I think one's words causing another to feel stabbed is sufficient reason to care all by itself for any decent person, which I should say that I think Bujold is based on my overall knowledge and interactions. But Dono doesn't feel like he exists in relation to anything trans* at all--I recall nothing in the text that suggests he identifies as such, or recognizing that there are other reasons for the same actions, or just *anything* beyond the surface instrumentality of it. And yet even in complete ignorance of the existence of trans* people, I think it's reasonable of me to expect that Bujold -- an SF writer deliberately writing about biology != destiny and transformation -- would recognize from simple character-building principles that this event needed to be more than just a plot device.