Offer of sex change drugs to nine year olds should make us question therapists’ ideological presuppositions

Children as young as nine are to be prescribed drugs which delay the onset of puberty as the first step towards a sex change operation (Mail on Sunday and Daily Telegraph).

Doctors at the Tavistock and Portman NHS Foundation Trust said a trial of the treatment on ‘gender dysphoria’ patients aged 12 to 14 had been successful and it could now be offered even earlier.

Monthly injections of the drugs, known as hypothalamic blockers, are used to slow the development of the children’s sexual organs by blocking the production of the hormones testosterone and oestrogen.

The rationale is that by delaying the onset of sexual maturation this gives more time for gender conflicted youngsters to decide whether they wish to embark on hormone treatment and surgery aimed at changing their gender. 

Most people will be shocked at this news but it is actually a logical consequence of accepting four prior ideological presuppositions – that gender is a social construct, that personal autonomy should trump other considerations, that emotional suffering should be avoided at all costs and that technology should be used to achieve these ends. 

There are obvious safety concerns - although the gender treatment is reversible, the long-term effects on brain development, bone growth and fertility have not yet been fully evaluated.

But safety considerations aside, using hormones to suppress puberty in transgender children is highly controversial, not least because of deep societal disagreements about the causes and nature of transsexuality and the effectiveness and appropriateness of transgender therapies per se.  This means that therapists remain strongly divided about the best way of handling the issue.

Transgender people are born with the anatomy and physiology of one sex but believe that they belong to the opposite sex.  Should therapy therefore be aimed at changing bodies (using hormones and surgery) to match a person’s beliefs or should it rather be aimed at helping people to adjust mentally to accepting the bodies they were born with? Even more fundamentally, is ‘gender dsyphoria’ a mental disorder or is it just a normal variant like eye or skin colour?

Up until recently ‘gender identity disorder’ was classified as a mental disorder (in the Psychiatric diagnostic inventory DSM-IV) but it has now been reclassified and renamed ‘gender dysphoria’ (in the DSM-V).  This change was strongly ideologically driven and many psychologists and psychiatrists dispute the reclassification. They still see ‘gender identity disorder’ as a kind of body dysphoria, whereby a person has an unshakeable false belief that they are one sex when in fact they are the other. It has been likened to anorexia nervosa, where the affected individual is convinced she is fat whilst being grossly underweight.

Those who supported the reclassification however, take the view that gender identity is biologically fixed and determined and that it is harmful to affected individuals to deny them sex change therapy or to 'force' them to live with the body they were born with. Some even hold to the strongly postmodern view that gender, regardless of what one’s genes or hormones suggest, is simply a social construct, even a matter of choice. If you wish to appreciate how passionately these views are held, then try expressing a traditional understanding on twitter using the hashtag #lgbt!  

Is gender identity fixed as male or female or is it more of a spectrum or continuum? Can it change over time? How effective is therapy is changing the strength and orientation of one’s beliefs? How might suppression of puberty using hormonal treatment affect bone, brain and sexual development?

Research is still at an early stage with many of these questions and strong ideological convictions one way or the other mean that scientific objectivity about the real effects of sex change therapy may always be a matter of contention.  It is perhaps not surprising that both opinion and research in this whole area is often driven by powerful ideological vested interests.

Complicating this is the fact that gender identity may change in an individual over time, and that it may be very difficult to predict the outcome of for any particular person. Some children are much more appropriately described as ‘gender nonconforming’ or ‘gender-fluid’ rather than transgender. In many others gender identity may change with time.

Toronto specialist Ken Zucker, who opposes the use of sex change therapies, claims that only about 12% of boys and girls with gender dysphoria will still have persistent dysphoria as adults. This fact alone should lead even the most committed supporters of early intervention to err strongly on the side of caution.

The CMF File ‘Gender Identity Disorder’ goes into the issue in more detail and also looks at biblical principles which can be applied.

The Bible teaches that human beings are created in God's image and of two sexes – male and female (Genesis 1:27). Jesus drew on this when he commented, 'haven't you read, that at the beginning the Creator “made them male and female”, and said, “For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh” (Matthew 19:4-5).

The Old Testament command 'you shall not commit adultery' also indicates that sexual intercourse should only occur within the framework of marriage (Exodus 20:14). Sex outside the marriage bond is wrong, whether with someone of the same or opposite sex (Leviticus 18:22, 20:10).

The ideal pattern for existence was spoilt at the Fall when mankind rebelled against God's rules. One consequence of this is that moral values, sexual patterns and also biology (genes and hormones) have become distorted.

The good news at the centre of Christianity is that Jesus, through his death and resurrection, gives people new life and power to change. On top of this, there will be a time in the future when all rebellion against God's plans will come to an end and a perfect relationship with God can be fully restored. This brings the hope that transsexual people may find support as they seek to live in ways that are honest to the way God made them, and open to God's ideals.

It's worth noting that the Bible regards celibacy as a high calling. Jesus was fully human and male, but never married nor had sexual intercourse. He also taught that marriage is not for everyone (Matthew 19:12).  It is important to acknowledge this, as for some people, battling with gender conflict may be a life long process. 

Major poll finds three in ten voters will not back Tories due to same-sex marriage

It looks like David Cameron’s decision to redefine marriage seems set to hurt the Conservative Party’s electoral chances in the European elections. 

Almost three in ten voters cite the Prime Minister’s policy on same-sex marriage as the reason why they are not backing the Conservatives.

The poll of over 2,000 people comes ahead of the local and European elections next week.

The ComRes poll:

• Predicts a UKIP win in the Euro elections, with a scrap between Labour and the Conservatives for second place.
• Unveils a widespread scepticism about the PM’s motives for introducing gay marriage. Six in ten people believe the Prime Minister introduced same-sex marriage to make the Conservative Party look trendy.
• Shows that over half of those surveyed don’t believe that Mr Cameron has the determination and power to block any proposals from Europe which would undermine our freedoms.
• Demonstrates that introducing same-sex marriage not only irked older voters but young people too, with nearly one in four 18-24 year-olds citing it as reason for not voting Conservative in the upcoming European elections.

The detailed poll results are available on the ComRes website

As the Prime Minister was warned at the time, redefining marriage without any mandate from the British people would cost him huge numbers of votes.

The outcome of the vote next week looks set to be fascinating. 

I suspect on the basis of this poll that the redefinition of marriage will be a significant factor.

The benefits of regular Bible reading – the inspiring example of George Mueller

George Mueller (see John Piper’s excellent biography here) was a 19^th century British pastor who is best known for his care of orphans. He built five large orphan houses and cared for 10,024 orphans during his life, but in so doing inspired many others so that fifty years after he began his work, at least one hundred thousand orphans were cared for in England alone.

However Mueller did not consider his work amongst orphans to be his first priority.

In 1834 (when he was 28) he founded The Scripture Knowledge Institute for Home and Abroad which developed five branches:  1) Schools for children and adults to teach Bible knowledge, 2) Bible distribution, 3) missionary support, 4) tract and book distribution, and 5) to board, clothe and Scripturally educate destitute children who have lost both parents by death.

He did all this while he was preaching three times a week from 1830 to 1898, at least 10,000 times. And when he turned 70 he fulfilled a life-long dream of missionary work for the next 17 years until he was 87. He travelled to 42 countries, preaching on average of once a day, and addressing some three million people.

The foundation of Mueller’s success was his deep devotion to God’s word. He read his Bible from end to end almost 200 times during his lifetime, believing that it really was inspired by God and would make him ‘complete for every good work’ (2 Timothy 3:16, 17). It did!

Mueller’s knowledge of the Bible was the result of a lifetime of regular reading. Imagine how effective today’s church might be if we shared Mueller’s devotion to Scripture.

Like most Christians I have struggled in my own Bible reading and study over the years but have learnt that making time for it every day is a huge blessing and motivation in living the Christian life and walking closely with Jesus.

There are 1,189 chapters in the Bible altogether so reading just 3-4 chapters a day will get you through it in a year. This takes just fifteen minutes a day. To read it almost 200 times over 60 years, as Mueller did, would mean reading it through on average about once every four months, about ten chapters a day, or 45 minutes. When we look at it like this Mueller’s level of reading doesn’t look that impossible at all. It is simply a matter making it a priority.

There are lots of excellent Bible reading plans available on line (for example see here). The CMF Bible reading guide (free on request via our website) will take you through the Old Testament once and the New Testament twice each year in a way that varies the input to maintain your interest.

Personally I have found the three bookmark method the most useful. I start with one bookmark in Genesis, one in Psalms and one in Matthew. I then read about seven chapters in total using the three bookmarks every day just after waking up and after making a big strong cup of tea. This gets me through the whole Bible in just under six months and then I start again with another version. It takes just half an hour a day. Doing it with my wife makes it easier – we keep each other to it and then pray together after we have read. We tend to read different parts of the Bible from each other which also gives the opportunity to share and talk about what we have each read later in the day.

In my past ministry with medical students I noticed that even around exam time, no matter how busy they were, they always found time to eat. Of course physical food is very important. But the spiritual food we get from the Word of God is even more important, and is much more satisfying. It’s all about priorities.

How about you? Do you have a system established to ensure you get your daily diet of God’s Word? If not, why not start today? Just fifteen minutes a day, three chapters, will get you through the Bible in just over a year. This may not quite be Mueller’s rate, but it will make an enormous difference to your life.

Remember Moses advice to Joshua: 'Keep this Book of the Law always on your lips; meditate on it day and night, so that you may be careful to do everything written in it. Then you will be prosperous and successful.' (Joshua 1:8) 

I finish with a poem devoted to Christian medical students struggling with Bible reading.

Plain Bible Reading

A medical student who crams
While reading for final exams
To accomplish the feat must remember to eat
To avoid losing thousands of grams

Maintaining one's state of nutrition
Will stave off cerebral attrition
And help to ensure one can ably endure
All those stresses that threaten cognition

In practice it's seldom one sees
In those seeking medic's degrees
One tell-tale effect of nutrition neglect
(Let alone kwashiorkor disease)

One wishes the same could be said
Of feeding on spiritual bread
But perusing the Word is more often deferred
Which results in it seldom being read

The Devil employs cunning schemes
But few so effective (it seems)
As curbing the feeding (the plain Bible reading)
Of those whom the Father redeems

How sex selection abortion and illegal pre-signing of abortion authorisation forms are tolerated in Britain

I was recently interviewed by Emily Graves of Crossrhythms Radio about that the failure of the Crown Prosecution Service (CPS) to take action in cases of sex selection abortions and pre-signing of abortion forms. The full transcript is available on line and is reproduced here.

The CPS has opted to take no further action in regard to two named doctors who sought to authorise abortions on grounds of sex selection in 2012. In a letter to Christian Medical Fellowship the Metropolitan Police said that, although there is sufficient evidence for a realistic prospect of conviction, it is not in the public interest to prosecute.

With regard to doctors at 14 NHS Trusts who pre-signed abortion forms authorising abortions for women they had not actually seen, the CPS has also opted not to act on grounds that 'the practice of pre-signing has clearly evolved over a number of years', is 'clearly widespread' and may well be due to 'clinical pressures' or 'good intention'.

Emily: Please could you give us a general picture of what your position on abortion is at the Christian Medical Fellowship?

Dr Peter Saunders: We're opposed to abortion, because we believe that all human life is made in the image of God and incredibly precious. The whole Christian ethic is that the strong make sacrifices for the weak - that's what Jesus did for us - and there's nothing more vulnerable and more innocent and weaker than the baby in the womb. We believe that that baby deserves legal protection and that to take the life of an innocent human being is wrong. So that's where the position is based.

Emily: Tell us a little bit about the cases of sex-selection abortions that have taken place in the UK.

Dr Peter Saunders: Well, the Daily Telegraph, a couple of years ago, sent some of their undercover reporters to a number of abortion clinics to ask for abortions purely on grounds of the baby being the wrong sex and two doctors were secretly filmed authorising abortions on those grounds, when in fact the Health Minister has been very clear that that's against the law. That led to a police investigation and a report by the Crown Prosecution Service, which has stirred up all the controversy.

Emily: There has been a rise, then, in cases of this description?

Dr Peter Saunders: Well, there hasn't been clear evidence of sex-selection abortions happening with any great frequency in Britain. But abroad, particularly in South Asia - in India and in China - there have been a large number of sex-selection abortions. In fact there are 160 million missing females in those two countries as a result. And because there are Asian populations here who favour boys, there's been a concern that there've been undercover sex-selection abortions. The Telegraph sting was aimed at identifying doctors who, presented with a case scenario, would actually go ahead and authorise these abortions. Of course the people going were undercover reporters and so no abortions were performed in these two situations, but it was still against the law and the Crown Prosecution Service said that there was enough evidence to prosecute these doctors, but they felt it wasn't in the public interest to do it and that's what's caused all the uproar and controversy.

Emily: We will talk a little more about that in a second, but what about these cases is particularly worrying, apart from the reaction from the Crown Prosecution Service?

Dr Peter Saunders: There's a range of opinion on abortion in Britain as you would expect, from the pro-choice to pro-life end - but abortions done purely on grounds of sex seem to unite everyone right across the political spectrum and across the pro-choice/pro-life spectrum. What's been striking about this is that a lot of the criticism has come from pro-choice feminists, who are nonetheless strongly opposed to sex-selection abortion because they believe in this case, that it discriminates against women and undermines all the work they've been doing on trying to curb human trafficking and sex abuse. So the Director of Public Prosecutions has attracted the wrath of all sides because everyone, with a few exceptions, seems to be of the view that, even if abortion is acceptable in some circumstances, that it's most definitely not on grounds of sex-selection alone.

Emily: So what does pre-signing abortion forms actually entail?

Dr Peter Saunders: This is another problem and this was again identified as a result of a survey by the Care Quality Commission that was carried out in response to an article in the Telegraph. They found that in 14 NHS Trusts doctors had pre-signed forms. Now what this means is that under the Abortion Act, you can't have an abortion unless two doctors sign a special statutory form to say that the conditions laid down in the Abortion Act apply. What had happened in these 14 trusts was that doctors had gone through and pre-signed a whole load of forms without seeing the women concerned, so in other words it was left to just one doctor to authorise the abortion rather than two. That is a form of perjury: it's knowingly and wilfully putting your signature to a statutory document to say things that you know aren't actually true. I think there will be more controversy on this as to why the Director of Public Prosecutions didn't prosecute in the case of these NHS Trusts. He argued that this is a widespread practice; well you know, speeding is a widespread practice, but we still prosecute people who speed. It just seemed a ridiculous argument. If the law is there and it's the will of Parliament, then it is the Crown Prosecution Service's job to uphold the law; not to interpret it and let people off just because a lot of people are breaking it. The problem with the Abortion Act is that there has been pretty widespread, if not flagrant, abuse of the provisions of the Act in a whole host of areas, of which pre-signing is one.

Emily: So you've got two different things here: you've got the pre-signing forms and you've got the doctors allowing these sex-selection abortions to take place?

Dr Peter Saunders: Yes, actually authorising them to take place.

Emily: Going back to the Crown Prosecution Service, what has been their position on why they haven't gone and taken action?

Dr Peter Saunders: Well the Crown Prosecution Service position on sex-selection was that there was enough evidence to prosecute but it wasn't in the public interest to do so and on the forms it was just that it's such a widespread practice that they essentially were going to let them off. What they argued was that it's a matter for the General Medical Council, not for the courts and that's what's provoked the huge reaction. Within hours of this story appearing in the Telegraph, the Health Minister Jeremy Hunt had asked the Attorney General Dominic Grieve to demand from the Crown Prosecution Service an urgent clarification as to why they'd made this decision. Then the next morning on the Radio 4 Today programme, the previous Director of Public Prosecutions before the current one heavily criticised the Crown Prosecution Service saying he didn't understand why they had made this decision. Then the Shadow Attorney General, who is Labour and a pro-choice feminist woman, Emily Thornberry, she wrote to the Crown Prosecution Service saying that they'd undermined all the work they'd done on sexual abuse and this was inexcusable: they were bypassing Parliament. Then everyone weighed in; we had 50 MPs writing to the Telegraph saying that this was completely unacceptable and then the General Medical Council itself said: Well, we're a regulatory body: it's not our job to bring these doctors to task; it's up to the courts. There's been a phenomenal amount of reaction.

Emily: Yeah, because really they're not doing the job properly.

Dr Peter Saunders: Exactly! The Director of Public Prosecutions is paid to head up the Crown Prosecution Service, which is meant to uphold the law; if he's not upholding the law that's very, very serious.

Emily: So what does the Christian Medical Fellowship want to see happen in order to tackle this issue?

Dr Peter Saunders: What we'd like to see is for the law to be properly upheld and we believe that these two doctors should be prosecuted - if there's enough evidence to do it, as the CPS has already said there is, they should go ahead and prosecute them and hear their cases in court. If they're convicted of illegal abortion then it should then at that point go to the General Medical Council to decide whether these doctors should be struck off. That's the proper procedure for it. If that doesn't happen then I'm sure there will be more reaction from Parliament, but this issue isn't going away and we haven't really seen the issue of pre-signing forms yet aired in the media but that may well be coming as well because it's the same sort of problem of the CPS not upholding the law.

Emily: How can we find out more about this issue?

Dr Peter Saunders: There's quite a lot on it on the Christian Medical Fellowship blog, which you can access through our website; there's lots in the newspapers, particularly in the Telegraph and other Christian organisations like Christian Concern and The Christian Institute have been covering it as well, but it's a story that's going to run and run and to evolve further.

As Christians we believe that God puts the governing authorities in place and he expects them to create or to uphold justice and keep order and so it's very serious when, in a democratic society, laws have been made and then they're not being properly upheld. I mean in a sense, it's sending a signal to the world that Britain is open for business as far as sex-selection abortion goes, if doctors can do it, authorise it and then not to be brought to account when it's clearly against the law. 

Why assisted suicide should not be legalised in Britain

I have recently been published in a head to head with Sir Terence English in the Oxford Mail on whether assisted suicide should be legalised in Britain. My contribution to the debate is reproduced below. Perhaps not surprisingly I have said ‘no’.

Any change in the law to allow assisted suicide or euthanasia would inevitably place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others.

The ‘right to die’ would so easily become the ‘duty to die’. This would especially affect people who are disabled, elderly, sick or depressed and would be greatly accentuated at this time of economic recession with families and health budgets under pressure.

Elder abuse and neglect by families, carers and institutions are already real and dangerous and would be made worse.

Any so-called ‘safeguards’ against abuse, such as limiting it to certain categories of people, will not work.

This is because exactly the same arguments – autonomy and compassion – would apply to people outside the categories decided upon and so any law allowing it for some would immediately be challenged under equality legislation.

If for terminally ill people, why not for those who have chronic illnesses but are ‘suffering unbearably’?

If for adults why not for ‘Gillick competent’ children? If for the mentally competent why not for people with dementia who ‘would have wanted it’?

The news coming from other jurisdictions which have gone down this route, particularly Belgium and the Netherlands, shows a pattern of incremental extension and pushing of the boundaries – an increase in cases year on year, a widening of categories of people to be included and people being killed without their consent.

Belgium has recently legalised euthanasia for children and in the Netherlands babies with spina bifida and people with dementia are already put to death.

This is why British parliaments have rightly rejected the legalisation of assisted suicide in Britain three times in the last seven years and why the vast majority of UK doctors, almost all medical groups including the British Medication Association (BMA), Royal College of Physicians (RCP) and Royal College of General Practitioners (RCGP), and all major disabled people’s advocacy groups are also opposed.

Persistent requests for euthanasia are extremely rare if people are properly cared for, so our real priority must be to ensure that good care addressing people’s physical, psychological, social and spiritual needs is accessible to all.

This issue is understandably an emotive one but hard cases make bad law and even in a free democratic society there are limits to human freedom. Our present law with its blanket prohibition on all medical killing does not need changing.

The penalties it holds in reserve act as a strong deterrent to exploitation and abuse whilst giving discretion to prosecutors and judges to temper justice with mercy.

DR Peter Saunders is a retired surgeon and campaign director of the Care Not Killing Alliance, representing 40 organisations opposed to the legalisation of assisted suicide and euthanasia:

Northern Ireland rejects same sex marriage for the third time in 18 months

Yesterday the Northern Ireland Assembly rejected a motion calling for the introduction of legislation to introduce same-sex marriage by 51 votes to 43.  

This is the third time in the last 18 months that the Northern Ireland Assembly has rejected a motion seeking to introduce same-sex marriage. Last year, MLAs rejected gay marriage by 53 votes to 42, and in 2012 the plans were voted down 50 to 45.

I support Care NI and others in its welcome to the Assembly’s rejection of calls to redefine marriage in the province and like them will continue to work to uphold the traditional definition of marriage in the months and years to come.

My heartfelt thanks goes to all in Northern Ireland who wrote to their MLAs on this issue and all of those who prayed for the current definition of marriage to be maintained.

You can read more about the vote here and here. Amnesty International has apparently warned that a legal challenge is likely. Same Sex marriage was legalised in England and Wales last year.

I have previously catalogued on this blog the reasons I opposed the legalisation of same sex marriage and have published 24 blog-posts on all aspects of the debate. My personal oppositions remains unchanged.

Is the RCOG breaking the law by preventing pro-life doctors from receiving its degrees?

Last week I highlighted the fact that a faculty of the Royal College of Obstetricians and Gynaecologists (RCOG) is barring doctors with pro-life views from receiving its degrees and diplomas. The story has been picked up by the Telegraph today. 

Doctors and nurses who have a moral objection to prescribing those ‘contraceptives’ which can act by killing human embryos are to be barred from receiving diplomas in sexual and reproductive health even if they undertake the necessary training according to updated FSRH guidelines .

The Faculty of Sexual and Reproductive Health (FSRH) is also barring such doctors from membership of the faculty and from specialty training.

Or to put it bluntly – if you refuse to fit coils or prescribe the morning after pill (MAP) then you can’t train to treat infertility, cervical cancer or HIV either. This effectively means that many thousands of doctors will not be able to pursue a career in gynaecology and sexual health. 

And yet the use of emergency contraception and IUCDs like the coil makes up only a tiny part of the specialty of sexual and reproductive health (SRH) which also encompasses the following long list of conditions, treatments and procedures: screening for cancer of the cervix, ovary, breast, bowel, prostate and testes; all methods of contraception which act before fertilisation; reproductive endocrinology; SRH epidemiology; miscarriage and ectopic pregnancy; forensic gynaecology (management of sexual assault); genitourinary medicine (sexually transmitted infections, HIV, AIDs);  infertility/subfertility (male and female);  medical gynaecology (menorrhagia, dysmenorrhoea, dyspareunia, endometriosis, PCOS, amenorrhoea, pelvic pain, PMS ,continence, menopause); management of menopause; postnatal depression; prenatal diagnosis and psychosexual issues.

So the effect of this RCOG ban will be to drive those with a moral objection to interventions which kill early human embryos (including Christians, Muslims and others) not just out of family planning but out of all these other areas of medical care as well.

This is an extraordinary case of taking a sledge-hammer to a walnut more worthy of gulag or gestapo than what David Cameron has called a ‘Christian country’. Surely reasonable accommodation could be made for pro-life doctors? Can the RCOG really argue that there is no creative alternative to these draconian measures?

After all, allowance is already made by the RCOG for doctors who have a moral objection to abortion to train in sexual and reproductive health because the Abortion Act 1967 has a conscience clause. 

But the RCOG, it appears, is exploiting the fact that no similar legal provision exists for fitting coils or prescribing the MAP, by punishing doctors who want to abide by the Declaration of Geneva (which enjoins the utmost respect for human life from the time of conception).

This action by the RCOG is not just profoundly discriminatory but may also be illegal. Under equality legislation, it is unlawful to discriminate against people who have ‘protected characteristics’ - treating someone less favourably because of certain attributes of who they are. This is known as ‘direct discrimination’.

Examples of direct discrimination include dismissing someone because of a protected characteristic, deciding not to employ them, refusing them training, denying them a promotion, or giving them adverse terms and conditions all because of a protected characteristic.

These protected characteristics include religion or belief. It’s also possible to be discriminated against for not holding a particular (or any) religion or belief. Imagine the outcry if the College were to bar from training doctors who wished to prescribe the morning after pill.  But the belief that killing embryos is OK, is a belief, just like the belief that it is not OK.

So it appears, at least on the surface, that the RCOG might well be guilty of direct discrimination. The RCOG is claiming in the Telegraph today that these guidelines are not new as if that somehow justifies their position. But the key issue is that the guidelines are not just and fair and now that the news is out I'm sure that many will be concerned. 

I expect that some serious questions will be asked in parliament and elsewhere about this matter in the coming days and I would not be surprised if some government ministers got very angry as a result, or if a doctor, or a group of doctors and nurses, contemplated bringing a legal case against the College.