Submission to consultation Ending conversion practices in Scotland

conversion practices

Transgender Trend’s written submission to the Scottish government’s Ending conversion practices in Scotland consultation:

In addition, the legislation will attempt to protect new contested identities and sexualities. Part 4 of the consultation states that the objectives of the conversion therapy legislation are to “Protect the rights and dignity of all involved, including LGBTQI+ people and respect freedom of religion and
expression.” According to Stonewall, the Q and I of the acronym refer to Queer/Questioning and Intersex. Intersex is not an identity or sexual orientation, but is shorthand for variations in sexual development, or DSDs, rare developmental conditions involving genes and hormones.

+ refers to an expanding and undefinable group of identities and sexualities. At #59 the draft brings in a new sexual orientation “asexual” which is not part of the protected characteristic of sexual orientation in the Equality Act. Asexuality may be the result of trauma, abuse or being on the autism spectrum. There have been no verifiable examples of conversion therapy either from or to being asexual.

The draft claims at #44 that a ban would apply equally to everyone, although it will be mainly directed at practices that effect “LGBTQI+ people.” But there is little to no evidence for conversion practices directed at trans people. Westminster government commissioned research by Coventry University in 2020 concluded “There is currently relatively little evidence regarding gender identity change efforts.”

There is ample evidence that children and adolescents are being subjected to conversion therapy to a transgender identity. The dominant culture young people experience is pro-affirmation, they are told online, at school and by activists that their gender identity is more important than their biological sex.

LGBT organisations have redefined homosexuality to mean same-gender attraction. Children attach importance to their likes, clothes and appearance before they are ready to think about their sexual orientation. Affirmation tells they may be ‘trans’ based on these preferences. Many will likely grow up to be same-sex attracted. The draft legislation is in essence homophobic conversion therapy.

The Cass Review into NHS gender healthcare for children and young people wrote in their Interim report that an unquestioning affirmative approach to children with gender-distress led to other mental health conditions being ignored, leading to diagnostic overshadowing. Dr Cass found that children with neurological conditions, looked-after children, those who have experienced trauma or abuse were overrepresented at the Tavistock GIDS. She reported clinicians under pressure from parents and those who’d socially transitioned to affirm a trans identity.

Schools have been told to affirm a child who says they are trans. Supporting transgender young people in schools: guidance for Scottish schools sets out a wholly affirmative approach. It takes no account of the developmental stages of a child’s life, peer reviewed research on outcomes for children with gender dysphoria, the findings from the Cass review, or evidence from detransitioners.

46 says it will not criminalise parental non-directive or non-coercive discussions so long as they are not directed to a gender identity that is ‘preferable.’ This is unworkable. Conversations between children and their parents should never be subject to legal sanctions. Children and teens with gender-related distress are rarely exploring their issues. They are absolutely certain that they are ‘trans.’ This would mean that a parent who thinks it preferable that their autistic same-sex attracted teenage boy is reconciled with their body and sexuality could face prosecution.

It is unclear how therapists can work with any person who wants to, as stated in Part 4, “explore” their gender identity. #35 says “Conversion practice are inherently harmful.” A therapist treating a teenage girl who had experienced sexual trauma and was firmly of the opinion that she was a boy, that she had
a male gender identity, would not be able to explore the reasons for this belief because that would be “inherently harmful.” Therapists working with gender-distressed children and adolescents are already liable to prosecution due the professional code of conduct, the Memorandum of Understanding on Conversion Therapy (2).

The chilling effect is already happening as Dr Cass said “Some clinicians also reported feeling unable to undertake the process of assessment and differential diagnosis that would be the norm in their clinical practice because they perceived that there is an expectation of an unquestioning affirmative approach.” There is a danger therapists will be at risk of false or malicious accusations if they offer a questioning rather than affirmative approach.

One of the four objectives in Part 4 says the legislation must “Not inhibit nor criminalise legitimate gender transition or regulated medical intervention.” This objective protects conversion practices towards gender transition. In relation to children and young people this would enshrine in law existing harmful ideas and medical practices. Those who raise objections could face sanction using the criminal offence or a civil protection order. There is no lower age restriction for this objective. This leaves children and young people unprotected from activists and/or clinicians who promote an affirmative or pro-transition pathway. Until around their mid-twenties, young people are still maturing and exploring their identity.

The Cass Review stated “Regardless of the nature of the assessment process, some children and young people will remain fluid in their gender identity up to early to mid-20s.”

The draft says nothing about the growing number of detransitioners. These young people were encouraged to believe they would be happier and healthier living as the opposite sex. At least a third of young people seen at the Tavistock GIDS were on the autism spectrum, two thirds of the girls were
same sex attracted, children in care were overrepresented, as were those with other serious comorbidities. Most of these young people were subject to pro-transgender conversion therapy, with life-long health consequences. Young female detransitioners suffer among other things, male pattern baldness, facial hair, deepened voice, loss of breasts, loss of uterus, vaginal/urinary problems.

The evidence base for safety of medical interventions is low. The evidence for the safety of puberty blockers is low according to NICE. Their use is restricted in England, Denmark, Sweden, Finland, and France as research links their use to bone density problems and possible mental impairment. They
have been proven, according to research from GIDS, to lock a child into a cross-sex identity, leading on to the prescription of cross-sex hormones. A young person then becomes a medical patient for life, with increased risks of cardio-vascular disease, alongside the other risks and side-effects of genital
surgery.

No. The draft contains no definition or guidance as to what would constitute suppression, while at the same time admitting at #54 that it allows “a wider net of protection for LGBTQI+ people.” We reiterate objections to including the terms ‘QI+’ made in answer to Q1. The criminal act is widely drawn and would criminalise any behaviour which suppresses what a person considers to be or may consider to be their gender identity.

At #50 the examples are “Controlling appearance eg clothes make-up” and “restricting where a person goes and who they see.” This vague and subjective formulation will for instance have a chilling effect on parents who do not subscribe to a belief in gender identity and want to prevent their child attending a trans youth group.

The offence of “suppression” could also capture and criminalise any parent who wants to make sure their child is safe and does not act or behave in ways that put them at risk of bullying or physical harm. Examples include a parent advising their gender distressed teenage son not to wear the girls’ uniform
at school; a parent telling their trans identified teenage daughter not to bind her breasts as she is putting her health in danger or that by using male public toilets she is putting herself at risk of sexual assault.

A parent who does not believe in ‘transgender identity’ or ‘being cisgender’ would still be at risk under this legislation if they take action to prevent their child from harmful steps to alter their bodies. They could be prosecuted for not adhering to a belief. The incoherence of ‘suppression’ is contained within #54 – 56 which states that conversion therapy can happen even if the therapist acknowledges that it is not possible to change sexual orientation or gender identity. Even if parents, teachers and anyone dealing with young people agree that they are not seeking to change ‘gender identity’ any action they take or than affirmation could be defined as the crime of “suppression.”

Existing criminal law already outlaws harmful practices which constitute degrading treatment and psychological suffering on others. Police have powers to prosecute these offences. Private individuals also have the right to bring proceedings against someone for inflicting degrading or inhuman treatment. The Equality Act 2010 protects those with the protected characteristic of gender reassignment from unwanted conduct which creates an “intimidating, hostile, degrading, humiliating or offensive environment.”

This proposal would have a chilling effect on therapists and parent support groups who openly advertise their preference for a watchful waiting approach when treating gender-distressed children and adolescents. This approach is internationally recognised as the best way of allowing these young people work out their identities without recourse to experimental drugs or surgery. These approaches have a preferred outcome, that a child is reconciled to their biological sex, does not take steps to alter their bodies or continue to believe and act as if they are the opposite sex.

#94 and 95 make it clear that any group or organisation that offered such information via a website or series of webinars could be prosecuted.

This proposed offence will have a chilling effect on parents who have a predetermined belief that their child’s actions such as breast binding or tucking will lead to harm. #102 stipulates that an offence will have to have been undertaken on at least two occasions. Anyone looking after a teenager who tries to prevent them taking a harmful course of action could be prosecuted. Controlling day-to-day activities, as set out in #104, is what parents do to keep their children safe.

Conversion therapy is framed at # 35 in this draft legislation as conversion from a trans identity. But the real victims of conversion therapy are those who were guided to a trans identity. They are the young adults, like Keira Bell, who suffered both physical and psychological harms when their mental health problems were ignored in favour of a trans affirmative diagnosis.

The draft weights all defences of reasonableness in one direction only; towards healthcare professionals who follow an affirmative approach to gender identity. # 114 protects those who “encompass practices that are offered through regulated healthcare services provided in line with the practitioner’s professional opinion, and which comply with relevant medical, ethical and legal rules and guidelines.” At present the relevant rules and guidelines in Scotland promote only affirmation of gender identity.

Therapists have to follow the Memorandum of Understanding on Conversion Therapy (2) which
stipulates affirmation. Treatment pathways for children and young people adhere to WPATH standards, now rebranded SPATH in Scotland, which allow puberty blockers at the start of puberty and cross sex hormones at 16.

115 protects medical treatment intended to align a person’s physical characteristics with their gender identity. This will protect clinicians who prescribe hormone treatments or carry out surgeries only. NICE has found there is insufficient evidence for the safety or benefit of puberty blockers. NICE also found the evidence for the effectiveness and safety of gender affirming hormones to be of low quality. Clinicians who reject these experimental and unevidenced approaches could find themselves accused of conversion therapy for failing to follow these guidelines.

Do not agree

The penalties are draconian considering the lack of any evidence that conversion practices from a trans identity are taking place. They will have a chilling effect on parents who will fear that keeping their children safe from harmful practices like breast binding, taking puberty blockers or hormones could result in their prosecution. Clinicians and therapists are likely to stop treating gender-distressed children.

No

There will be adolescents and young adults who want to talk to a therapist, family member or community leader about their gender distress with a view to being reconciled with their biological sex. The consultation at # 35, 45 -48 denies this group autonomy or the right to take a decision by stating that only advice or therapy that is non-directive is excluded from the definition of conversion therapy.

Detransitioners wanting to discuss their doubts about transition and to access help in returning to live as their birth sex will be prevented from seeking help. Therapists are likely to be unwilling to undertake this sort of work for fear of prosecution.

No

Do not support

The consultation document relies on two studies which purport to prove that people have been taken from Scotland for conversion practices. Both are methodologically weak and neither breakdown figures for sexual orientation and gender identity. The draft legislation does protect affirming clinicians, such as those who approved the referrals, between 2014 and 2020, of at least 50 girls under 18 were sent to England for double mastectomies. As we know these are likely to be same-sex attracted and/or on the autism spectrum this is conversion therapy to a trans identity. We believe this is best dealt with by Standards of Care based on the findings of the Cass Review and not by banning conversion therapy.

Do not support

There is no evidence that people are sent out of Scotland for gender identity conversion therapy with the exception of those sent for sex change surgeries. This should be stopped within the normal processes of regulating health care. Penalties are therefore inappropriate.

Do not support

As conversion practices are difficult to define or prove it would be unfair to make them an aggravating factor. The legislation proposes introducing the new sexuality of asexuality. Introducing this concept into sentencing without a definition would be using the law to invent new sexualities or identities
and circumvent medical opinion.

Yes. The provisions in the draft legislation are not compatible with Articles 8,9,10 of the ECRH. A ban would be incompatible with Article 8 which protects rights to private and family life. This gives parents protection from State interference. The proposed legislation is also likely to be in breach of Article 2 of the First Protocol of the Convention, with respect to the right of education and the right that a child’s upbringing be in accordance with parents’ own religious and philosophical convictions.

A ban on conversion practices as drafted by the Scottish government is also likely to be in breach of Article 9, the right to freedom of thought, conscience and religion, and Article 10 freedom of expression. Article 11, freedom of association, may be breached if a conversion practices ban is used to prosecute a group of parents who do not subscribe to gender identity beliefs and want to organise a support group to protect their children, or a group of therapists who set up a practice based on the clinically proven approach of ‘watchful waiting.’

Do not support

As the standard of proof will be lower than for a criminal case we’re concerned that disputes within families over what constitutes conversion therapy for gender identity could be subject to civil action. A parent’s refusal to adopt a child’s self-diagnosis being trans, refusal to agree to puberty blockers, to
agree to using new pronouns or names could be liable to prosecution as conversion therapy. # 175 widens the net considerably to capture individuals or institutions whose conduct “puts the public or community at large at risk.”

There would be no need to identify a specific person who was the subject of conversion therapy. Groups and organisations who support parents wanting to keep their children grounded in reality will be vulnerable to prosecution under these provisions. Reputable websites dedicated to publishing factual evidence about the harms of hormone and surgical treatments for children and young people exist to inform parents and the public. These are very likely to be the subject to such conversion practices protection orders.

Do not agree

193 says “….it is essential that family, friends, or a support organisation are able to apply for an order in relation to a person at risk. This is particularly important as individuals may not be aware that they are victims of conversion practices.” This would open the door to activist groups intervening against
parents on behalf of a child or young person. We’re concerned that these groups will be able to threaten to report parents and parents’ group to the police whether or not any conversion practice has taken place or whether the supposed victim is aware of it or supports such reporting.

This will give the green light to ideological actors to intervene, and whether successful or not, it will have a silencing effect on those who do not believe in gender identity or the possibility of ‘changing sex.’

A conversion practices bill would bring in sweeping powers to prosecute or threaten parents or their support groups or a therapist group on the evidence of a third party body only. This could be then made into a criminal offence if those given an order do not comply. We do not doubt this power would be misused by the activist groups who see any action other than full affirmation as conversion therapy.

Yes. Those with the protected characteristics of sex, sexual orientation, disability, and belief will all be impacted by this legislation. Because the legislation is weighted towards a gender affirmative approach it will have negative effects on those who have the following protected characteristics:

Sex. There has been a rapid increase in the number of teenage girls adopting a trans identity. The reasons for this are still being researched. A conversion practices ban will make it harder for these girls to get the exploratory therapy they need.

Sexual orientation. The most common outcome of a watchful waiting approach to children with gender dysphoria was that they grew up to be homosexual. Testimony from detransitioners confirms that most were in denial about their same-sex attraction.

Disability. The Cass Review found that around 30-40% of the children who were seen at GIDS were on the autism spectrum. This group are more susceptible to black and white thinking about gender, and to believe that if they like opposite sex clothes and activities this means they are the opposite sex.

Belief. People who do not believe in gender identity will be unable to express this lawful belief for fear of being accused of conversion therapy.

Yes. Children are protected under Articles 5 and 18 to the care and protection of their families. We believe this legislation would undermine the rights enshrined in these Articles.

Article 5 says the State should “…respect the responsibilities, rights and duties of parents … to provide in a manner consistent with the evolving capacity of the child appropriate direction and guidance in the exercise by the child of the rights recognised in the present Convention.”

Article 18 says “Parents … have the primary responsibility for the upbringing and development of their child: the best interests of the child will be their basic concern.”

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