Playing the game of law and healthcare – Non-binary people's access to and experiences of trans-specific healthcare in Finland

Abstract: For non-binary people the law is not securing trans-specific healthcare in Finland. The current regulation is built on understanding of gender as binary and according to the Act on Legal Recognition of the Gender of Transsexuals (563/2002) a person can be confirmed to belong to the “opposite gender” if she/he fulfils the preconditions. One of the requirements is a mental health diagnosis prior to a non-binary or a transgender person can receive gender-affirming care or have their legal gender recognised. Depending on the diagnosis a care-seeker may not receive all the treatment they need. The task of this thesis is to discover how non-binary people experience the accessibility of trans-specific healthcare and trans-specific healthcare itself in Finland as well how the Finnish law drafting material represents accessibility of trans-specific healthcare. The data consists of 13 interviews, and minutes of Parliament’s plenary sessions which are both analysed by using thematic analysis. As a theoretical starting point the Foucauldian concept of power is applied. According to the results, a starting point for the current regulation has been the historically dominant medical discourse portraying transgender people as mentally ill and highlighting a normative understanding of gender as binary. During the Parliament’s plenary sessions statements of importance of psychiatric expertise, abnormality of transgender people, and traditional values have been used for entitling medico-legal control over transgender people while ignoring self-determination entirely. Non-binary people’s access to the trans-specific healthcare is defined by unpredictability and arbitrariness of the healthcare system. The trans-specific healthcare itself is experienced as a game that a care-seeker has to survive as the healthcare system has the power to deny one’s treatment. Overall, encounters with healthcare professionals are defined by the uneven power structure that occurs during the process through healthcare professionals’ assumptions of gender as binary, and inappropriate and questioning behaviour towards care-seekers. Results show that the obstacles non-binary people face in Finland within trans-specific healthcare are tied up with healthcare system’s and professionals’ assumptions of gender as binary, the uneven power structure, the diagnosis criteria and the process as a game. The current regulation should be revised so that it is based on a self-determination of a person seeking gender-affirming care and/or legal gender recognition, and so that the medical and legal processes are not bound together. Further research is needed especially regarding experiences of non-binary and transgender youth of trans-specific healthcare and access to it.