Push for progress on transgender rights in healthcare

by Jennifer Trueland

Doctors’ leaders have strongly affirmed the rights of transgender and non-binary people to access healthcare and live their lives with dignity.

Last reviewed: 16 September 2020

Following a wide-ranging debate at the BMA’s annual representative meeting, doctors backed the right of transgender and non-binary people to self-identify, said that under-18s should be allowed to access healthcare, and that trans people should be able to receive healthcare in settings appropriate to their gender.

Doctors also agreed that trans healthcare workers should be able to access facilities appropriate to the gender they identify as, and that trans people should be able to access gendered space in line with the gender they identify as.

The debate heard from doctors with strongly differing views – at one point, representative body chair Helena McKeown said the tension in the room was ‘palpable’ – but in the end the meeting sent a clear message that the BMA supports trans rights.

‘Costly reports to an opaque committee’

Grace Allport, from BMA northwest regional council, said it was important to remember that transgender people were not only our patients, but also colleagues. ‘That’s why it’s so disappointing to hear the statements and leaks coming from the Government, threatening to row back the rights of transgender people and to deny healthcare to under-18s who experience gender dysphoria. It’s important for us to pass this motion now to protect the rights of transgender and non-binary people.’

Dr Allport said the Government had repeatedly ‘kicked the can down the road’ in the two years since opening consultation on the Gender Recognition Act, despite overwhelming support for self-identification of gender.

‘This process currently requires doctors to determine whether somebody’s transition is “valid”, requiring them to produce lengthy and costly reports about the life and medical history of transgender people to be sent off to an opaque committee which never meets the individual in person. As doctors, we should take no part in such a process.’

Dr Allport said that countries such as Ireland, Norway, Argentina and Portugal already allow identification on the basis of sworn, witnessed statements, and that this was working well.

Matters of debate

Dr Allport also said the Government was planning to ban puberty-blockers and hormones for under-18s with gender dysphoria. ‘These medications are used off-label, which is not uncommon in under-18s.’

But Angela Dixon, a GP from Scotland, told the meeting that while all transgender people should be able to access healthcare and live their lives with dignity, the BMA should not be supporting medical interventions for gender dysphoric children, saying they were ‘far from evidence-based. Nor should the BMA be supporting legal changes that conflict with women’s sex-based rights,’ she said.

‘If the BMA is saying that trans women should be treated as women on the basis of self-ID, it impinges on provisions to ensure that women can access healthcare safely and with dignity.’

Dr Dixon said the treatment of children and young people with gender dysphoria was ‘a matter of debate’ but that puberty blockers and hormone treatment could cause irreversible changes to the body, including infertility. Some people who transitioned later regretted it, she added. ‘Trans people deserve safe and effective healthcare, and this is what the BMA should be calling for.’

Cultural evolution

But BMA council member Tom Dolphin said that trans people were the victims of ‘culture wars’ that sought to find someone to ‘other’, or make the focus of a moral panic. ‘Thirty years ago it was the gays, of course – we were paedophiles and perverts wanting to corrupt the moral purity of the nation. We had open homophobia in parliament, in pubs, and in the papers. Section 28 was the result of that and it took years to repeal.’

There is now a similar moral panic about trans people – one of the most vulnerable groups around, warned Dr Dolphin.

‘The BMA is a proud supporter of LGBT rights – we supported the repeal of section 28, and we should stand with trans people now at a time when they are being subjected to a moral panic.’