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Healthcare professionals, hate crime and transphobia definitions

(17 Posts)
vivariumvivariumsvivaria Tue 23-Feb-21 17:38:03

I am an HCP and have worked with trans and NB people if they access my specialism. I am not part of a gender clinic and I have only seen a handful of trans and NB people at work.

I have been qualified for a long time and so I am well used to dealing with people from all sorts of backgrounds with all sorts of preferences and all sorts of needs. I am good at my job.

However, I have twice been called transphobic by trans or NB patients or their relatives at work. Both times it was because I was refusing to provide the patient with what they believed that they needed, and on both occasions there was no clinical need for it. In fact, if I had done as they had asked me then I would have been working beyond my own scope of practice and in breach of my professional guidelines.

Both times the patients said they would report my to my governing body. I don't believe that they did because I didn't hear anything from them - and I am confident that any examination of my decision making process would have found me to have been working professionally and safely.

However, this proposed Hate Crime Bill and the new SNPand Lib Dem definitions of transphobia worry me.

My two patients believed me to be transphobic, they believed that I was withholding treatment because of their gender status. I was not, but, that is not relevant to their distress at being denied something that they believe they needed.

If the Hate Crime Bill is passed what happens to me if I am accused of transphobia by a patient who is unhappy that I won't give them what they believe they need, but I cannot justify it or know it would be harmful?

If my clinical reasoning and my critical thinking are sound then I know that any subsequent investigation would find me to be acting in my patient's best interests, as it would for any other patient who is unhappy with their care. However, the added element of "hate" and the inclusion of denying biological reality in the definitions really worry me.

I cannot pretend that the person in front of me has a sex if that is relevant to their care. Sex is fundamental to health care. Gender is not, other than awareness and sensitivity is needed in order to build a therapeutic relationship, but, it is not possible to harm a patient by getting their gender wrong in the same way as it is possible to harm them by getting their sex wrong.

Will the Hate Crime Bill and the transphobia definitions make a criminal of me if a patient I am caring for (to the best of my ability and within my professional guidelines and also professional limitations) believes me to be acting in a way that is transphobic?

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Apollo440 Tue 23-Feb-21 17:43:02

Short answer, yes.

If (by the SNP) definition 'biological male' is hate speech then everything is. You weren't expecting it to make sense were you?

OhHolyJesus Tue 23-Feb-21 18:11:10

Please re-write that and send to your MSP and Humza and copy or bcc For Women Scot.

This cannot go on and the very threat of action being made against you is enough to make you concerned for your job, a job where you are clearly highly trained and patient-facing and could be in receipt of similar accusations.

I'm really sorry. It's insane.

vivariumvivariumsvivaria Tue 23-Feb-21 18:20:40

No, Appollo, not really. It's so bat shit that it does feel a bit like "hang on, am I the bad guy?", you know? The previous incidents were unpleasant, but, to be honest, the patients were generally challenging, as very stressed people can be in hospital. It wasn't their gender status that made them prickly, it was the situation they were in. Them being angry with me wasn't about me - but, it was not nice to be on the receiving end of it, even though I knew it wasn't personal. However, at that point I wasn't being accused of a crime.

Holy that is actually why I posted on here. I'm going to request a meeting with my MP and MSP. I'm trying to figure out how to word it for my union - who are woke as woke and won't like my question at all.

But, thank you - I do often wonder whether I am actually wary of transpeople and acting in an unconsciously biased way. Maybe I am, but, if so I'll tell you this much, I am becoming increasingly unconsciously wary of working with that community because of this sort of bollocks.

OP’s posts: |
NecessaryScene1 Tue 23-Feb-21 18:30:15

This sort of concern is why there are an ever-increasing number of judicial reviews and court cases in progress.

These laws and guidelines have not been properly thought through. And many vulnerable people are also not thinking things through clearly, and could try to use such a law as a cudgel.

Maya Forstater's case has so far seemed to me to one the most key - her claim being partly (to paraphrase) "as part of my international development work, sex is relevant, so I must be free to discuss sex".

If that Scottish law passes, someone like you is going to fall foul of it. But being actually criminal rather than civil, it's not clear how much we can crowdfund that person out of it.

Another medical concern has been the drive to outlaw "conversion therapy" - this nominally being about "sexuality", despite that really not being a thing in 2021, but also sneaking in "gender identity" - in effect outlawing therapy for gender dysphoria or any attempt to dissuade from medical intervention.

These laws are not coming through as the result of proper consideration of reasonable responses to real problems that would be solved by laws - they're the results of lobby groups with an agenda. And those same lobby groups are intimidating people into not objecting.

Fallingirl Tue 23-Feb-21 18:44:42

A similar issue will be facing transwidows and children of late transitioners.

How do you explain how those children came to be?
And do the wives have to say their husbands are female?

andyoldlabour Tue 23-Feb-21 19:28:11

This whole sityation has teally snowballed over the past couple of years. From depriving women of sporting titles, Labour women's officers hounding women out of their jobs, university students hounding academics out of their positions and now the chance that experienced, valued healthcare staff could be hounded out of their jobs and possibly criminalised.
And all for what?
A glance, a "wrong" word, possibly "wrong" thinking.
It all bouils down to "hate speech", or one word, the word which is the most difficult to understand or explain in the English Language, the word which must not be named - Transphobia.

Leafstamp Tue 23-Feb-21 19:38:27

Another nightmare scenario caused by this ridiculousness.

I'd like to think the scenario in the OP would never come to fruition in terms of a case, let alone a prosecution. But maybe I'm being naive?

I'm trying to think if there is a comparable in terms of denying (say) a disabled, or particular ethnicity a clinically unnecessary treatment and then them saying you were being disablist or racist?

MaudTheInvincible Tue 23-Feb-21 19:40:10

Perhaps your governing body could give you some advice, op? It seems very unfair to expect health and social care professionals to deal with these issues without providing guidance.

Saw this the other day:

The Evidence-Based Social Work Alliance has written an open letter to the Chief Executives of all four UK social work regulators, CAFCASS and BASW.

A request for policy review and practice guidance

An Open Letter to:

Colum Conway, Chief Executive, Social Work England
Lorraine Gray, Chief Executive, Scottish Social Services Council
Sue Evans, Chief Executive, Social Care Wales
Patricia Higgins, Interim Chief Executive, Northern Ireland Social Care Council
Ruth Allen, Chief Executive, The British Association of Social Workers
Jacky Tiotto, Chief Executive, Children and Family Court Advisory and Support Service

Request for policy review and practice guidance

We write as a coalition of qualified practitioners, academics and social work students under the umbrella of the Evidence Based Social Work Alliance (EBSWA). We are concerned by the current policies and practices regarding sex and gender identity that have been adopted throughout the social work profession.

We remain anonymous because of our concerns as to how social work professionals who question gender identity policy and practice are treated. This is reflected by our awareness that social workers are being investigated by regulatory bodies for engaging in discussion on this topic.

EBSWA gather and consider evidence on the questions of sex and gender identity to inform professional discussion, and we are concerned by the uncritical use of gender identity theory in social work and other professions. The group believes that there is insufficient knowledge to support the current policies and practice that have been adopted throughout the profession and further debate and discussion is required.

EBSWA believes that our professional Code of Ethics as social workers mandates and requires us to explore evidence relating to policy and practice decisions and contribute to the professional debate and discussion.

The aims of our group are:

• Discuss our responsibilities towards service users, as well as social workers and other professionals, when considering issues of sex and gender identity in policy and practice.

• Consider the needs and best interests of children particularly, but not exclusively, children who experience gender dysphoria.

• Seek the voice of children and others affected by notions of gender-dysphoria and gender nonconformity for their views and experiences.

• Consider evidence in the public domain on gender dysphoria,
gender identity and the treatment of children presenting with distress in these areas.

• Collaborate with allied professions to share and discuss our findings and concerns.

• Defend the right as professionals to challenge and question the merits of existing guidelines and practice of gender dysphoric and gender non- conforming children using an evidence-based approach.
Of immediate concern is the increasing numbers of children and young people with gender dysphoria who are presenting to the profession. The welfare of gender-dysphoric children is increasingly being discussed within the child-protection context, and yet our attempts to explore alternatives to the affirmation model are being met with accusations of hateful conduct and referrals to our regulator for investigation. We are being silenced in our attempts to understand and discuss the evidence-base approaches to exploring this phenomenon.

The recent high-profile Judicial review of the Tavistock and Portman Trust’s treatment of Keira Bell, and the resulting update in NHS England guidelines for treating gender dysphoria in children, will change the way in which professionals approach this issue. Social work policy and practice must engage and respond in line with these developments.

It is of deep regret to us that in the past social workers have not always spoken up to safeguard children, when it is clear in hindsight we should have. Our failures in the Rotherham child-grooming scandal is one such example. We believe that in order to ensure social workers do not let down our children again we should be prepared to ask questions of an ideological approach to sex and gender identity.
We therefore request from you the following:

• A review of policy and update of practice guidance for social workers who are working with gender dysphoric children, their families, and schools.

• To make available the evidence upon which policy and practice guidelines in issues of sex and gender identity, both for adults and children, are based.

• To facilitate respectful and considered debate on the topic of sex and gender identity in social work practice.

• To make clear that threats, bullying and intimidation towards social workers who explore evidence for practice in this field will not be tolerated.

We look forward to hearing from you,

Kind regards

Evidence Based Social Work Alliance

Manderleyagain Tue 23-Feb-21 19:48:58

Other professions where this is relevant - eg health professionals - could do with their own version of the evidence based social Work alliance.

vivariumvivariumsvivaria Tue 23-Feb-21 20:58:52

That is BRILLIANT from the SW.

I will contact them and ask them how they found each other. There are other members of my governing body who think like me - they emailed me after I posted on a professional forum asking for help about how to handle the upset patients. Usual story, they weren't able to speak up publicly. ]]

OP’s posts: |
Xpectations Tue 23-Feb-21 21:34:05

Obviously as you are providing care, you will be documenting your interventions and clinical decision-making in the patient’s record. If you can cross-reference this with relevant policies, and crucially, discuss the case with a peer/clinical team (and document this) you will have done the bare minimum of providing best practice plus peer review.

MaudTheInvincible Tue 23-Feb-21 21:35:21

I hope you get somewhere with it. Incidentally, have you seen the current FWR thread about members of BACP? You're not alone in feeling this way. Lots of HCPs and others are having similar worries, especially around the stifling culture of silence that's been allowed to develop in these professions.

Any other BACP members on here?

Xpectations Tue 23-Feb-21 21:35:34

^should a patient escalate a complaint.

Xpectations Tue 23-Feb-21 21:40:56


Obviously as you are providing care, you will be documenting your interventions and clinical decision-making in the patient’s record. If you can cross-reference this with relevant policies, and crucially, discuss the case with a peer/clinical team (and document this) you will have done the bare minimum of providing best practice plus peer review.

I’ve just given advice that wasn’t asked for OP, my apologies.
I was transported right back to my nursing days on a particular ward when I felt I had to indemnify myself against everything.

lalawasthebestteletubby Tue 23-Feb-21 21:55:47

OP this is truly frightening. The NHS is captured, unions are captured, professional bodies are captured, who will stand with us if we're accused of hate crimes while in our sincere clinical judgement we are doing the best for our patients? We're trying to work in the real world, while subject to the laws of rainbow sparkle unicorn bullshit world sad

vivariumvivariumsvivaria Tue 23-Feb-21 22:30:59

Xpectations no, you have a very good point.

Yes, I knew I would be fine because I know my notes are all that support me in court. I had previous experiences where patients complained about me and I realised how important notes were - which I think is a normal part of being an HCP. I really have been qualified for a long time and there isn't much I haven't seen.

What I am worried about is that if I reflect on those experiences, where my notes protected me, I am not at all confident that it would be sufficient if I my best practice conflicted with the wishes of the patient then I could be accused of a hate crime.

This is a new law. The government are captured and need someone to make an example of. I am worried that will be a HCP who is just doing their job - given that there is this nonsense at the root of government, police and union policy now that sex is a choice, that gender is what matters and not biology.

To be frank, I am worried that an example would be made of me. Well, or of my colleagues - we cannot do our job without knowing and recognising sex.

Humza et al can pontificate about what they think is right. If I get it wrong people get hurt. At the very best, they get hurt.

OP’s posts: |

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