I learned two things from a good piece in the British Medical Journal whose title is below. First, that “affirmative care”, which I always thought meant tendentious psychological affirmation of a child or adolescent’s declared gender identity with no probing, is far more than what I thought. It in fact is more medical than psychological. As the American Academy of Pediatrics (AAP) notes:
Among the components of “gender affirmation” the AAP names social transition, puberty blockers, sex hormones, and surgeries.
In fact, a lot of the “affirmative care” given to young people involves very little psychological evaluation, moving kids right from showing up in a clinic to taking puberty blockers or gender-changing hormones. I should have known this before, but it’s gradually dawning on me that “affirmation” is often based more on taking hormones than simply discussing (or buttressing) a young person’s self-image.
Second, the article shows the tremendous controversy between those (mostly American) organizations who assert that hormones, puberty blockers, and gender affirming care are perfectly safe, supported by evidence, and those (mostly European) organizations who say that the data aren’t all in and we should proceed carefully before we begin wholesale affirmation therapy. The good thing about this article is that is really does show how thin the evidence is that supports quite robust statements by the three biggest American organizations that push affirmative care (the AAP, the World Professional Association for Transgender Health, or WPATH, and the Endocrine Society, or ES). Note that the ACLU is on their side as well, as well as Scientific American (I’ve put a link below to their piece).
I don’t think this article takes sides in the controversy about how to treat young people with gender dysphoria (which is, as the article notes, a condition increasing exponentially), but it does make a strong case that there is not enough evidence to support affirmative therapy, especially the part about drugs.
Click to read (free access):
Here are statements from American people and organizations saying that affirmative care is perfectly safe (there are references in the original article):
On 15 September 2022 WPATH published the eighth edition of its Standards of Care for the Health of Transgender and Gender Diverse People, with new chapters on children and adolescents and no minimum age requirements for hormonal and surgical treatments. GnRHa treatment, says WPATH, can be initiated to arrest puberty at its earliest stage, known as Tanner stage 2.
The Endocrine Society also supports hormonal and surgical intervention in adolescents who meet criteria in clinical practice guidelines published in 2009 and updated in 2017. And the AAP’s 2018 policy statement, Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents, says that “various interventions may be considered to better align” a young person’s “gender expression with their underlying identity.” Among the components of “gender affirmation” the AAP names social transition, puberty blockers, sex hormones, and surgeries. Other prominent professional organisations, such as the American Medical Association, have issued policy statements in opposition to legislation that would curtail access to medical treatment for minors.
These documents are often cited to suggest that medical treatment is both uncontroversial and backed by rigorous science. “All of those medical societies find such care to be evidence-based and medically necessary,” stated a recent article on transgender healthcare for children published in Scientific American “Transition related healthcare is not controversial in the medical field,” wrote Gillian Branstetter, a frequent spokesperson on transgender issues currently with the American Civil Liberties Union, in a 2019 guide for reporters. Two physicians and an attorney from Yale recently opined in the Los Angeles Times that “gender-affirming care is standard medical care, supported by major medical organizations . . . Years of study and scientific scrutiny have established safe, evidence-based guidelines for delivery of lifesaving, gender-affirming care.” Rachel Levine, the US assistant secretary for health, told National Public Radio last year regarding such treatment, “There is no argument among medical professionals.”
Contrast this with the much more tentative statements from other countries:
Internationally, however, governing bodies have come to different conclusions regarding the safety and efficacy of medically treating gender dysphoria. Sweden’s National Board of Health and Welfare, which sets guidelines for care, determined last year that the risks of puberty blockers and treatment with hormones “currently outweigh the possible benefits” for minors. Finland’s Council for Choices in Health Care, a monitoring agency for the country’s public health services, issued similar guidelines, calling for psychosocial support as the first line treatment. (Both countries restrict surgery to adults.)
Medical societies in France, Australia, and New Zealand have also leant away from early medicalisation. And NHS England, which is in the midst of an independent review of gender identity services, recently said that there was “scarce and inconclusive evidence to support clinical decision making” for minors with gender dysphoria and that for most who present before puberty it will be a “transient phase,” requiring clinicians to focus on psychological support and to be “mindful” even of the risks of social transition.
Here is promotion of affirmative care in the US despite weak evidence:
For example, one of the commissioned systematic reviews [by the ES] found that the strength of evidence for the conclusions that hormonal treatment “may improve” quality of life, depression, and anxiety among transgender people was “low,” and it emphasised the need for more research, “especially among adolescents.” The reviewers also concluded that “it was impossible to draw conclusions about the effects of hormone therapy” on death by suicide.
Despite this, WPATH recommends that young people have access to treatments after comprehensive assessment, stating that the “emerging evidence base indicates a general improvement in the lives of transgender adolescents.” And more globally, WPATH asserts, “There is strong evidence demonstrating the benefits in quality of life and well-being of gender-affirming treatments, including endocrine and surgical procedures,” procedures that “are based on decades of clinical experience and research; therefore, they are not considered experimental, cosmetic, or for the mere convenience of a patient. They are safe and effective at reducing gender incongruence and gender dysphoria.”
. . . balanced by calls for caution outside the US:
Sweden conducted systematic reviews in 2015 and 2022 and found the evidence on hormonal treatment in adolescents “insufficient and inconclusive.” Its new guidelines note the importance of factoring the possibility that young people will detransition, in which case “gender confirming treatment thus may lead to a deteriorating of health and quality of life (i.e., harm).”
Cochrane, an international organisation that has built its reputation on delivering independent evidence reviews, has yet to publish a systematic review of gender treatments in minors. But The BMJ has learnt that in 2020 Cochrane accepted a proposal to review puberty blockers and that it worked with a team of researchers through 2021 in developing a protocol, but it ultimately rejected it after peer review. A spokesperson for Cochrane told The BMJ that its editors have to consider whether a review “would add value to the existing evidence base,” highlighting the work of the UK’s National Institute for Health and Care Excellence, which looked at puberty blockers and hormones for adolescents in 2021. “That review found the evidence to be inconclusive, and there have been no significant primary studies published since.”
Even the basic facts are at issue:
As the number of young people receiving medical transition treatments rises, so have the voices of those who call themselves “detransitioners” or “retransitioners,” some of whom claim that early treatment caused preventable harm Large scale, long term research is lacking and researchers disagree about how to measure the phenomenon, but two recent studies suggest that as many as 20-30% of patients may discontinue hormone treatment within a few years. The World Professional Association for Transgender Health (WPATH) asserts that detransition is “rare.”
Well, of course, that depends on your definition of “detransition”, but I would think that patients who discontinue hormone treatment within a few years aren’t happy with it. This is one more issue that needs objective examination. (I note again that I’m sure that most people who transition are happy with the results, though we don’t know the long-term effects of some interventions yet.)
In general, we see pro-affirmative-care people making strong statements and recommending irreversible care but without much evidence, while their opponents aren’t “transphobes,” but simply wary and wanting evidence.
Will we get some? Well, there’s a big NIH study in progress, but it lacks controls, and one researcher admits we lack crucial data (bolding is mine).
In 2015 the US National Institutes of Health awarded a $5.7m (£4.7m; €5.3m) grant to study “the impact of early medical treatment in transgender youth.” The abstract submitted by applicants said that the study was “the first in the US to evaluate longitudinal outcomes of medical treatment for transgender youth and will provide essential evidence-based data on the physiological and psychosocial effects and safety” of current treatments. Researchers are following two groups, one of participants who began receiving GnRHa [gonadotrophin-releasing hormone analogues—puberty blockers] in early puberty and another group who began cross sex hormone treatment in adolescence. The study doesn’t include a concurrent no-treatment control group.
But how can you assess the long-term effects of puberty blockers themselves without a control?
Robert Garofalo, chief of adolescent medicine at the Lurie Children’s Hospital in Chicago and one of four principal investigators, told a podcast interviewer in May 2022 that the evidence base remained “a challenge . . . it is a discipline where the evidence base is now being assembled” and that “it’s truly lagging behind [clinical practice], I think, in some ways.” That care, he explained, was “being done safely. But only now, I think, are we really beginning to do the type of research where we’re looking at short, medium, and long term outcomes of the care that we are providing in a way that I think hopefully will be either reassuring to institutions and families and patients or also will shed a light on things that we can be doing better.”
The admission of American researchers like Garofolo that we don’t have proper evidence, as well as the reticence of other countries to use full-on therapy without clinical trials, stands in strong contrast to the baseless assurance of American investigators. Along with the medical treatments, interventions involving pure therapy seem crucial, and these have been sorely neglected. That was one of the strong criticisms of the Tavistock Gender Centre by the Cass Report—the urgency of putting children on the one-way conveyer belt to gender transition without proper “psychosocial” therapy and psychological assessment.
45 thoughts on “The conflict over gender dysphoria and its treatment”
The prime activist tactic is to control the language, and sadly the mainstream media are all too ready to fall for it. So “gender-affirming health care” doesn’t actually mean “health care” (the body is in a far healthier state without it).
Similarly, the MSM always describes critics as “anti-trans” when they’re not at all against trans people, they’re against contentious ideology. Just see how often the MSM have called JK Rowling “anti-trans” when she’s never said a single word against them.
Once again, this rule of thumb is affirmed: euphemisms are oftentimes flags for morally or intellectually suspect positions. From “enhanced interrogation” to “affirmative care”, the practice of deceit is stranger to no party or intellectual class.
But “affirmative care” is particularly evil in the potential for harm to children. Try to explain it to many intelligent people even now. The reality of it sounds so crazy that they assume you must be some kind of right-wing, trans-hating ignoramus—surely no medical professionals would act so ideologically and irresponsibly, surely. Uh huh.
The new thought I had on this topic was how gender dysphoria is to be distinguished from schizophrenia. I do not know. As to prevalence, Wikipedia says :
“About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime. In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally.”
… so as an ignoramus, I think if someone thinks they are not their natal sex, in the old days, doctors might say it’s schizophrenia. Maybe sone of that is gender dysphoria now.
But – speaking as a spectator here – it seems an important distinction to make (not that I understand it).
In the case of many people with gender dysphoria, they don’t think they are not the sex that people tell them they are. They hate being that sex, and want to be the other sex. See for example Sophie Grace Chappell, a very articulate philosopher, about her childhood. She knew she was a boy.
Re “… Sophie Grace Chappell, a very articulate philosopher, about her childhood. She knew she was a boy.”
And yet … she wasn’t.
Isn’t it more accurate to say, “She was a natal female with a strong internal sense of herself as male”?
It’s hard to take seriously any of the arguments in favour of “gender-affirming care” when the lead argument is that it is “lifesaving” because trans kids are all at risk of suicide and gender-affirming care will reduce that risk. None of the available evidence suggests this is true. In the most widely cited study
about 40% of ~900 trans adults in the UK who responded to an online survey (IOW a highly non-representative sample) reported they had attempted suicide at least once in their lifetimes. But for obvious reasons none of them had ever actually killed themselves.
Again those were adults.
Among trans youth, actual suicide rates can be very high overall
Those NEJM authors claim that gender-affirming care improves mental health, but this claim has been thoroughly debunked
Note 2 out of the 315 individuals in their study committed suicide while receiving gender-affirming care. That’s lower than one other suicide rate for a population of trans youth receiving gender-affirming care (5 out of 177 at a Belgian clinic), but higher than many others. Singal reviews all of these suicide rates, which vary a lot and are probably measured with a large uncertainty because the sample sizes are small.
The point is that whatever these suicide risks, they don’t seem to go down among youth receiving gender-affirming care.
The biggest problem that Singal noted about that NEJM study: the authors preregistered their methods, and said they would ask participants about gender dysphoria and suicidality. But in the published study nothing is mentioned about those most critical study variables, and one guesses that’s because suicidality and gender dysphoria didn’t actually improve with gender-affirming care.
An adult who adopts the trans lifestyle is almost certainly someone with years of issues already influencing them. Trauma, sexual abuse perhaps. Mental illness. Some seem to be perverts, using the trans identity to watch little girls in changing rooms.
A kid, any kid, can be taught to believe almost anything. If a trusted adult has the time and is willing to go to the effort, any child is a potential victim, unless they have been specifically prepared against such advances.
But it isn’t just the teacher of guidance counselor. The school recommends a therapist who enthusiastically affirms them. The therapist knows about a specific doctor who will assure them that medical treatment is the only way they will ever be happy. It takes a strong will to disagree with such authority, especially if one’s parents are excluded from the conversation.
I think people are way too focused on the idea that trans kids surely come from bad home situations, have been victims of abuse, or have a history of mental issues.
The reason they focus on kids is because kids are pliable, and probably more desirable to those who have more prurient than political motives.
I recommend this article by Lionel Schriver about the difference between the search for identity and the search for character (absolutely relates to the trans issue) https://unherd.com/2023/01/how-we-created-a-self-hating-generation/
Excellent article. I’m going to subscribe.
This is good :
“Rejecting the passé “character building” paradigm, we now inform children that their selves emerge from the womb fully formed. Their sole mission is to tell us what those selves already are. Self is a prefabricated house to which only its owner has a key.”
Sadly, the words in the lead paragraph will snag on woke tripwires, and that religion will keep one more small piece of reason from making sense.
Is it not fascinating that some are happy to say gender is hard-wired from birth, yet those same people will be convinced blank-slaters when it comes to, say, educational achievement?
Just one more :
“In contrast to becoming, being is an inert affair.”
Indeed – so much talk about “what do you want to be” – so little about what “you” want to do..
Good piece. Shriver has been bold in challenging some of the current progressive orthodoxy.
I like this: “These days, discussion of ‘character’ is largely relegated to fiction workshops and film reviews. Instead, we relentlessly address ‘identity,’ a hollowed-out concept now reduced to membership of the groups into which we were involuntarily born — thereby removing all choice about who we are.”
What other … social phenomena (?)… will unconditionally assure their audiences they are individually special?
I am reminded of Fight Club (though now I have to _read_ it).
The struggling protagonist searches and searches for something in his life by joining any possible support group he can find – at some point, he’s at the “blood diseases” support group – even though he has no blood disease.
I predict a ton of lawsuits down the road.
And a recent one in California
Makes sense that the most aggressive position is found in American Institutions … if, like me, one is convinced that the entirety of Woke, under which “gender affirmation by medical means” is subsumed, is a deliberate wartime Modern-Marxist-collectivist project. Infiltration of our institutions and professional organizations is the front line, and receives the highest concentration of aggression.
It makes sense because — despite 140 years of Progressivist counter-Revolution insurgency — the USA remains the most anti-Woke in its Foundation Principle — individualism, freedom, capitalism, private property, small watchkeeper government … the bitter enemy and target of Woke et al.
Yeah, it smells like ideological capture. Note that the phrasing is not “is supported by many large studies”, but “is supported by major medical organizations”. I imagine that Lysenkoism was also “supported by all major biological-research organizations” in the good old USSR.
This is BAD, not just for the poor kids who are led down the path to self-mutilation, but for academic and medical institutions in general, and for public trust in science and its institutions.
SOGD is very much comparable to Anorexia nervosa, that is not my observation, but Shriers, I think she’s spot on indeed. Many young women/girls are not happy about what is happening to their bodies. Intriguing is that it is mainly among girls in well off families. I’m not sure -if true- what that implies.
I also think that it is definitely not an easily treatable problem, but puberty blockers, let alone surgery, should have no place there. The former is bad medicine, the latter is criminal.
Surely we should consider gender dysphoria as a symptom of underlying distress, not as a diagnosis? It may even be a helpful symptom, resolving some conflicts, avoiding certain issues, gaining attention or perhaps serving other purposes. But treating symptoms does not address the cause behind them. And like prescribing an aspirin for a brain tumour, it won’t fix the problem, merely temporarily covering it up. And to turn distressed children into sterile, mutilated surgical patchworks fails to give them any of the help they really need, as well as, almost incidentally, expressing the underlying contempt for the homosexuals many of them would have become, as well as that for the women they will have to pretend to be. This is not just a scandal: it is shameful.
The list I would make would start with “unhappy love and sex life of parents, unhappy money situation of parents, unhappy child-expectations pushed by parents, and neglect by parents.”
Right away, it is clear these would be relegated to the dim recesses of dynamics. “Doctor, my daughter is insisting and persisting that she is a boy, please affirm her boyhood.” Should be followed by “what’s wrong in the family.” However, that is like stepping on the third rail on the tracks of the subway. The parents would say “none of your business.”
This is where the state needs to put its fist down, no matter how hamfisted that will be. The doctor needs to be able to tell the parent making that request, “Sorry. That is against the law. How else can I be of help?”
The term “gender affirming care” is clever and deceptive.
Children who claim to be trans have repeatedly presented with co-morbidities such as autism, depression, poor self-mage and others. However, for a therapist to probe in any way that question their trans identity is considered “conversion therapy” and I believe it’s illegal to do that in various states, California among them. It’s also reason for someone to lose medical license.
In essence, there is a cooptation of public expectation as to what the “care” is and also a cooptation of “gay conversion therapy” as something bad.
There are also the euphemism of “top surgery” and “bottom surgery”. Top surgery is a double mastectomy Whereas bottom surgey is an almost comforting name for drastic medical procedures such as orchiectomies, penectomies, vaginoplasty, and other procedures.
I highly recommend this article by Lisa Selin Davis:
“The Beginning of the End of ‘Gender-Affirming Care’?
Britain is closing the infamous Tavistock Centre. Finland and Sweden have radically revised their treatment guidelines. But American doctors are advertising surgeries to children on TikTok.”
Top surgery is evil, but bottom surgery is the bottom. It nearly makes me ashamed of being a surgeon, but I luckily don’t work near those areas.
Part of what’s driving this lack of proper caution in medicine I think is a firm conviction that being trans is not a belief a child has about themselves: it’s a condition they were born with. When a child “reveals” that their sex on the outside isn’t the one on their inside, it’s simply not possible that they were influenced by anything in their environment— not trauma, not bullying, not sexist messages, not confusion, and not the back-and-forth normal process of sexual identity formation which child development specialists have written about for many decades.
No, this is something they can be trusted on. On this particular issue, they suddenly have a wisdom beyond their years. Kids as young as three not only diagnose themselves, but they know what treatment they need lest they lose their soul. “Believe the Children,” a mantra which once fueled Satanic Panic, is now fueling this one.
It’s ironic then that the Gender Critical position, with its cautions against strong medical and surgical treatments for children as a first resort, is often castigated as a form of “social panic” and “irrational hatred and fear.”
Yes, the idea it’s a condition one is born with leads naturally to the medicalization of the condition and the vilification of critics as gatekeepers.
A very astute comment, the analogy of “Believe the Children” in so-called affirmative care to that in the Salem witch trials. And, of course, trans activists carefully use the
adjective slipped in from “affirmative action”. As I have suggested before, the next step will be to reject all empirical data entirely, under the slogan of “affirmative affirmation”.
It is not unusual that children play out ideas about their gender ID at various early ages which do not comport with their anatomical gender. This one wants to play with dolls and paint their nails. That one wants a Nerf gun and to have their hair cut short. This can swing back and forth, and then eventually settle into longer term views about where they are in that spectrum. Sometimes they come out cis. Sometimes they come out as trans. Sometimes they settle somewhere in between, and some continue to oscillate back and forth (I knew a person of that latter sort. It made a big impression on me). Of course there are the cross-dressers which want to dress as the opposite sex, but still prefer the anatomy of their birth. So how would a child even know what they are going to be when they grow up?
So this whole thing is complicated, but loud and clear it means: Wait. Just hold on, and let’s see where things are stabilizing (and if they are stabilizing) before we break out the syringes and the scalpels.
[ hmmm… what is “Believe the Children” ]
[ looks at Wikipedia ]
[ well I’ll be… ]
“… and not the back-and-forth normal process of sexual identity formation which child development specialists have written about for many decades.”
[ apologies for length, but I’d like to add the following notion to that exposition – because I wonder if this is at play ]
Yes, the transgender phenomenon is a totally new discovery, derived from totally new interpretations, so the evidence is so new that there is nobody alive who knows the way to work with it. We have to invent new treatment just like what happened before penicillin was discovered – it can be expected to be rough going at first – the Old Way of thinking will not help with this issue, and has likely impeded progress, and is probably why there has never been a large transgender population – until now.
^^^ I would call this special pleading. “Neat, plausible, and wrong” (H. L. Mencken, 1921).
You don’t have to be an endocrinologist to know that interfering with one of the most profound changes our bodies will ever undergo with chemicals is incredibly dangerous and risky.
This . . ., warrants being typed in all caps. The cavalier attitude of some medical professionals, and lots of activists, towards the use of puberty blockers on kids is just FREAKING NUTS. For the medical professionals that prescribe and administer such treatments it seems like a criminal dereliction of duty to me. They are telling us these treatments are safe and effective, and there is no way in hell they can know that. It would take many years, perhaps a generation, of study to determine that, at best. They have no idea what the long term effects will be.
I’ll go there. If Nazi doctors had been experimenting with puberty blockers on concentration camp victims they would have been found guilty of war crimes. And yet here we are, the same crowd that feels that punching Nazis is always appropriate feels that experimenting on children with drugs that interfere with the incredibly complex process of puberty is absolutely wonderful.
Especially where the drugs and surgery are being prescribed specifically to obtain those deleterious effects. I know you mean the long-term undesired effects like osteoporosis and heart attack but prescribing a drug or doing an operation just to obtain its short-term predictable toxicity seems particularly perverse.
“I can’t prescribe this drug for you. It’ll coarsen your features, grow hair everywhere, and generally make you look like an incel man. You won’t even get upper-body muscles unless you go to the gym and lift weights. A lot.”
“Yeah. That’s what I want.”
I strongly recommend Sophie Grace Chappell’s piece
Along with her point, that there is no one story about transgender people, but lots of stories.
Chappell’s writing seems sincere. I admire people who write honestly about these things (in contrast to the twitter activists who want to burn everything down).
But without knowing the biological basis for what people like Chappell are expressing (this longing to have the appearance and presentation of the other sex), it’s hard to credit the argument that these feelings and claims should be taken at face value.
The contrast with same-sex attraction is helpful: this attraction is observed in other primates (and many other animals); it has a partially heritable basis; and there is good theory to account for the evolution of genetic variants within a population that lead to same-sex attraction in some individuals but have other benefits when those variants are expressed in other individuals, including in humans and in other species.
This can’t be said for transgender identity, which seems more likely to represent a uniquely human pathology, and not an adaptation. As Sastra has said here several times, humans don’t have a gendered soul that’s knowable only by introspection, fixed from early life, but also fluid and changeable.
I will comment, but try to avoid repeating myself.
I certainly ask myself why so many people work so hard to convince normal children that they are born in the wrong body.
The participating medical and mental health professionals seem to have their medical ethics displaced by a desire for profit or are caught up in the madness of the times.
Much trust in the objectivity of the medical profession was lost when we were told that public gatherings put us in serious risk of disease unless the gathering is related to BLM or related causes.
A hormone treatment that is considered to pose too many risks to a post menopausal woman is not going to be safe for a ten year old kid to take for the rest of their life.
A virus is not going to refrain from infecting you because your political views are trendy, nor will prescription drugs spare you from their side effects because of your delusions.
In every case that I know of personally, the hormones lead to significant mood swings and depression, and more drugs are prescribed to address those symptoms. Inevitably, it becomes a precarious balancing act.
The prescribing doctor has to notice that their course of treatment will likely make the patients worse, and that the kids who come to them have expectations that cannot be met.
If the doctor is treating them without discussing the reasonable and likely outcomes with the patient or their parents, it is malpractice, as is treating them with the knowledge that the patient’s expectations are wildly unrealistic.
Promising them that they can make them a real girl or boy when they cannot even begin to do so seems criminal, doubly so when the patient is a child.
From my perspective, it is Mengele-level wickedness.
Hannah Barnes has written a book about Tavistock titled “A Time to Think”. Along with all of the co-morbidities associated with children wanting sex-changes, she claims the children at Tavistock were 10X more likely to have a registered sex-offender as a parent which I find astonishing and alarming.
Whoops. I went there. I began sequence to “open an account.” It asked for my phone number.
Me too. Not a chance.
There’s no such thing as “gender-changing hormones”. First of all, they mean sex, not gender. Second of all, humans cannot change sex, no matter how many hormones and surgeries you give them. All they’re doing is changing secondary sex characteristics (which don’t actually define your sex) to “more closely match how the person feels”. It is NOT an actual “sex change”.
On 15 September 2022 WPATH published the eighth edition of its Standards of Care for the Health of Transgender and Gender Diverse People, with new chapters on children and adolescents and no minimum age requirements for hormonal and surgical treatment. The eighth edition also added a new chapter to include eunuchs as a gender identity!
Age requirements were present in the draft chapters of SOC 8, but were removed just before it was finalized. On 18 September 2022, at the WPATH conference, Amy Tishelman, lead author of the Child chapter explained that it was to protect practitioners from lawsuits:
“And then we were thinking, and it was scary for me, about the potential uses of the chapter for legal and insurance contexts. Again, what we didn’t want to do was create a chapter that would make it more likely that practitioners would be sued because they weren’t following exactly what we said. We wanted there to be some clinician judgment without being at risk for being held in court for not sticking completely to these standards. So we did write them in a way, I think, so that there is leeway, that we recommend things, but then we suggest that clinicians use their judgment about what to do in therapy situations and in, um, assessment situations so that they, so that you can use individualized clinical judgment and not face malpractice suits. On the other hand we didn’t want it to be so loose that insurance wouldn’t cover things because they’ll say they’re not necessary. So, we tried to bridge those considerations. Um, and we didn’t want overly general standards that would dilute their meaning and importance as I said earlier.”
Litigation, or at least the possibility of future justice through litigation, is what keeps the the issue within the bounds of civility.
I could absolutely see how lobbyists for the trans industrial complex would very much want to issue themselves a blanket immunity, as momentum starts to build against them.
Telling parents that “We can do whatever we want to your kids, and you will have no legal avenues to do anything about it” is really a bad move.
Really, a cascade of malpractice settlements, even loss of professional credentials or personal bankruptcy would be getting off fairly easy.
Telling parents that “We can do whatever we want to your kids, and you will have no legal avenues to do anything about it” is really a bad move.
Exactly Max. No one can insulate himself from justice just because he’s an expert. And the courts really roll up their sleeves, civilly of course, when a bunch of them try.
The trans medical industrial complex is trying to stake out the standard of care. Normally, a doctor who adheres to it in every way (which is not just the provision of the treatment itself but the diagnosis, informed consent, follow-up, rescue — the whole deal) will not be found liable in a malpractice suit where the treatment causes damage. That the treatment is discredited after it was given, or serious harms later come to light, won’t be retrospectively held against the doctor if he could not have foreseen the future. Judges are usually deferential to expert opinions about what the standard of care was at the time.
Usually. But not always. The judge, at least in Canada, is perfectly free to reject the expert medical opinion about the standard of care and substitute his own common sense standard if it better serves the interests of justice. Standard of care is a legal concept, not a medical one, we are reminded. The judge (or a jury) need not accept any testimony from doctors about the standard just because they were called as experts. The judge is particularly likely to reject expert testimony if he thinks it smacks of self-dealing. The experts might be motivated to cover their own butts if the whole lot of them were going to end up in court as defendants, not witnesses.
In response to, “We all do it this way, therefore you can’t sue any of us”, the courts can say, “Wrong. We’re awarding damages against all of you.”
(Canadian judges have discarded the expert standard in at least two cases that went to trial in which the patient-plaintiffs were successful. These have been extensively discussed in medical-legal seminars. In both cases the judges ruled that the standards that the defendants had adduced — one was a surgeon, the other our non-profit blood-collection and distribution agency — provided inadequate protection of patients/the public given the state of knowledge and common sense available at the time. The standards written in by the judges in those cases are now part of the standard of care in Canada.)
Treatment of minors and the control usurped from parents is another dimension which you are more knowledgeable than I am.
As always, wish you peace and joy.