I read the excellent article on Transgender issues in the latest CMQ
I just wondered where we stand if a patient asks us for a referral for a transgender clinic? I am certainly not happy with doing so and am dreading someone coming asking for this! (Obviously I would treat them with respect and explore all the underlying psychological issues etc)
Is there any guidance on conscientious objection?? I was appalled to see recent program on BBC where children as young as around 6 were living as opposite sex - and adults approving of this!!!!!
Thanks for any guidance
That’s very kind of you to say so. Writing it was hard work.
When the GMC revised its document of personal beliefs they started out with a view that one protected group (religion) would not be able to impose its views on another protected group (Transgender). As a result they suggested that the trans group would trump the religious viewpoint and that to refuse services to them would be “defacto” discriminatory. We pointed out that that could not be so. If a thing is unethical it should not be done and the fact that a minority group member which has legal protection is asking for it cannot be a sufficient reason to be forced to provide it and to abandon ethical considerations. For example, if a Catholic mother insisted upon intensive care admission for an infant which had no chance of survival, the fact that this was a request from a minority group would not mean that the request could not be refused.
That view carried the day and it was concluded that if we think a procedure is unethical, then we can refuse to provide it. But the right of ethical rand conscientious objection does require that we must refuse to provide it to all groups and not just the minority group.
That stipulation does not particularly matter for transgender issues as the things that are done are moreorless entirely specific to that group. Although there is a real challenge for doctors and pharmacists who are asked to provide on-going prescriptions for sexual phenotype changing hormones.
For contraception it works well for those (Catholics) who refuse to provide the pill to all women married or not, though it works less well for those Anglicans who only want to give the pill to married couples.
For Viagra, and in other circumstances, there are some real challenges. Many are likely to think that Viagra to enable continued sexual intercourse between a husband and wife is different from giving Viagra to single men who are wanting to be able to have a one night stand. We hope to publish more on that soon.
So there is some real complexity. Would you prescribe Viagra for an unmarried man who wants a one night stand? Would the GMC respect your refusal to do so?
But with the transgender campaign there is, in fact a more complex issue which probably triggered the pharmacists troubles earlier this year. Some pharmacists (and some GPs are refusing to provide the oestrogens etc to transitioning and transitioned (to female phenotype) men. In men who are starting transition, we might well refuse to provide the hormones as we think that such treatment is mutilating. And therefore unethical. But for those who are established on female hormones, is continuation of those hormones a continuation of the mutilation, or has the water passed under the bridge and is this maintaining the (new) status quo the best remaining option. It might well be. I don’t think we fully understand that issue yet. And it needs careful thought and discussion. The instinct is not to provide and not to cooperate. But although we should not cooperate in an unethical act , we will support people with ethical care once that unethical act has been completed. I am thinking of the very different situation of a woman undergoing an abortion.