The Mail on Sunday has today quoted my blog in a story titled ‘Doctors “forced to carry out sex-change ops” under rules meant to “marginalise Christian medics”’.
The article picks up on comments I made last week about new draft guidance issued by the General Medical Council which says that doctors who refuse to provide sex-change operations risk being struck off the medical register.
The new draft guidance, ‘Personal beliefs and medical practice’, was issued on Thursday and is subject to consultation. It warns that ‘serious or persistent failure’ to follow it ‘will put your registration at risk’.
The guidance recognises that ‘in some areas the law specifically entitles doctors to exercise a conscientious objection’ and opt out of ‘particular treatments or procedures’. It cites participating in abortion as a specific example.
It also allows doctors to opt out of providing other procedures or treatments provided that they ‘make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you’.
However, the GMC makes a clear exception to this rule, with regard to sex-change operations.
Section 5 reads as follows:
‘You may choose to opt out of providing a particular procedure because of your personal beliefs and values.*’
But the asterisk refers to a footnote which states:
‘*The exception to this is gender reassignment since this procedure is only sought by a particular group of patients (and cannot therefore be subject to a conscientious objection – see paragraph 5). This position is supported by the Equality Act 2010 which prohibits discrimination on the grounds of gender reassignment.’
It then goes on to add the following:
‘But you must not refuse to treat a particular patient, or group of patients because of your personal beliefs or views about them†
Another appended footnote reads:
‘†The Equality Act 2010 prohibits discrimination on the grounds of nine protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. ‘
The Daily Mail quotes an unnamed GMC spokeswoman saying that the new guidelines only reflected the ‘law of the land’. She said the Equality Act 2010 already prohibited doctors from discriminating against people who are undergoing gender reassignment treatment.
But do you see the problem here? She has not actually addressed the real question.
On the one hand the guidance says that doctors should not refuse to treat people because of their personal beliefs or views about them.
Absolutely right! If I have a patient who needs treating for pneumonia and or diabetes then I must treat them without any partiality or discrimination regardless of their ‘age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation’. It would be profoundly negligent to do otherwise.
But the guidance also says that doctors have no right to opt out of ‘providing’ the ‘procedure’ of ‘gender reassignment’ (ie. A sex change operation). Furthermore it claims that the Equality Act 2010 upholds this duty.
Gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with their biological sex and/or the gender they were assigned at birth). It is classified as a medical disorder by both the ICD-10 CM and the DSM-IV TR and that is how many doctors still regard it.
On the other hand many transgender people and researchers support the declassification of GID as a mental disorder for a variety of reasons.
In other words there is a major debate going on currently between leading professionals about what Gender Identity disorder actually is. But the GMC has disregarded this and instead chosen to take one controversial view held by some people on the subject as the only acceptable view.
Gender reassignment 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 procedure, either as surgeons or anaesthetists or as part of the referral pathway or pre-operative assessment.
But the GMC is now saying that they have a duty to provide it and have no right to opt out of doing so. It is also threatening them with being struck off if they do not comply.
That is a bridge too far.
This draft guidance not only imposes a duty on doctors which violates their professional freedom. But I suspect it also significantly over-interprets the law.
The GMC has some serious explaining to do. And quickly.
(A much fuller treatment of Gender Identity Disorder is available on the CMF website)