Elaine Miller

After standing in the public gallery of the Scottish Parliament, lifting her skirts, so that she appeared to be flashing her genitals though it later emerged that she was wearing sheer tights and a “merkin”, Elaine Miller has demonstrated that she is not fit to practice as a physiotherapist. Can any action be taken?

Listening to the transphobes

The Nuffield Council on Bioethics has launched an open consultation on treating gender dysphoric children and adolescents, to which anti-trans campaigners may easily respond. The working group does not include a single trans person. Dr Ruth Pierce has written a detailed critique of the project and its inadequacies. I had a look at the questions.

Nuffield produces reports on ethical issues in bioscience and health. It is funded by the Nuffield Foundation, the Medical Research Council and the Wellcome Trust. This page has links to its work on gender identity. This is its call for evidence.

They start by asking what gender dysphoria is, explaining that some people think it is a medical condition- genetic, hormonal, neurodevelopmental or psychiatric; some think it a social construct, and some a “normal variant of gender expression”. They don’t want a single agreed view, but want to understand how different views affect the approach to care and treatment.

Trans is what some people are, just as gay is. Attempts to suppress our personality fail. Attempts to prevent us from expressing ourselves through transition may succeed, though at the cost of great psychological distress.

Gender dysphoria is the distress at having to conform to the wrong gender, or at living with transphobia including internalised transphobia.

Those anti-trans campaigners who imagine they are left-wing feminists conceive of transgender as a threat to AFAB children: to those who want to transition, whom they call girls, threatened by infertility and physical changes preventing them from living their lives as “adult human females”; and to cis girls generally, from trans girls, whom they characterise as a threat to privacy or even a sexual threat. They cannot believe that transition could ever be right for someone.

However, trans people exist. Transition benefits us. Medical treatment with hormones and surgery at the very least helps us pass better, so to function better in a transphobic society, and at best cures the gender dysphoria arising from our bodies being wrong. Before transition I hated my body. Now I love it.

Anyone asserting that transition is always or mostly wrong is therefore denying reality, and their views should be discounted. However as Ruth Pierce shows the Nuffield press release quotes the approbation of extreme anti-trans campaigners.

Nuffield then asks what social factors are most relevant to the discussion on gender identity, and names a number of possibilities. On “intense sexualisation and objectification of women” I would add rape culture and pervasive sexual violence, but not primarily as having an effect on the trans boys but on the anti-trans campaigners. Many who once were feminist have been traumatised by that sexual violence, and they imagine that trans boys are fleeing it rather than expressing their true selves. It blinds them to the phenomenon of the trans boy who benefits from transition.

Nuffield names “increased visibility of trans individuals in public life”. Well, yes. Rather than trying to conform to the assigned gender, we realise transition might be possible. I felt I could not transition, because the trans women I knew seemed to be having awful lives. When I met some who seemed to prosper, it seemed possible that I could make a go of life as a trans woman, and so I decided to transition.

It does not mention the public transphobic campaigns of the Republican party in the US and the Conservatives and their allies here. That terrifies trans children, and makes them attempt to conform to their assigned gender. It causes mental anguish and even illness. We live in an atmosphere of extreme transphobia. That Nuffield names homophobic bullying but does not explicitly name transphobic bullying shows that they are trying to find a mid point between trans people and the anti-trans campaigners, rather than finding what is right for the children.

Nuffield then asks whether the evidence base justifies the use of puberty blockers and gender affirming hormones (which they call “cross-sex hormones”). I don’t know. There are great difficulties with producing evidence that these treatments are beneficial- the privacy of the trans people involved, the rarity of treatment, and the reasons why treatment is given. Trans children want PB and GAH because they want the right sex characteristics and not the wrong ones. Gender clinics justify treatment as a way of alleviating distress at the time of treatment, not anticipated problems and benefits in the future. That fits Nuffield’s next question- what should be the purpose of PBs?

How should trans children be treated? Before asking this, by way of context, they refer to “desisters”. I would draw attention to people who detransition under the extreme transphobia of society, and later transition again.

Nuffield asks, “Should children be encouraged or supported to transition socially?” Of course. It is the only way to find whether they will prefer life transitioned. But look what Nuffield has to say. Social transition “makes it difficult for young people to change their minds, and in fact increases the likelihood of later medical transition”.

Social transition of cis children is torture. It does not work. This way of presenting the issue makes transition look like a bad thing. The point is, for trans people, social transition makes our lives better. We do it under the pressure of worse transphobia than in Britain now. Nuffield is echoing transphobic talking points.

Nuffield then asks about a range of harms, even those which might be seen as harming those who do not desist, such as, loss of fertility. Stem cells can be made to develop into gametes. That is the way to address loss of fertility. They posit “the negative consequences of disrupting physiological puberty, given the role it might play in the formation and development of a consistent gender identity”. That is mere speculation, simply a more formal way of saying “Don’t indulge them. They’ll grow out of it.” BUT WE DON’T.

This is what Ruth Pierce means about the distress of facing these endless questionnaires, surveys and consultations. I want to cry. Why can Nuffield not see?

Then they ask about consent. They go into detail on the doubts expressed by the judges in the Bell case. They ask, “Do you think that children and adolescents have the capacity to consent to PBs and CSH?” No, scream the anti-trans campaigners. Trans people don’t say there are no risks, just beg the cis gatekeepers to consider the risks of not treating.

Again, the questions make the anti-trans case. “Is there anything distinctive about PB and CSH that they warrant a different standard of consent?” No, not really. All treatment has risks. Should a fifteen year old girl have an abortion? What if she regrets it, and is incapable thereafter of becoming pregnant? There is nothing distinctive, because this is treatment which can have great benefit. Many claims of risk are fearmongering and evidence-free speculation. But transphobes are so wise, and disinterested, in their calls for “transparent public debate”.

My sarcasm is a defence mechanism.

Nuffield asks if there’s anything else you want to say. Getting the distinctions and similarities clear in your mind, clarifying why phobes’ objections are irrelevant, is a particular skill. Not all trans people have that skill. Facing demands for explanation, we might just give up. Nuffield will produce a report over many pages, with many considerations weighed and taken into account, but for us it’s quite simple.

Transition saved my life. It may save others.

I am not going to answer this consultation. I dare to hope someone will express the potential benefits of PB and GAH in such a way that it will be clear to any disinterested person that they should be given, and that only considering the alleviation of current distress to justify treatment is unethical.

Consequentialism

I assert my morality is mainly consequentialist, with a tincture of rules-based and virtue-ethics. Perhaps I should read up on what that means. So I turned to the Stanford Encyclopedia of Philosophy. Moral philosophy consists of people putting up theories, and people picking holes in them. When the theorists try to defend, that can be like a Ptolemaic astronomer finding ever more tiny epicycles to fit the data.

Stanford is better than “allaboutphilosophy.com”. There I read of Situational ethics: the idea that a moral response depends on all the circumstances of a situation, and not on any fixed law. I agree: but the site’s killer argument is that Situational ethics “contradicts the Bible”. Yet still Stanford felt like a series of straw men.

Most people could live on less, and give more to charity. That charity might save lives. Consequentialism might seem to put an obligation on us to save lives, and socialise at home rather than in the pub. However much you do for others, most people could find ways to make more sacrifices, and do more. I could see the greater sacrifice as morally preferable, but not obligatory. Or I could attempt to use Aristotle’s golden mean, a virtue ethics argument, to say that too great sacrifice is a fault. Or a Quaker line: “A simple lifestyle freely chosen is a source of strength.” JS Mill would argue that an act is only morally wrong if liable to punishment: it does not maximise utility to punish people for not being absolutely as moral as they might.

Philosophers refer to agent-neutral and agent-relative views. The theorist of agent-neutrality says that an act which is right for anyone is equally right for everyone. The agent-relative theorist might say here that a parent has a particular obligation to their family. This starts to look like argument after the fact: one can rationalise any decision. How to balance competing claims?

The article expresses it differently, but considers the Trolley problem. Imagine a train is coming down the tracks towards five workers. Points could divert it to another line where there is only one worker. Do you pull the lever, to save five lives at the cost of one?

Such problems have to be unreal. No, you cannot warn the driver or slow the trolley. No, you cannot warn the workers, and they cannot jump out of the way. Perhaps they are tied there- one damsel in distress on one line, five on the other. The argument for not pulling the lever is that my action will have directly caused the death of the One, even though saving the five, so I will not. What if the death would be my fault, asks Stanford: the workers were in danger because I had told them to work there, and had not known the trolley was coming because I had not bothered to check. In that case, I might collapse into a fugue of terror and do nothing.

I come away from the article with more questions than answers, and perhaps better able only to rationalise after a decision, rather than decide morally before.

Article on Consequentialism.

Morality and contraception

Things happen. Human beings have purposes and intention. Things don’t.

Here’s the Catholic Church on contraception, taken as before from Rejection of Pascal’s Wager. John Chrysostom found it appalling: Indeed, it is something worse than murder, and I do not know what to call it; for she does not kill what is formed but prevents its formation. Weird. Pius XI wrote, No reason, however grave, may be put forward by which anything which is intrinsically against nature may become comformable with nature and morally good. Since, therefore, the conjugal act is designed primarily by nature for the begetting of children, those who in exercising it deliberately frustrate its natural power and purposely sin against nature and commit a deed which is shameful and intrinsically vicious. So a condom to prevent spreading AIDS was forbidden by John Paul II.

The current position: Wikipedia’s source claims condoms were permitted by Benedict XVI; but Francis dodged the question, claiming other problems of Africa were more important. Indeed they are, and indeed the Pope crying out against poverty is a good thing; but one word permitting condoms where there is risk of AIDS transmission is not too much to ask. Francis referred to the “openness to life of the sexual act”.

A single celled eukaryote ancestor of all flora, fauna and fungi produced a gamete requiring another gamete to produce a new organism. How this evolved is a mystery. The result is to permit the evolution of complex, multicellular organisms, but that was not the purpose.

Orangutan females have sex with lots of males. A theory is that they are aware of fertility, mate with the best male when he will be the father, and mate with the others so that they will not kill an infant which might be their own. Humans have sex when infertile. This has the effect of bonding people together. It did not evolve with that purpose, but arose at random, and flourished because it promoted reproduction.

Sex is not designed. It has effects, and people do it to achieve those effects; and we ignore the risk of other effects because that, too, promotes reproduction: this forgetfulness flourishes. Natural law theory fails because it confuses is and ought; and because in this case it chooses the troublesome, rather than the pleasurable, effect of sex as its purpose. Thomas Aquinas said contraception is a grave sin and to be classified as a crime and against nature- I sourced that quote from Father Hardon– so the Roman Catholic Church is stuck with facilitating the spread of AIDS. I find that immoral- but I judge it by results, rather than by considering the acts causing them.

The Catholic Church and abortion

They are against it. They imagine they have moral reasons for this. Their method of moral reasoning is inferior to mine. My method of moral reasoning fits free people; theirs fits people following the rules of an oligarchy.

Catholic morality is deontological, following rules. Certain acts are considered sins, whatever the consequences: the end never justifies the means, they say. My morality is at least in part consequentialist: I look at the intended result.

Can a foetus be aborted to save the life of the mother, when if it is not aborted both will die? No, they say: Two natural deaths are a lesser evil than one murder. John Paul II wrote, The deliberate decision to deprive an innocent human being of his life is always morally evil and can never be licit either as an end in itself or as a means to a good end. It is in fact a grave act of disobedience to the moral law, and indeed to God himself, the author and guarantor of that law; it contradicts the fundamental virtues of justice and charity. “Nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo. This is clearly not an argument: it is merely a reiteration of words, to be completely clear.

However, in the case of ectopic pregnancy, where the foetus has implanted in the fallopian tube, removal of that tube is permissible under the principle of double effect- the surgeon removes the tube, mutilating her and making pregnancy later less likely, in order to save the woman’s life, with the unintended consequence that the foetus dies. However, removal of the foetus from the fallopian tube, saving the tube, is not permitted, because that is the direct act of killing the foetus.

I analyse this situation by its consequences. This is named consequentialist ethics. Consider the choices:

1. Remove the foetus without damaging the tube. The foetus is dead, the woman’s life is saved, she retains her chances of pregnancy later.
2. Remove the foetus and the tube. The foetus is dead, the woman’s life is saved, her chances of pregnancy are reduced.

To me, clearly, the first is preferable. The church considers the second preferable because it considers acts rather than consequences. For me, the end justifies the means. For them, the need to avoid the wicked act of directly killing the foetus justifies mutilating the mother.

I cite the legal principle that a person is presumed to intend the consequences of their acts. The Catholic doctor knows that the foetus is implanted in the fallopian tube which s/he removes; how can it be said that the doctor does not intend to kill it?

To me, there are situations where moral rules are useful. Do not lie, do not cheat, do not steal; but it seems to me that I follow rules from virtue ethics rather than deontology: I am not the kind of person who does that. This makes me a moral agent, the judge of my own morality, rather than slavishly following rules thought out before consequentialist ethics was conceived.

Catholic position from The Rejection of Pascal’s Wager.

British Values

Islamic Extremism is a British value: most of the European fighters in Syria are British. There are two kinds of Islamic extremism- those who want armed struggle for the umma, and those who think the world was created less than 10,000 years ago and all unbelievers are going to Jahannam. They overlap but are not the same. Theresa May fails to understand the difference, writing We do, however, need to recognise that many moderate Muslims, as well as people of other religions, believe that covering one’s hair is a religious requirement and some parents will therefore want their children to do so. The text on dress requirements should therefore not be part of the extremism definition.

Michael Gove will require England’s 20,000 primary and secondary schools to actively promote tolerance, fairness, respect for other faiths, and the rule of law and democracy, says the Daily Mail, whose readers imagine that it epitomises Britishness, in its casual racism and loathing for LGBT and benefit claimants. Prejudice, drunkenness and spontaneous violence are British values since before Great Britain was. Any lesson on English culture should include the many uses of the word “fuck”.

“Respect for other faiths” is incompatible with preventing them teaching that Noah is a historical figure, if they want. There is a tension here. Sweeping the difficulties under the carpet is a British value.

Tolerance, a sense of fair play and the stiff upper lip are British values, and so is the hypocritical assertion that these are more British than foreign, or that they are more British than the eye for the main chance. Consider the War of Jenkins’ Ear, fought from 1739-1748 to ensure the lucrative right to sell slaves in Spain’s American colonies. We talked of the White Man’s Burden to civilise India, and indeed we managed to abolish suttee, which I read is the manifestation of the moral goodness (sat) in women.

Pretence is the core British value: we are the good people, shocked and amazed when our bad side comes out. So we have no way of channelling it. Cynical denial of such Good is a reaction to our pretence, necessary to purge it, but leaving us without a moral centre. Though our poets tell us the answer:

Speak what we feel, not what we ought to say.

Ah, love, let us be true to one another!

By all means teach tolerance, fairness, respect for others and the myths and metaphors which speak to them, commitment to truth, grace in movement and repose. Children should be taught to come to their own understanding of what is the Good Life, by criticising different views of how to live well. Teach the best virtues of humanity, but not as British rather than Islamic. Fear of the Bogeyman is very British, but never ends well.

Seeking the slime

The test of liability for medical negligence in the UK is that in Hunter v Hanley, or Bolam. Against a case of negligence for choosing a particular treatment, or a failure to treat, there is a defence if

the doctor has acted in accordance with a practice accepted as proper by a responsible body…of professional opinion.

If an outmoded and ineffectual treatment is still chosen by a minority of old-fashioned practitioners, then there is no liability on the doctor for choosing it.

In the light of the Equality Act, the General Medical Council is revising its guidance on personal beliefs:

5 You may choose to opt out of providing a particular procedure because of your personal beliefs and values. But you must not refuse to treat a particular patient, or group of patients because of your personal beliefs or views about them. And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.

The Daily Mail got in a complete tizzy about this: Christian doctors forced to carry out sex change operations!! Indeed, those seeking gender reassignment (as opposed to the larger group who are gender variant) are protected under the Equality Act, but a surgeon has a choice of what operations s/he will train to perform. More generally, a doctor cannot refuse to refer to a gender clinic, or refer for speech therapy and perhaps hair removal if the health authority will pay for it, where the entire scientific and medical consensus is that reassignment is the correct treatment. Previously, a bigot could refer his patient to a colleague, which I might prefer, but can no longer.

It is disturbing that someone would say “Christianity” prevents him from properly practising the profession of doctor, and giving the treatment which proper doctors give. That is a Christianity from Hell, and not from Heaven. Also, it is disturbing that someone would practise as a doctor without sympathy for his patients. However, the Mail managed to find a doctor who feared that he would be forced to treat against his “conscience”. Only twenty gender recognition certificates are issued each month, so he is unlikely to see one of us.

What the Mail does is seek out “It’s the end of the World as we know it” stories on the most spurious grounds. What are the threats? What are the reasons for me to

Always keep a hold of Nurse
For fear of finding something worse?

This is a bad habit, and too common: how did I find out about the Mail article? Because trans folk were discussing it on Facebook, looking at how hostile people might be to us. When I recognised it in myself I called it slime-hoovering, seeking out and sucking up the slime to justify a fearful, constrained existence. I do it less, now I have seen it in me. I still err on the side of slime hoovering rather than unreasonable optimism, I think.

It is one of the reasons why I have any time at all for the “law of attraction”: being open to opportunity and blessing in the world has to be better.