Anne health Susie Greens new clinic

"I consent" is not a magic wand to over-ride doctors' ethics.

A patient can unwisely refuse treatment if they choose. A doctor, however, has responsibility not to give a treatment that they know on balance will do harm. It's not patriarchal (who said the doctor was a man anyway?), it's ethics. Used to be called 'first do no harm', the oath doesn't apply any more but the principle does.

There are any number of cases where that has been applied apart from gender stuff. People who want their limbs removed. People who want other extreme forms of cosmetic surgery. But also other things - say someone obese who needs a particular surgery that's too dangerous because of their body weight, they can't just say "i consent anyway, it's worth the risk to me" - the doctor has to insist that they lose weight first so it can be done ethically. Because they would be struck off if they were shown to have done something recklessly that harmed a patient, whether the patient consented or not.

I understand them entirely. I just disagree with them.

I don't believe that the decisions women make about their own bodies should be subjugated to some wider societal context, much less some mystical predetermination based on our biology.

I don't agree that 'individuated' approached to medical decisions are in any way wrong or contrary to medical ethics. On the contrary, I think medical decisions should be individuated to each specific individual, so that treatment matches the specific needs and wishes of individual patients to the extent possible.

Oh I can get my head around it alright.

I can get my head around what happens when people dictate that grown women can't possibly make decisions about their own bodies when it concerns their fertility and reproduction because they are incapable of making a decision.

I can get my head around what happens when a medical system is based around the concept of doctors disregarding women's wishes because they know better what the woman should want.

The court judgment was that a blanket determination that under 16s are automatically incapable of understanding the effects of puberty blockers, or that it is a necessary condition of assessing capacity that they also have capacity to understand the effects of cross sex hormones.

Yes, that's right. I disagree because you're just so subtle.

Not because what you're advocating is that women's autonomy over their own bodies should be subjugated to some pre-ordained societal factors determined by our biology.

Interestingly, on a thread about a woman with no medical background who was sacked from one charity after ruining its reputation and has now started up a business designed to cause medical injury to children, there has been strong efforts to derail with talk of abortion rights.

Susie Green moved from being an IT worker (I think) to become CEO of Mermaids. She took the charity and from being an actual support charity helping distressed children to an organisation that has suffered a serious data breach, a scandal with a trustee who write in favour of paedophiles and was featured in a pornographic publication online.

They featured a boy dressed up as a sexualised ‘doll’ in a bedroom in pictures in their website. There were serious safeguarding failures with their online messaging service and I think they were sending binders to children without their parents knowledge.

There is footage of her laughing about her sons ‘micropenis’ caused by early puberty blockers and admitting that her husband was homophobic and refused to accept an effeminate son so ‘somehow’ her son ‘realised’ (after being subjected to punishments like having all his favourite toys taken away) that he was really a girl. This was keenly embraced by his parents and as a young teen he was taken abroad for puberty blockers, then to Thailand for surgery on his 16th birthday.

This woman is now deliberately and repeatedly enabling parents to circumvent the law and harm their own children. As Helen Joyce observed, these parents can’t ever let go of the ideology as admitting they’ve harmed their children for such a huge lie is impossible.

Your insistence that an 18 year old has this ‘capacity’ is extremely troubling.

You are just writing your own script now, and not making any attempt to actually understand the points that people are trying to make about 'autonomy' and about ethics. And so you are misrepresenting them.

Are you saying that there was a court judgment which stated that pre-pubescent children are capable of understanding the effect of treatment which would sterilise them and leave them with impaired sexual function?

And a court judgment which stated that there is evidence that this treatment is beneficial for minors?

Can you post some links to these judgments?

You cannot seem to get your head around alternative perspectives.

Autonomy; separatness, individuation..... whatever you want to call it.......

I'm not disputing personal choice, although, of course, ideas about personal choice are in many respects very much liberal, western constructs. I have said that the very nature of female biology, in certain ways, negates ideas of separateness and bodily autonomy. And ultimately, none of us is really separate and autonomous. Male or Female. We all make decisions and choices within the context of certain sets of social conditions, cultures, family of origin and so on - over which we have no input and no control and which we didn't choose.

Maybe this is too subtle an argument or a perception for you to grasp.

This post makes no sense. I never said anything about independence. The point is that it should always be a woman’s choice if she wants children or not and if she doesn’t then it should be her choice as to the best means of avoiding having children.

All this talk about obligations to society and some almost mystical nonsense about the very idea of women negating full autonomy is patriarchal nonsense. It is straight out of the playbook of every person who has ever sought to limit women’s reproductive freedom. Insisting that to be a woman necessary means you give up the right to decide what happens to your own body for some greater good has all sorts of terrifying implications.

You still can’t seem to get your head around what capacity to consent actually means.

It does not mean that a patient must have certainty that they are making the right decision or certainty that they will never regret it.

It means that they are capable of understanding the procedure, understanding the risks and benefits, and of making an informed and free decision. Your insistence that a 29 year old woman lacks this capacity is incredibly patriarchal.

This is nonsense, as established by the courts. You folk are fond of relying on court judgements right?

Why would you bring children or people below the age of consent (I’m not clear why you’d separate the two since by definition all of the latter are also the former) or people of an unsound mind into your argument about denying health care to women in their twenties on the basis of capacity?

Is that really where you place adult women in the spectrum of capacity? Similar to children and people of ‘unsound mind’? That line of argument sounds familiar…

I'm not sure of your point about contraception?

You seem to be assuming that a woman must always push for total autonomy and independence to have integrity ? Whereas on certain levels and to a certain extent the very nature of the female body and its biological function negates the idea of total bodily autonomy. The interior nature of the female sex organ plus the very fact of pregnancy, childbirth and childcare very definitely ties women into a sense of themselves as integral beings that is not entirely rooted in autonomy, exteriority or separateness. Which is why some of the more strident demands for abortion can come across as being very distasteful:

" Parasites have no rights" for example, or " My body, my choice"

There are ethical questions around abortion, and which is why the termination of a pregnancy can be such a painful and/or difficult choice. Autonomy is not the be all and end all. We do have responsibilities towards others, towards the collective and so on. We are all inter-dependent on the co-operation of, and input from, others.

Gillick principles:

"Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment."

The reason that 'gender affirming care' would not meet this criteria is not the patient's trans identity, but that the child is too young to understand the long term impact of the treatment.

Separately, there is no evidence that the treatment is beneficial, while there is evidence that it does harm.

No we’re not. I’d be happier if the same standards of caution were applied to young people with ’gender dysphoria’ as to women wishing to be sterilised (and men wanting a vasectomy).

So called ‘affirming surgeries and procedures’ are not in the same ball park (or the same planet) as hormone contraception and the reasoning for allowing young girls to access contraception is completely different.

Gillick principles were established for a very specific and limited reasons. ‘Trans’ does not fall into any of that.

But there is a clinical foundation to someone who cannot tolerate an IUD due to pain,

Yes, and presumably through bitter experience, doctors are still very mindful that despite the protestations of some women, they will end up wanting children and determine that the mental fallout of sterilisation does not tip the balance of justification. In some individual cases, it may feel unjust but the doctors are doing their best to reduce harm based on prior knowledge.

Whereas there is ZERO clinical need for so called ‘affirming’ surgeries and treatments and plenty of evidence that they make mental health WORSE. Yet you advocate for 18 year olds to be allowed to do this and live with the consequences of their decisions.

As I said, I don’t think you have any understanding of 18 year olds and their decision making abilities.

If I decided at 35 that I did want children, that does not render my 25 year old self incapable of consenting to a sterilisation in full recognition that I may later regret that decision.

So you recognise that people can change their minds yet you still think that 18 year olds, some with very poor mental health for a variety of reasons should be allowed to make life changing decisions and elect to amputate their breasts or remove their penis and have to live with the consequences of getting it wrong?

Are you aware that the brain doesn’t fully develop, particularly around more complex decision making/risk taking until around age 25?

That seems like an utterly brutal view that would permanently harm vulnerable people and then say “tough, it was your decision”. I’d that this you intend it to come across?

Ritchie Herron was vulnerable when he was encouraged and rushed into extreme surgery. He is now incontinent and without a penis. Are you trying to say that it’s ok that Ritchie and Keira were medically harmed so that others take their own risks? Are you suggesting that it’s tough luck for them?

Do you think that there should be any protections for people to prevent self inflicted medical harm or should anyone be enabled to commission whatever procedures they want on the NHS?

I don't know. She did have mental issues & several suicide attempts before being given testosterone as a teenager. It's the males who transition as adults who are the cross dressers & AGPs all getting a sexual kick out of playing at being a woman.

But there is a clinical foundation to someone who cannot tolerate an IUD due to pain, doesn’t want the side effects of pharmacological contraception and doesn’t want to be reliant on her sexual partners compliance required of condoms to seek the only available form of contraception that meets her needs.

Claiming that a woman cannot consent to that form of contraception is massively paternalistic. Which is to say nothing of your grounding of medical ethics in a societal interests space, which is of course the standard approach to every attempt to force women to do with their bodies that which they do not wish to do.

No. I support the very long established Gillick principle for trans and non-trans people alike.

It is folk like you who demand differential assessments of capacity when trans healthcare is involved.

Bodily autonomy in this instance relates to consent to treatment. Although, of course, the treatment must have a clinical foundation in the first place, or else it is unethical. 'Consent' doesn't mean that a medical practitioner can do anything to my body that I ask of them. Autonomy also means the right to refuse a treatment that has been recommended for clinical reasons.