Can we be honest about the need for affirmation?

[FortunateCookie]

I posted some of this on the misgendering thread but it was lost in amongst everything.

I asked on that thread whether refusing to affirm someone’s gender identity was a big deal or not, and many people thought it was, and that it could lead to mental health problems and possibly suicide.

If non- affirmation is so damaging then it also follows that positive affirmation would be extremely rewarding and fulfilling.

It seems obvious that this could lead to serious conflicts of interests. For example, in the case of the woman who asked for a female nurse to carry out her smear test, and was faced with a trans nurse.

Here, when the patients needs should be paramount, she instead becomes either a cause of huge distress, or a vehicle to experience the reward of validation. Either way, it is difficult to see how her needs could be centred against the pull of such a powerful motivation. Do eg hospitals, rape crisis centres recognise this dynamic?

Either it is a big deal that a trans person has their identity affirmed, in which case it should also be recognised that this can cause conflicts of interest in situations where affirmation or not is a factor (ie performing smear tests, working in a women’s refuge)

Or it’s not that big of a deal if a trans person has their identity affirmed and therefore they won’t be offended when a patient asks for a female nurse to carry out their smear.

Which is it?

I recently had a smear test. It was incredibly painful despite hormone treatment beforehand to try to encourage the cervix to open up a little more.

As some here may know, the smear test post menopause can be very painful.

No I would not want a transwoman to perform the test and I would refuse. Frankly, any excuse to get out of having a smear test would be fine by me! I had a very intimate discussion with the nurse doing the test. She of course has had to go through them too. And that matters to me. Empathy can only go so far. There is no equivalent for men you can compare a painful smear test to.

I don't want a man doing a smear test and I don't want a woman who used to be a man doing it. My needs as a patient should come before the healthcare professional or where does this end?

Do you believe Muslim women should be excluded from cervical screening?

Frankly, any excuse to get out of having a smear test

That's so relevant. So many woman avoid smear tests. We have to make woman feel as safe and comfortable as possible because smear tests save lives. Feeling that you might have to be forced to be examined by a transwomen will discourage women from getting the test done.

We need the right to ask for biological females. If transwomen want to work as midwives and nurses fine, that's their right. But females need to be able to request actual females without fear of being labeled as transphobic. In these sorts of circumstances gender should not be relevant, only sex.

Baroquehavoc - Must, IMO. But like Poppyred85 said, asking the patient appears to be common place, though in the examples that FortuneCookie and boatyardblues have provided, this does not always appear to be the case.

FortuneCookie - If I am reading your post correctly, by reviving health case do you mean the likes of CPR and other emergency situations? In this instance, I feel that patients comfort is to be waived in favour of patient survival.

With respect to crisis shelters.. I think that the individual situations should be taken in to consideration. But I also understand why someone who having to use these services would feel uneasy about voicing their discomfort to someone they perceive as trans.. I also disagree with the single sex blanket ban. You would be forcing otherwise passing transwomen to go to a mens shelter (which would likely be traumatic for them). And you would still end up in situations whereby transmen would then have to go to the women's shelter which would be equally traumatic for the transman but also potentially add to the trauma of non trans individuals at the women's shelter by being confronted by someone who appears male.

Sorry haven't read the whole thread, but absolutely agree with the OP that there are serious ethical issues around transwomen who are HCPs seeking validation from patients. To avoid this, I think transwomen who are HCPs should avoid roles where patients are likely to request care from women , for example taking smear tests.

They should also avoid other roles that could give them positive affirmation (or distress if not given), such as bra fitters or rape counsellors.

There are plenty of other jobs they can do.

Agreed terfing. It should be acknowledged that these things are either a conflict of interest or a perceived conflict of interest and they should seek other roles.

Really interesting thread. Trying to formulate my views on very little sleep!

You are all so reasoned, passionate and with logical, well thought out points, and I can't understand how people don't get it.

You would be forcing otherwise passing transwomen to go to a mens shelter

If TIM don't want to use men's shelters, the alternative isn't to use women's.

NatLuc

If I am reading your post correctly, by reviving health case do you mean the likes of CPR and other emergency situations?

I’m sorry, I’m not sure what “reviving health case means”. But if I’ve got the gist of your point, no I don’t think this would apply to CPR or other situations as here is no validation being requested of the patient in these scenarios, and it would not be expected that you could request a female HCP at these times.

terfinginthevoid

there are serious ethical issues around transwomen who are HCPs seeking validation from patients.

You have just managed to sum up in one sentence what it has taken me posts and posts to try and work out

NatLuc apologies! It is my typo from a previous post. It should be receiving. Receiving medical care.

If TIM don't want to use men's shelters, the alternative isn't to use women's.

YY. If TIMs all said "actually, the feminists are right, we shouldn't invade their shelters but should make our own", I for one would be glad to chip a few bob to help them fund it.

FortunateCookie - Lmao no problem... I suppose I should not have been so dim and figured out what you meant though!

In that case yes I agree with that patient comfort is paramount. And as I mentioned in my followup post, it seems that HCP (as per Poppyred85 said) that this is routinely asked of the patient.. though maybe it should be stressed more that it should be done.

As I mentioned, in the case of intimate exams such as a smear test trans status should be revealed. The trans person does not necessarily need to out themselves, the patient could simply show up to the appointment and the receptionist could simply ask 'Do you have a preference of who performs your test'. Thus keeping the status of any trans HCP confidential but also allowing the patient to express their wishes.

I think the difficulty is that some people wouldn't mind a man doing it per se, but they would mind a TIM because of his complicated and disturbing relationship with women's bodies/his own male body could be perceived as a 'conflict of interest' - to put it mildly.

'Do you have a preference of who performs your test'.

I would take that as meaning a named person. I expect the receptionist to ask me if I was ok with a male performing the examination at the time of booking. If I specify a woman, I would expect a woman not a TIM as would the vast majority of the population.

there are serious ethical issues around transwomen who are HCPs seeking validation from patients.

This is the crux of it. The HCP should be seeking nothing from the patient at all. To seek validation is wrong. To require validation is wrong. To involve the patient in a paraphilia when they do not consent - well that’s assault.

NatLuc sorry, totally my fault! Thanks for your reply.

*PermissionToSpeakSir

complicated and disturbing relationship with women's bodies/his own male body

Mmm. Another important and difficult to acknowledge factor at play.

the patient could simply show up to the appointment and the receptionist could simply ask 'Do you have a preference of who performs your test'

If anyone asked me that - my response, as I have not got a menu of the options available to me, would be 'no'. I still would not want a trans woman performing my smear. This is not the right question to ask.

I always say 'I want a female nurse'. I expect that person to be female, not a transwoman

I'm trying to imagine a situation where I would feel ok about a man or a trans woman doing my smear.

Where I am, smear tests are usually carried out by the practice nurse. I don't know if it's the same everywhere. I have health conditions that need regular reviews so I probably get to know the practice nurse better than those of you who are healthier.

I can imagine that if we had a nurse who was a man or a transwoman I might feel comfortable enough letting them do my smear, having met them numerous times previously for bloods etc, if I trusted them.

But I would expect them to at least ask whether I wanted one of the female doctors to do my smear instead - because a lack of acknowledgement of the potential problems would seem like a red flag to me.
So I guess the only way it would work for me is if the nurse can read my mind or something.

shouldn't invade their shelters

I meant shouldn't invade women's shelters as shelters are for non-feminist women too. Proofreading is hard on hand-held devices.

To take pressure off the woman, this should be something that’s asked of her well in advance, or perhaps even added to her file? When booking a smear for example, the person should ask ‘do you require a woman to perform this?’ Or when you register as a patient someone asks you - when we call your for smears, do you require a female HCP? It should also be made clear that even if a woman ticks no, she still has the right to refuse at any point

Absolutely agree.

There's a fundamental dishonesty for a TIM to be presenting as a female for completing a smear test.

The implication is that the transperson 'passes'. If they do, and the woman does not notice (unikely) then where is the consent? If they don't, then the woman is in put in a postion where she either has to submit to it because she is too frightened/embarassed/intimidated to say no, OR say no and know that she is 'hurting someone's feelings', which women generally don't like doing.

And being judged as being a 'bigot'. Because she does not want a male human being shoving a speculum up her fanny and finding and scraping her cervix. The bigoted cow.

If it was a male doc or nurse it would be straightforward to say no, and noone would think you would be unreasonable (or a fucking bigot) for asking for a female.

This is sinister and coercive.

Exactly. Almost like women have no rights or say in the matter.

'Do you have a preference of who performs your test'.

I would also take this as being a named person.

What’s needed is a direct question ‘do you require a female for this procedure?’ And at registration at a practice ‘do you prefer or require a female practitioner for examinations?’ Plus note on file.

If yes, a female provider is given as default. If no, the patient is reminded that at any point she has the right to request a different provider. All intimate exams should be chaperoned or offered to be chaperoned as standard.

This allows for pre planning as well. It should be win win for surgery and patient.