Something troubling is happening in premier UK medical institutions like the Royal College of Psychiatrists. There is a schism between the influential proponents of gender ideology, which is ascendant across the NHS, and those who view it as unscientific and an impediment to safe-guarding and freedom of speech. Dissenting clinicians are concerned about an increasingly dogmatic promotion of gender identity ideology. Their resistance was explicit during a fraught webinar presentation at the RCPsych on 23 November, which was partially leaked on Twitter.

80 per cent of UK medical schools have already signed the GLADD charter

The gender presentation and its themes will be familiar to anyone who has experienced similar training under the aegis of Equality, Diversity and Inclusion(EDI). The presenter was Dr Joseph Hartland, EDI Deputy Ed Director at Bristol Medical School. In the leaked slides, pronouns are pivotal. They are the visual symbol of allegiance to the new orthodoxy. Everyone is encouraged to prominently display them. Pronoun agnosticism is discouraged. One slide asserts that failure to use examples such as ze/hir correctly constitutes an “act of aggression”. In another slide, biological sex is described as “socially contrived” instead of fundamental to life. “People with testes” is presented as an example of “appropriate language”. Failure to insert a space between “trans” and “woman” is potentially pejorative language. This linguistic minefield requires delicate navigation and constant self-editing. Dr. Hartland concluded by exhorting his audience to stop talking about “gender dysphoria” and instead “help patients achieve euphoria”. The implication is that the pathway to this destination is pharmaceutical.

Perhaps Dr. Hartland expected applause or silent compliance. He was unprepared for questions from the members of the Royal College of Psychiatrists, and his reaction to being challenged was less than professional. He denounced the forty-five questions as “80 per cent transphobic”, posted a picture of nail marks he had made on his hand in an act of catharsis and then locked his Twitter account. This is surprising behaviour from one of the premier authors of a medical charter already signed by 80 per cent of UK medical schools. There are serious questions about the level of scrutiny conducted prior to signing this binding document and about its ambiguous contents.

According to its website, the GLADD (Association of LGBTQ+ Doctors and Dentists) charter was written by “queer medical activists” in conjunction with GLADD and Lancaster University Medical School. Its ostensible purpose is to effect a ban on “so-called conversion therapy”. Its critics are concerned that it is a flawed, unscientific document motivated by activism, not clinical considerations. They worry that it promotes the “affirmative care” paradigm which dominated the Tavistock and is currently under review by Dr Cass. 

One experienced medic speaking under conditions of anonymity put it starkly. He told me, “This is not the language of medicine. It is the language of religion.” The charter’s language is clunky and repetitive; definitions are obscured. Its lack of clarity is striking. One core principle asserts that it is important to “affirm” the gender of LGBTQ+ people. Medical schools must “produce graduates” who do not “favour one gender over another”. What implications does this have for the clinical treatment of a 12-year-old girl who diagnoses an incongruity between her physical body and metaphysical identity? Should she be “affirmed?” Is the clinician’s role to facilitate a pharmaceutical pathway via puberty blockers and hormones to attempt an alignment? Will a graduate of a school welded to this charter be primed to prioritise that treatment? Another charter principle requires “joyful representation” of LGBTQ+ people in curricula. Will this prevent medical schools from discussing the phenomenon of detransitioners like Keira Bell? Will it prevent a scholarly examination of the troubling clinical decisions which enabled her to have irrevocable medical procedures including surgery which she now regrets? 

Is this an environment conducive to considered debate?

What critical analysis was conducted by the institutions who have signed this document? Did they delegate it to their EDI departments? One possible reason for its rapid adoption by almost all the UK’s medical schools is that their students have been actively encouraged on social media to demand their colleges sign. There is an updated display online showing boxes with a blank space to highlight missing signatures. One of the Charter’s authors, who is an NHS doctor, told his Twitter followers that failure to sign was indicative of “queerphobia” and to “let them know we’re watching”. Is this an environment conducive to considered debate? Will the Charter’s adoption and implementation enlighten or hobble the medical education of future clinicians?

In a curious parallel, the Culture Secretary, Michelle Donelan, recently announced that the government intends to enact a legal ban on “trans conversion therapy”. The difficulties in writing such legislation without causing serious unintended consequences is already evident. How is “trans conversion therapy” defined? How can parents or clinicians discuss a child’s gender distress if any deviation from a rigid affirmative paradigm is criminalised? It will require surgical linguistic precision and rigorous critical analysis. If the last two decades of UK politicians exemplify one consistent principle irrespective of party, it is that bad policies and bad laws are simple to write. Removing them once written is an arduous, if not impossible task. 

The Royal College of Psychiatrists denounced its audience for their “appalling” questions in response to the gender webinar by Dr Hartland. The RCPsych tweeted that “appropriate steps will be taken”, an ominous warning which elicited a scathing backlash. Does the RCPsych believe that unsubstantiated, unscientific assertions should be accepted without challenge by its members? An orthodoxy imposed from above which demands submission and views questions as heretical has no place in the medical arena. Its ascendancy within the medical establishment should concern us all.