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Review

Clinic to be reviewed

28 April 2004

The Clinical Review is undertaken by Prof Graham Burrows within the powers of the Chief Psychiatrist to inquire into the care and treatment of persons receiving care of a mental illness. It will involve consideration of individual patient files and is therefore a confidential process.

In this instance the inquiry is limited to a specific complaint against the assessment and referral process adopted by the clinic.

The inquiry is expected to occur in May.

The resulting report will be confidential to the Director of Psychiatry and the Chief Executive of the health service, and the Director of Mental Health. The inquiry will consult with relevant persons including the Director of the Clinic.

This inquiry will be supplemented by consideration of the number of current patients of the clinic, new referrals, number of patients requiring hormonal therapy and/or surgery and staffing profile, in determining the future funding arrangements of the clinic.

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Press

Sex Change Law Change

Thursday 15 April 2004

All Australian States and Territories (except Victoria) enacted legislation between 1988 - 2002 to provide a legislative mechanism by which an individual who has undergone “sexual reassignment surgery or procedures”, is unmarried and meets the jurisdictional requirements, may apply to have their legal sex (as recorded in the Registry of Births Deaths and Marriages) amended to reflect their new gender role.

In all cases the intent of the legislation was to limit it’s application to people whom “truly experience transsexualism” and whose cross-gender identification is “permanent and irreversible”. Medical professionals working in the area, however, lack of any kind of acceptable diagnostic criteria by which such candidates could be selected.

New South Wales, the Northern Territory, the Australian Capital Territory, Tasmania and Queensland have tried to circumvent this problem by making it mandatory that the applicant has undergone sexual reassignment surgery. The problem with this approach is that some patients recover from the illness subsequent to surgery and go back to living in their biological gender.

In addition to the requirment of surgery, legislation in South Australia and Western Australia also requires that the applicant be approved by the Magistrate (SA) or a Gender Reassignment Board (WA). The problem with this approach, once again, is that a Magistrate or panel is even less equipped than the medical profession to make a determination as to whether or not the transsexual condition in any given person is permanent or irreversible.

Another problem with making surgery mandatory is that not all persons diagnosed as transsexual wish to undergo hormone treatment or surgical procedures. These procedures are still unproven and experimental and carry with them a plethora of serious risks and complications the incidence of which cannot be ascertained with confidence due to small studies in which there are high rates of losses to follow up. Furthermore, the existing legislation has no provision for those who subsequently regret the transition and want to change their sex back to what it was before. The current legislation is therefore grossly inadequate.

In his judgment in the case of "Alex", Family Court Chief Justice Alistair Nicholson slammed current state laws commenting that:

"A requirement of surgery is not only generally inconsistent with human rights; it is a form of indirect discrimination,"

Such an approach, however, would present the government and society with some difficult challenges. Persons who are allowed to change the legal status of their sex but who refrain from sex modification procedures are still fertile. This means that a male-to-female transsexual could still “father children” and a female-to-male transsexual, although considered legally a man, could never the less become pregnant and give birth to a child.

It is difficult to see how an appropriate decision with respect to the proposed changes to legislation could be made under present circumstances where the long-term outcome of patients treated with sex modification procedures remains unknown. Such decisions should be postponed until the government has completed the pending review of it’s Sex Change Program at Monash Medical Centre and until the public has had a chance to fully consider all the implications of the proposed legislative changes.

Statutory sex change

Wednesday 14 April 2004

The family court has authorised a 13-year-old girl to commence an experimental sex-change program to change her into a boy. Sex-change specialists have diagnosed the girl as having gender identity dysphoria and have placed her on hormones to stop menstruation and the feminisation of the body. The court has given the doctors the go-ahead to start administering testosterone as soon as she turns sixteen and to undertake surgery when she turns eighteen. In the meantime, she will have her birth certificate changed and will be enrolled into a new school as a boy.

The girl’s background is tragic. She and her mother came to Australia when the mother married a man who sponsored them. The girl was subsequently estranged from her mother and went to live with her father with whom she developed a very close relationship. The father treated her like a boy until his sudden death when she was six years old. She was the subject of a child protection investigation, was made a ward of the state and currently resides with her Aunt.

The girl currently suffers from major depression and suicidal ideation, which she attributes to gender issues. There is no indication whether or not the girl has been given an adequate psychotherapy to explore the issues of her background that may be contributing to her gender confusion. There is also no indication as to whether or not the Court had sought a second opinion on her condition from a psychologist working outside the controversial area of sex-change surgery.

Although Justice Nicholson recognised that Alex faced challenges including possible bullying and ostracism, it does not appear that the court has given sufficient consideration to the broader consequences of this social experiment.

What will happen, for example, when this girl becomes romantically involved with another girl at school? Initially, her girlfriend would have no idea that she is anything other than a young boy. She will be presenting as a boy, her teachers and parents will say that she is a boy. The girlfriend’s parents would also have no idea that their daughter is becoming romantically involved with another girl. Is such a situation morally and ethically acceptable?

What are the consequences going to be for her young girlfriend when she eventually discovers that who she thought was a boy is really a girl and what she thought to be a normal heterosexual relationship turns out to be a “lesbian” relationship? What implications would such an experience have on the girlfriend’s continued social-sexual development? How would the girl’s parents feel about such a deception?

Simply changing the sex recorded on the girls birth certificate and enrolling her into school as a boy cannot begin to address the major issues facing this 13 year old and those with whom she becomes involved.

GMC complaint

Wednesday February 18, 2004

A man who was given a sex-change to become a woman by the UK's best known expert on transsexualism has recovered from the illness and is now living as a man again. He now attributes his condition to a severe mental breakdown caused by the break-up of his marriage and he has lodged a complaint of inadequate assessment against the treating psychiatrist. Twelve other patients have also come forward with similar complaints against the specialist.