Informed consent must always be at the heart of clinical practice

THROUGHOUT my NHS career, UK healthcare professionals upheld informed consent as a fundamental ethical and legal principle. It required each of us to ensure patients had a clear understanding of a proposed treatment or procedure, including its purpose, potential risks and benefits, alternative options and the potential consequences of refusal.

For consent to be informed the person must be provided with information in a manner that is accessible and tailored to their individual needs, ensuring they have the capacity to comprehend and weigh the information provided.

Importantly, informed consent requires a person to voluntarily agree to a proposed intervention without coercion or undue influence. Healthcare professionals must also respect patients’ autonomy and involve them in decisions, allowing them to ask questions, seek clarification, and express their preference or refusal.

The point of informed consent is to uphold a person’s rights, build trust in the healthcare system, and ensure medical interventions are conducted ethically and in the best interests of each individual.

In my years of clinical practice, clinical leadership and academic endeavour these fundamental principles were sacrosanct across the multidisciplinary team.

So, when the WPATH Files report was published recently by Mia Hughes I was disturbed by the casual disregard for these foundational principles of safe and effective clinical practice.

The report draws on leaked evidence about the so-called best practice guidelines of the World Professional Association for Transgender Health (WPATH) and exposes a disregard for informed consent, scant consideration of best interests, a dismissive attitude to clinical screening or the long-term effects of treatment, an ideological refusal to even consider a differential diagnosis and a casual disregard for evidence-based medicine.

In short, the report is horrifying, but what’s worse is the silence about this global medical scandal from the UK’s main broadcasters and most politicians.

The report illustrates how an organisation that has been allowed to set standards of care for transgender healthcare across the world is neither a scientific nor medical organisation. Unqualified activists set the agenda and doctors who raise valid concerns are admonished and monstered.

One of the primary concerns highlighted in the report is the alleged influence of pharmaceutical companies and other vested interests on WPATH’s guidelines. Hughes argues these influences may prioritise medical interventions such as hormone therapy and surgery over alternative and arguably more appropriate ones, leading to over-medicalisation and inadequate, or in many cases, a complete failure to assess patients’ individual needs and preferences.

Furthermore, the report criticises WPATH for its handling of dissenting voices within the transgender community, particularly detransitioners and people who have experienced regret over or dissatisfaction with their treatment.

Hughes asserts that WPATH has been dismissive of such voices, deaf to their concerns and has failed to consider alternative perspectives. Hughes calls for greater transparency and accountability as well as a more cautious approach to recommending medical interventions that have irreversible consequences.

The report underscores the need for much more rigorous scrutiny of the practices and guidelines of organisations such as WPATH and the role they have been allowed to play in shaping healthcare.

These recommendations should be uncontroversial given they merely amount to a call to match and adhere to clinical standards expected in every other field of clinical practice.

Evidence of this medical catastrophe is there for all to see, yet so many are unwilling to even look, never mind discuss it. But that is changing. Across these islands brave detransitioners have been telling their harrowing stories.

I have paid tribute to Sinead Watson, Ritchie Heron and Keira Bell many times but there are clarion calls from across the world warning us to improve our approach to the care of vulnerable and often traumatised young people.

Last year detransitioner Chloe Cole delivered a powerful and moving address to the US Congress. What she said included: “I used to believe I was born in the wrong body and the adults in my life, whom I trusted, affirmed my belief, and this caused me lifelong, irreversible harm. At the age of 12, I began to experience what my medical team would later diagnose as gender dysphoria. It set our entire family down a path of ideologically motivated deceit and coercion.

“A month later, when I was 13, I had my first testosterone injection. It caused permanent changes in my body. My voice will forever be deeper, my jawline sharper, my nose longer, my bone structure permanently masculinised.

“I had a double mastectomy at 15. And my doctors with their theories on gender that all my problems would go away as soon as I was surgically transformed into something that vaguely resembled a boy — their theories were wrong.

“When my specialists first told my parents they could have a dead daughter or a live transgender son, I wasn’t suicidal. I was a happy child who struggled because she was different. However, at 16, after my surgery, I did become suicidal.”

I urge you to read her address in full.

It is precisely because of the undermining of the fundamentals of ethical clinical practice, safeguarding and the active dismantling of equality and human rights principles that I have, and will continue to speak out against the anarchic queer theory movement. This is based on my deep understanding of safe and effective practice accumulated during a four-decade career working with and advocating for children and young people.

With the introduction of the Hate Crime Act and the conversion practices legislation, the Scottish Government is wilfully acting to suppress this and related scandals.
It has ignored every warning it was given in deference to queer theory dogma.

I care too much about the principles of good clinical practice and the rights of young people to be silenced. If Humza Yousaf and his coterie choose to criminalise such concerns, in time he will deservedly reap the whirlwind.