Tuesday 26 March 2013

GMC backs down on requiring doctors to provide 'gender reassignment' as lobby group brings 98 patient complaints

The General Medical Council has backed down on requiring doctors to provide 'gender reassignment' just as a lobby group has brought forward 98 patient complaints. 

The blog was prompted by new draft guidance issued by the General Medical Council which implied that doctors who refused to provide ‘gender reassignment’ risked being struck off the medical register.

The draft guidance, ‘Personal beliefs and medical practice’ allowed doctors to opt out of providing procedures or treatments to which they had a conscientious objection provided that they made sure that ‘the patient has enough information to arrange to see another doctor who does not hold the same objection as you’.

But it made an exception in the case of ‘providing gender reassignment’ (P5 footnote) for which it said doctors had no right not to be involved.

It justified this stance on the grounds that these ‘procedures’ are ‘only sought by a particular group of patients (and cannot therefore be subject to a conscientious objection)’ under the Equality Act 2010. 

Understandably the report generated some media interest at the time.

The GMC has now published its definitive guidance and has backtracked significantly apparently as a result of responses to its consultation.

In its consultation it asked specifically:

‘At paragraph 5, we explain that gender reassignment is only sought by a particular group of patients who have ‘protected characteristics’ as defined in the Equality Act. Gender reassignment cannot be withheld because of doctors’ personal beliefs, without breaching the Act. Is this guidance on gender reassignment clear? If no or not sure, please say why.’

In fact the statement was not only unclear but legally incorrect.  We made the following response in our official CMF submission:

‘Answer – No

a. The guidance is not clear on gender reassignment and appears not accurately to reflect the requirements of the law. We recommend that the confusing footnote to p5 on gender reassignment be removed.

b. In the footnote to paragraph 5 it states that doctors have no right to ‘opt out of providing’ ‘gender reassignment’ but it does not clearly define what ‘providing gender reassignment’ actually entails. Does it include just gender reassignment surgery and/or hormone treatment or does it also entail being part of the referral pathway?

c. The treatment of gender identity disorder (alternatively gender dysphoria) is extremely controversial and many doctors do not believe that surgery or hormone treatment is clinically appropriate or ethical in many (or even any) cases. To force such doctors to ‘provide’ such ‘treatment’ with no option to opt out is inappropriate.

d. The argument that provision of ‘gender reassignment’ is required is we believe a misapplication of the Equality Act 2010. The natural reading of the law is that doctors should not refuse to treat patients who have already undergone gender reassignment for conditions that they would treat other patients for (eg. Infections, heart disease).

e. It does not mean that doctors are required to provide ‘gender reassignment’ to those diagnosed with gender identity disorder. This interpretation would place doctors under an obligation to provide treatments that they regarded as unethical to the other eight groups protected under the Equality Act 2010 also and would undermine their professional status by making them servants of the state. It could also be open to legal challenge.’

I was therefore most gratified to see that the GMC which issued its definitive guidance earlier this week had completely rewritten the section on gender reassignment.

The definitive guidance (para 8 page 2) now reads as follows:

‘You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.’

A footnote (footnote 3 page 2) now makes it clear that this does not mean that doctors must provide ‘gender reassignment’, but rather that they must not withhold treatments from transgender patients which they would provide to others (eg antibiotics, pain killers, infertility treatment etc):

‘For example, this means that you must not refuse to provide a patient with medical services because the patient is proposing to undergo, is undergoing, or has undergone gender reassignment. However, you may decide not to provide or refer any patients (including patients proposing to undergo gender reassignment) for particular services to which you hold a conscientious objection, for example, treatments that cause infertility.’

This now protects doctors who have a conscientious objection to providing gender reassignment ‘treatment’.

It seems that this change has come not a moment too soon.

According to Pulse magazine (and Gaystar News) transgender activists have assembled a list of 98 patient complaints after a survey of transgender patients about their experience of dealing with medical professionals which it submitted to the GMC earlier this month.

The regulator has confirmed that a meeting with a group of transgender rights activists has resulted in 39 cases warranting an initial investigation, although they are at a ‘very early stage’.

Campaigner Helen Belcher, a member of the UK Parliamentary Forum on Gender Identity, said 15 GPs may be investigated by the GMC as a result.

The complaints include reports of sexual abuse, humiliation, inappropriate diagnoses, and denial of treatment. Patients also complained their transgender status was brought up when they were seeking treatment for entirely unrelated health concerns.

It is interesting that news of this campaign hit the media on the very day that the GMC released their revised guidance.

Was this in anticipation of the possibility that the revised guidance might aid such a campaign? I wonder.

It appears however that given the GMC’s revised wording it will be much harder now for activists to target doctors who simply wish not to be involved in providing ‘gender reassignment’.

People who have been discriminated against, sexually abused, humiliated or denied medical treatment because they belong to a minority group deserve justice and protection. Doctors found guilty of such misdemeanours must be dealt with promptly and effectively.

But to force doctors to collude in ‘treatments’ which they consider to be inappropriate or unethical is another thing altogether.

If there are any cases of this latter kind in the dossier of cases these activists have presented to the GMC then I hope the GMC will give them short shrift.

‘Gender reassignment’ - through hormones and/or surgery -  is legal in this country but remains very controversial. Many doctors in this country, for a variety of reasons, do not wish to be part of providing this ‘treatment’, either through prescribing hormones, or acting as surgeons or anaesthetists or as part of the referral pathway or pre-operative assessment.

It is good that the GMC has now recognised that these doctors do actually have a legal and ethical right not to be involved, while still offering the same standard of medical care to transgender patients as they do to any other patients.

(A much fuller treatment of Gender Identity Disorder is available on the CMF website)

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