The polarisation of medicine and medical defence organisations.
The mutually exclusive “affirming” pathways for children wishing to change sex represent a clear ethical divide in which it is essential for medicine, not activists and not governments, to be decisive and authoritative. There is no neutral.
It is inevitable that at some point there will be consumer legal action for either affirming OR failing to affirm.
Who will decide? Will it be doctors, psychologists or the lawmakers? If doctors, then will it be the psychiatrists or paediatricians who tend to have opposing views? Associations of paediatricians hold very definite opposing views.
Which side of the polarity regarding child abuse will Medical Defence Organisations defend? If they defend surgeons who do transgender mastectomy for a 25-year-old on the grounds that fully informed consent was given, will they also defend surgeons who have done the same procedure for a 13-year-old who decides to sue when an adult?
Further, will MDOs defend the surgeon who refuses to do a mastectomy for a 13-year-old?
And how will MDOs decide? Will different MDOs have different approaches to these matters because their boards have been taken over by people with set ideologies?
Will MDOs simply side with what is legal — if governments declare that affirmation of birth sex or reversal counselling is child abuse and punishable by law?
For the sake of our MDO insurance premiums we need decisions now, rather than a decade from now. It is to be hoped that MDOs will continue their honourable, professional status and be much more than just another insurance company.
This is a clear ethical divide in which it is essential for medicine, not activists and not governments, to be decisive and authoritative. There is no neutral.
A note regarding the affirmation of feelings, unsupported by evidence:
“Yes, you must affirm the feelings — progress is not possible unless you do.”
“The evidence doesn’t have to support the feeling — it doesn’t have to be totally true.”
Consider “recovered memories syndrome”. After attending a seminar in 1995 on Memories of Abuse, I wrote the following:
If we have not ultimately questioned historical accuracy by using intervention strategies at some point, and 20 people are imprisoned as a result of subsequent criminal charges, and it is then found that the memories were not factual, then — despite the existence of disclaimers and contracts — we may be accused of having failed in this wider responsibility. This is equally true even if only one person is unjustly imprisoned, and it is also true even if only one person is unjustly accused.
Regarding those suffering gender dysphoria: if we have not even queried whether there are possible contributing factors or stressors in children wishing to change their sex — such querying itself labelled as abuse by those who insist on affirming the wish — then we have failed our ethical and professional responsibilities as doctors, and our duty as community leaders and parents.
We have failed the child and we have failed the community. We have failed medicine.