High Court Battle - pronouns

[PigeonLittle]

Not sure if this is being discussed here, couldn't see it after a brief look.

www.dailymail.co.uk/news/article-10507853/Christian-doctor-David-Mackereth-sacked-trans-views-fight-High-Court.html

There are more pronouns than just ‘she’ and ‘he’. ‘It’ is also a pronoun.

My siblings and I occasionally referred to each other as ‘it’ when we we children and teenagers. It absolutely conveyed disdain and a lack of respect for one another. In fact, that was the whole point. Hy

It was extremely rude of us. But it wasn’t illegal.

I don’t want to be forced to ‘respect someone’s pronouns’. I recognize that not doing so might be rude but the alternative is compelled speech which is unacceptable to me.

The assumption that gender should be affirmed implies that people are all really aware what is going on. It assumes 'madam patient' must know they're actually a man and we just need to be kind. But if we have a generation of people becoming adults who genuinely think you can change sex and genuinely don't realise that that dangly thing in their pants means they are a man, then it could be disastrous for healthcare. Doctors should be holding a line on the issue. You step into a medical setting and it's sex only until you're out of the door.

@GreenUp yes! Exactly that!

@DifficultBloodyWoman it sounds like what you're saying that it's okay for a doctor to be extremely rude to his patients, because it's not illegal. And that the rude doctor shouldn't lose his job, even if he makes it clear he's going to continue being extremely rude to patients going forward.

I just wanted to check that's what you mean. Because, if so, I'm really uncomfortable with that. I think it's entirely reasonable that patients should expect to be treated with dignity and respect, and spoken with politely. I avoid doctors as is (it only takes one bad experience...) and can't imagine that entitling them to be rude to their patients would in any way increase attendance or trust in the profession.

In the same way, my worry with @Carbiesdreamhouse's suggestion is that all it will do is ensure that trans people don't seek healthcare.

For clarity, I applauded Robert Winston when he said 'You can't change your sex' on twitter. I just can't quite see him insisting on calling a transwoman patient "Mr Smith", because that would inevitably impact on the quality of care he provided to his patient. What happens in political debate, and what happens in the confines of a consultation, are two different things because the terms of the interaction are different.

Getting back to this case, the Tribunal determination is very clear that terminating Mackareth's employment was reasonable, not because of his beliefs, which he is entitled to hold. But because how he proposed to act from of those beliefs would be offensive to patients and would disrupt the smooth running of the service. Unless one wants to argue that it's okay for doctors to knowingly set out to offend their patients and to pick and choose who they treat on religious grounds, then it's hard to say that the tribunal was wrong.

Obviously Christian interpretation will vary but there will be a significant number of Christians who take issue with the idea that our bodily sex is irrelevant.

The Catholic Church has been clear that they don't consider that it's possible to be in the wrong body or have the wrong sex as such, so that's 50% of Christians worldwide.

Never was there a better illustration of the difference between Birmingham and the Black Country for those that like to confuse the two.

Birmingham - land of the free, anything goes
Dudley - "yow fookin wot?!"

[quote Motorina]@Cismyfatarse yes, it's very different.

It's closer to someone choosing not to treat people who have sex out of wedlock, because it doesn't accord with their own beliefs, even if the reason the patient has attended is due to their nosebleeds.[/quote]
But he's not unwilling to treat people.

Part of the problem here is that the law seems to be using all kinds of language where no one really knows what it's supposed to mean, which has no clear scientific or social meaning that is close to universally accepted - is in fact quite controversial on a number of levels.

It's really not just a problem for certain religious people. Many people don't believe in the underlying ideology. And of those, some of them think it is wrong to lie about it, or actively damaging to society.

@MangyInseam

Obviously Christian interpretation will vary but there will be a significant number of Christians who take issue with the idea that our bodily sex is irrelevant.

The Catholic Church has been clear that they don't consider that it's possible to be in the wrong body or have the wrong sex as such, so that's 50% of Christians worldwide.

What about other religions, Muslims, Jews, Sikh, Buddhist do they believe people can be in the wrong body?

I imagine for many it's an issue, as I don't think any religions support gay marriage. If they were to accept transwomen are women. Then a transwomen marrying a man is a bit of a loophole in the anti gay marriage stance.

Well there are countrie like Iran where the prefer transition over same sex marriage. But I don't know how they conceptualize that theologically - if they think it really represents a change or is more a way of dealing with a problem.

Buddhism and some other eastern religions tend to have a somewhat different view of the body and material world than western religions typically do. So perhaps there is more room there for an idea like that, but I have no idea how they would actually explain it.

All of these religions have roots in a time when it was difficult to ignore the real consequences of reproductive role, unlike modern society where it is possible to suppress some of them through technology. So that may be a factor too.

[quote Motorina]@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.[/quote]
There was no medical appointment.

No personal consultation for a medical matter.

The person attending the doctor is not a patient.

The doctor was employed by the arm of the State empowered to prevent the fraudulent acquisition of Taxpayers remitted funds.

The assessment is an anti-fraud measure.

Society has decided that an applicant can give up some rights in exchange an applicant gets a portion of the redistributed wealth.

The assessor doing a gyne exam is sexually assaulting the applicant.
If presented with bunions the doctor will assess that that applicant is partially mobile so is suitable for work.

There are situations where accepting a polite lie is acceptable; an auditor doing that while conducting an audit is not one of them.

There are situations where accepting a polite lie is acceptable; an auditor doing that while conducting an audit is not one of them.

Also, the issue is one of compulsion. You might decide it preferable to agree to go along with a lie out of politeness, but compelling someone to go along with a lie is another matter.

Society has decided that an applicant can give up some rights in exchange an applicant gets a portion of the redistributed wealth.

I do not believe that people on benefits should have to give up the right to be treated with dignity and respect.

I do not think it okay to address someone on benefits in a way that even Dr Mackareth agrees is offensive, and expect them to accept it as their lot because they're receiving a share of the communal wealth.

@thinkingaboutLangCleg

this man is refusing to [use the patient’s choice of pronouns] and he is in a position of power over his trans patients.

But he is not abusing his position. He is not refusing treatment. He simply refuses to collude with the patient’s fantasy.

That fantasy could have real life consequences. Could the right to be addressed as 'she' entitle a man to access female spaces such as refuges and changing room? We should not collude in accepting any aspect of transgender ideology.

I think @SolasAnla sadly speaks for many people when it comes to the benefits system which is why it's got such a terrible reputation - the assumption that benefits claimants are not entitled to compassion or dignity, not to mention the suggestion that they are all fraudsters anyway.

@GreenUp

Having skim read the first tribunal judgement I don't think it's possible that he can work in that role with the manifestation of the belief that he has (refusing to use someone's given pronouns or title).

The service said it can't know in advance which attendee will be trans so they can't assign the case to a different assessor. The doctor as per GMC rules is not allowed to discriminate against patients based on his own beliefs. The same anti-discrimination requirement is made by the Disability Assessment employer. There aren't any backroom (non user facing) roles that he would be qualified for because he would have to gain 12 months experience in working as an assessor first.

My experience of working in services, whether its health or social care, is to be person-centred, not worker-centred. If you work in a clinical role there will be plenty of situations in which you will have to hold your tongue or do things that don't comply with your own belief system.

It would be one thing if he refused to confirm that a male can have ovarian cancer as that would be a statement of fact. But refusing to use the title provided by the patient/service user just seems a bit petty especially given that it is unlikely that he would often have to do this in person. He could use the person's name during the appointment and use their name in reports and might just have to tick a box for the titles.

I think maybe he could win the first part of an appeal because it seems discriminatory to say you can't hold christian beliefs. But I think he will lose the second part of the appeal based on not being able to function in the role as required given the manifestation of his belief. But I'm not a lawyer

(refusing to use someone's given pronouns or title) while they are in direct contact?

"Jane can you sit in the red chair"
"Mrs. Jane Smith can she sit in the red chair"

He could use the person's name during the appointment and use their name in reports
Simple solution part 1.

and might just have to tick a box for the titles.
He never gets to choose or allocate titles. These will be collected but have no value as data points and have no relevance to the assessment process.
In fact under good data protection policy the question should be why is this data collected at all.

However some titles fall within the PC belief. How about requiring a woman to address someone "allah" or "Big Daddy"?

The Service Provider is an employer so they have a legal duty to their employees to not discriminate on the 9 PC grounds.

The Employer has to make reasonable adjustment to not discriminate.
Has the Employer done this in this work environment?

At the appointment the applicant in not unknown to the Employer as its a service provider which has had prior contact and collected multiple data points.
Has the Employer assessed that there is a conflict of PC's and conflicts between how it approaches if in its employer role and service role?

Some NHS hospitals, focus on their obligation as Employer looked at GI as a PC and created policy which was some employee centred. The policy conviently ignored the other conflicting PC's. A woman could wear a hospital issued uniform which was modified to accommodate her PC but was expected to share a locker room in breach of two of her PC's. On the service side Management created a reporting system to deal with patients who availed of their right to give limited informed consent around their treatment. These policy also create a hierarchy of paitent care by instructing staff to actively lie to some patients to benefit other patients.

The core of the assessment is an adversary process not an advocacy.
General point is that he is not being employed as a medical doctor in a patient facing role.
Rather the role is someone who is an sufficiently qualified gatekeeper with enough professional competence to challenge other professional opinions. In this role the Courts expect the role to be filled by a person who uses the term doctor to summarise the achived quallifiactions.

Can the Pastafarian Employer insist on colanders being worn and that staff greet everybody as using the Pastafarian terms.

PS replace the word woman with man in each example what changes?

If you enforce collusion in one social interaction you embolden the enforcer to demand the same in all social interactions.

@SolasAnla if you read the tribunal determination you'll see outlined the steps that the DWP went to to try and accommodate his beliefs.

His preferred solution was that, on meeting a client, he first conduct an assessment of whether they were transgender. If they were, he would stop the assessment and direct the client back to the waiting room to wait and be assessed by someone else.

The DWP considered (and the Dr agreed) that that was likely to cause offence. It would also inevitably delay the assessment which might lead in some cases to the individual having to return another day.

The DWP considered, and the tribunal agreed, that that was not a reasonable or workable accommodation.

In weighing up the rights of the Dr and the rights of the client, it considered that the rights of the client took priority. Just as they do when I say I want a female clinician for an intimate procedure.

I do see your point Motorina but isn't it like the gay marriage cake case? Which I also can see the other side for but come down on the side of freedom of people in the workplace not to have their speech compelled.

I do not believe that people on benefits should have to give up the right to be treated with dignity and respect.

I completely agree, but think people should be able to conscientiously object from gender identity ideology. It shouldn't be an expectation for people that they will always be catered to in matters of their personal identity. The benefits issue is irrelevant.

It shouldn't be an expectation for people that they will always be catered to in matters of their personal identity

That's a good point, @Ereshkigalangcleg. Even if the majority agreed this was to be accommodated there will be problems when people with neurodiversity, learning disabilities or who are very young state what they see - which is a biological fact that that person is not what they say they are.

The way that young man in Wales was treated was awful. He was, I think, 19, had autism and a learning disability and asked a trans man police officer whether they were a boy or a girl. He was convicted of a hate crime.

I'd have argued that the trans man's upset and insistence of charging the young man was a hate crime in itself. That young man had protected characteristics too, ones which mean that he is vulnerable.

So, the TRAs can bring in laws to enforce group think and control our language, in order to create an expectation that their identity will be accommodated - but truth will always out. You cannot change sex. You have to learn to cope with not being able to change sex.

Also, who PUNISHES a person with a learning disability for behaving asking a blunt, insensitive questions?

It's a similar issue to this doctor who has religious beliefs, which are protected under the EA2010. His religious belief doesn't allow him to collude in a lie that the person has actually changed sex, or to believe that you can change sex. Which he knows you can't because he's a medic.

Giving people with learning disabilities criminal records and disciplining medics for stating biological facts - well, it's just not a good look.

@Ereshkigalangcleg I think any time there's a conflict of rights, then where the balance lies between them is very case specific.

In the gay marriage cake case, the baker was being asked to make a positive statement in support of gay marriage. In this case, the doctor isn't being asked to make a statement in support of trans rights. I agree that would be unreasonable. He's being asked to use the preferred name and title for the client in front of him. So to call Mrs Smith, Mrs Smith.

In the case of the cake, the consequence of the customer leaving is that they didn't get a cake. They could go to 1001 other bakers.

The consequences in this case are:

1. Causing further distress to someone already so severely mentally unwell they cannot work.
2. Delaying their assessment, possibly requiring them to come back another day. Not easy for someone profoundly disabled and on benefits!
3. If they are so upset they leave, they lose access to disability benefits.

In the first case, what is being asked of the provider is high, and the impact of refusal is low. In the second, what is being asked of the provider is lower, and the impact of refusal is much higher. So the balance of rights swings the other way.

Basically equitable health care and equitable access to support for the disabled is more important than equitable access to cake. And I say that as a cake-lover! Particularly when the client has no choice but to engage, and the consequences of disengagement are devastating.

So, the TRAs can bring in laws to enforce group think and control our language, in order to create an expectation that their identity will be accommodated - but truth will always out. You cannot change sex. You have to learn to cope with not being able to change sex.

This. We need to stop pretending that people can change sex, or that sex doesn't matter. It's not helpful, it's not kind to either them or others, it's not sustainable and it's not realistic that everyone will comply 100% of the time. A lot of this problem has stemmed from people using this control over others as a power trip. See the AIBU about a non binary person currently running, where the OP is having to manage a very difficult individual who is causing trouble for everyone.

That "hate crime" police officer "misgendering" case was a scandal, the poor young man involved should have had better legal representation. If he had the network GC feminists have there would have been a crowdfunded defence, I'm sure.

Basically equitable health care and equitable access to support for the disabled is more important than equitable access to cake.

I mean in terms of the freedom of belief and speech principle. Not about what it's about.

As I said, I see your point but I don't agree with compelled speech. Many mental health conditions involve thinking things are true which are not the case, there are limits on how much these beliefs are catered to, aren't there?

@vivariumvivariumsvivaria
“The way that young man in Wales was treated was awful. He was, I think, 19, had autism and a learning disability and asked a trans man police officer whether they were a boy or a girl. He was convicted of a hate crime. “

It is extraordinary that he was convicted. I did not know about that story.

Yes, @Ereshkigalangcleg - I think I agree with you.

What is the ethics of accommodating the trans woman's pronouns if it means we are supporting or reinforcing a belief which is harmful for that individual?

This is all very new, we don't yet know what the long term consequences of transition are.

"First do no harm" is a solemn vow that medic will have taken. If he is not confident that the changed language is harmless then what is a man of principle to do?

What a mess. This could all have been sorted out if Ruth Hunt had encouraged debate. But, she decided to obfuscate things and now we have a vulnerable person who is upset and a medic having to defend beliefs and science.