High Court Battle - pronouns

Society has decided that an applicant can give up some rights in exchange an applicant gets a portion of the redistributed wealth.

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

I do not think it okay to address someone on benefits in a way that even Dr Mackareth agrees is offensive, and expect them to accept it as their lot because they're receiving a share of the communal wealth.

There are situations where accepting a polite lie is acceptable; an auditor doing that while conducting an audit is not one of them.

Also, the issue is one of compulsion. You might decide it preferable to agree to go along with a lie out of politeness, but compelling someone to go along with a lie is another matter.

[quote Motorina]@DontLikeCrumpets as a rule of thumb they shouldn't

However, we're talking within the specific confines of a medical appointment. Not only that, a one off medical appointment for a very specific purpose - to assess suitability for work. And the imposition is the relatively minor matter of addressing someone by their chosen name and title.

We accept that, in other circumstances, the rights of patients outweigh the rights of medical staff. I can, for example, insist on a female gynaecologist even if that means a male trainee lacks the opportunity to gain experience, or a male doctor's right to work is infringed. My rights as a patient to receive treatment I am comfortable with outweigh the doctor's rights. As they should.

I think this is another of those circumstances. I think that in part because of the power imbalance in this particular medical consultation. And in part because calling someone with a 5 o'clock shadow 'Mrs' if that's their preference is a relatively minor infringement for the doctor, but has fairly major impact for the patient.

Others have said there are situations where it may be appropriate to challenge a patient on the validity of their gender identity. I agree. If you're going to your GP because of mental health problems, and your gender identity feeds into that, then that shoudl of course be open for exploration. If the appointment is for a physical problem when sex is relevant, then of course that should be considered. But if someone's long-transitioned and is going for their bunions, then the doctor would be obnoxious to insist on addressing them in a way appropriate to their sex.

It's not requiring the doctor to believe that the person in front of them has changed sex. That would be a nonsense. It's simply requiring the courtesy of addressing a patient in a way they prefer, when the reason for that preference is not clinically relevant.

There are situations when the pronoun line must be held firmly. This situation isn't one of them.[/quote]
There was no medical appointment.

No personal consultation for a medical matter.

The person attending the doctor is not a patient.

The doctor was employed by the arm of the State empowered to prevent the fraudulent acquisition of Taxpayers remitted funds.

The assessment is an anti-fraud measure.

Society has decided that an applicant can give up some rights in exchange an applicant gets a portion of the redistributed wealth.

The assessor doing a gyne exam is sexually assaulting the applicant.
If presented with bunions the doctor will assess that that applicant is partially mobile so is suitable for work.

There are situations where accepting a polite lie is acceptable; an auditor doing that while conducting an audit is not one of them.

Well there are countrie like Iran where the prefer transition over same sex marriage. But I don't know how they conceptualize that theologically - if they think it really represents a change or is more a way of dealing with a problem.

Buddhism and some other eastern religions tend to have a somewhat different view of the body and material world than western religions typically do. So perhaps there is more room there for an idea like that, but I have no idea how they would actually explain it.

All of these religions have roots in a time when it was difficult to ignore the real consequences of reproductive role, unlike modern society where it is possible to suppress some of them through technology. So that may be a factor too.

I imagine for many it's an issue, as I don't think any religions support gay marriage. If they were to accept transwomen are women. Then a transwomen marrying a man is a bit of a loophole in the anti gay marriage stance.

Part of the problem here is that the law seems to be using all kinds of language where no one really knows what it's supposed to mean, which has no clear scientific or social meaning that is close to universally accepted - is in fact quite controversial on a number of levels.

It's really not just a problem for certain religious people. Many people don't believe in the underlying ideology. And of those, some of them think it is wrong to lie about it, or actively damaging to society.

[quote Motorina]@Cismyfatarse yes, it's very different.

It's closer to someone choosing not to treat people who have sex out of wedlock, because it doesn't accord with their own beliefs, even if the reason the patient has attended is due to their nosebleeds.[/quote]
But he's not unwilling to treat people.

Never was there a better illustration of the difference between Birmingham and the Black Country for those that like to confuse the two.

Birmingham - land of the free, anything goes
Dudley - "yow fookin wot?!"

Obviously Christian interpretation will vary but there will be a significant number of Christians who take issue with the idea that our bodily sex is irrelevant.

The Catholic Church has been clear that they don't consider that it's possible to be in the wrong body or have the wrong sex as such, so that's 50% of Christians worldwide.

@GreenUp yes! Exactly that!

@DifficultBloodyWoman it sounds like what you're saying that it's okay for a doctor to be extremely rude to his patients, because it's not illegal. And that the rude doctor shouldn't lose his job, even if he makes it clear he's going to continue being extremely rude to patients going forward.

I just wanted to check that's what you mean. Because, if so, I'm really uncomfortable with that. I think it's entirely reasonable that patients should expect to be treated with dignity and respect, and spoken with politely. I avoid doctors as is (it only takes one bad experience...) and can't imagine that entitling them to be rude to their patients would in any way increase attendance or trust in the profession.

In the same way, my worry with @Carbiesdreamhouse's suggestion is that all it will do is ensure that trans people don't seek healthcare.

For clarity, I applauded Robert Winston when he said 'You can't change your sex' on twitter. I just can't quite see him insisting on calling a transwoman patient "Mr Smith", because that would inevitably impact on the quality of care he provided to his patient. What happens in political debate, and what happens in the confines of a consultation, are two different things because the terms of the interaction are different.

Getting back to this case, the Tribunal determination is very clear that terminating Mackareth's employment was reasonable, not because of his beliefs, which he is entitled to hold. But because how he proposed to act from of those beliefs would be offensive to patients and would disrupt the smooth running of the service. Unless one wants to argue that it's okay for doctors to knowingly set out to offend their patients and to pick and choose who they treat on religious grounds, then it's hard to say that the tribunal was wrong.

The assumption that gender should be affirmed implies that people are all really aware what is going on. It assumes 'madam patient' must know they're actually a man and we just need to be kind. But if we have a generation of people becoming adults who genuinely think you can change sex and genuinely don't realise that that dangly thing in their pants means they are a man, then it could be disastrous for healthcare. Doctors should be holding a line on the issue. You step into a medical setting and it's sex only until you're out of the door.

There are more pronouns than just ‘she’ and ‘he’. ‘It’ is also a pronoun.

My siblings and I occasionally referred to each other as ‘it’ when we we children and teenagers. It absolutely conveyed disdain and a lack of respect for one another. In fact, that was the whole point. Hy

It was extremely rude of us. But it wasn’t illegal.

I don’t want to be forced to ‘respect someone’s pronouns’. I recognize that not doing so might be rude but the alternative is compelled speech which is unacceptable to me.

@EmbarrassingHadrosaurus

And yet we have women who have a traumatic history who have been labelled transphobes and bigots for requesting a female HCP for a mammogram. Even more, they've been used as an example of transphobia and bigotry in a report issued by their healthcare trust.

This person-centred v worker-centred seems to be awfully partial at times.

Yeah I agree so we should fight against the sexism inherent in prioritising the needs of the TW clinician over the needs of the vulnerable patient who requests a female clinician.

I suppose another way of thinking about the disability assessment situation is what if the assessor was Adrian Harrop and he insisted on referring to us as "c*s woman" or "not-trans woman" or "non-man" in his reports or during the assessment.

We would feel utterly disrespected but our reliance on him for a positive benefits judgment would render us powerless to challenge him in that situation.

@CismyfatarseCismyfatarse

UnderlForgive me if I am wrong but is it not that Doctors can opt out of performing, or being involved in, offering abortion services? So isn't there already something in the rules that allows for the Doctor's religious beliefs to allow him / her to opt out of a part of patient treatment.

Now, I understand that someone with these beliefs might, instead, choose to work in orthopaedics or ENT where abortions are not an issue. But, their beliefs are accommodated when working in particular areas of the NHS during training.

Is this significantly different?

The right not to participate in abortion is codified in law though as part of the the 1967 Abortion Act under section 4(1) of the Act.

I don't think he has any legal protection to not use titles/pronouns for a specific group in the same way that he does if he wants to opt out of participating in abortion.

Forgive me if I am wrong but is it not that Doctors can opt out of performing, or being involved in, offering abortion services?

I've had a doctor refuse to prescribe me the morning after pill, he just got a colleague to do it.

As far as I can tell this doctor didn't discriminate against the trans individual? He was willing to perform the assessment, but not to make statements of belief he did not agree with (that probably had no bearing on the content of the assessment?)

Seems fairly similar to that bakery case where they were happy to bake a cake, but not ice a message supporting gay marriage (and the bakery won AFAIK).

I think what people are missing is that using preferred pronouns and the requirement to do so reinforces gender ideology - which has real consequences for people outside of the consulting room. There are some things we just can't bring ourself to do because we know that to be the case - e.g. using racist language. You could say that if a client wanted you to refer to someone else in those terms it's just what the client wants, it's just in the consulting room. But it's not is it?

I've stated my expectations and perspectives earlier and we're in agreement on some points. I distinguished holding beliefs and manifesting them.

However, in the same way that HoL debates in advance of 2004 GRA correctly anticipated many of the difficult situations that have subsequently manifested despite reassurances to the contrary.

In the scenario I have advanced, and given the discordant recollection of assessment interviews that many people report for PIP and similar claims, can you not anticipate that there may be a consequence for the right for people to argue for their perception of their condition and its impact has to be accepted.

Despite the status of some conditions as recognised clinical entities, there are many reports from distressed patients/claimants of treatment/assessments that go awry because an HCP doesn't believe in it or the impact of it. I'm not aware that they can insist upon an HCP/assessor who believes in a condition or who is trained not to manifest their personal lack of belief in it. I could use long Covid as a common topical example.

I see a disparity in treatment opening up. DWP already loses a fair number of PIP, DLA and ESA appeals (67% iirc). I'd anticipate that a new area for challenge will open up.

@Cismyfatarse yes, it's very different.

It's closer to someone choosing not to treat people who have sex out of wedlock, because it doesn't accord with their own beliefs, even if the reason the patient has attended is due to their nosebleeds.

[quote EmbarrassingHadrosaurus]My experience of working in services, whether its health or social care, is to be person-centred, not worker-centred. If you work in a clinical role there will be plenty of situations in which you will have to hold your tongue or do things that don't comply with your own belief system.

And yet we have women who have a traumatic history who have been labelled transphobes and bigots for requesting a female HCP for a mammogram. Even more, they've been used as an example of transphobia and bigotry in a report issued by their healthcare trust.

This person-centred v worker-centred seems to be awfully partial at times.

www.mumsnet.com/Talk/womens_rights/3763519-A-woman-who-asked-for-her-NHS-breast-screening-to-be-carried-out-by-a-female-born-clinician-was-pilloried-as-a-transphobe-by-a-hospital-trust[/quote]
Forgive me if I am wrong but is it not that Doctors can opt out of performing, or being involved in, offering abortion services? So isn't there already something in the rules that allows for the Doctor's religious beliefs to allow him / her to opt out of a part of patient treatment.

Now, I understand that someone with these beliefs might, instead, choose to work in orthopaedics or ENT where abortions are not an issue. But, their beliefs are accommodated when working in particular areas of the NHS during training.

Is this significantly different?

@EmbarrassingHadrosaurus different scenarious.

The equivalent to your hypothyroidism/ME/etc scenarious is if a claimant were saying, "I can't work because I'm trans. Being trans has these impacts on my ability to work..."

In that case, it's totally within his remit to assess whether there are medical grounds for their claims on how their gender identity impacts on their ability to work.

That's not what's happening here. Based on the tribunal information, he doesn't believe in transgenderism and has a conscientious objection to it, and bases this on the opening verses of Genesis. So he refuses to use people's chosen names and titles. He refuses to do so even if the reason they can't work is back pain, or cancer, or having lost a limb. So nothing at all to do with their gender identity.

His preferred solution is that he doesn't assess anyone who is trans.

He raised this in training. The DWP looked into it and decided stopping him seeing any trans clients wouldn't work for two reasons. Firstly, often the assessor doesn't find out that someone is trans til they're already in the room. Stopping the consultation saying, "I don't believe in how you're choosing to identify, so I'm not prepared to assess your bad back" is bound to cause offence. It also delays the person's assessment, as they'll have to wait for another assessor to become available, and may mean they have to come back another day.

Which may involve 3 bus rides. For someone with a disability. Where every penny counts.

How would we feel about an assessor choosing not to see a gay client because he is fundamentally oppossed to their lifestyle on religious grounds? Or a client from a different religion?

The DWP decided this wasn't okay, and so fired him.

The tribunal decided that his beliefs were "genuinely and ferverently held" and that he was entitled to hold them. They're very clear on that.

What he wasn't entitled to do was act on those beliefs in a way which he agreed trans clients would find offensive, and which would inevitably delay them being assessed.

I'm GC in my beliefs. I think sex cannot be changed and that single sex spaces are important. I'm willing to fight for those beliefs (and have dug in various gardens to do so).

I wouldn't dream of calling a trans patient - or any patient - by anything other than their preferred name and title. Because when I'm seeing a patient the consultation isn't about me.

My experience of working in services, whether its health or social care, is to be person-centred, not worker-centred. If you work in a clinical role there will be plenty of situations in which you will have to hold your tongue or do things that don't comply with your own belief system.

And yet we have women who have a traumatic history who have been labelled transphobes and bigots for requesting a female HCP for a mammogram. Even more, they've been used as an example of transphobia and bigotry in a report issued by their healthcare trust.

This person-centred v worker-centred seems to be awfully partial at times.

www.mumsnet.com/Talk/womens_rights/3763519-A-woman-who-asked-for-her-NHS-breast-screening-to-be-carried-out-by-a-female-born-clinician-was-pilloried-as-a-transphobe-by-a-hospital-trust

Having skim read the first tribunal judgement I don't think it's possible that he can work in that role with the manifestation of the belief that he has (refusing to use someone's given pronouns or title).

The service said it can't know in advance which attendee will be trans so they can't assign the case to a different assessor. The doctor as per GMC rules is not allowed to discriminate against patients based on his own beliefs. The same anti-discrimination requirement is made by the Disability Assessment employer. There aren't any backroom (non user facing) roles that he would be qualified for because he would have to gain 12 months experience in working as an assessor first.

My experience of working in services, whether its health or social care, is to be person-centred, not worker-centred. If you work in a clinical role there will be plenty of situations in which you will have to hold your tongue or do things that don't comply with your own belief system.

It would be one thing if he refused to confirm that a male can have ovarian cancer as that would be a statement of fact. But refusing to use the title provided by the patient/service user just seems a bit petty especially given that it is unlikely that he would often have to do this in person. He could use the person's name during the appointment and use their name in reports and might just have to tick a box for the titles.

I think maybe he could win the first part of an appeal because it seems discriminatory to say you can't hold christian beliefs. But I think he will lose the second part of the appeal based on not being able to function in the role as required given the manifestation of his belief. But I'm not a lawyer

There are a fair number of contested areas where claimants/patients assert that they have a condition in which HCPs/assessors do not believe.

afaict, there is no drive to compel HCPs/assessors to accept a claimant/patient's firmly held beliefs that an array of symptoms are associated with hypothyroidism/ME/fibromyalgia/B12 issues/microvascular angina. There are a fair number of peer to peer support groups where you can see people who are profoundly unhappy at the diagnostic delays for the tests that they want or who have opted to self-medicate because of the severity of their symptoms. They also feel very angry when they are judged to be unreliable narrators of their own experience and when the HCPs/assessors do not accept their diagnosis or reject the severity and impact of their symptoms.

In the tribunal assessment, I can see that it's acknowledged that there are special sensitivities around transgender people because of an association with poor mental health that is a consequence of perceptions of treatment by society (possibly the healthcare system).

I wonder about the disparity of treatment for one protected characteristic that is not available for other categories.

Sorry - pressed post too soon! That judgement makes it clear it's not about his clinical assessment where trans issues affected people's ability to work, but it is entirely about his refusal to use preferred name, title and style of address, because of his religious beliefs.