De-sexing the Medical Record? An Examination of Sex Versus Gender Identity in the General Medical Council’s Trans Healthcare Ethical Advice

[ItsAllGoingToBeFine]

www.tandfonline.com/doi/full/10.1080/20502877.2020.1720429?src=recsys

This is from Feb so may have been discussed already. It's a really interesting read.

Abstract:
What do the terms sex and gender identity, or gender history, mean in a medical context? When does it matter to a healthcare professional whether a patient has male or female reproductive biology? How should a doctor approach a patient who does not wish for their biological sex to be openly acknowledged? The General Medical Council (GMC) advises doctors that transgender patients may have the marker for their sex amended to instead reflect their gender identity. This paper will attempt to critically examine two key points in the GMC trans healthcare ethical advice using Beauchamp and Childress’ Four Principles approach, exploring how doctors might consider an incongruence between sex and gender identity in clinical practice.

Thank you. What a great read. This is brilliantly thorough and clear. It presents lots of real world examples of when biological sex is materially significant, and shows how it affects pretty much everything in medical care. Essential reading for anyone working in medicine, I'd say, and for everyone else it makes a compelling case for likening a trans identity to a religious conviction, and for the importance of keeping biological facts on people's medical records:

"Even if clinicians intend only the laudable aim of reducing distress and confirming a trans patient’s identity in the records, doctors should not promote untruths. If a tuberculosis patient ‘identified as cured’ when they objectively were not, the clinician would have a moral responsibility not to document a falsehood, even though it might cause discomfort to the patient."

And I appreciate this definition of gender identity (and the fact that someone has actually bothered to try to define it properly):

"Gender identity is a deeply held, spiritually significant, personal belief that can neither be confirmed nor rebutted by external evidence and biological data."

I'm surprised more wasn't made of this at the time!

Thanks for posting, that's an interesting read. Demonstrating that using gender identity in place of sex in medical records causes problems both for healthcare practitioners and transgender people.

Thank OP I hadn’t read this before, it is well written and will no doubt prove a useful resource in discussions on this topic.

Gender identity is a deeply held, spiritually significant, personal belief that can neither be confirmed nor rebutted by external evidence and biological data.

Not completely sure on this, as for me gender identity still has roots in social constructions and expectations of how males and females should behave. I have certain aspects of my gender identity (I just don't believe it is my essence) that I know to be patriarchically determined hooey. It's not 'spiritually' significant at all.

Oh, I read the argument as just saying that gender identity, where someone feels it strongly, is spiritually significant to that person. She goes on to make a comparison between trans people who choose medical procedures which might harm their physical health, and Jehovah's Witnesses who refuse blood transfusions, a choice which is spiritually significant to them.

I do agree that social expectations must play into how gender identity develops into a personal spiritual belief. I don't have a strong sense of gender identity myself at all so I do see it as similar to a religious belief that I don't share.

Interesting, thanks for posting

What a beautifully-written, clear, sensitive and balanced article. Thank you for posting.

"The justification for why trans patients specifically should alter clinical facts in a medical record is unclear. If the rule is adjusted so that all patients may freely amend any facts they find unpleasant, clinicians might find themselves in a difficult situation of not knowing what parts of their documentation they can trust."

And this is the crux of it.

"Gender identity gives meaning to trans people’s lives, and cannot be assessed for truth or falsehood. As long as the trans patient is aware of empirical truth (i.e. their biological constitution), yet truly believes in their gender identity, then gender identity is similar to a religious assertion and ought to be respected. The challenge lies in untangling and navigating language during the clinical encounter, as the terminology of sex and gender identity designates the same words to denote very different concepts."