If you read one single thing today from the weekend’s Sunday Papers, make sure it is the extraordinary piece by Mark Tighe in yesterday’s Sunday Independent concerning the new National Gender Service. The piece includes a stark admission from one of the country’s most senior doctors that he fears that he will face “consequences” for speaking out:
Professor Donal O’Shea, the HSE’s national clinical lead for obesity, who also works as an endocrinologist with the NGS, told the Sunday Independent he is prepared to put his leadership position on the line by speaking out about “dangerous” moves by senior HSE managers on gender healthcare….
….The doctors first raised concerns with the HSE in 2018 and 2019 about its practice of referring Irish under-18 gender patients to the Tavistock. O’Shea said they were silenced and reprimanded by the HSE then, but he expects he may be “silenced and sanctioned” now by being asked to give up his national lead obesity role for speaking out.
Even if the charges made by O’Shea in the piece were not serious – and they are, but we’ll come to that in a second – the revelation that he was silenced and reprimanded for going public with concerns previously should be enough by itself to send a responsible Oireachtas rushing to open public committee hearings into the management and culture within the health service. When senior Doctors are saying in public that their jobs are at risk for highlighting genuine worries they have for patients, then the similarities with the Garda Maurice McCabe situation are very hard to miss.
We are not long removed from the national conversation about, and commitments made to, whistleblowers in the aftermath of the Garda penalty points scandal. And yet here we have a very senior doctor saying in public that he faced career consequences for publicly flagging an issue that he felt was a real concern within the HSE. One might speculate that had his concerns related to something that the media at large are comfortable discussing – like cancer treatment – this situation would be attracting the attention of many more journalists than simply Mark Tighe.
But it is not simply that Professor O’Shea makes shocking claims about the treatment of whistleblowers: It is also, probably more importantly, what he says about the new national gender service itself:
Teni and some other transgender support groups support “affirmative” care that allows patients to proceed with hormone treatment once they give informed consent acknowledging the risks involved.
O’Shea said the way the new clinical lead job is designed is “absolutely an attempt to have an activist-informed model of care that would be dangerous and goes against all emerging evidence of the need to be safe and careful”.
He also believed there was an “ideology” at senior HSE levels that is led by transgender activists who want affirmative care.
“The idea that you would have an activist-driven model of care within the medical setting is just unthinkable,” he said. “There is no condition where you invite the activists to come in and direct how care should be delivered.
There is much more than that at the link above to the full piece, which I strongly encourage you to read in full.
Put simply though, the accusation is as follows: That when it comes to the new national gender service, activists, not doctors, are in charge, and that this situation is being actively facilitated if not encouraged by the civil servants running the HSE. In even plainer language, that decisions on the treatment of individual patients are likely to be made with ideology, rather than medical need, in mind. He also says that an NGO with no medical expertise – the Transgender Equality Network of Ireland – has had an outsized role in formulating medical policy.
These are very serious charges, and the simple fact that such claims are being made – not by activists, but by a very senior doctor – should be one of the top political issues this week. Will it be? Not likely.
If anything, the story is broadly in keeping with the accepted political approach to the transgender issue in Ireland in the years since the introduction of the gender recognition act, which treats gender dysphoria not as a medical condition at all, but as a simple matter of choice: Since you do not need to have had any diagnosis or treatment to legally change your gender under the Gender Recognition Act, it would logically follow that “affirming treatment” – the supply of hormones and so on – is not a medical issue at all but a simple matter of identity. If changing your gender and expressed sex is a simple choice, then supplying access to hormones and so on should be in the same category as dispensing hormonal contraception to women who seek it: You need a prescription, yes, but nobody should deny you one. That is the thinking that underpins the state’s approach.
But, as Professor O’Shea points out, gender affirming treatment is a far cry from hormonal contraception, given that it has permanent and irreversible effects including infertility and loss of sexual function. Ascertaining whether such a radical intervention is medically or psychologically warranted is, he believes, the basic duty of a doctor.
On that, apparently, many in the HSE disagree. Many members of the public will, as well. The only question that remains is whether Irish politicians – many of whom also disagree – have the courage to speak up on this.
I wouldn’t hold out much hope, alas.