Quiet Quitting
The pathway to change that you have never heard about...
In 2022, the term “quiet quitting” emerged on social media, describing employees who fulfill their basic job duties but avoid going above and beyond. This trend was seen as a way to achieve better work-life balance, especially following the Great Resignation during the COVID-19 pandemic.
In 2023, a similar phenomenon began to be noticed within a smaller group of experts in pediatric gender medicine. These individuals observed evidence suggesting that “quiet quitting” was becoming a movement within the field of pediatric gender interventions.
To discuss this topic further, we interviewed two prominent figures in the field, to discuss this with the LGBT Courage Coalition.
How would you define quiet quitting?
Quiet quitting, in the context of pediatric gender medicine, refers to a growing trend of individuals, corporations, and policymakers gradually disengaging from the practice of medicalizing minors who experience gender distress. This involves implementing strategies to reduce the demand for such services and to increase safeguards against potential harms.
Many gender clinics, even in states still supportive of medicalization, have quietly ceased performing surgeries on minors. This shift can be attributed to several factors, including increased awareness of the irreversible and significant risks associated with these procedures, concerns about consent and liability, and growing public ambivalence about the appropriateness of such interventions, even in ‘blue’ states.
Quiet quitting is often implemented without public announcements or acknowledgments, reflecting a risk management approach. In some cases, hospital executives may make top-down decisions to gradually reduce medical interventions for minors without terminating services entirely. This can involve increasing oversight, safeguards, and internal processes to slow down the provision of these procedures.
Should quiet quitting be the goal or is it one of the options that we should be considering?
Quiet quitting is a pragmatic approach given the current cultural climate. The ethical and legal consequences of acknowledging the flaws in pediatric gender medicine are substantial. Liability insurance concerns are a significant factor driving this trend, as evidenced by health systems that have reduced services or closed gender clinics under pressure from insurers. However, these institutions also face the risk of being labeled as “transphobic” or “anti-LGBTQIA.”
Quiet quitting offers a way to reduce the number of harmed youth without publicly admitting wrongdoing or drawing attention. Even when directly questioned about closures, institutions often remain vague or refuse to comment.
Ideally, leaders in pediatric care, endocrinology, surgery, and psychology would acknowledge the lack of evidence supporting these interventions and publicly admit the potential for irreparable harm. They should endorse the thorough and reputable Cass Review and publicly condemn the harmful and unethical growth of pediatric gender medicine in the United States. The American Academy of Pediatrics could have taken a leading role by publishing a similar systematic review of the evidence.
Unfortunately, most organizations will likely choose the path of quiet quitting to avoid liability and public conflict. The courage to admit the harmful nature of these interventions is beyond the reach of many institutions.
How does quiet quitting fit within the other options?
Legislative regulations, often referred to as bans, are a top-down approach to curtailing the practice of medicalizing minors. These regulations, imposed by state legislatures, mandate the cessation of such interventions. In just two years, nearly half of the country has implemented these bans, effectively reducing the supply and, consequently, the demand for these services.
However, such legislation is not feasible in most remaining states for the foreseeable future. Attempts to implement these bans would likely be met with resistance from Democrats, who view them as extensions of Republican efforts and perceive concerns about these practices as political rather than medical.
In these states, the quiet quitting strategy is a more viable option. This bottom-up approach involves implementing nuanced strategies over time to eliminate or reduce both the supply and demand for these interventions.
What are the pressure points to getting quiet quitting to work?
Gender clinics and healthcare providers operate within a market-based system where medicalization services are considered a profit center. They provide these services when the direct and indirect benefits outweigh the costs. Currently, the calculus favors the benefits, which include both direct payments and indirect benefits like enhanced community goodwill. Costs are measured in terms of implementation and liability.
Efforts to characterize medicalization as a “right” and subject to “sex” discrimination laws are a legal strategy to increase the benefits of providing these services.
The pressure points in this model are factors that can alter the cost-benefit calculus, such as increasing implementation or liability costs or reducing demand, payments, or public goodwill. The growing risk of legal liability and public exposure is also a significant pressure point. In many cases, centers that have faced whistleblowers have subsequently closed or changed their practices.
What are other ways to facilitate quiet quitting?
Extended Statute of Limitations: Increasing the time period during which medical malpractice claims can be filed.
Comprehensive Informed Consent: Requiring written, signed informed consent from all legal guardians.
Stricter Scrutiny of Medical Necessity: Implementing stricter criteria for insurance coverage of medicalization services.
Coverage of Detransitioner Care: Providing coverage for care related to detransitioning.
Enhanced Oversight and Accountability: Establishing stronger policies for oversight, assessment, and monitoring.
Measures to Reduce Demand and Public Goodwill: Increasing education about the harms associated with these interventions, restricting marketing to minors, and limiting social transitions in schools.
How can you promote quiet quitting?
This will be the topic of our further exploration this month, including toolkits and materials. Please subscribe to find out more and share this post.
Excellent. "The courage to admit the harmful nature of these interventions is beyond the reach of many institutions." You seem to be providing people and organizations the way to opt out if they lack the courage to do it in a more vocal/public way. My daughter was medicalized without any treatment for her underlying comorbidities and distress, which of course follow her into her drug and surgery altered body. I wrote a book about it and write on Substack, so I have developed courage to speak up. That being said, I will take any and all strategies to help other parents and kids not medicalized gender identities. It is too late for my daughter and my family, but I still work for other kids and their families. Thank you for the work you do.
This is an important option, although certainly should not be the "goal" or the only option. We need to continue every means of preventing unnecessary medical interventions that cause harm. We need to change attitudes, bring awareness, stop medical malpractice and compensate all those who have been harmed.
That having been said, quietly walking back the care is a good option for many institutions afraid to admit they have been actively engaging in malpractice (makes sense from a risk perspective).
I think insurance companies are a key component here. They can slow this down by simply refusing to cover "care" that has no medical basis, or at least require a higher standard of proof. (Right now there is no standard of proof from what I can see; it's just "sure, if it relates to 'gender affirming care,' we'll cover it all!") Medicaid is included here. If life-saving medication can be denied to those with rare and deadly diseases (look up San Filippo Syndrome - experimental drugs were actually helping these children and then the funding ended) due to being "experimental," why are insurance companies covering the removal of healthy body parts and the interference with the delicate endocrine balance in healthy individuals simply because people want it?
On the other hand, all detransitioners deserve full and unquestioned coverage to repair the damage done to their bodies at every front. The insurance companies can then sue the doctors who caused the harm to recover the costs of these treatments.
While I hope we one day can point the finger at every single individual and entity that contributed to this horrific medical scandal and sick social experiment, assuring that nothing like this ever happens again (and that includes politicians, medical organizations, journalists, professors, etc.), for now I am happy for any strategy that helps prevent more vulnerable individuals from being harmed. If quiet quitting can keep some naive young people healthy, I'm all for it.