Britian
— Tomorrow the General Medical Council
<http://www.gmc-uk.org/>
is set to announce the formal charges in a serious
professional misconduct hearing against the UK's
best-known expert on transsexualism.
The inquiry into
allegations that consultant psychiatrist Dr Russell Reid
repeatedly put the health of several of his patients at
risk could prove a defining moment in the care of people
with gender identity disorders. For this is first time in
its 50 year history that UK transgender healthcare has
been seriously investigated by an official medical body.
The hearing will assess
allegations that Dr Reid wrongly referred people who were
not transsexual for sex change operations, and put other
patients' lives at risk by failing to ensure they were
taking sex changing hormones safely.
Dr Reid denies these
allegations and his many supporters in the transgender
community consider them a slur on his reputation. But to
dismiss - as
Peter Tatchell did last
week - the GMC
inquiry as a transphobic plot hatched by conservative
elements of the medical professional is highly
misleading.
Over the past three years
I
have interviewed dozens of transsexual
people, including
several ex-patients of Dr Reid. It should be noted that
many have nothing but praise for him and believe they
would not be alive today were it not for his care and
support.
However, several of his
ex-patients question aspects of his treatment regime. Two
told me that while Dr Reid probably was a great doctor if
you really were transsexual the problem was they felt
that he did not appear to do enough to rule out the
possibility that some of his patients might not
be.
The role of psychiatrists
in transgender healthcare is crucial. While
transsexualism is no longer regarded as a mental disorder
by many doctors, many patients seeking gender
reassignment surgery do suffer from mental health
problems. What the psychiatrist must assess is whether
those mental health problems are a result of the patient
being transsexual - eg they suffer from depression as a
result of discrimination and abuse - or whether they have
a disorder - such as schizophrenia or manic depression -
that causes them to mistakenly believe they are
transsexual. So Tatchell's claim that this case is about
whether a doctor should have "a right of veto over the
wishes of a mature, rational, informed patient" ignores
the purpose and complexity of transgender
psychiatry.
One woman told me that Dr
Reid failed to recognise that she was suffering from a
serious mental illness, which made her believe she wanted
to become a man. Her family claim that they warned Dr
Reid of her psychiatric history. Just days before she was
due to undergo surgery, she was sectioned and diagnosed
with manic depression. Following treatment, she says she
no longer had any desire to change sex.
Another
patient, Paul Rowe,
believes Dr Reid failed to take into account his recent
traumas - including the death of his mother, two
divorces, and losing his job - when assessing his
suitability for surgery. Rowe says his desire to change
sex was a symptom of severe depression. Post-op he now
feels trapped in "gender limbo", not knowing whether he
should live as Paul or Paula.
Dr Reid, who retired from
private practice earlier this year, maintains that he
assessed all of his patients thoroughly. But the
complainants in the inquiry, who include gender
psychiatrists from the main NHS gender clinic at Charing
Cross hospital and ex-patients of Dr Reid, believe that
he disregarded standards of care set by the Harry
Benjamin International Gender Dysphoria Association
<http://www.hbigda.org/>.
These guidelines are flexible directions rather than
strict criteria, and Dr Reid's supporters say that where
he departed from them he did in the belief that it was in
the patient's best interests. What the GMC must decide is
whether he merely flexed the rules or in fact broke
them.
The outcome of the
hearing will have a wider impact on transgender medicine.
It is expected that they will influence new UK standards
of care being drawn up by the Royal College of
Psychiatrists <http://www.rcpsych.ac.uk/>
in consultation with several transsexual groups.
If Dr Reid is cleared
then the NHS may well need to reassess whether a more
flexible approach could be taken with certain patients.
But if he is found guilty, it is not unreasonable to
expect that the new UK guidelines will err further on the
side of caution. For example, they may insist on all
patients living in their desired gender role for two
years before surgery - the current period set by most NHS
gender clinics.
What is at stake here is
the quality of care for some of the most vulnerable in
society. If Tatchell does not support every clinical
decision taken by Dr Reid then why is he so opposed to
this inquiry? As a gay rights activist does he really
think the GMC should not investigate allegations that
some gay men and lesbians may be being misdiagnosed as
transsexual and undergoing unnecessary and irreversible
genital surgery? And don't people - of any sexual
orientation - with mental illnesses that may cause them
to mistakenly believe they are transsexual have rights
too?
It is understandable that
transgender lobby groups have closed ranks. They no doubt
feel that condemnation of one of their most notable
doctors will spur some to question whether sex changes
should ever be carried out and whether transsexualism
exists.
Transsexual people need
extensive care and support and many patients do
experience excessive waits on the NHS (though due to
local trusts' debts rather than clinicians' moral
judgments). But pleading special treatment for Dr Reid
does them no favours. If they are to be properly treated
and protected, their doctors must be subject to the same
scrutiny as those in any other field of medicine. Dr Reid
may well be innocent but the accusations against him
raise issues that are too serious to simply
dismiss.
