Friday 30 June 2017

How should Christians respond to the transgender issue?

You might think that there are few things more self-evident than the fact that human beings are divided into two distinct types, male and female. Females have XX chromosomes, female hormones, breasts, ovaries, wombs and vaginas. Males have XY chromosomes, male hormones, testes and penises. Don’t they?

But now we’re being told that gender is simply a social construct, the product of a biased society. That gender has no biological basis at all. That gender roles are being forced upon people. That it’s all simply a result of the way that people are being brought up. That gender is fluid.

When even feminist and gay icons like Germaine Greer and Peter Tatchell get called ‘transphobic bigots’ and being barred from speaking in British universities simply for expressing the view that ‘trans women’ are not real women then the situation is getting pretty serious.

We are starting to see real pressure being put on people to adopt a new ideology, use new language, affirm the beliefs of transgender people and participate in surgical and hormonal gender reassignment. Some lobby groups want these things to be legally enforced.

The problem seems to be increasing. A family doctor in a British university town recently told me, ‘I’m seeing one gender conflicted teenager every day. They’re all asking to be referred to the gender reassignment clinic in London and they are all on antidepressants. What should I do?’

There’s been a huge increase in the number of children and teenagers being referred to this clinic with numbers doubling with each passing year. The same thing is happening all over the UK and elsewhere in the Western world. This new ideology seems to be quite contagious and now schools are being accused of 'sowing confusion' in children's minds by over-promoting transgender issues.

So what actually is transgender? Is a ‘trans woman’ really a woman trapped in a man’s body? Or is ‘she’ really just a man who has an unshakeable false belief that he is a woman?

As recently as 2013 doctors called this condition ‘gender identity disorder’. Many doctors, like me, feel it should still be called that. We believe that giving sex hormones and gender reassignment surgery to transgender people is not only clinically inappropriate but an abuse of professional privilege.

But some doctors, driven more by cultural pressure than scientific evidence, have changed their minds. They think we should be offering these people hormones and surgery.

So what’s going on? Let’s start by being clear on two things.

First, there is such a thing as ‘intersex’ where there are abnormalities in a person’s chromosomes, hormones or external or internal genitalia. Doctors recognise dozens of these conditions and there are fairly clear guidelines about how to treat each one. But this is not transgender. In transgender people chromosomes, hormones and genitalia are either male or female.

Second, there is a real medical condition that used to be called ‘gender identity disorder’ and is now being called ‘gender dysphoria’ (It is incidentally still called 'gender identity disorder' in the ICD 10). It’s very rare affecting fewer than one in 10,000 people. The affected person feels deep distress over the sex that they had been born with and tries to resolve these feelings by identifying with the opposite sex.

So this is the key question. If there is a disconnection between the body and mind, then do you shape the body to fit the mind or do you shape the mind to fit the body? Do you try to help them to become reconciled with their body through counselling and psychotherapy? Or do you give them hormones and surgery so that their body conforms to their chosen gender identity?

Well, it depends on whether you think the real problem is in the body or the mind. And I, like many other doctors, am in the latter category. I think we’re being seduced and even coerced into thinking that the body, rather than the mind, is the real problem when there is actually no scientific evidence to back that up.

Everyone can see that a woman with anorexia nervosa is not fat, but she has an unshakeable belief that she is, so she is radically dieting and regularly purging herself. How do we help someone in this situation?

Well, we certainly don’t affirm her belief that she is fat or encourage her to diet or, least of all, offer her liposuction. And yet anorexia nervosa has a lot of similarities to gender dysphoria. You have a person who is deeply dissatisfied with the body that they’ve been given and may be obsessively preoccupied and distressed by it.

A high proportion of people who suffer from gender identity disorder also suffer from other mental health conditions like depression, anxiety, substance abuse, self-harm, suicidal thoughts, personality disorders and autism (see also here and here). In many of them these problems do not resolve with gender reassignment. In fact hormones and surgery deal only very superficially with what is often a very deep psychosocial problem that doesn’t lend itself to quick technological fixes.

So how should Christians respond to the phenomenon of transgender?

First, we need to see it through the lens of creation. The Bible is unashamedly binary. Genesis 1:27 tells us that God created man in his own image – male and female. This is perfectly consistent with what we see in nature – male and female are different - genetically, hormonally and physically. Researchers have identified 6,500 genes that are expressed differently in men and women.

Next, we must appreciate that we live in a fallen world where our collective rejection of God (Genesis 3) has affected the human race at all levels - physical, psychological, emotional and spiritual – so we should expect to find conditions like intersex and transgender. People affected by these conditions are often deeply hurting and we need to treat them with the love and respect we should show to any human being made in God’s image. We are all tainted by the consequences of the fall and we are all sinners in need of God’s forgiveness.

Third, we must not capitulate to transgender ideology. Loving people does not mean affirming their false beliefs, using their chosen names, admitting them to their chosen facilities, allowing them to compete as the opposite sex in sports events and offering them hormones and gender reassignment surgery. That is not love – it’s actually a form of abuse. You might get called a transphobic bigot or worse. But the Bible, science and common sense are on your side. God created us male and female. It’s really that simple. 

Fourth, we must grasp the gospel opportunity transgender presents. Jesus welcomed everyone but in so doing he did not endorse all their beliefs and behaviour. Rather he called them to repentance and faith – to a life of obedience enabled by the Spirit, to be transformed by the renewal of their minds (Romans 12:1,2). And he called them to find their identity not in their chosen gender, or anything else, but in him.

Finally, we need to get informed better about the issue.

Here are four helpful resources that can get you started:

Gender Dysphoria – CMF File 59 – Rick Thomas and Peter Saunders
True to Form – FIEC Primer Issue 03 – Various authors
Transgender – Talking Points - Vaughan Roberts
Sexuality and Gender – The New Atlantis – Lawrence Mayer and Paul McHugh

Sunday 25 June 2017

Over 1,000 doctors reject BMA abortion decriminalisation motion 50 – this is why

Over 1,000 doctors and medical students have signed an open letter urging the British Medical Association (BMA) to reject a motion calling for the complete decriminalisation of abortion. Also, just under 21,000 members of the public have signed a similar petition on Citizen Go

Motion 50, which I have already reviewed in some detail, will be debated at the BMA annual representative meeting in Bournemouth at 10am on Tuesday 27 June. The debate will be streamed online via the BMA website.

The letter, titled ‘Reject motion 50’, hits out at extreme pro-abortion campaigners who have been working behind the scenes to get the BMA’s support ahead of a private member’s bill in Parliament calling for all abortion to be decriminalised.

The bill is expected to be drafted along the same lines as Diana Johnson’s radical Reproductive Health (Access to Terminations) Billwhich received some support in parliament earlier this year. At that time Maria Caulfield MP argued strongly against the bill, in a speech well worthy of study.

The doctors’ letter argues that the overwhelming majority of women do not wish to see abortion decriminalised and that if the BMA passes the motion it will not only be completely out of touch with the mood of the nation but will but will also severely damage the reputation of the medical profession.

In the last few years, polls have consistently shown that a larger proportion of women want more, not fewer restrictions on abortion. A ComRes poll in May 2017 found that only 1% of women wanted to see the time limit for abortion extended above 24 weeks and only 1% of women wanted to see the time limit for abortion extended through to birth. The same poll found that 70% of women wanted to see the abortion time limit reduced to 20 weeks or below. The poll also found that 91% of women favour a total and explicit ban on sex-selective abortion. Clearly, women want the law to be stricter on the legality and regulation of abortion, not more lax.

Last year, the Royal College of Midwives saw a major media and public backlash following their announcement that they would be supporting a campaign to introduce abortion for any reason, up to birth. Many commentators on this controversy were pro-choice but recognised that taking this position was an extreme move, and the outrage caused reputational damage both to the Royal College of Midwives and to the wider midwifery profession. If the BMA follows suit, it will risk severely damaging its reputation as a professional body.

These alone are two good enough reasons to reject motion 50 but there are many more.

First, this whole campaign is based on the false premise that women who seek ordinary abortions are living under the constant shadow of arrest. That is clearly not the case. Prosecutions are already exceptionally rare under the existing criminal provisions [section 58/59 of the Offences Against Persons Act / Infant Life (Preservation) Act] and abortion is widely available under the terms of the Abortion Act. Prosecutions are exceptionally rare—in many years there have been none at all—and in the past two years there were just two convictions, both of them in extreme and disturbing scenarios. One involved a man who had attacked a pregnant woman and caused her to miscarry and the other a woman who aborted herself at 32 weeks.

Second, decriminalising abortion would remove abortion from the Offences Against Persons Act and render the Abortion Act null and void. This would mean that anyone at all could cause the death of an unborn baby in any way whatsoever, with or without the mother’s consent, and be liable only for any damage done to the woman. Furthermore, this could happen right up until 28 weeks, the statutory age of ‘viability’ under the Infant Life Preservation Act. Babies now survive in large numbers in neonatal units from 23-24 weeks so this would mean legalising abortion for babies aged 24-28 weeks who would normally be born alive – effectively legalising infanticide.

It would also dismantle the entire regulatory framework surrounding abortion – including the need for two doctors’ signatures, the 24 week upper limit, the need for approved premises, licensed drugs, conscientious objection, reporting and accountability.  Abortions could be done for any reason, by anyone, in any way and anywhere at any gestation up to 28 weeks. So that includes sex selection abortion, abortion to cover up rape, sexual abuse and incest, do-it-yourself abortion – it would mean abortion on demand.

Decriminalisation would also aggravate the problem of amateur or backstreet abortion and would surely lead to a huge increase in the availability, circulation and use of abortifacients. It would facilitate the procuring and supply of abortion pills, whether by women (including teenagers), who could lawfully take them and/or pass them round to their friends and acquaintances, or by men, not least those who have impregnated women and who would ‘encourage’ those women to take them.

Third, the tide is turning against decriminalisation in jurisdictions where it has been tried and found wanting. It appears that the abuses that have been seen in the two Australian states that decriminalised abortion previously (Victoria, 2008 and Tasmania, 2013) have made it clear to politicians and wider society that radical laws should not be more widely adopted.

Both New South Wales and Queensland have more recently rejected moves to decriminalise.  In fact, there are now moves underway to repeal the law in Victoria because of the problems there – an increase in the number of later abortions and abortion tourism (see here, here and here).

No decriminalised abortion model has yet shown to provide accurate abortion statistics. In jurisdictions like Canada and the states of Victoria and Tasmania, where abortion is decriminalised and largely deregulated, abortion data collection is unreliable or simply not recorded in any meaningful way. Canada, for example, recorded a 40% drop in the number of abortions between 2004 and 2010, due to a lack of data being reported by abortion practitioners. That said, all the current anecdotal evidence (see herehere and here) indicates a big increase in terminations post-24 weeks and a host of other problems such as a very sharp increase in babies born alive following termination.

Sex selection abortion is also fuelled by decriminalisation. In 2012 the Canadian Medical Journal reported that easy access to abortion and advances in prenatal sex determination have combined to make Canada a haven for parents who would terminate female fetuses in favour of having sons, despite overwhelming censure of the practice. A 2006 investigative report entitled ‘Canada’s lost daughters’ has highlighted how sex selection abortion has impacted on male female ratios in certain ethnic communities. In Brampton, Sikh areas had 109 boys to 100 girls and areas around Chinatown showed ratios of 108 boys to 100 girls.

Fourth, decriminalisation would remove scrutiny from private abortion providers at a time when they are increasingly under the spotlight. Perhaps this is why they are leading the charge for it. The majority of abortions in the UK take place at private abortion providers and recently, severe and repeated malpractice has been discovered.  

In August 2016, the Care Quality Commission (CQC) had to step in to protect women from potential harm at Marie Stopes abortion clinics and their report in December showed doctors had been bulk-signing abortion consent forms, babies remains had been left in open bins, women were left at risk of infection, staff were not trained in how to respond to deteriorating patients and post-surgery safety checks were being completed before the surgery started.

An investigation by a national newspaper revealed in March 2017 that practices that concerned CQC inspectors are continuing at Marie Stopes clinics, with, for example, abortions being signed off by call centre workers with no medical training after discussions which were as short as 22 seconds.

Already within our current legal framework we have seen doctors pre-signing abortion forms, gender-selective abortions being offered, live babies being left to die following abortions that have gone wrong and children with minor disabilities, such as cleft palate, being aborted. In this context, where the current law is supposed to be preventing such appalling practices, the thought of allowing abortion, on demand, up to 28 weeks or even birth, is seriously worrying. If these kinds of breaches in patient safety protocols are occurring under the current law and close inspection of clinics, what would happen if all legal restrictions are lifted from abortion practice?

But fifth, and finally, the decriminalisation campaign ignores the key fact that abortion is not like other healthcare procedures because it involves the intentional taking of another human life. This is precisely why the law has always treated it differently from regular medical procedures, and continues to do so.

The Offences against the Person Act, like many of our country’s laws, was originally based on the Judeo-Christian ethic which forbids the taking of innocent human life on the basis that all human lives are made in the image of God.  It treats abortion in the same way as murder - that is, as a crime punishable by life imprisonment.

Not many people know that abortion is also against historic codes of ethics like the Hippocratic Oath, the Declaration of Geneva (1948) and the International Code of Medical Ethics (1949) or that in 1947 the British Medical Association itself called abortion 'the greatest crime'. Ironic indeed!

There are many good reasons for the BMA to give this decriminalisation motion short shrift on Tuesday. Let’s hope that it does so. 

Tuesday 20 June 2017

Doctors debate the complete decriminalisation of abortion at BMA ARM

Doctors could back the complete decriminalisation of abortion in Britain next week.

On Tuesday 27 June the British Medical Association annual representative meeting in Bournemouth will vote on a motion seeking to end all legal restrictions on abortion.

Currently, abortion remains illegal in Britain under the Offences Against the Person Act 1861. Under this law both mothers attempting to abort on their own, or any other person (including doctors) seeking to help them, are potentially liable to life imprisonment.

But under the Abortion Act 1967 doctors can authorise abortion on several grounds relating to the health of mother or baby. Although the Abortion Act was intended to be restrictive, allowing abortion only in strictly limited circumstances, its provisions are very liberally interpreted leading to the situation where one in every five pregnancies ends in abortion. 

There have been over eight million abortions in Britain since the abortion act came into being 50 years ago this year.  Department of Health figures for England and Wales released earlier this month show that there were 190,406 abortions in 2016 and that 98% of these were carried out on mental health grounds.

So in practice, although abortion is still technically illegal, the law is widely flouted and we have a situation tantamount to abortion on demand.

Now some doctors are seeking to decriminalise abortion completely.

The six part motion (motion 50), from the BMA agenda committee, is to be proposed by the BMA’s City and Hackney Division. It reads as follows:

That this meeting:
i) supports the principles set out in part three of the February 2017 BMA discussion paper on decriminalisation of abortion;
ii) believes that abortion should be decriminalised in respect of health professionals administering abortions within the context of their clinical practice;
iii) believes that abortion should be decriminalised in respect of women procuring and administering the means of their own abortion;
iv) believes that decriminalisation should apply only up to viability in respect of health professionals;
v) believes that decriminalisation should apply only up to viability in respect of women procuring and administering the means of their own abortion;
vi) believes that abortion should be regulated in the same way as other medical treatments.

It is likely that each part will be considered separately by the 500 BMA delegates with each section receiving a majority vote becoming official BMA policy.

The votes will follow an hour long presentation of a 52-page discussion paper on abortion decriminalisation which the BMA claims is ‘neutral’.

The British Pregnancy Advisory Service (BPAS), the country’s leading abortion provider, and the Royal College of Midwives (RCM) have campaigned heavily for a change in the law in recent months.

This culminated earlier this year in parliament voting by 172 votes 142 to support Diana Johnson’s radical Reproductive Health (Access to Terminations) Billwhich seeks to remove all legal restrictions on abortion (more here).

As this was a Ten Minute Rule Bill it will not become law but it is most likely that a very similar bill will be reintroduced following the Queen’s Speech later this month, either in the House of Lords or House of Commons.

In theory, Johnson’s bill would have made the 1967 Abortion Act defunct by scrapping section 58 and 59 of the Offences Against the Person Act, which make carrying out abortions, or supplying drugs or equipment for that purpose, illegal.

Johnson implied that the 1929 Infant Life (Preservation) Act, which makes it illegal to destroy a child ‘capable of being born alive’ (the act defines this as 28 weeks although many babies born as early as 23-24 weeks now survive), may also be scrapped under her plans. If so this would make abortion legal for any and every reason right up to term.

The BMA motion has been deliberately crafted to match the terms of Johnson’s bill as part of a wider campaign to change the law.

Johnson’s Bill is primarily backed by private abortion provider BPAS. The decriminalisation campaign specifically acknowledges that they are campaigning for a situation that would remove all gestational time limits for abortion. This position was affirmed by BPAS CEO, Ann Furedi, who said at the London launch of the campaign, ‘I want to be very, very clear and blunt... there should be no legal upper limit.’

If such a bill were to become law, and this would be far more likely with BMA backing, abortions could be carried out legally in any location, for any reason, potentially at any stage during pregnancy.

Without legislation on abortion, practices such as sex-selective abortions, mail-order abortions and school nurses handing out abortions pills on school premises would all be perfectly legal. The conscience clause would also fall, meaning that health professionals might be forced to carry out abortions or lose their licenses to practise.

Last year the Royal College of Midwives support for the BPAS’ abortion up-to-birth campaign caused widespread condemnation from midwives, the media and the general public against this extreme proposal. Over 1,000 midwives have now signed the open letter asking for RCM position to be revoked.

If the BMA were to pass motion 50 it would be signalling that abortion should be treated in the same way as surgical procedures like having one’s appendix or tonsils taken out – requiring consent only.

It would also put the doctors’ trade union at odds with its historical ethical code and with public opinion in Britain.

The Hippocratic Oath forbids abortion in all circumstances and the Declaration of Geneva requires that doctors show the utmost respect for human life from the time of conception.

But this new motion, if passed, would entrench doctors’ position as abortion’s greatest facilitators.

In the last few years, polls have consistently shown that a larger proportion of women want more, not fewer restrictions on abortion. A ComRes poll in May 2017 found that only 1% of women wanted to see the time limit for abortion extended above 24 weeks and only 1% of women wanted to see the time limit for abortion extended through to birth.

The same poll found that 70% of women wanted to see the abortion time limit reduced to 20 weeks or below and that 91% of women favour a total and explicit ban on sex-selective abortion. Clearly, women want the law to be stricter on the legality and regulation of abortion, not laxer.

The BMA must not bow to the will of this small and extreme pressure group. Motion 50 needs to be voted down. 

If you are a doctor or medical student, you can sign an open letter to the Chair of the ARM calling for the rejection of Motion 50. If not, you can still sign the Citizen Go petition.