Hazel McHaffie

transgender athletes

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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Gender, sex, chromosomes and other details

In our family, the two generations below me are runners. With the Edinburgh Marathon Festival in a matter of days now, we’re all gearing up – in my case just to be there at as many vantage points as possible to cheer them on as usual. In their case to be in peak condition to stay the course and surpass their personal bests. And this year is exceptional in that one of them (son-in-law) is doing the 5K, followed by the 10K on the Saturday, then the half marathon followed by the full marathon on the Sunday. Now, that’s keen! Super fit. Totally focused.

Although the competitors all run together, divided at the starting point into bands according to speed and ability, the results are announced by gender – fastest male, fastest female. So, X and Y genes do matter! But what if there are question marks over one’s gender? And that’s what’s preoccupying part of the sporting world at this precise moment. The male-female definition isn’t as binary as people used to think; about 1.7% present with atypical patterns of chromosomes and biological characteristics. And the South African runner, Caster Semenya, is caught in this hazy overlap.

It seems that all her life Caster has been portrayed as ‘a frea’. Imagine the burden of that!  As a youngster, she grew accustomed to having to show her genitalia to a coach before a race. The mind boggles. And since she rose to fame as a gifted athlete her success has been overshadowed by doubt, vilification and abuse. As it’s reported anyway, she was born intersex. But she was brought up as, and identifies as, a female. In the sporting world however, now she’s an adult, there are questions about her right to compete as a woman. She produces unusually high levels of testosterone. Such a fact must be difficult enough to deal with in one’s own local community; but because she’s an Olympic champion gold medallist, and because these results got into the wrong hands, her personal information has been paraded world-wide. And now she has – again publicly – lost her case to compete in her natural state. Henceforth she must take medication to lower her testosterone levels if she wishes to race against women. No one knows what that medication would/will do to her, but in her world every second counts.

Shutterstock image

This is about much more than justice in sport; it raises huge ethical questions. In Caster’s case, the Court of Arbitration for Sport has decided the rights of the individual must be sacrificed to ensure the welfare of the majority. They say their decision is ‘necessary, reasonable and proportionate’ in the interests of fairness. Is it? From her rivals’ point of view, I’m sure we can all appreciate that it does seem unjust to lose to someone with such a huge inbuilt biological advantage. But what about other athletes with inbuilt advantages – eg. swimmer Michael Phelps with his massive arm span and double-jointed ankles and low production of lactic acid which means he doesn’t tire as quickly as ordinary men? Should he have been disqualified?

And what about Caster’s own perspective? After being cruelly ridiculed for her body all her life, here was something she naturally excelled at, for which she trained hard, and now she’s being denied the opportunity to compete as the woman she is. Lose, lose. What a monumental injustice this must seem. In fact she’s shown immense dignity in the face of this latest humiliation. She admits to feeling upset and degraded by this ‘unwarranted and invasive scrutiny of the most intimate and private details’ of her very being. At the moment she’s contemplating leaving the arena. ‘I’m finished’ she tweeted when the ruling came through. ‘Knowing when to walk away is wisdom. Being able to is courage. Walking away with your head held high is dignity.’ How desperately sad.

Why do I talk about this case on my blog this week? Partly because the questions it raises have been exercising my mind, and partly because it’s another example of the reality that there are very few absolute black and whites in the world of ethics – my world! And that’s before you start factoring in transgender athletes and self-assignment of gender and competing interests and … It goes on and on. Scrambles the mind, doesn’t it?

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