Guest Contributors: Kendrick T. Clack
and Jasmine Perkins

A new wave of anti-trans legislation is sweeping across the United States, and Texas is leading the charge. One of the most alarming bills under consideration is House Bill 3817 (HB3817), which seeks to make “gender identity fraud” a state jail felony. If passed, this law could have devastating consequences for transgender individuals, criminalizing them simply for identifying as their true selves.

Under this proposed law, anyone who knowingly makes a “false or misleading” statement about their biological sex to a government agency or employer could face felony charges. This means that a trans person could be prosecuted for updating their driver’s license, applying for a job, or even filling out medical forms. The bill is dangerously vague, leaving room for selective enforcement, which could open the door for state-sanctioned discrimination, harassment, and job loss. If enacted, HB3817 would take effect on September 1, 2025, adding yet another legal barrier to the already hostile climate for transgender people in Texas.

This bill is part of a more significant national effort to police gender identity and restrict trans rights, further marginalizing an already vulnerable population. Critics argue that HB3817 isn’t about fraud! Instead, it’s about erasing trans identities and making everyday life more dangerous for transgender people. Supporters suggest that such laws are needed to protect women and express concerns that misrepresentation of one’s biological sex could lead to uncomfortable or potentially unsafe situations, particularly in environments like workplaces or public facilities.

Beyond the legal implications, this law could drive LGBTQ+ individuals and businesses out of Texas, harming the state’s economy and reputation. It also sets a dangerous precedent for other states, paving the way for even more extreme anti-trans legislation across the country. While legal challenges are likely, the fear and uncertainty created by this bill could have immediate and severe consequences for transgender Texans.

So, what does this mean for nurses? As frontline healthcare providers, we will be directly impacted by HB3817 in how we care for transgender patients and uphold our professional and ethical responsibilities. This imposition could create moral distress. Moral distress arises when a healthcare professional feels constrained from acting on their moral convictions, leading to feelings of powerlessness and potentially causing emotional, physical, and psychological harm (Medical News Today, 2023).

We must not forget that transgender patients are humans that have families. There are millions of transgender individuals and couples in the United States, many of whom have children. The passage of such a bill is unethical and has collateral consequences. These are legally and socially imposed penalties that automatically occur upon a person’s conviction of a felony and are imposed in addition to the sentence enacted by the court (American Bar Association 2004).

Felony convictions impact an individual’s ability to flourish. Such conviction can limit employment opportunities, accessibility to health services, one’s ability to obtain housing, and the right to vote (Sheely & Kneipp, 2015). These consequences are not limited to individual suffering but span to the family. Incarceration impacts the physiological health as well as the social and emotional development of children due to parental absenteeism and psychological trauma (Shlafer et al., 2017). This has lifetime consequences and further perpetuates homelessness, poverty, and unemployment among LGBTQ+ persons (Ghandnoosh & Stammen, 2022).

Nurses Must Take Action! This bill is not just a political issue; it’s a public health crisis that nurses cannot ignore. The 2025 Nursing Code of Ethics emphasizes compassion, advocacy, and social justice, making this bill impossible to ignore. Nurses pledge to do no harm and have moral obligations to the communities we serve.

Provision 1 requires nurses to provide care with respect for human dignity. Trans patients deserve to be treated with affirmation, not discrimination. Nurses provide compassionate and individualized care with the understanding that each individual, family, and community is unique and that their lives have worth.

Provision 3 calls on nurses to advocate for patients’ rights, health, and safety, putting them at odds with a law that criminalizes gender identity. This places nurses in a vulnerable position, impacts our ability to build trust with transgender patients, and leaves nurses feeling powerless to act on what is right and responsible.

Provision 9 pushes nurses to fight for social justice and eliminate health inequities, including those that disproportionately harm transgender individuals.

If HB3817 becomes law, nurses could face ethical and legal dilemmas when documenting a patient’s gender identity or providing gender-affirming care. Worse, this bill could discourage transgender patients from seeking medical treatment, leading to delayed care, worsened health outcomes, and increased mortality rates. This would violate the nursing profession’s commitment to patient-centered care and public health.

Guided by Peggy Chinn’s Peace and Power framework (2018), nurses can take collective, courageous action against HB3817 by centering values of cooperation, empowerment, and justice in our professional and community roles. This begins with cultivating awareness and seeking to understand how such legislation harms the health, dignity, and human rights of transgender individuals. Nurses can then empower themselves and create moral communities by sharing accurate information, advocating for inclusive policies, and creating affirming care environments. A moral community is a group of people united by a common moral purpose to promote the well-being of others, characterized by strong support systems, inclusivity, fairness, open communication, and collaboration (Wocial, 2018). Nurses can foster solidarity and amplify marginalized voices through cooperative dialogue with colleagues, advocacy groups, and policymakers. Above all, Peace and Power encourage evolvement and commitment to continuous reflection and action that dismantles systems of oppression and promotes holistic well-being.

According to Sally Thorne, as referenced in the Nursology.net blog post, “We Were Made for These Times,” nurses should refuse any mandate to engage in hateful acts, acts of division, and any action that further disadvantages the many and privileges the few. In the face of HB3817, nurses must resist silence, stand in ethical protest, and reclaim our power as protectors of health equity and human dignity.

Does a transgender person’s life have less value? Do the lives of families and children of transgender persons have less value? Upholding the Nursing Code of Ethics means advocating for vulnerable patients, speaking out against harmful legislation, and ensuring that all individuals receive safe, compassionate, and affirming healthcare. Nurses have the power to educate, advocate, and challenge policies that threaten the well-being of our patients. Now is the time to raise awareness, join advocacy efforts, and push back against HB3817 and any laws that infringe upon the rights and social well-being of transgender individuals. Taking these steps can help nurses overcome moral distress and be change agents who fight to build stronger and healthier communities through human caring.

References

American Bar Association. ABA standards for criminal justice: Collateral sanctions and discretionary disqualification of convicted persons. Washington, DC: 2004. 

Chinn, P. (2018, August 23). Peace & power. https://nursology.net/nurse-theories/peace-power/

Chinn, P. (2025). We were made for these times. https://nursology.net/2025/03/19/we-were-made-for-times-like-these/

Gender Identity Fraud, TX HB3817, 89th Texas State Legislature. (2025). https://capitol.texas.gov/tlodocs/89R/billtext/pdf/HB03817I.pdf#navpanes=0https://www.sentencingproject.org/policy-brief/incarcerated-lgbtq-adults-and-youth/

Ghandnoosh, N, & Stammen, E. (2022). Incarcerated LGBTQ+ adults and youth. Policy Brief: https://www.sentencingproject.org/policy-brief/incarcerated-lgbtq-adults-and-youth/

Sheely, A., & Kneipp, S. M. (2015). The effects of collateral consequences of criminal involvement on employment, use of temporary assistance for needy families, and health. Women & Health, 55(5), 548–565. https://doi.org/10.1080/03630242.2015.1022814

Shlafer, R. J., Reedy, T., & Davis, L. (2017). School‐Based outcomes among youth with incarcerated parents: Differences by school setting. The Journal of School Health, 87(9), 687–695. https://doi.org/10.1111/josh.12539

Washington, N. (2024, August 20). Understanding moral distress. https://www.medicalnewstoday.com/articles/moral-distress#What-is-moral-distress?

Wocial, L. (2018). In search of a moral community. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Search-of-Moral-Community.html

About Kendrick Clack and Jasmine Perkins

Kendrick T. Clack, a board-certified Family Nurse Practitioner and U.S. Navy Nurse Corps veteran provides primary care and monitors clinical research participants. Specializing in sexual health, gender-affirming care, and HIV treatment/prevention, he is an award-winning advocate pursuing a PhD in Nursing Science at Texas Woman’s University.

Jasmine Perkins is a dedicated registered nurse and community health advocate passionate about working with marginalized populations. She has developed and led community programs to improve healthcare access and outcomes for East African refugees. She is pursuing a PhD in Nursing Science at Texas Woman’s University and is committed to developing global nursing leaders.