High Court Battle - pronouns

Knowing the patient in front of you is male or female is not a religious belief though is it?

The tribunal decision is at assets.publishing.service.gov.uk/media/5d9b0c8aed915d35cff2225d/Dr_David_Mackereth_v_The_Department_for_Work_and_Pensions___Advanced_Personnel_Management_Group__UK__Ltd_1304602_-2018-_Judgment_and_reasons.pdf If that's been linked to before then I apologise!

Yes, but that's what the hypothetical scenario was.

And he chose to make it all about him and his religious beliefs.

This consultation isn't about him. It's about the poor bugger who has no choice but to be there (or lose benefits), can't request a different clinician (or they'll lose benefits), and for whom the outcome could be lifechanging.

Their needs outweigh his. In the same way as my need for a female gynaecologist outweighs the need of a male gynaecologist to earn a living.

If it's relevant to the consultation and clinical decision making then of course it should be addressed. If it isn't? Wrong time to draw a line in the sand.

That's not why he was fired. He was fired for refusing to address the patient in the way they felt comfortable being addressed, where there is nothing to suggest that that is relevant to his clinical assessment.

Was he? From the reporting that I've seen, he was fired because he was given a hypothetical scenario by his line manager and he didn't answer in accordance with the line manager's wishes. I don't know if the wishes were in line with an official DWP policy or not.

So the correct response for the assessor doing the clinical assessment to decide if the applicant qualifys under the rules for tax funding
said "I identify as being a woman who can't work due to having cervical cancer, missing a left leg, and not being able to speak"
is "I am not your psychiatrist so have approved your self identified issues".

No, of course it isn't. It's to say 'there's no objective medical evidence of any of those things therefore I cannot agree to this claim on medical grounds'.

That's not why he was fired. He was fired for refusing to address the patient in the way they felt comfortable being addressed, where there is nothing to suggest that that is relevant to his clinical assessment.

@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.

...and believing people are male or female and that their sex can have implications on health outcomes is not a religious belief its a biological reality.

Having been rush into A&E with a condition that was specific to my sex A&E doctors don't have the time or energy to pander to the delusions of a patient who may walk out fine in an hour's time or end up in a life or death situation.

There is a time and place for indulging people's ideas of how they'd like others to see them but A&E isn't it.

@Motorina: "Not the time or place for a doctor to be imposing their religious beliefs on the patient."

You ignore the fact that gender ideology is nothing but a religious belief so why should trans people impose their religious beliefs onto others?

We've got into a fine mess with all the trans stuff. Thr tide will turn it has to.

It is indeed those two protected characteristics which are clashing, not gender identity. GI and GR are different and not interchangeable as I understand it, and I think the difference is important.

Not the only time the MRAs conflate terms and sit back and watch the confusion. We need to be clear in response.

I've been in the position of being under the care of a doctor who had some very conservative views - my first psychiatrist insisted that my relationships with women were a symptom of "risk taking behaviour" and "low inhibitions" and was quite blunt about this. I'm sure he also thought he was just stating biological fact. It was very distressing and impossible to really challenge as he had a great deal of power over me, as the doctor.

I agree with PP, it is awful you were treated in this way. The difference was that he felt free to express his opinions to you and inform you all about his perceptions and interpretations of your sexuality and lifestyle. In essence to lecture you and try to bully you out of your sexuality. Absolutely unacceptable.

You were not requiring him to lie to you however. Nor the case of him politely saying I can't use that language you would like to require me to use, because it is making me say something I don't believe to be true, and which goes against my own beliefs. Nor was he in danger of repercussions if he failed to obey your instructions requiring his compelled language and enactment of belief.

What is being required here is mutual tolerance. I can be perfectly accepting of someone's belief that they need to pray five times a day. I am not going to be accepting of a requirement that I do it too, along with them, and enact their belief as if it was my own.

I don't understand why it's assumed that only people of faith object to lying. I am an atheist yet I believe in science and reality and the truth. I would find it very difficult to be forced to deny the evidence of my eyes and ears.....
I hope this man wins his case, whatever the Bible says.....

I've been in the position of being under the care of a doctor who had some very conservative views - my first psychiatrist insisted that my relationships with women were a symptom of "risk taking behaviour" and "low inhibitions" and was quite blunt about this. I'm sure he also thought he was just stating biological fact. It was very distressing and impossible to really challenge as he had a great deal of power over me, as the doctor.

That's absolutely appalling and I'm sorry you were subjected to that. It's not comparable though as it is clearly not a biological fact that we are 'supposed' to be heterosexual because you have moved beyond one body and therefore clearly into the social realm. There has been bigotry so so many times in the past and there still is now. But that does not mean that refusing to conflate 'woman' with 'feminine' is bigotry.

For those saying using preferred pronouns is no big deal, I'd be interested in whether you have actually had to do this in practice?

I thought I would be fine with it, but when actually put in the situation (6ft beardy bloke at work now "identifies as a woman" - no physical changes at all) I am finding it deeply upsetting.

Thankfully I've not been in that situation. If I was I think my brain might explode. I'm autistic and I cannot say something to someone which I believe to be untrue. I know NT people don't always get it, but I just can't. The truth always pops out instead. Like if you've had a bad hair cut and ask me if looks ok, I know I'm supposed to say it looks great but I literally have to put my hands over my mouth to stop the truth coming out.

@Goopamz
That is awful for you, and your colleagues too I should imagine.

In the situation of a DWP assessment, if a doctor is faced with someone who is clearly delusional, it is surely a relevant mental health issue. To ignore it would not work in favour of the person , and to pretend , does that person no favours either. There are many people who find that others will not ever accept their mistaken ideas that they are the pope of Joan of Arc, and yes it affects their life once others pretend to go along with it. It would not be professional to imply you believe the person, while recognising that they believe all sorts of nonsense .

Or can you sell someone an apple instead of a banana? And call them abusive for insisting that which you identify as an apple is in essence a banana.

This is in essence, two questions.

Is there a right to force, under threat, a person to speak and enact a belief they do not in fact hold?

Do we live in a two tier society where some people get to choose their language and express themselves and have their needs and feelings met on demand, while other people must put aside their own language and self expression and their own needs and feelings to service others?

Well, he is a doctor and he mentions following the science. That stuff is completely anti-science. It is not just the religious belief aspect. If he is not required to follow the science on this, it is the same as a doctor making up any old thing which giving care. If you can make sex up, then nobody should be struck off for debasing evidence led practice on other things also.

I think there's a plausible workaround to set this up so that the issue doesn't arise but that's not what the case is about.

It's not a GC matter but compelled speech is a matter for all of us as is the low bar for transphobia (the thread about the school and the 5 year-old).

Should be interesting. I hope he wins.