Hazel McHaffie

gender dysphoria

Ethical challenges – did anyone press the pause button?

Well, the world may have been on pause this year, but ethical issues have still raised their heads above the parapet periodically. However, I suspect most of them were lost in the cacophony of sound relating to the pandemic, so to illustrate, I’ll share a selection from the past three months up till yesterday.

December
Sweden’s gymnastic federation has now ruled that young athletes under the age of 18 will be able to train and compete as whichever gender they choose to identify as. They will not need to provide a doctor’s endorsement or any evidence of gender dysphoria.

Following a landmark High Court ruling, in the UK, new guidelines have been introduced by the NHS that make it necessary for children with gender dysphoria to obtain a court order before they are legally allowed to take puberty blockers. It is felt that under 16-year-olds are highly unlikely to fully understand the long-term risks and consequences. However the Tavistock and Portman NHS Trust which runs the UK’s only gender identity development service has said it will appeal against this ruling.

`November
New euthanasia rules are being introduced in the Netherlands – a country already known for its liberal social attitudes. Doctors will now be permitted to spike patients’ drinks before lethal injections are administered, in cases where it’s impossible to obtain informed consent from a person with an advanced directive who has already expressed a wish for help to die when the time is right, but who might resist the final act. The change comes in the wake of a court case where a doctor in a nursing home secretly slipped sedation into coffee for a lady at an advanced stage of dementia. Opponents of euthanasia are understandably alarmed by this widening of the limits in the medical code.

The English Health and Social Care Secretary, Matt Hancock, spelled out confirmation that travelling abroad for assisted dying constituted a legitimate reason to break lockdown restrictions.

It was an accidental error that led to the Oxford/Astro-Zeneca vaccine against Covid-19 reaching 90% efficacy. About 3000 of the more than 20,000 volunteer trial participants had been given just half the dose they should have received according to the research protocol. The ‘correct’ dose achieved just 62% efficacy. A serendipitous result. And a lucky break for whoever was responsible for the mistake!

October
The Dutch government approved plans to allow euthanasia for terminally ill children under the age of 12 who are suffering hopelessly and unbearably. Objectors see the thin end of the wedge visibly widening.

Legislation to allow medically assisted death was passed by the New Zealand parliament last year, but lawmakers delayed implementing it until the public had had their say in a referendum.  Under this law, the End of Life Choice Act, a mentally sound adult who has a terminal illness with a life expectancy of less than six months, and who is experiencing unbearable suffering, can request a fatal dose of medication. New Zealanders have voted overwhelmingly to legalise this, which means the measure will now pass.

An angry backlash developed when the Women’s Prize for Fiction opened up its eligibility criteria to include transgender women.

Six consecutive days of protest followed a near-total ban on abortions in Poland by the constitutional court. A country of 38 million people, Poland already has some of the most restrictive abortion laws in Europe, and an estimated 80,000 – 120,000 Polish women travel abroad for terminations or seek illegal abortions each year.

The English government has been keen to make the process of applying for a Gender Recognition Certificate kinder, cheaper and less complicated. As part of a drive for greater equality, the Women and Equalities committee are in the process of examining whether the currently mandatory diagnosis of gender dysphoria should be dropped from the legal process of transitioning, whether transgender people should be required to live in their preferred gender for at least two years before formally transitioning, and how their rights can be better supported.

As it stands, parents in this country are allowed to terminate a pregnancy where the fetus has Down’s syndrome, at any point up to full term. Three adults with Down’s Syndrome are now launching a landmark legal challenge to the Government’s abortion legislation on the grounds that it makes them feel they shouldn’t exist and would be better off dead.

A former Public Health England medical director, Professor Paul Cosford, had never wanted to be a supporter of assisted dying, but after developing incurable lung cancer himself, changed his view and bravely declared his hand in the BMJ.

A poll of 29,000 BMA members found – for the first time – that a majority were in favour of medical professionals being able to prescribe life-ending drugs. The BMA’s position currently is that they are opposed to assisted dying.

A Dutch fertility doctor has been found to have fathered 17 children during the 1980s and 90s, with women who thought they were receiving sperm from anonymous donors.

September
After President Macron turned down his personal appeal for euthanasia, a Frenchman in his fifties, Alain Cocq, suffering from an incurable condition where the walls of his arteries stick together, announced he would refuse drink, food and medicine, and live stream his death. However Facebook said it would block this being broadcast on its forum. M Cocq subsequently said he had lost capacity for the fight, it was too difficult, and he accepted palliative care.

Last year staff at the Gender Identity Development Service raised serious concerns about safeguarding issues relating to the use of inhibitors and the speed or referral for treatment for young people. It transpired that England’s only NHS gender clinic for children knew about recommendations for puberty blockers from an internal review carried out 15 years previously, but failed to implement them. An independent review into these services is underway now to improve access to and delivery of support for these young people.

Who knew there were so many, huh? I shall never be short of material for my novels!

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Image and appearances

It’s 4 years now since I published Inside of Me, but body image and transgender issues keep popping up above the parapet, and hauling me back into that world of tortured self-doubt and secret longing.
– In the last few weeks we’ve had the BMA saying that people should be able to gain legal recognition of their changed gender without the input of a registered doctor, and indeed with no more than a witnessed sworn statement. As things stand, you need a diagnosis of gender dysphoria, and a report from a registered doctor detailing treatment received, and proof that you’ve lived for at least two years in your chosen gender, and intend living in for the rest of your life.
– But subsequently the government announced that plans to allow transgender people to self-identify as the opposite sex have been shelved; they feel that the current system means that ‘proper checks’ are in place. However the current fee of £140 is to be reduced to £5.
– Then, the transgender community, already incensed by JK Rowling‘s comments about what a woman is, have trained their sights on her yet again, because her latest Robert Galbraith novel, Troubled Blood, features a serial killer who dresses in women’s clothing.
– And then there’s the mother of a dead transgender 18 year old, campaigning to honour her daughter’s dearest wish: to have children. The youngster changed gender from boy to girl in the teen years, but had sperm frozen at 14. The mother is planning to launch a landmark legal case to preserve the sperm (now due to be destroyed) to enable her to have a grandchild via a donor egg and a surrogate mother.

Just a few of the news items. But of course, each one brought the complicated ethical issues very much back into my mind, and that in turn, led me to a book near the top of my tbr pile – For Today I am a Boy by Kim Fu.

One day I’ll grow up, I’ll be a beautiful woman.
One day I’ll grow up, I’ll be a beautiful girl.
But for today, I am a child. For today, I am a boy

This truncated quote beautifully sums up the essence of this brave novel.

Peter’s father only ever wants a son: ‘In a family, the man is king. Without you, I die – no king.’ But two daughters come first, before Peter, followed by another girl. With only one chance, Mr Huang is determined to make a real man of this longed-for boy, forcing Peter into male ways from an early age. He teaches him how to shave when he’s 6 years old, tears anything female out of his schoolbooks, approves and rewards brutish male behaviour, makes sure his son doesn’t do ‘women’s work‘ like the dishes. Peter is acutely aware that his sisters get much more lenient treatment.

But Mr Huang is steeped in Chinese traditions about ancestors and what is right. Appearances matter. He has high expectations of his only son, even whilst being unfaithful to his own wife. Peter describes his father’s mistress, the neighbour Mrs Becker,  beautifully. She was …
‘Pale and thin and seemed to quiver at the edges, like she was made of water. She had limp red hair. Her freckles were a handful of sand tossed in her face … light shone through her skin to the blue veins along her forehead … her smile looked unstable.The structure of her face couldn’t sustain the weight’ … and when she betrays Peter – ‘a jittery nobody, the human equivalent of onionskin paper.’
Mr Huang is appalled at a deep level by Peter’s ‘differentness‘, his ‘weaknesses‘. his proclivities. He must at all cost keep them secret, not shame the family, not let down his ancestors. And even when facing his own imminent demise, he reminds Peter he’ll still be watching him ‘from the other side.’

With this threat haunting him, even excursions into the female world carried out behind closed doors are fraught with fear and guilt for the conflicted Peter. When he puts on a wig, pouts his lips, looks in a mirror, ‘I felt my father staring through my eyes, the grotesque image in the mirror, the halfsie freak. The grandfather I hadn’t known, the great-grandfather, all watching as my father strove not to shame them, every day until he died. All of them watching me now.’

In this fragile tale, shot through with melancholy, Kim Fu powerfully captures the young child’s only-partially-understood longing to be other than he was. The ‘nightmare years‘ of adolescence. The ongoing desperate struggle to live up to the expectations of others – gang members, pals, work mates, family. The terrible loneliness of not being understood. The pervasive malevolent forces that would crush people like Peter Huang, learning slowly and painfully the real meaning of being a woman. The terrifying consequences if he names his inner conviction.

He becomes increasingly aware of consequences outside his battles with his own body, too; the larger fight against hatred and prejudice. ‘It’s not just about me and my body. There were marches, vigils, hate crimes, unjust laws, a world that needs education. There were other people like me … there were forces that had crushed us.

I was struck by the essential loneliness or unresolved doubt. Do any of us really understand what goes on in the lives and minds of others? Books like For Today I Am a Boy help us to sidled a little closer, understand a little better.

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