High Court Battle - pronouns

I've got splinters on my arse from the fence sitting, which smarts a bit, but I agree with both points of view and am enjoying this discussion.

I think there's a further nuance - how willing I'd be to concede pronouns is probably dependent on how vulnerable I thought the person was. For instance, if I thought the person was a fetishist I'd be less inclined to be willing to work with them because I don't want to be part of their fetish. If I thought the person had dysphoria I'd be likely to use them without hesitation.

Ouch. There's another splinter up my hole.

You can't refuse to treat someone due to a protected characteristic. So I can't decline to treat black patients, or gay patients.

If an individual is abusive you can decline to treat, yes.

In practice it's rare, and I'm amazed his A+E job allowed him to decline to treat all trans patients, which is what the tribunal determination says happened.

If an individual patient is abusive to an individual clinician, then the NHS has a zero tolerance policy. If a transwoman were abusive to this doctor of course he could decline to treat them.

But there's nothing to suggest that this was the scenario here.

I agree the Welsh case is appalling. As is the mammogram case further upthread. And how Scottish rape victims are treated is appalling.

But rights don't exist in a vacuum. Yes, this doctor has the right of freedom of belief. His clients have the right to be treated fairly, with dignitiy and respect, and without disadvantage due to their beliefs.

It's always a balance.

If you said to me that that balance has sometimes swung too far in the TRA direction I would wholeheartedly agree.

I just don't think this is that case.

Sometimes taking a principled stand has consequences. The military offers (or at least used to?) university scholarships to my profession. Worth literally tens of thousands. To take one up means committing to serve; they are, for obvious reasons, not open to pacifists. I happen to know that the local butchers offers the best paid apprenticeship opportunity in the region. I'm vegetarian - I wouldn't expect them to modify the role so I only cut tofu steaks in order to avoid disadvantaging me. Following a religion carries costs. Christ, after all, was crucified.

I also don't agree with compelled speech. I do agree with courtesy. Particularly from a doctor to their patients or clients. There are places to challengs the trans view. Either in public, like Sir Winston and Question Time. Or with an individual patient, where clinically relevant.

A 40 minute assessment on benefits eligibility is not that place. It achieves nothing except further distressing someone who is already distressed. Treat your clients with courtesy and fairness, even when you don't agree with them. Or accept this is the wrong job for you.

A midwife who doesn't believe in abortion is protected in law to not play a part in any termination services.

Their obligation is to find another HCP to take over caring for that patient. As far as I read this article, that's what he was asking to do.

Exactly, I am a pro choice feminist but I don't believe people should be compelled to do something they personally believe is deeply unethical. This ideology can be considered in certain aspects to meet that description.

@ScrollingLeaves IIRC there was some comment from Autism UK about the case.

It should have been a huge story and a national outcry and an appeal.

If you feel unsafe with the patient you won't be able to build a therapeutic relationship with them. And everyone deserves excellent care, so if something is getting in the way of you providing that it's compassionate to find someone else.

I have treated dangerous people who attended with escorting staff and were cuffed and didn't bat an eyelid. I have been in all manner of mix ups with all manner of people and been totally comfortable. I have treated people who verbally abused me because of my sex, shape, faith, accent - HCPs are well used to that. The one person I refused was someone that I just didn't want to be alone in a room with and there was nothing specific about them, but I did not trust them and so got a man to deal with them.

All I had to do was record that I passed the care onto a colleague.

@vivariumvivariumsvivaria
Thank you for that link.
It certainly seems unfair to have convicted him given he was autistic. No account seems to have been taken of that at all. I hope it would be different now.

Thank you for the clarification vivarium. I just wanted to understand whether it was a requirement to treat people or whether you could argue it wasn't compatible with your own rights.

@Ereshkigalangcleg - yes, you can withdraw from a patient for any reason. You would have to find them someone else.

It is usually done for violence, stalking, aggression or sexually inappropriate behaviour and is very unusual. In 30 years I have refused one patient.

Here you go, @ScrollingLeaves.

If it was now then yes, I expect there would be a crowdfunder and help from Joanna Cherry for him.

As it is, he now has autism, a learning disability and a criminal conviction which is particularly nasty in nature. And the movement who encouraged the officer want me to be sympathetic to the trans man because they feel that people don't like them very much.

Well, how about you stop taking people with learning disabilities to court? FFS.

www.walesonline.co.uk/news/wales-news/teen-prosecuted-after-asking-whether-17651755

If a male patient hates women and calls them all "whore", as a female doctor or nurse can I be forced to treat him without being able to opt out and leave it to someone else, or is that considered an unacceptably hostile environment given that I also have a protected characteristic under the EA? Genuine question, which I don't know the answer to.

Yes, @Ereshkigalangcleg - I think I agree with you.

What is the ethics of accommodating the trans woman's pronouns if it means we are supporting or reinforcing a belief which is harmful for that individual?

This is all very new, we don't yet know what the long term consequences of transition are.

"First do no harm" is a solemn vow that medic will have taken. If he is not confident that the changed language is harmless then what is a man of principle to do?

What a mess. This could all have been sorted out if Ruth Hunt had encouraged debate. But, she decided to obfuscate things and now we have a vulnerable person who is upset and a medic having to defend beliefs and science.

@vivariumvivariumsvivaria
“The way that young man in Wales was treated was awful. He was, I think, 19, had autism and a learning disability and asked a trans man police officer whether they were a boy or a girl. He was convicted of a hate crime. “

It is extraordinary that he was convicted. I did not know about that story.

Basically equitable health care and equitable access to support for the disabled is more important than equitable access to cake.

I mean in terms of the freedom of belief and speech principle. Not about what it's about.

As I said, I see your point but I don't agree with compelled speech. Many mental health conditions involve thinking things are true which are not the case, there are limits on how much these beliefs are catered to, aren't there?

So, the TRAs can bring in laws to enforce group think and control our language, in order to create an expectation that their identity will be accommodated - but truth will always out. You cannot change sex. You have to learn to cope with not being able to change sex.

This. We need to stop pretending that people can change sex, or that sex doesn't matter. It's not helpful, it's not kind to either them or others, it's not sustainable and it's not realistic that everyone will comply 100% of the time. A lot of this problem has stemmed from people using this control over others as a power trip. See the AIBU about a non binary person currently running, where the OP is having to manage a very difficult individual who is causing trouble for everyone.

That "hate crime" police officer "misgendering" case was a scandal, the poor young man involved should have had better legal representation. If he had the network GC feminists have there would have been a crowdfunded defence, I'm sure.

@Ereshkigalangcleg I think any time there's a conflict of rights, then where the balance lies between them is very case specific.

In the gay marriage cake case, the baker was being asked to make a positive statement in support of gay marriage. In this case, the doctor isn't being asked to make a statement in support of trans rights. I agree that would be unreasonable. He's being asked to use the preferred name and title for the client in front of him. So to call Mrs Smith, Mrs Smith.

In the case of the cake, the consequence of the customer leaving is that they didn't get a cake. They could go to 1001 other bakers.

The consequences in this case are:

1. Causing further distress to someone already so severely mentally unwell they cannot work.
2. Delaying their assessment, possibly requiring them to come back another day. Not easy for someone profoundly disabled and on benefits!
3. If they are so upset they leave, they lose access to disability benefits.

In the first case, what is being asked of the provider is high, and the impact of refusal is low. In the second, what is being asked of the provider is lower, and the impact of refusal is much higher. So the balance of rights swings the other way.

Basically equitable health care and equitable access to support for the disabled is more important than equitable access to cake. And I say that as a cake-lover! Particularly when the client has no choice but to engage, and the consequences of disengagement are devastating.

It shouldn't be an expectation for people that they will always be catered to in matters of their personal identity

That's a good point, @Ereshkigalangcleg. Even if the majority agreed this was to be accommodated there will be problems when people with neurodiversity, learning disabilities or who are very young state what they see - which is a biological fact that that person is not what they say they are.

The way that young man in Wales was treated was awful. He was, I think, 19, had autism and a learning disability and asked a trans man police officer whether they were a boy or a girl. He was convicted of a hate crime.

I'd have argued that the trans man's upset and insistence of charging the young man was a hate crime in itself. That young man had protected characteristics too, ones which mean that he is vulnerable.

So, the TRAs can bring in laws to enforce group think and control our language, in order to create an expectation that their identity will be accommodated - but truth will always out. You cannot change sex. You have to learn to cope with not being able to change sex.

Also, who PUNISHES a person with a learning disability for behaving asking a blunt, insensitive questions?

It's a similar issue to this doctor who has religious beliefs, which are protected under the EA2010. His religious belief doesn't allow him to collude in a lie that the person has actually changed sex, or to believe that you can change sex. Which he knows you can't because he's a medic.

Giving people with learning disabilities criminal records and disciplining medics for stating biological facts - well, it's just not a good look.

I do not believe that people on benefits should have to give up the right to be treated with dignity and respect.

I completely agree, but think people should be able to conscientiously object from gender identity ideology. It shouldn't be an expectation for people that they will always be catered to in matters of their personal identity. The benefits issue is irrelevant.

I do see your point Motorina but isn't it like the gay marriage cake case? Which I also can see the other side for but come down on the side of freedom of people in the workplace not to have their speech compelled.

@SolasAnla if you read the tribunal determination you'll see outlined the steps that the DWP went to to try and accommodate his beliefs.

His preferred solution was that, on meeting a client, he first conduct an assessment of whether they were transgender. If they were, he would stop the assessment and direct the client back to the waiting room to wait and be assessed by someone else.

The DWP considered (and the Dr agreed) that that was likely to cause offence. It would also inevitably delay the assessment which might lead in some cases to the individual having to return another day.

The DWP considered, and the tribunal agreed, that that was not a reasonable or workable accommodation.

In weighing up the rights of the Dr and the rights of the client, it considered that the rights of the client took priority. Just as they do when I say I want a female clinician for an intimate procedure.

If you enforce collusion in one social interaction you embolden the enforcer to demand the same in all social interactions.

"Jane can you sit in the red chair"
"Mrs. Jane Smith can she sit in the red chair"

He could use the person's name during the appointment and use their name in reports
Simple solution part 1.

and might just have to tick a box for the titles.
He never gets to choose or allocate titles. These will be collected but have no value as data points and have no relevance to the assessment process.
In fact under good data protection policy the question should be why is this data collected at all.

However some titles fall within the PC belief. How about requiring a woman to address someone "allah" or "Big Daddy"?

The Service Provider is an employer so they have a legal duty to their employees to not discriminate on the 9 PC grounds.

The Employer has to make reasonable adjustment to not discriminate.
Has the Employer done this in this work environment?

At the appointment the applicant in not unknown to the Employer as its a service provider which has had prior contact and collected multiple data points.
Has the Employer assessed that there is a conflict of PC's and conflicts between how it approaches if in its employer role and service role?

Some NHS hospitals, focus on their obligation as Employer looked at GI as a PC and created policy which was some employee centred. The policy conviently ignored the other conflicting PC's. A woman could wear a hospital issued uniform which was modified to accommodate her PC but was expected to share a locker room in breach of two of her PC's. On the service side Management created a reporting system to deal with patients who availed of their right to give limited informed consent around their treatment. These policy also create a hierarchy of paitent care by instructing staff to actively lie to some patients to benefit other patients.

The core of the assessment is an adversary process not an advocacy.
General point is that he is not being employed as a medical doctor in a patient facing role.
Rather the role is someone who is an sufficiently qualified gatekeeper with enough professional competence to challenge other professional opinions. In this role the Courts expect the role to be filled by a person who uses the term doctor to summarise the achived quallifiactions.

Can the Pastafarian Employer insist on colanders being worn and that staff greet everybody as using the Pastafarian terms.

PS replace the word woman with man in each example what changes?

I think @SolasAnla sadly speaks for many people when it comes to the benefits system which is why it's got such a terrible reputation - the assumption that benefits claimants are not entitled to compassion or dignity, not to mention the suggestion that they are all fraudsters anyway.