Recognition, freedom, and the assault on transgender existence

Recent efforts to withdraw federal funding from hospitals that provide gender-affirming care to transgender adolescents represent more than a controversial policy choice. They constitute an assault on the very conditions under which transgender people can exist as recognized members of the moral and political community. While such a move is indefensible from familiar ethical standpoints-utilitarian and deontological alike-it is from a Fichtean perspective that its deeper irrationality comes into view. Properly understood, this policy is not merely unjust or harmful; it is a denial of recognition that strikes at the heart of the state's purpose and undermines the intelligibility of healthcare as a public institution.

From a utilitarian standpoint, the policy fails in straightforward terms. The predictable consequences include increased psychological distress, higher rates of depression and suicidality among transgender youth, disruption of clinical care, and the withdrawal of trust from healthcare institutions. Even if one brackets contested empirical debates, the asymmetry is stark: the harms are concrete and concentrated, while the alleged benefits are speculative, diffuse, or symbolic. A policy that foreseeably increases suffering without demonstrable compensating gains cannot be justified by any plausible calculus of overall welfare.

From a deontological perspective, the policy fares no better. It instrumentalizes a vulnerable population for ideological ends, treating transgender adolescents not as ends in themselves but as means to a broader cultural or political agenda. By coercively restricting access to medically recognized forms of care-care sought by patients, families, and clinicians acting in good faith-it violates duties of respect, nonmaleficence, and professional integrity. Even on conservative Kantian grounds, such a policy cannot be universalized without contradiction: a healthcare system that selectively withholds care from disfavored identities undermines the very idea of equal moral standing.

These objections are decisive-but they remain incomplete. They describe what is wrong with the policy, not why it is fundamentally unintelligible as an act of state power. For that, we must turn to Fichte.

Johann Gottlieb Fichte's philosophy begins from a radical and demanding claim: freedom is not an inner possession but a social achievement. One becomes a self-a bearer of rights and responsibilities-only through relations of mutual recognition. To be recognized is not merely to be tolerated or acknowledged as a biological organism; it is to be affirmed as a rational being whose agency, self-understanding, and embodied existence count within a shared normative order.

For Fichte, the state exists to secure the conditions under which such recognition is possible. Its legitimacy does not derive from tradition, sovereignty, or majoritarian preference, but from its role as the institutional guarantor of reciprocal freedom. When the state acts in ways that deny recognition to a class of persons, it does not merely err morally-it contradicts its own justification.

Healthcare occupies a privileged place in this framework. Because freedom must be embodied to be real, and because illness, distress, and bodily alienation directly threaten agency, access to healthcare is not a discretionary social good. It is a condition of participation in ethical life. To deny or sabotage healthcare is to undermine the material basis of recognition itself.

Gender-affirming care for adolescents-whatever one's position on its clinical contours-functions within this ethical structure as a response to a threat to embodied agency. Transgender adolescents often experience profound forms of bodily and social dissonance that impair their ability to act, relate, and recognize themselves as agents among others. Clinical care in this context is not about indulgence or preference; it is about stabilizing the conditions under which a person can exist intelligibly to themselves and to the social world.

When the state moves to defund hospitals that provide such care, it is not neutrally regulating medicine. It is declaring that certain forms of embodied selfhood are unworthy of institutional support. It is saying, in effect: you may exist biologically, but your way of existing will not be recognized by the structures that sustain freedom for others. This is not a mere policy disagreement. It is a withdrawal of recognition.

From a Fichtean standpoint, the irrationality of the policy lies in its internal contradiction. The state claims to act in the name of protecting children, preserving medical integrity, or safeguarding public values-yet it does so by destabilizing the very institutions tasked with sustaining embodied agency. It weaponizes healthcare funding to enforce an ideological boundary around who counts as a legitimate subject of care.

But a healthcare system cannot function on such terms. Once recognition becomes conditional on conformity to a sanctioned identity, healthcare ceases to be an institution of freedom and becomes an instrument of exclusion. The result is not moral clarity but institutional incoherence: clinicians are placed in impossible positions, patients are rendered suspect, and trust-the lifeblood of medical practice-is corroded.

For Fichte, institutions must be universal in form even when their applications are particular. A state that secures healthcare for some while structurally denying it to others based on identity abandons universality altogether. It no longer operates as the visible body of freedom, but as an apparatus of differentiation and control.