Should taxpayers have to pay for a convicted murderer's sex change?

In a potentially groundbreaking ruling, a federal judge has ordered Massachusetts to let a transgender prisoner undergo a sex-change operation — and make taxpayers foot the bill. Prison officials oppose the surgery, worrying that they won't be able to keep a male-turned-female inmate safe in an all-male prison after a sex change. But Chief U.S. District Judge Mark Wolf said that was a poor excuse. Wolf based his ruling on recommendations from Department of Correction doctors, who said the procedure was the "only form of adequate medical care" for the inmate, Michelle Kosilek. Is this really a good use of taxpayer money? Here, a brief guide:

Who is Michelle Kosilek?

In 1993, Kosilek, who then went by Robert, was convicted in the 1990 murder of his wife, Cheryl Kosilek. Also in 1993, Kosilek officially changed his name to Michelle. Diagnosed with severe gender identity disorder, Kosilek has been living as a woman in an otherwise all-male prison in Norfolk, Mass., for the last two decades.

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What is gender-identity disorder, exactly?

It's a condition in which a person's physical gender is out of sync with the one he or she identifies with — in this case, Kosilek was born male, but feels like he's a woman. The cause is unknown, and not all people who have this rare disorder are affected the same way, according to the National Institutes of Health. Some deal with it by cross-dressing, and many experience depression and anxiety. Adults who have gender-identity disorder often want to be rid of their genitals. Some respond to individual or family therapy. Others resort to hormones and sex reassignment surgery, although even then they sometimes continue to have identity issues.

What does Kosilek want?

Kosilek says she needs a sex-change operation, and argues that the state has a duty to provide it. "Everybody has the right to have their health care needs met, whether they are in prison or out on the streets," she says. "People in the prisons who have bad hearts, hips, or knees have surgery to repair those things. My medical needs are no less important or more important than the person in the cell next to me." Kosilek first sued the Department of Corrections 12 years ago. Judge Wolf ruled two years later that Kosilek should receive treatment, but he didn't order the operation, which can cost $20,000. Kosilek has been receiving hormones, but says that's not enough, and sued again in 2005, arguing that an operation was not a choice, but a medical necessity.

Why did the judge change his mind?

Kosilek has attempted self-castration, and twice tried to commit suicide, according to court documents. Wolf now says that even though his ruling is "unprecedented," the surgery is the only way doctors see to adequately treat Kosilek's condition, and that denying her request would amount to a violation of the Eighth Amendment's prohibition on cruel and unusual punishment. Wolf, who was appointed to the bench in 1985 by Ronald Reagan, writes that the government can't deny an inmate necessary medical treatment just because it is controversial and "unpopular."

Has Wolf's ruling invited a backlash?

Yes. Sen. Scott Brown (R-Mass.) blasted it as an "outrageous abuse of taxpayer dollars." But the way Judge Wolf sees it, the state has no choice. "It may seem strange that in the United States citizens do not generally have a constitutional right to adequate medical care," Wolf wrote in his decision, "but the Eighth Amendment promises prisoners such care." Sen. Brown urged the state to appeal, but the Department of Corrections declined to say what its next move would be. If Kosilek does have the surgery, the case could wind up in court again — to decide whether the state will have to transfer Kosilek to a women's prison.

Sources: Associated Press, NIH, NPR, Wall Street Journal