Framing it as a stark choice between two evils is helpful, because it forces you to be explicit about what values you are trading off.

Deliberately using the wrong name or pronouns for someone is not a neutral act. It communicates that you do not recognise their self‑understanding, and for many people it is part of a pattern of erasure and discrimination that causes real psychological harm. In everyday life, respecting people’s identities is a low‑cost, high‑value way of treating them with dignity, and there is a strong moral presumption in favour of doing so.

Ethical theories differ on what to do when values collide. A duty‑based, deontological approach might say that you have an obligation to tell the truth and to respect persons as ends in themselves, so you should not misgender even if pressured. By contrast, a broadly utilitarian approach evaluates actions by their consequences. On that view, the harm done by a single act of misgendering, while not trivial, is vastly outweighed by the preventable loss of a million lives. Choosing the “lesser evil” in an extreme, hypothetical situation would be justifiable because it minimises overall suffering.

Even if you accept that reasoning, it doesn’t license casual disrespect. The fact that you can imagine an extraordinary situation where a normally wrongful act would be the least harmful option underscores how seriously we should take both sides of the equation: the human cost of misgendering on one hand, and the gravity of allowing preventable deaths on the other. In real‑world situations, the right course is to look for ways to honour people’s identities and to protect life, rather than treating them as mutually exclusive.