Transcaptive

Australia's health professions regulator has traded its authority for gender groupthink

Photo by Cecilie Bomstad on Unsplash

Sandra Pertot

The first step in reforming the Australian Health Practitioner Regulation Agency (Ahpra) is to make sure that its capture by the gender-identity worldview becomes widely known and understood. For this reason, we should welcome the recent series of articles in The Australian newspaper shedding light on this dark corner of trans activism where the regulator allows trans activists to misuse its complaints process. There must be an end to the persecution of health professionals who in good faith challenge the gender-affirming model of care for young people.

The trans movement isn’t about supporting individuals who, for a range of reasons, believe they would be happier living as the other gender. Transsexuals of previous times were mainly men who wanted to live as women. They didn’t believe they changed sex, even though they underwent what was called sex-reassignment surgery. They simply wanted to blend into society and live their lives in peaceful anonymity. These are the trans people I worked with, and I had no problem with helping them live their best life as transgender women.

The modern version of trans activism is a very different kettle of fish. It has a broader agenda than the cause of individuals who are unhappy with their lot in life as men or women. There is an insidious core at the heart of modern trans activism. Queer theory, which has the stated aim of demolishing all societal norms for sexuality and gender, is now the foundation of trans aims and strategies.

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No boundaries: UK therapist James Esses sees ruination in queer theory

Who benefits?

In plain language, queer theory claims that all forms of gender and sexual expression are equally valid, and gender identity is whatever the individual wants that to be. The question is, who benefits from this? Certainly, there are female and male adults who, like those of earlier times, just want to live their lives quietly in their preferred gender role. However, the push for legalising self-ID gender has opened the door for adults with other motivations.

Now, it is essentially a male-rights movement, preferencing the wants and desires of males who are exhibitionists, voyeurs, transvestites, indeed any male with a paraphilia no matter how bizarre, whether it is claiming to be a lesbian and demanding access to lesbian groups, being aroused by acting like a baby including wearing nappies and being bottle-fed (infantilism), or wearing prosthetic breasts and female clothing in public. The list is endless.

Children and women are collateral damage in this drive for control. The sudden explosion in “trans kids” gives legitimacy to—and distraction from—the adult wants and behaviours. Any woman who challenges the loss of long-held sex-based rights, such as single-sex changing rooms and sports, is accused and punished as a transphobic bigot.

Under this ideology, sex is not acknowledged as binary and immutable. Its role as the reproductive strategy of our species, where males produce small and mobile gametes (sperm) and females produce large and immobile gametes (eggs), is rejected as “bio-essentialism” in a way that isn’t ever explained. And now we are presented with an infinite spectrum of sexes with no defined purpose other than self-satisfaction and pleasure. It is here that so many health professionals have abandoned their science-based professionalism and, in my view, their moral compass.

This deconstruction of sex has created a new world removed from any tethers to biological reality and spawned an ever-growing new language. This jargon paradoxically attempts to remove any hint of human biology while at the same time enforcing an “inclusive language” based solely on body parts and functions. Thus, a woman is not an adult female human but “a person with a cervix”, or one who menstruates, and so on. This raises some interesting questions: can a person with a cervix produce semen? Can a person with a penis have endometriosis or ejaculate ova? Or are there two distinct sets of biological characteristics that don’t overlap? Wouldn’t it be helpful if there were a noun to identify the individuals who belong to one of these biological categories, and not the other?

Instead, gender ideology requires health professionals to believe not only that there are more than two sexes but also that it is possible to change sex. Disorders of sexual development (DSD) are framed as normal variations. At the heart of these claims lies the pretence that there is no reliable way to distinguish the sex of an individual, such that a man who claims to be a woman is a woman.

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Informers

Health professionals who are fierce advocates of this ideology and its offspring, “gender-affirming care”, are ever ready to take what they seem to believe is the high moral ground and “dob” on any colleague who dares to express doubt about this out-of-touch-with-reality rewriting of human biology.

For me, it is beyond bizarre that any health professional would deny biological reality. Despite their rigorous training in evidence-based practice, these “gender-affirming” health professionals rely on a tortured pathway of circular reasoning to believe that a man can be a woman (“Trans Women are Women”), and a woman can be a man (TMAM).

The argument goes like this: many of the human characteristics that are influenced but not determined by sex overlap, so there is no absolute way of distinguishing a woman from a man. Therefore, any characteristics that are determined by sex can equally belong to either sex, so a woman can have a penis, a man can have a womb, which means that a person with female sex characteristics can be a male, and a person born with male sex characteristics can be a female.

In an attempt to make this make sense, advocates of gender ideology refer to the existence of individuals with a DSD, which used to go by the misnomer “intersex”. And so, we are told that because it is difficult to identify the sex of some people, it is problematic to identify the sex of any individual. Surely, all health professionals should know that a disorder is a disruption in normal form and function, not a normal variation, but we live in interesting times.

If it were just a fringe element of society pushing these claims, it would be easy to dismiss them as uneducated conspiracy theorists, but almost every health professional association worldwide endorses these beliefs and requires members to adapt their practices accordingly.

Irregular rule

Ahpra is a cross-jurisdictional statutory authority responsible for the regulation of 16 health professions in Australia. While responsibility for regulation sits with 15 independent National Boards (such as the Nursing and Midwifery Board of Australia), Ahpra provides day-to-day services such as managing registration of—and notifications (complaints) against—practitioners on behalf of the National Boards.

Ahpra acknowledges that it works with Pride in Diversity, an arm of the transgender lobby group ACON, to participate in the Australian Workplace Equality Index (AWEI). Ahpra quite openly demonstrates its commitment to LGBTQIA+ inclusion, with the stated aim to embed inclusive practices into their culture, policies, and the wider National Scheme. The problem is made more serious by the recent refusal of the National Health Practitioner Ombudsman—supposed to be the watchdog over Ahpra—to investigate a credible complaint about the regulator’s exposure to ACON’s influence.

Ahpra told The Australian it “rejected any suggestion that engaging with community organisations [such as ACON] creates bias in our regulatory processes”.

The opportunity arose for me to test this assertion by comparing the result of two complaints to Ahpra.

Case 1

A colleague attended a workshop on working with trans and gender-diverse clients. He went in good faith, wanting to gain a better understanding of what the controversy was all about. As is usual practice, feedback forms were issued to all the participants. My colleague answered honestly and outlined his concerns about gender-affirming care.

A few weeks later he was stunned to receive a notification that a complaint had been made to Ahpra alleging that he had “expressed professional views not consistent with evidence-based practice” and “behaved in a disrespectful manner and used disrespectful language” on the feedback form.

After several stressful months, during which time he spent hours consulting with his indemnity lawyer and producing a detailed response, the complaint was disallowed.

Ahpra said: “On thorough review of the material and information, we are satisfied that the practitioner has met the requirements of the guideline and appears to be advocating for an open-minded approach to clients and their individual needs.”

This might seem like a win for my tired and distressed colleague, but as has become obvious over recent years, complaints against practitioners who are critics of gender-affirming care aren’t necessarily meant to succeed but to harass and to warn others to stay silent.

In this case, the practitioner was asked for feedback, which was seen only by the workshop organisers. The complaint generated was ultimately found to have no substance, yet my colleague was put under intense pressure to justify his comments.

Case 2

I am deliberately obscuring any details that might identify the medical practitioner in Case 2. However, the views expressed by this person are held by many Australian health professionals, so it is an object lesson to demonstrate a broader issue.

Some months ago, I came across an article in an open-access health journal that focussed on the specific needs of mothers and their children in the event of a natural disaster. A medical practitioner in the Australian state of New South Wales (NSW) wrote a letter to the editor, complaining that relying on the definition of women as “adult female people”, and the use of words such as “mother” and “breastfeeding”, was “trans-exclusionary rhetoric”.

Apparently trans people are harmed if sex-based terms are used instead of the politically correct terms such as “birthing parent”, “cervix haver” and “chest-feeding”.

What concerned me about this letter was that it demonstrated the medical practitioner’s strong commitment to the tenets of gender ideology, in particular that there is no reliable way of identifying the sex of any individual, that biology does not define a person’s gender, and that a person born with male sex characteristics is a woman if he says he is. This sense of entitlement is supported by the legal right in all Australian states to change the sex marker on a birth certificate, in some states as many times as the person wants.

This raises what should, in my view, be very troubling issues. It seems clear to me that a medical practitioner who:

• claims to be unable to identify the sex of an individual puts some patients, but especially an unconscious patient, at risk if the intervention indicated by the presentation shows the need for a sex-based treatment;

• denies the biological definition of a woman and insists that all women change their internal sense of being a woman to include males who self-identify as a woman, thereby fitting the criteria for an unethical “conversion practice”.

In reality, there are distinct, sex-determined characteristics that clearly identify the sex of an individual, notwithstanding individuals born with a DSD.

These are not trivial issues. If a trans-advocate doctor genuinely cannot identify the sex of a patient, they should lose their registration. If they can distinguish the two sexes, they must acknowledge that gender ideology is based on nonsense premises.

If these practitioners insist that the biological definition of a woman is wrong, do they support sanctions against women who insist that a man can never be a woman, as in the Australian court case of Tickle vs Giggle and the fight by the Lesbian Action Group to exclude men who identify as a lesbian from their public events? Do gender-affirming practitioners support female athletes being threatened with expulsion if they protest about competing against males who identify as women? And what about nurses who don’t want to undress in the presence of a transwoman?

All these scenarios meet the criteria for an unlawful “conversion practice” because they aim to force women to change their deeply held sense of being a woman as an adult human female, such that they must include males who claim to be women. And sanctions are imposed if women don’t fall into line.

Anti-conversion law in NSW

• “(1) In this Act, a conversion practice means a practice, treatment or sustained effort that is—

• “(a) directed to an individual on the basis of the individual’s sexual orientation or gender identity, and

• “(b) directed to changing or suppressing the individual’s sexual orientation or gender identity [Emphasis added].”

Given the serious nature of my concerns about the gender-affirming doctor’s letter, I submitted a complaint to Ahpra. Complaints against medical practitioners in NSW may be lodged with Ahpra but are dealt with by the state Health Care Complaints Commission (HCCC) or the Medical Council of NSW.

Section 144 of the Health Practitioner Regulation National Law (NSW) outlines the specific grounds for making a complaint against a registered health practitioner. These grounds include criminal convictions, unprofessional conduct, lack of competence, impairment, or failing to be a suitable person to hold registration.

In my complaint, I argued that the medical practitioner lacked competence in the most basic requirement of the medical profession, that is, to be able to identify the sex of an individual by visual examination. I also argued that, by supporting a conversion practice against women, the medical practitioner endorsed an act which is criminal in NSW.

No response needed

I wasn’t so naïve to expect that my complaint, while made in good faith, would result in any disciplinary action against the health professional, but I did hope that there would be an acknowledgement that a woman is an adult female human, and that women have the right to rely on this definition as their deeply-held sense of being a woman.

And I did expect that the doctor would be required to explain and justify their beliefs, as has been the case for every health professional who has had a complaint to Ahpra about their criticism of the gender-affirming treatment model.

Instead, this was the response from the NSW HCCC—

“We did not require a response from Dr [X] as the information available to the Commission was sufficient to adequately assess the complaint. As Dr [X] is a registered medical practitioner, we shared the information obtained during the assessment process with the Medical Council of NSW, and consulted with them in order to reach an informed decision in relation to your complaint [Emphasis added].

“Outcome of Assessment

“After carefully considering the available information, the assessment process has concluded with the following findings:

“Medical practitioners are entitled to express their professional opinions within the scope of their expertise, and such opinions are not subject to review by the Commission [Emphasis added.]

“Any concerns regarding their published contributions are assessed against codes of conduct, not individual disagreement.”

Ahpra, please explain

Compare Case 1 to Case 2. One health professional who provides the requested feedback after a workshop is put through the wringer. Another, who promotes gender ideology in an open-access journal, is not even required to respond to a complaint.

Was the doctor even informed of my complaint? Why was this person given a free pass, while my colleague who aired his views in private feedback was put under enormous pressure and was significantly distressed by the whole process?

Was Dr Michelle Telfer, who led Australian adoption of the gender-affirming treatment model for minors, required to submit an extensive response to the complaint against her?

If the NSW medical practitioner I have discussed in Case 2 is entitled to their opinion, why did Ahpra not apply the same courtesy and respect to Dr Andrew Amos, a psychiatrist ordered by the regulator to cease his social media critique of the gender-affirming model? Another critic of that model, child and adolescent psychiatrist Dr Jillian Spencer, has been reported to Ahpra for a social media post sharing The Australian’s coverage of the regulator’s silencing of Dr Amos. Will Ahpra acknowledge Dr Spencer’s right to express her professional opinion?

If the concerns of practitioners such as Dr Spencer and Dr Amos had been acknowledged and properly considered from the outset, it is unlikely the situation would have escalated to the disturbing debacle that now exists.

Ahpra has access to the information I have provided here. All they have to do is ask me for details to identify the two cases. It is time for the board of Ahpra to acknowledge that they are compromised by their involvement with the Pride in Diversity program.

Dr Sandra Pertot retired not long ago after 50 years of practice as a clinical psychologist specialising in human sexuality, including sexual dysfunction, sexual orientation and gender diversity.