The authors dedicate significant space to attacking academics who support transgender rights, suggesting they lack "intellectual-cum-aesthetic judgment" and are motivated by cowardice rather than conviction. This ad hominem approach undermines their philosophical arguments.

Their claim that "it is obvious that there are no male women" and that denying this constitutes intellectual failure ignores the complex philosophical, biological, and social science literature on sex and gender. Dismissing decades of scholarship across multiple disciplines as "cowardice" or "feigned confusion" is itself a failure of intellectual engagement.

The authors particularly criticize academics for not answering whether "there are male women," presenting this as a simple question with an obvious answer. However, this framing itself begs the question by assuming that "male" and "woman" are simple, uncontested categories rather than terms whose definitions are precisely what's under discussion.

Here's how the question-begging works: When Kodsi and Maier demand academics answer whether "there are male women," they're already assuming that:

1. "Male" and "female" are simple, binary biological categories with clear boundaries
2. "Man" and "woman" are categories that must perfectly align with "male" and "female"
3. These categories are more fundamental than personal identity or social recognition

But these are precisely the claims under dispute! It's like asking "Have you stopped beating your kids?" The question assumes something (that you beat your kids) that may not be true. Similarly, their question assumes a simplistic sex/gender framework that much of modern scholarship challenges.

The actual scholarly debate involves complex questions like:

• How do we define sex when people can have XXY chromosomes, androgen insensitivity, or other variations?
• Should social categories like "woman" be based solely on biology, social roles, self-identification, or some combination?
• How do we account for the documented existence of gender diversity across cultures and throughout history?

By framing the question as having an "obvious" answer, Kodsi and Maier aren't engaging in good faith philosophical inquiry, they're demanding others accept their premises or be labeled intellectual cowards. That's not philosophy; it's dogma dressed up in academic language.

Statistical Misrepresentation and Selective Evidence

When discussing the "6,000 teenage girls" who received mastectomies between 2017-2023, the authors fail to provide crucial context:

• This represents approximately 0.003% of the teenage population
• These procedures require extensive evaluation and multiple approvals
• Regret rates for gender-affirming surgeries are exceptionally low (around 1%)[4]
• No comparison is made to rates of cosmetic surgeries in minors

The authors also invoke cases of transgender women in prisons without acknowledging that prison policies typically involve individual assessment and that the vast majority of transgender individuals pose no threat to others. Using extreme cases to argue against medical care for youth is a logical fallacy. In this case, this represents a hasty generalization fallacy, wherein one uses extreme or unrepresentative cases to draw conclusions about an entire group or practice.

This is intellectually dishonest for several reasons:

1. It assumes the extreme cases are representative of the whole
2. It ignores the safeguards and individual assessments already in place
3. It conflates entirely different issues (adult prison policy vs. youth medical care)
4. It uses fear rather than evidence to make their argument

By cherry-picking alarming anecdotes while ignoring the broader statistical reality, that gender-affirming care has high satisfaction rates and low regret rates, the authors reveal they're more interested in stoking fears than engaging with actual evidence.

[4]: See Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28(1), 13-20. https://pubmed.ncbi.nlm.nih.gov/26754056/

The Question of Harm

Throughout their essay, Kodsi and Maier assume that gender-affirming care constitutes harm without engaging with the extensive literature showing its benefits. They never address:

• Reduction in suicidality among youth receiving care[5]
• Improvements in mental health outcomes[6]
• High satisfaction rates and low regret rates
• The harm of denying treatment to those who need it

Their philosophical commitment to "natural development" blinds them to empirical evidence about actual well-being outcomes.

This represents more than simple cherry-picking. The authors engage in willful ignorance, deliberately avoiding engagement with contradictory evidence, while begging the question by assuming the very thing they need to prove (that gender-affirming care is harmful).

This is like a prosecutor arguing "Since the defendant is guilty, we don't need to examine any evidence of their innocence." They've decided gender-affirming care violates "natural development" and therefore must be harmful, so why bother looking at whether it actually helps people?

The philosophical malpractice here is profound: they've made their conclusion unfalsifiable. If you start with the premise that any deviation from "natural development" is harm by definition, then no amount of evidence showing improved mental health, reduced suicidality, or increased well-being can change your mind. You've insulated your position from empirical challenge.

This violates a fundamental principle of ethical philosophy: when making claims about human well-being, you must actually examine the effects on human well-being. Their philosophical commitment to "natural development" blinds them to empirical evidence about actual outcomes, thereby turning their philosophy into dogma rather than reasoned inquiry.

[5]: See Turban, J. L., et al. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725. https://pubmed.ncbi.nlm.nih.gov/31974216/
[6]: See Tordoff, D. M., et al. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2), e220978. https://pubmed.ncbi.nlm.nih.gov/35212746/

Conclusion: Philosophical Rigor Requires Empirical Engagement

Kodsi and Maier's "Philosophical Malpractice" ultimately fails as philosophical analysis because it:

1. Relies on contested premises presented as self-evident truths
2. Ignores relevant empirical literature
3. Commits logical fallacies while accusing others of doing so
4. Engages in ad hominem attacks rather than substantive argument
5. Misrepresents legal arguments and medical practices

True philosophical rigor requires engaging with the full complexity of issues, not dismissing inconvenient evidence or scholarship. The authors' insistence that transgender identity represents an "error" to be corrected, rather than an aspect of human diversity to be supported, reveals their analysis to be grounded in prejudice rather than principled philosophical inquiry.

What Kodsi and Maier have produced isn't philosophy, it's an essay espousing anti-trans ideology masquerading as rational discourse. They've decided their conclusion (trans people are making an "error") and worked backwards, cherry-picking arguments and ignoring contrary evidence. They accuse others of being captured by "trans ideology" while demonstrating textbook ideological thinking themselves: unfalsifiable premises, willful ignorance of evidence, and attacks on those who disagree.

The real philosophical malpractice lies not in supporting evidence-based medical care for transgender youth, but in using philosophical argumentation to obscure rather than illuminate important questions of human well-being, medical ethics, and constitutional rights.

As journalist Tim Weiner observed:

"Ideology is the enemy of intelligence. If you're an ideologue, you don't care what intelligence says; your mind is made up. Why be confused with facts?"

Kodsi and Maier have chosen ideology over intelligence, dogma over data, and prejudice over philosophical inquiry. That's not just bad philosophy, it's the abdication of philosophy itself.

Epilogue: The Real Philosophical Malpractice

So there we have it, folks. Kodsi and Maier have given us a solid lesson in how NOT to do applied philosophy. They've shown us that with enough academic jargon, you can dress up "I don't like trans people" as a philosophical position. They've demonstrated that if you selectively ignore evidence, misrepresent legal arguments, and attack your colleagues' integrity, you too can publish essays that get enthusiastically shared by anti-trans activists.

But here's the thing, and this is where the comedy becomes tragedy, real kids are suffering while these philosophers play their word games. Real families are being torn apart by laws that these "thought leaders" defend with their clever analogies about hawks and cheetahs. Real medical professionals are being prevented from providing evidence-based care because someone with a PhD thinks they know better than the entire medical establishment.

The authors end their piece lamenting that philosophy has been captured by "trans ideology." But the only thing that's been captured here is their ability to distinguish between rigorous philosophical argument and politically motivated sophistry. They're so busy defending their theoretical hawks that they can't see the actual human beings whose wings they're helping to clip.

Not to put too fine a point in this, but I would point out I am not a philosophy major, and even I managed to cite my sources and do my homework for this lay woman’s attempt at as serious an attempt at a philosophy rebuttal as I can muster right now. I most certainly am not afraid to engage with the breadth of the data and evidence out there, so why are they?

You want to know what philosophical malpractice looks like? It's using your Oxford education and MIT credentials to argue that trans kids should be denied medical care. It's wrapping transmisia in academic language and calling it principle. It's caring more about abstract concepts of "natural function" than about actual human suffering.

The inconvenient truth? When future philosophers look back on this moment, they won't be asking "How did so many academics fall for trans ideology?" They'll be asking "How did supposedly serious thinkers use their platforms to defend cruelty to children?"

And honestly? I don't think Kodsi and Maier are going to like the answer.

Because sometimes, folks, a hawk is just a hawk. And a bigot with a philosophy degree is still just a bigot.