From WPATH to the Cass Review: the crisis in medical ethics
Battle of Ideas festival 2024, Sunday 20 October, Church House, London
ORIGINAL INTRODUCTION
The long-awaited Cass Review – an independent review of NHS gender-identity services for children and young people – revealed that life-altering medical treatments like puberty blockers had been prescribed to children based on ‘remarkably low-quality evidence’. It also found that there had been inadequate follow-up with patients, with widespread general failures in care. The review was damning, recommending a halt to medicalised gender treatment for children until thorough research had been conducted.
Alongside the Cass Review came the revelation of the ‘WPATH files’ – leaked correspondence from members of the World Professional Association for Transgender Health. The files revealed deeply concerning practices within gender treatment, including professionals admitting that it was hard to get ‘informed consent’ from minors, and that the organisation was aware of patients who ‘regretted’ treatment, having not understood the long-term consequences of medicines like puberty blockers on their sexual life or fertility. For many, this blasé approach to children’s medicine proved that something had gone deeply wrong with medical ethics.
Why has this been allowed to happen? In addition to problems like the breakdown of a system of peer review, some argue that a simple lack of resources is to blame, with doctors forced to see more patients in a shorter amount of time. In the US, staff have bonuses tied to ‘patient experience scores’. Some argue that this has had a negative effect on care. For example, the liberal prescription of addictive painkillers has led to the misuse of both prescription and non-prescription opioids and at least 70,000 deaths from overdose. Competition for ‘excellence’ can also be a contributing factor – the now closed Tavistock Gender Identity Development Service in the UK sought to become the number one clinic for gender services, viewing an increase in treatment as a sign of success. As a result, referrals and prescriptions skyrocketed.
Others argue that a politicisation of healthcare is to blame. The condemnation of a gender-critical view – that biological sex cannot be changed – has imbued medical practices with political controversy. The idea that drugs or surgery can solve questions of identity is a view that many doctors now feel pressured into affirming, ignoring other avenues like mental-health treatment or autism diagnoses. Whistleblowing staff who raised qualms about the number of children being sent down medicalised pathways were often ignored at the Tavistock clinic, one of the reasons why it was shut down earlier this year.
Has a central idea of medicine – ‘first, do no harm’ – been lost in pursuit of what is politically correct? Have we given up on the cool-headed pursuit of medical ethics? And what do we need to do to restore trust in doctors?
SPEAKERS
Stephanie Davies-Arai
director, Transgender Trend; author, Communicating with Kids
Susan Evans
psychoanalytic psychotherapist; co-author, Gender Dysphoria: A therapeutic model for working with children, adolescents and young adults
Jennifer Lahl
founder, Center for Bioethics and Culture; program director, Genspect USA
Dr Margaret McCartney
GP, writer and broadcaster; academic, University of St Andrews
Stella O’Malley
psychotherapist; director, Genspect; author, What Your Teen is Trying to Tell You
CHAIR
Nancy McDermott
author, The Problem with Parenting: how raising children is changing across America; US editor, Inspecting Gender