Kaid van Kampen is a physician in B.C.
As a member of the LGBTQ+ community, my first reaction to Alberta Premier Danielle Smith’s January announcement that the province would restrict gender-affirming health care for transgender youth was one of sadness. But it was my identity as a physician that brought anger to the surface. I have experienced firsthand the discrimination many LGBTQ+ individuals face, especially youth.
In a hospital setting, when patient issues fall outside our specialty, physicians defer to the specialists who have the expertise and ability to provide the best treatment to patients. Politicians have no such obligation.
I wasn’t the only one upset by Ms. Smith’s proposal. The Alberta Medical Association and the Canadian Pediatric Society criticized the announcement, saying it would negatively impact trans youth and flew in the face of medical evidence. Ms. Smith ignored these medical professionals, and managed to turn her proposed policies into law this month. The newly confirmed legislation bans doctors and minors from choosing to proceed with puberty blockers and “sex-reassignment” surgeries.
But Ms. Smith’s bill goes beyond prescriptions and procedures, requiring minors under 15 years of age to obtain parental consent to change their pronouns. These proposed policies restrict a child’s ability to explore their identity and live as their authentic self, putting them at higher risk of depression, anxiety and suicidal ideation.
Ms. Smith’s legislation seems to ignore internationally recognized standards for the treatment of transgender youth. The science is clear: gender-affirming care saves lives. A patient-centred approach informed by the best science allows trained medical teams to give transgender kids the best chance to grow up healthy and happy.
Physicians are meticulous in determining if a patient has the capacity to make treatment decisions and provide consent. Arbitrary age restrictions undermine the physician-patient relationship; with the exception of Quebec, where the age of medical consent is 14, Canada’s “mature minor” law has no fixed age at which individuals are deemed capable to make their own medical decisions. When provinces fail to specify an age of maturity, the common law mature-minor doctrine is to be recognized and applied. Pediatricians must balance the best interests of the patient with respect to their autonomy, and navigate disagreements that may potentially arise between minors and their parents or guardians. When such disagreements cannot be resolved, ethical experts may be consulted. Clearly, decision-making for minor patients is complex, and thus it is ignorant to believe blanket legislation with a “one-size-fits-all” approach can address the nuances of the process.
In the case of a 14-year-old transgender youth who sought hormone therapy in British Columbia, the father sought an injunction to reject the desired therapy. Ultimately, the injunction was dismissed by the judge, who pointed to B.C.’s Infants Act. This legislation empowers youth under the age of 19 to make their own medical decisions without a parent or guardian’s consent should their medical provider assess them to have capacity and believe the treatment to be in the patient’s best interest. The decision to seek hormone therapy was in the youth’s hands.
Alberta’s new policies will have a negative effect on parental rights in two ways. First, parents seeking to deprive their child of gender-affirming care, even when such care is recommended by health professionals, are now empowered by this legislation. Second, by banning minors from using puberty blockers, parents are also now unable to advocate for their child to have access to trans-affirming, and potentially life-saving, care. Many trans kids are able to flourish with the encouragement of their supportive families, but Alberta’s policies actually curb the parental right to look out for one’s children.
Ms. Smith’s bill trumps physician expertise in other ways, too. It seeks to redefine medical diagnoses like “gender dysphoria,” which is already defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – the gold standard text for mental health disorders published by the American Psychiatric Association.
By capitalizing on sensationalized topics to push her own ideologies and political popularity, while ignoring science and medical experts, Ms. Smith is playing a dangerous game that could cost lives while undermining physicians already at a breaking point.
Ms. Smith should focus less on harming the health of the 0.5 per cent of Albertans who identify as trans, and instead focus on policies that could address Alberta’s health care crisis at a time when nearly half of its doctors intend to leave the province.
To quote Ms. Smith, whose penchant for playing doctor once included a tweet claiming hydroxychloroquine would cure COVID: “Doctors aren’t always right.”
That may be true. But by wedging herself into the sacred relationship between patients and their doctors, she is clearly in the wrong.