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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To think that for medical reasons it is important that transgender people are correctly sexed

933 replies

MenstruatorExtraordinaire · 09/07/2019 11:17

Saw this doctor on This Morning being called a bigot by Piers Morgan

www.dailymail.co.uk/news/article-7227479/Doctor-sues-government-sacked-trans-views.html

Religious views aside, I think he raises an important point.

I've seen several cases recently where transgender people have been incorrectly identified by medical staff leading to their death/serious injury or the death of a baby.

Surely the solution is to retain their correct sex on medical records, birth certificate etc with a TG marker.

So AIBU to think that for medical reasons alone it is important that transgender people are correctly sexed?

OP posts:
RedToothBrush · 11/07/2019 11:37

In that case, the NHS is failing millions of us.

Yes. I think it is tbh. But that's another thread in itself. Its not something that's off my radar and I haven't argued.

This is ridiculous. If a patient wants to lie to their Dr then that is their choice. It happens every day - do you drink, smoke, take drugs, have unprotected sex, at risk of being pregnant, exercise etc etc.

Do you plan on legislating for that too?

When a patient goes for major surgery then some of those things are taken into consideration when decision making and deciding whether to go ahead with treatment.

If it's found that a patient has lied about smoking or drinking or drugs and its relevant it can affect whether certain treatments go ahead because it affects the risk and chances of success.

Doctors can say no, on these grounds if they feel to go ahead will cause more harm. And offer an alternative set of treatments. They are not obliged to do exactly what the patient wants and demands especially if they are ignoring a key part of their health.

So no I don't intend to legislate for anything. Its already part of the framework of decision making and safeguarding against risk and the idea of minimising harm. Its not something that if you are trans you should be exempt from.

It does have some problems as a framework which at times I am uncomfortable with. However the idea that trans patients are being singled out isn't true. It's about risk management and the patient lying for whatever ends and how that affects the decision making process that a doctor has to make.

It's the heart of ethics that a doctor can say no, if they have concerns. That's the point.

nolongersurprised · 11/07/2019 11:37

Playing a game of “infer my sex to make sense of my symptoms to determine my diagnosis and if you use the wrong words even though they’re medically correct I’m going to try to have you fired” is subtle bullying.

NewarkShark · 11/07/2019 11:39

decomposing

But do you not accept that it will lead to a waste of scant NHS resources when investigations are made which are inappropriate for someone of that sex?

That’s not an anti-trans comment. One of the areas of the NHS that is woefully underfunded is trans services.

A treating doctor needs to know someone’s sex. They also should know their gender and their preferred way of being addressed, which should be respected. But they ought to know their sex as a relevant medical factor.

Datun · 11/07/2019 11:39

Playing a game of “infer my sex to make sense of my symptoms to determine my diagnosis and if you use the wrong words even though they’re medically correct I’m going to try to have you fired” is subtle bullying.

It's not even subtle. And, again, it's giving unimaginable power to people to wield. Funnily enough, it's normally men.

nolongersurprised · 11/07/2019 11:44

It's not even subtle. And, again, it's giving unimaginable power to people to wield. Funnily enough, it's normally men.

True.

Tyrotoxicity · 11/07/2019 11:46

It's the heart of ethics that a doctor can say no, if they have concerns. That's the point.

First do no harm gets misunderstood by many.

If a doctor believes something is not in the best interests of their patient, they are not compelled to go ahead with it. To do so would be making a conscious choice to do something which would do harm.

Unfortunately this gets twisted into "If I harm myself as a result of not having this treatment, the doctor is responsible."

I am reminded of the research into hypothetical people on a train track ethical conundrums.

DixieFlatline · 11/07/2019 12:13

I think Decomposing ‘the pregnancy will show up in the X-ray/scan’/‘if they are harmed due to their own stupidity then that’s their problem’ Composers could do with refraining from engaging in arguments relating to medical ethics/informed consent/the doctor-patient relationship, it seems to be a waste of everybody’s time.

DtPeabodysLoosePants · 11/07/2019 12:25

Such a shame Xarra seems to have disappeared Grin

DecomposingComposers · 11/07/2019 12:27

But when they do know, and say so, they get fired.

Really? How many times has this happened? And nothing else was a contributing factor? The Dr communicated well with the patient and then got fired?

DecomposingComposers · 11/07/2019 12:36

But do you not accept that it will lead to a waste of scant NHS resources when investigations are made which are inappropriate for someone of that sex?

Possibly it would do but how much given the the very small number of people it affects. There are many far more prevalent things that patients do that waste scant NHS resources - how about tackling those first and then when that house is in order look at this issue? How about all the people who just fail to turn up for an appointment for no other reason than they couldn't be bothered or "forgot"? Or those with the many self inflicted illnesses caused by lifestyle choices? If you are truly motivated by saving scant resources there are many other targets to aim for first.

@DixieFlatline

Really?I have no right to express my views on medical ethics/ issues of consent?

My view is that I want my right to consent to medical treatment as I see fit. I don't want someone else deciding that drs can over ride my decisions if I have competency so I'm not about to call for the same rights to be removed from others.

Where's the line drawn? Particularly around pregnancy - you appear to be giving the baby more rights than the person carrying it - that's a dangerous precedent to be setting. Right now you are arguing that the mother, by not disclosing their status, contributed to the death of the baby. Where do you draw the line with that argument?

Pregnant women that smoke, drink, do drugs during their pregnancy and possibly harm their baby? Women who eat the wrong foods and harm them? Where is the line?

Datun · 11/07/2019 12:39

"But when they do know, and say so, they get fired."

Really? How many times has this happened? And nothing else was a contributing factor? The Dr communicated well with the patient and then got fired?

Excellent. I'm glad you don't agree they should be fired for misgendering by recognising someone's sex.

Loveglee · 11/07/2019 12:45

I got to page 27 of the round and round arguments, and (forgive me if it has been covered later), but the essence of the argument appears to be that ‘gender’ is of utmost importance in all this. However, no one has suggested what that means. What does a man mean when he says he’s a woman? Is it that he thinks the way a woman thinks (how would he know what we think?!). Is it that he wants to wear dresses or have long hair (ridiculous to think these things make you a woman)? What IS a woman’s gender?

Datun · 11/07/2019 12:49

What IS a woman’s gender?

Well yes the entire thread could be reduced to that question and the subsequent (non) answer

Loveglee · 11/07/2019 12:53

Exactly - there would be, or should be a non answer. Because otherwise, all that’s happening is we are reinforcing gender stereotypes, when in fact we should be trying to do away with them altogether.

NewarkShark · 11/07/2019 12:55

Possibly it would do but how much given the the very small number of people it affects. There are many far more prevalent things that patients do that waste scant NHS resources - how about tackling those first and then when that house is in order look at this issue? How about all the people who just fail to turn up for an appointment for no other reason than they couldn't be bothered or "forgot"? Or those with the many self inflicted illnesses caused by lifestyle choices? If you are truly motivated by saving scant resources there are many other targets to aim for first

Yes I am truly motivated by that, and if I have posted anything which gives you cause to suggest otherwise then pleas identify it.

I completely agree we should tackle non-attendance. It isn’t either or.

I disagree that people with “self-inflicted” illnesses shouldn’t be treated, and I think that’s a fairly disgraceful thing to suggest.

It is an absolute absurdity on every level to say that trans people should be able to conceal their birth sex from a doctor, and I don’t in fact believe that this is something most trans people are seeking to do.

TailsoftheManyPaws · 11/07/2019 12:57

how many drs won't know that their patient is trans gender? Even if it is not openly discussed they will know and should consider that when making a diagnosis

What about doctors who don't have the patient in front of them, but only their scan/urine test results/bloods/peak flow reading, and no marker on the file to say 'female, but presenting as male'?

(If DH had my typical peak flow results, he'd be at his last gasp and needing urgent medical attention. If I had his, I could probably give Alison Balsom a run for her money.)

RedToothBrush · 11/07/2019 13:02

‘the pregnancy will show up in the X-ray/scan’/‘if they are harmed due to their own stupidity then that’s their problem’

What happens to any children who are born harmed as a result of the 'stupidity' of their parents?

Who is responsible?

This is important in terms of liability for hospitals. Could a child (rather than the parent) sue for negligence? Depends on the circumstances but possibly.

Also should doctors flag it as a potential future safeguarding concern if a patient persistently is in denail about their sex to the point of causing harm? For both them and their children.

Or should doctors be turning a blind eye merely 'cos trans' and its therefore 'a valid belief'?

The issue here is really about comorbidity rather than being trans itself.

My experience of pregnancy was that my mental health issues of extreme anxiety meant I got extra support and there was a conversation about the future interests of my unborn baby. Social services were not ultimately involved as they were reassured enough that I was willing to engage and address issues. But it was definitely presented as potentially on the table as it was made clear that it was an issue that health care professionals had to consider when the baby was born. It was about taking responsibility and recognising why you can't avoid certain subjects and avoidance behaviour is harmful.

If you are demonstrating that you are willing to make decisions that place you or your child at risk of harm in the past during pregnancy this may be a problem. Not because you are pregnant but because it's an act of self harm through denial. This would therefore also apply to effective self harm in health care in someway due to your denail of trans status before pregnancy just as much as your actions during the pregnancy.

The concern would be that you would continue to do so in future due to a failure to address comorbid mental health issues then it becomes very relevant and part of a pattern that doctors might look at with some concern both for you and any children you have.

(I'm trying to word this carefully as part of a demonstrated pattern about mental health issues not being addressed rather than being misinterpreted as something else relating to the behaviour of a pregnant woman).

It's not a simple area to navigate and deeply complex and would be down the severity of the individual case and willingness to work with HCPs.

Also see cases relating to custody battles and acting in the best interest of your child and whether your gender identity means you disregard your child's needs in some way.

DecomposingComposers · 11/07/2019 13:05

I disagree that people with “self-inflicted” illnesses shouldn’t be treated, and I think that’s a fairly disgraceful thing to suggest.

I don't think they shouldn't be treated. I'm just wondering why people are concentrating only on trans gender people when deciding what constitutes a waste of NHS resources.

I'm glad you don't agree they should be fired for misgendering by recognising someone's sex.

Depends what you mean by "misgendering" really. Repeatedly calling someone sir when they've been asked not to? Yes, they should be disciplined for that.

NewarkShark · 11/07/2019 13:12

don't think they shouldn't be treated. I'm just wondering why people are concentrating only on trans gender people when deciding what constitutes a waste of NHS resources

The issue at hand is about whether doctors should be aware of trans people’s birth sex and resources has been mentioned as a facet of that. It is a untenable leap to say that this means people on the thread are focussing only on trans people when it comes to resources.

If it were a thread about NHS resources and people were only mentioning transgender people then I would agree with you. It isn’t, non-attendees at appointments are not relevant, and there is no basis for your suggestion that people are implying transgender people are the only problem with nhs resources.

You’ve also ignored that I’ve explicitly said I want greater resources for medical support of transgender people.

It’s ridiculous how everything except complete capitulation is skewed as being somehow anti-trans.

RedToothBrush · 11/07/2019 13:16

I'm just wondering why people are concentrating only on trans gender people when deciding what constitutes a waste of NHS resources.

Except I've mentioned how there are decisions made when it's found that a patient has 'self inflicted'.

Transplants are the ultimate example where age, health, smoking, drinking etc are taken into consideration when deciding how resources are spent and allocated in terms of risk.

Major surgery decisions are also very much subject to this.

If someone is found to have lied about smoking/drinking/drugs then yes that might have ramifications and cause s doctor to say 'no' and offer an alternative treatment instead which the patient might not always agree with.

Datun · 11/07/2019 13:19

Depends what you mean by "misgendering" really. Repeatedly calling someone sir when they've been asked not to? Yes, they should be disciplined for that.

Who's done that?

DecomposingComposers · 11/07/2019 13:56

Datun

How then has a Dr been fired for misgendering a patient?

@NewarkShark

That's different then if people are calling for the same rules to apply across the board - so all patients who choose not to disclose everything to their Dr are all treated the same.

I still don't agree with you. I think as patients we are all entitled to choose what we disclose, on the understanding that any harm caused by that is our responsibility. I also expect to be treated with respect by any HCP that I interact with, on the understanding that I treat them with respect also.

RedToothBrush · 11/07/2019 13:58

How then has a Dr been fired for misgendering a patient?

He hasn't.

He's been fired for refusing to agree to hypothetically use the pronouns demanded.

Just refusing to comply in theory was enough to get fired.

No one actually made a complaint.

Datun · 11/07/2019 14:18

He's been fired for saying that using the wrong pronouns goes against his conscience.

He has also said

'I want to stress this isn't personal - we are not out to get anybody. As a Christian doctor I believe we have to show compassion to all our patients whatever their background.

He hasn't actually said anything. To anyone.

But the DWP decided it would constitute harassment under equality law.

He has been fired for theoretical harassment - in the future!

Datun · 11/07/2019 14:19

The most oppressed group on the planet is managing to wield power without even being there!