By Steve WilliamsThe international board of the World Medical Association (WMA) has announced new guidelines for how clinicians should deal with trans patients, as well as the body’s support for ending discrimination against trans and gender variant people.
The meeting, which is an annual event and was this year held in Moscow on Sunday, October 18, recognized an issue raised by the German Medical Association saying that transgender people face a disproportionately high rate of discrimination and disenfranchisement, which in turn can lead to poorer overall health. It recognizes that physicians are ideally placed to provide crucial support and that doctors must ensure the advice and subsequent treatment they give to trans people and their families fulfills the duty of care every doctor has to their patients.
The approved guidelines reject any form of discrimination against trans people in a health care setting. In addition to this, the WMA specifically recognized that there have been therapeutic attempts to “cure” trans people, saying unequivocally that it rejects any “coercive” attempts to prevent people transitioning. Given the spotlight that has been placed on anti-trans therapy, and anti-LGBT therapy as a whole, this is a welcome announcement from the WMA.
The delegates also affirmed that being trans is “not a disorder” and that there is a fundamental right for a person to define their own gender. The body also agreed that “every effort should be made to make individualized, multi-professional, interdisciplinary and affordable transgender healthcare.”
The guidelines also suggest that appropriate training be given to new medical staff that specifically addresses trans needs. The guidelines do not come up with a specific framework for that, but individual countries can reasonably extrapolate their approaches based on overall care guidelines as well as specific population requirements that might need considering, for example if they know that a particular group of trans people may currently be vulnerable (for example, trans women of color or trans men who may be at risk of certain cancers).
WMA President Sir Michael Marmot is quoted as saying of the regulations: “We condemn all forms of discrimination, stigmatization and violence against transgender people and want to see appropriate legal measures to protect their equal civil rights. And as role models, physicians should use their medical knowledge to combat prejudice in this respect. We would like national medical associations to take action to identify and combat barriers to care. It is important that there is appropriate expert training for physicians at all stages of their career to enable them to recognize and avoid discriminatory practices, and to provide appropriate and sensitive transgender healthcare.”
The WMA represents 112 member associations from across the world including the UK’s British Medical Association and many European medical bodies, as well as several medical groups from across Africa. This statement therefore is being treated as a positive step toward ensuring that trans people are afforded the dignity and same access to health care as everyone else. In particular, this statement has extra resonance given that the WMA also has members in states like Nigeria and Russia where trans identity is not currently recognized. The WMA acknowledged that this may mean the WMA risks offending cultural sensitivities, but its duty of care to its patients obviously comes first.
This has wider impact though, too. For example, any European countries still require trans people to undergo genital change surgery before they are allowed to change their official gender markers. This usually means them being made to choose between having children and living their lives with their gender officially recognized. This statement, while not specifically touching on that issue, would appear to put the WMA at odds with those laws.
It also comes at a time when the United States, which is involved with the WMA, has proposed greater protections for trans people seeking medical care and, specifically, transition related care. In the past, transition related hormone treatments are surgeries that have been regarded as cosmetic and not essential. This is despite the fact some trans people need certain surgeries (for example, a mastectomy for a trans man) in order to feel their outward appearance is congruent with their gender. While not all treatments are currently covered, the Obama administration has attempted to greatly improve that coverage.
It’s hoped that the WMA’s recent statements, then, signal that trans health care is being overhauled and, crucially, that physicians are the ones who will spearhead that change and set a tone of acceptance and care for the trans people they are treating. –Care2
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