Thread by @adhib

In honour of #IWD, a fairly in-depth thread on what the core issue is with the Bill @ScotGov has introduced. Lot of folks like @MhairiHunter and @agcolehamilton are spinning this as simple admin, as Sturgeon did last night. That's a lie.

Thread:

De-medicalising transgender identification cannot be understood as an isolated, technical matter. Removing the medical hurdle will be to complete a profound shift in our institutional posture towards trans issues, from a healthcare framing, onto a human rights framing.

This has far-reaching implications for gay, lesbian and gender non-compliant children, for all dysphoric patients, and for many others (eg women, children and vulnerable patients) whose safeguarding rests on the clear boundary of sex – both in law *and* in public understanding.

Such a change will have substantial implications well beyond the purely technical scope of the Act. The GRA 2004 has already done much to alter wider *non-statutory* expectations and practices in this direction, as has the confused guidance around EA2010, just lately corrected.

The political goal of one school of trans activism is to achieve full de-medicalization, to move societal and policy assumptions wholly away from the sense of their being a patient group with particular care needs, and onto the basis of a political and ethical minority.

They demand our laws recognise trans identity as directly equivalent to LGB or BAME, and in no way akin to a patient group, where talk of anorexic or alcoholic ‘rights’ would be recognised as both absurd and harmful. Their evidence for this is impressive, but paper-thin.

In earlier rounds of lobbying for GRA reform, de-medicalisation was the primary goal of trans advocacy, explicit and fully articulated. Why as it repackaged as "just admin"? Was it because that earlier demand was met with due seriousness and fine attention to the implications?

Removing the medical gate in the GRA process will grant the complete achievement of that original goal, in Scotland, finishing the project of relocating trans issues onto a rights-bearing minority footing.

Please: let's focus on what Demedicalisation means:

1/ Normalising dysfunction. If the law institutionalises transition as a normative human state, NOT a palliative psychiatric treatment of last resort, then clinicians, parents and other guardians seeking to avoid its harms will be interfering in the "human rights" of the child.

A disturbed teenager will no longer benefit from open exploration of the source of their distress before surgical interventions and cross-sex hormones, with its mortality risks and long-term DALY impact. Treating that life path as sub-optimal will inevitably become unlawful.

2/ Harms to LGB teens. The normalisation of transition is particularly harmful to gender non-compliant (GNC) girls. Non-compliance with heterosexuality and gender stereotypes is already being seen as a sign that the child is ‘trans’ and may expect to change sex.

Parents are ‘socially transitioning’ such children well ahead of puberty. Social services with limited scope to risk-assess such situations will subsequently face the full force of a human rights defence of such abuse. Who will stand up for the fledgling lesbian, gay or bi kid?

3/ Patient care vs. Rights. We can only support the welfare of people with a wide range of disorders as patient groups, not as political solidarities. Patient care turns oppositional in a mental health context if a patient’s self-diagnosed ‘need for X’ is framed as a human right.

Teens presenting at GIDs already use scripts learnt online to get past a 'gatekeeping' clinician. The Rights framing of a mental health issue puts patients at severe risk of misdiagnosis, eg, a child who may have reconciled with her sex or sexuality being medicalised for life.

4/ Bulk. Removing the ‘quality control’ of a medical diagnosis risks a substantial increase in the sheer quantity of people within the scope of the Act. Hansard records HMG proceeded on the basis that a few thousand individuals desperate enough to need a GRC.

By removing the medical hurdle on the ‘funnel’ into this pipe, demedicalisation might increase the number of males legally recognised as female by a factor of x45, on GEO estimates. How will public perceptions of the GRA in its entirety respond to a shift of that scale?

5/ Public safety. The public’s trust in the efficacy of governance over transition will be further undermined. There are many cases in public awareness where a male claiming trans identity has harmed women and girls, with ministerial approval of, eg, self-ID in the prison estate.

Retaining the gate of medical evaluation supports a degree of public trust. Discarding the gate entirely will look like a total abdication of governance. The public will read that as irresponsible, and challenging of transsexuals in public spaces will most likely increase.

6/ Safeguarding. A large body of law and policy relies on a clear distinction between male and female. Medical diagnosis is the sole gate that stands between a psychologically disturbed, predatory male who seeks and is then granted full legal recognition as a woman.

Removing it logically sabotages every single safeguarding protocol, formal or informal, that relies on distinctions between and/or segregating by sex. And as drafted it provides yet another method for a person to conceal a history of offending.

7/ Democratic deficit. YouGov polling (June 2020) shows that no more than 16% of the electorate would support the removal of the medical gate, and in excess of 60% actively oppose. Removing it directly contradicts known public sentiment, tending to undermine trust in democracy.

In sum, then ... do not let them play their shell games with petty details of what a GRA does and does not entitle a person to do.

The point is DEMEDICALISATION. Shona Robison knows this - it's the word she uses as shorthand for the reform in the launch debate.

Call them out!

PS: if by any chance you've come this far and you're now thinking "fine, so dysphoria's a health issue, transition is the treatment, all is well" ... I invite you to consider what the drivers of dysphoria might be: unherd.com/2022/03/the-ta…