Honoring Dignity in Violent Times

The night had been busy, and stabbing calls usually sounded much worse over dispatch than the reality on-scene. It was easy to keep my eyes closed in the back of the fire engine as we rumbled to the call. The blue light of police cars illuminated the open front door. I got to her first, following a trail of blood down the narrow hallway to a back bedroom. A police officer knelt, holding pressure on her neck, his face white. Her eyes seemed ready to leap from her face, her brown skin tinged gray. A faint five o’clock shadow threatened the edges of her mouth. Opening the medical kit, I retrieved a trauma pad to slide under the officer’s gloved hands.

As we worked, she mouthed, sometimes rasped, for help. Her hands grasped at shirts, the wall, our hands, finally, fiercely, clutching my right hand. My partners worked a lifting tarp under her, asking if we were ready to roll him. The police officer, hands still pressed to her neck, quickly corrected them: “Her. She uses ‘her.’”

Three of us carried her down the hallway, to the waiting ambulance, the police officer still holding pressure. The paramedics met us with the gurney. As we slid her onto the stretcher, they asked how he had been stabbed. Again, the officer corrected, “She uses ‘she.’” The lead medic snorted, shook his head, and grunted a “whatever.” We rolled the gurney to the back of the ambulance as he rested two fingers lightly on the frame. I took the police officer’s place at her neck, climbing inside before the back doors banged shut.

INCREASING VIOLENCE TARGETING TRANSGENDER COMMUNITIES

This happened in 2018, a year after a different Portland, Oregon, stabbing. A White supremacist stabbed three passengers in the neck on a commuter train. They had intervened in his racist rant directed at two young passengers of color. One survived. Violence against systematically marginalized groups is on the rise,¹ coalescing into domestic instability fueled by dehumanizing political rhetoric and targeted legislation that limits access to voting and gender-affirming and reproductive health care. There are moments of desperation when defending the dignity of a dying person may be the only way to access our interconnected humanity. But, it is not enough. Indifference to violence intended to dehumanize must be met with collective urgency to challenge structural violence² with structural protections that affirm the inherent dignity that underpins our human rights.

Violence is concentrated in the intersections of oppressed identities.³ The year 2021 was the deadliest year on record for transgender people in America.⁴ Black transgender women accounted for two thirds of known victims of fatal violence against transgender people since 2013.⁴ In 2019, the American Medical Association declared an epidemic of antitransgender violence, especially against Black transgender women.⁵ Increasing threats of physical violence are paralleled by the record-setting introduction of 155 state-level antitrans bills by October 2022.⁶ This legislation seeks to codify trans people out of existence by criminalizing access to gender-affirming care, restricting participation in organized sports, implementing “bathroom bills,” and prohibiting the correction of identification documents.⁶ Only 16 states have banned “gay/trans panic” legal defense strategies that allow perpetrators of violence to blame their actions on their victim’s gender or sexuality.⁷

A healthy democracy demands equal access and full participation. Antitrans structural and sectarian violence restricts the ability of transgender people, especially Black trans women, to fully participate in society. The othering implicit in antitrans legislation kindles violence out of entitlement to civic participation and state protection for some, but not for all. Self-determination and bodily autonomy are rights, not privileges. Laws and policies that suggest otherwise create distinctions between groups that are antithetical to the social cohesion instrumental to peaceful democracy.

An increasingly bold and extreme sect of the far right seeks to further restrict the rights of systematically minoritized groups while simultaneously challenging the legitimacy of our democracy. The belief that the rules do not apply evenly, and to everyone, was echoed in the January 6th rallying cry to “take back our country.” It is evident in the violent protests against the perceived violation of bodily autonomy via mask mandates while the American Medical Association and pediatric care organizations are imploring the Justice Department to investigate threats of violence against providers and families of children seeking gender-affirming care.⁸ Fear of dispossession radicalizes rhetoric into violence. Ijeoma Oluo describes the “desperation, disappointment, despair, and rage”⁹ that accompanies fear of perceived irrelevance. An increase in interpersonal violence against trans people is augmented by organized extremist violence at Pride parades and drag queen story hours. A sense of entitlement to the benefits of society, while simultaneously denying them to others, is consistent with the realities of the history of our nation but not the spirit of the democratic experiment.

DIGNITY AS THE BEDROCK FOR STRUCTURAL CHANGE

Structural violence requires structural solutions. Affirming inherent human dignity is fundamental but, on its own, is not enough. Creating refuges for transgender people to access care, or exist without fear of violence, is critical. And still not enough. As public health professionals, we are asked to look to root causes to find solutions for ill health. Our collective ill health is in the weakness of our legislative bodies to draft unwavering protections of the right to self-determination for all people. Only 54% of lesbian, gay, bisexual, transgender, queer plus (LGBTQ+) people live in a state where their gender identity is protected under hate crime laws.¹⁰ In an increasingly sectarian environment, the states have proven they are not honest protectors of human rights, and federal legislation is needed to protect the rights to bodily autonomy and self-determination. Furthermore, there must be federal action to improve consistency and effectiveness in existing hate crime legislation that accounts for motivations in increasing antitrans violence.

In a democracy, the power of our institutions derives from civic participation. Though it is necessary to establish political power to restore the capacities limited by violence, this same violence isolates the communities it targets. Healthy People 2030 lists “social cohesion” under social and community determinants of health.¹¹ This collective efficacy hinges on community trust and solidarity, guiding community members to follow social norms that result in lower rates of neighborhood violence and improved health.¹¹ As trust builds social cohesion, it, in turn, highlights our interdependence. In this interdependence is our collective fate as a democracy. Social cohesion reveals our shared liberation from structures that oppress us all when they oppress any of us.

Former United Nations Secretary General Ban Ki-moon declared peace dependent on the recognition of human “dignity, rights and capacities” for all people.¹² Our ability to create fully democratic institutions relies on our collective capacity that emerges from understanding that we are all diminished until we are all free. The trust required to build social cohesion begins with believing in each other’s right to dignity. In the face of growing structural violence, concern over dignity may seem meek. But honoring dignity is not nothing. In fact, it could be everything. Allowing someone their full self in turn allows us our full selves. We dignify ourselves when we dignify others.