I have reviewed the proposal. I am competent to do so for several reasons:
• I have graduate degrees in religious ethics (MA, UVA,1983), clinical ethics (MA, UVA,1994) and Public Health (MPH, UVA,2007 )
• I am professionally credentialed in health education (CHES, #16864)
• I have more than four decades’ advocacy leadership, and organizational leadership, in issues of sexual and gender minority (SGM) health, including
• served on advisory committee with Virginia Department of Health in issues of HIV/AIDS, SGM communities, 1994-2014, including participation in planning and research phases, assessment and implementation of findings of primary community based research with SGM communities
• participated in planning and research phases, assessment and implementation of findings, for groundbreaking transgender health research in Virginia (2005 – 2011)
• leadership roles with establishing education and advocacy committees, task forces and projects for SGM communities regarding human rights protections, anti-violence services, access to cultural competent services (with law enforcement agencies, with health care providers, with faith communities, with social services agencies, with schools, etc)
• leadership roles with establishing SGM youth programs in the Charlottesville/surrounding counties area
• leadership roles regarding SGM concerns with the University of Virginia
• leadership roles with the Ethics Section of the American Public Health Association
• attended and presented at many local regional, national and international meetings, conferences and sessions on issues of SGM values, issues, and concerns, and particularly in non-discrimination and violence prevention, human equitable access to services, and human rights protections

And have had the privilege of receiving awards for this leadership
• Serpentine Society (University of Virginia alumni organization), Outstanding Service Award, 2012
• Equality Virginia, Outstanding Virginian, 2012 (cited for work in health and human rights with LGBT and other Virginians)
• University of Virginia Equal Opportunity Programs Champion, 2009 (cited for work with increasing attention to organizational diversity)

My comments will be brief. I invite contact for any clarification, further discussion, or other inputs. Thank you.

First:
Contrary to some opinions evidence supports that the effort to examine and model treatment of transgender students in public elementary and secondary schools is a worthwhile endeavor.

Second:
The draft’s design fails scientifically, ethically, and operationally by failing to address the reality that effective guidance to protect and support a vulnerable group in the school system must also address how the other groups (of all other students and their parents/guardians, of teachers and other employees, etc.) will be protected and supported. These failures threaten the rationality, morality, and stability of the draft guidance.

Third:
Among other places these failures are found immediately in the glossary and definitions of the draft terminology.

For example:
the definition of ‘gender’ necessarily requires distinction – definitionally – against a genetic description of ‘sex’, for example as the World Health Organization does:
https://www.who.int/genomics/gender/en/#:~:text=(1)%20'Gender'%20describes,%2C%20health%20policy%2C%20and%20legislation. A definition of ‘sex’ must also be included since the term is used in many of the other definitions but is not here defined. We find no where in the document discussion of the important scientific, biological terms regarding gender.
Not including this important scientific information suggests that the model guidance is an ideological document intended to appease or indoctrinate rather than to support all members of schools’ communities.

For example:
there are no definitions of ‘detransitioning’ or ‘retransitioning’ which are being used by the most advanced SGM health agencies in the United States, including
The National LGBT Health Education Center of the Fenway Institute a private world class agency in Boston and the San Francisco Health Network of the San Francisco Department of Public Health a world class public health agency:
https://www.lgbtqiahealtheducation.org/wp-content/uploads/2018/03/Transgender_Health_Care_Detransitioning_and_Retransitioning.pdf
Therefore, the model’s definition of ‘transgender’ is scientifically, ethically and operationally inaccurate and unsound and threatens the dignity, safety, and well being of each and every student and their parents/guardians.
Not including this important clinical and health related information suggests that the model guidance is an ideological document intended to appease or to indoctrinate rather than to support all members of schools’ communities. In fact at various points in the document indoctrination appears to step forward that bespoils the model guidance.

Fourth:
The document avoids, or poorly discusses, manifold ethical issues and concerns that are of paramount importance.

For example:
Of paramount importance in every ‘breath’ of the model guidance – on paper and in implementation – must be ethically sound judgement. Ethically sound judgement requires consideration of all levels of experience of the guidance: how administrators, how teachers, how other workers, how students, and students in their manifold diversity, how parents/guardians, and others will experience the guidance. There is no evidence in the document of these considerations.
Another paramount issue for ethical inquiry is how the model guidance protects - or does not protect - each and every student from coercion(s). Coercion(s) to believe things about themselves or others that are harmful to themselves or others, and coercion(s) to behave in ways that are harmful to themselves or others. Discriminatory practices are a form of coercion. Bullying and other violence or threatened violence are a form of coercion. There are many other forms of coercion, including repression of inquiry, oppression of speech, failure to protect divergent points of view, and failure to ascertain and to protect valid informed consent and processes for achieving valid informed consent. Issues of coercion and consent at vexed and complicated at all times in health care systems, and should be, for the protection of human dignity and human rights. Recently in the United Kingdom issues of legal and ethical consent processing resulted in a high court ruling, discussed briefly in the British Medical Journal - https://www.bmj.com/content/371/bmj.m4699.full :

Children under 16 cannot consent to the use of puberty blockers for gender dysphoria unless they can understand the immediate and long term consequences of the treatment, which is unlikely, the High Court in London has ruled.1
Victoria Sharp, president of the Queen’s Bench Division, sitting with Lord Justice Lewis and Mrs Justice Lieven, said it was “highly unlikely” that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. She said that the judges were “very doubtful” that a child aged 14 or 15 could understand and weigh the long term risks and consequences of the administration of puberty blockers.

In the light of paramount ethical principles regarding ensuring non-coercion and ensuring valid consent the document’s many occasions of de-valuing, de-limiting, and at times dis-crediting/dis-enfranchising parents/guardians is ethically unsound, and may be legally unsound, not to mention objective harmful to some students. In one prominent instance the guidance explicitly advises that schools may – or should - lie to parents/guardians. Establishing lying as a moral guide in the school system is unethical and presents the school system as a threat to community morality. In another prominent instance the guidance invites the school system to act ‘in loco parentis’ regarding the student’s health and well being without consulting with the parents/guardians, and without social systems in place and ready to meet every need of the youth instead of the parents/guardians. This is morally and ethically ir-responsible. Furthermore even when the school system is acting ‘in loco parentis’ it is still ethically obliged to do nothing with the valid continuing consent of the youth. The guidance, as stated, show no interest in these paramount ethical concerns for consent.

For example:
there are no definitions of the protected human rights of all students, including the manifold particular individuals who are transitioning, who are detransitioning, who are retransitioning, who are nonconforming to sex assigned at birth, who are nonconforming to social norms of transitioning, who are nonconforming to social norms of SGM or other advocacy groups, who are nonconforming to social norms of a particular faith or moral community, who are conforming to the social norms of a particular faith or moral community, who are nonconforming to social norms of a particular school system or school community (including by conforming to the social norms of their family, faith or moral community).

In fact the definitions and various items in the model appear to reify inhumane and harmful social constructs at the same time as resisting as inhumane and harmful a culturally inherited ‘binary system’. In this way the model already appears profoundly outdated, as well as un-scientific, un-ethical, un-healthy and un-workable (as it is) - if the document intends to protect human dignity and rights. Despite the language in the document – “The key guiding principle of the model policies is that all children have a right to learn, free from discrimination and harassment” – there is no full discussion or operationalization of how the human dignity of each and every student who is cisgender affirming, non-transitioning, transitioning, detransitioning, retransitioning, nonconforming to social norms of transitioning, nonconforming to social norms of SGM or other advocacy groups, nonconforming to social norms of a faith or moral community, nonconforming to social norms of a particular school system or school community, conforming to the social norms of the family, faith or moral community, and other students will be protected – and moreover – be protected equally.

This raises serious Constitutional concerns as well as concerns for justice as well as calling into question the meaning of the document’s assertion of its purpose, that no student, anywhere, at any time will feel un-free to learn.

Fifth:
The guidance is especially muddy in matters that we know to be of primary importance to health and safety.

For example:
We know that biological systems – including at a genetic level – respond differently to environmental conditions. The field of research - epigenetics – is providing further clarification of the complexity of the biological/social/psychological human being including regarding gender. See for example: https://www.newsweek.com/transgender-people-gender-dysphoria-gene-variants-study-1486270
This inherent complexity - at the biological and genetic level - requires the utmost vigilance when school systems become involved in the supervision of medications.

How does the guidance ensure proper medical proper administration and use of any and all medications and treatments for transitioning, destransitioning, retransitioning and other students take while at school, in school functions, while under the supervision of the school system? How does the guidance ensure that no student provides their medications to other students? How does the guidance ensure that no student advocates that other students start of use their medication plan, their treatment plan, their transitioning/detransitioning/retransitioning plan? What is the school system’s responsibility to ensure valid continuing consent? What is the school system’s liability?

The guidance – which as stated above – may appear intended to appease or to indoctrinate rather than to support all members of schools’ communities – may also appear to do that at the risk of individuals’ health, safety and well being.

As stated above definitions in the guidance are already outdated, inaccurate, incomplete and unsatisfactory to protect the human dignity, human rights, non-coerced valid consent of each and every youth in the school system. And parts of the guidance appear infected by outdated, inaccurate, incomplete and unsatisfactory thinking in other harmful, not helpful, ways.

I do have other input but will stop here for now.

Respectfully,

Edward Strickler MA MA MPH CHES
104 Russell’s Way, Farmville VA
edwardnvirginia@hotmail.com