[Canada] Canadian Politics Redux

[Sheilbh]

1) Your quote makes it seem like you're attributing BB's words to me.

Sorry - not my intent, just laziness on quotes.

2) When people are taking to the streets in the name of fighting "radical gender ideology" (we had one protest n town just this weekend - using the same approach as the convoy sympathy protests we had during that time), when they're protesting at schools and doxxing teachers because they hate "radical gender ideology", when legislation is being passed to ensure trans kids don't get support - again in the name of fighting "radical gender ideology" - you think it's "not healthy in a democracy" to link those things to a politician who makes "fighting radical gender ideology" a speaking point?

Is this because the article used the term "rooted in"? Or is it because you're persuaded by BB's argument that Pierre Poillievre doesn't actually mean anything specific when he says he think we should "fight radical gender ideology" even though actual specific policy changes are being argued for by people using those exact terms.

Mainly the "rooted in". Those are weasel words to insinuate without publishing something actionable. Also cheaper than reporting on LGBT+ issues, because it's media commentary.

I also think it is unhealthy, particularly in a democracy, to move from talking about the thing to talking about discourse. It is, in it's way, like Poilievre saying "radical gender ideology" or, say, talking about "cultural Marxism" or queer theory (which is, at least, a real thing). I think it's not a massive leap to conspiracy-mindedness, constantly de-coding what people are "really" meaning/where that discourse has come from. I think it's the path to Russian politics where everything is codes, conspiracies, discourse and meanings beyond the meaning. I think it's a really dangerous slippery slope.

Talk about the thing - and I think that's the challenge to Poilievre too. It should be about making him uncomfortable by asking what he means and on the details and the facts.

If there's a problem, based on your description it seems it's one of of misaligned incentives in profit driven medical care rather than ideology.

This was an NHS clinic although money played a role in terms of state funding for that NHS Trust. The FT review with that section of that book (by a BBC journalist) on the Tavistock clinic, is good:
https://www.ft.com/content/a45a9a0b-5d2f-4c4a-b2ef-6a8796ea5d10

It has now been shut down partly because of failures in care, also in record keeping so once someone was treated by the clinic they were gone from the data. But also because the approach of having this single national centre of excellence in gender identity services for young people made sense when it was founded in 1989 - and even 2009 when it had under 100 referrals a year. When it was receiving thousands, it was clearly not working and the recommendation from the independent review which recommended it was closed is to establish specialist services distributed across the country (as well as better record keeping, better integration with counselling and other services and more research).

It's sadly not the profit motive (but it did becomoe a huge source of revenue for the trust because it appears to have started operating as a bit of a conveyor belt). Ideology I think plays a part - an activist charity (that I've actually organised a fundraiser for) seems to have been too involved to be healthy. But also a wider story of a funding crisis particularly for mental health treatments (it was in a mental health trust) and a huge increase in demand for this type of care and stretched staff.

Certainly this has recently become a major talking point and concern for the right wing across a number of countries.

Medical authorities in the UK, France, New Zealand, Finland and Sweden (the latter lot all under left-wing governments) have recommended against certain treatments such as puberty blockers for people under 18. In all cases they've basically said it should only be prescribed in exceptional circumstances, or in a research setting until there's more and better data (particularly in the long term). In the UK those recommendations have not come from anyone political but specialist NHS reviews - my understanding is they have also been made independently by clinicians in those other countries too.

The challenge, of course, is that the kids who may benefit are here now. So it's a decision that is balancing potential harms.

The other fact is that for a number of circumstances medical care providers are able to assess whether a minor has capacity to give consent.  That is that they both understand the decision they are making and have the mental capacity to determine the risks and benefits.  But more to the point, the medical professional must also make the medical judgment that the treatment is in the best interests of their patient.

Yeah I agree. People under 18 can have capacity to make decisions and give informed consent for medical treatment. I don't think there is any reason to in effect carve this specific treatment out of that.

Having said that, my understanding is, that there is very little data and there have been very few long term studies - which experts in trans care for young people are calling out for. And is also why Tavistock's failures around record-keeping and follow up for over 30 years of specialist care is a huge shame. They have a view but it is, from what I've read, caveated with the need for more research. The caveating doesn't necessarily survive in the press releases or activism around what is appropriate care, which is exactly what you'd expect. And other medical experts have reached a different view - on the same lack of underlying long term research.

The one area I find a little concerning is the massive gender imbalance which has been flagged by people who are doctors specialising in care for trans young people. My understanding is that's new and it's only present in teenagers.

[Jacob]

Yes, this is something that is happening now in the appropriate medical circumstances.

I will post the same case I linked for BB which describes what must occur for that medical treatment to occur.

https://www.bccourts.ca/jdb-txt/ca/20/00/2020BCCA0011.htm

Thank you for that.

I lack the lawyer's facility for quickly extracting key points from several hundred pages of legal documents, so I'm reduced to asking:

• How old was the child in this case?
• How long did the process take, from diagnosis to actual treatment?
• If one was inclined to look for "radical gender ideologists" pushing children into getting irreversible medical treatments for gender dysphoria for ideological reasons, who are the most likely candidates here? I presume it's a combination of medical professionals and psychiatrists? Are those people operating independently, or are there a number of second opinions involved?
• And - this is probably not in the caselaw, but maybe someone knows - how many kids are getting this kind of treatment without parental consent in Canada? Are we talking one child every five years? Are we talking fifty kids a month? What's the order of magnitude here?

[crazy canuck]

Jacob,

Here are the facts in this case which answers part of your question

AB has identified as male since he was 11 years old. At 12, he began to socially transition, enrolling in school under a chosen male name and using male pronouns with his teachers and peers.

[12]         Around 13 years of age, after two years of consistently identifying as male, AB's persistent discomfort with his body led him to want to take steps to appear more masculine. With the support of his mother, AB went to see a registered psychologist, Dr. IJ, for a number of sessions.

[13]         Following these sessions, Dr. IJ finalized an assessment and treatment plan for AB. The plan concluded that AB met the diagnostic criteria for gender dysphoria. As described in the consent form signed by AB, gender dysphoria is a recognized medical condition where a person experiences significant distress because the gender identity they experience differs from their genetic or biological gender, and how others perceive them.

[14]         Dr. IJ found that AB would be a good candidate for hormone treatment, and referred him to the BC Children's Hospital (BCCH) for further assessment.

[15]         In August 2018, AB met with pediatric endocrinologist Dr. GH at the Gender Clinic at BCCH. Dr. GH conducted a further assessment of AB and again determined that masculinizing hormone treatment was both reasonable in the circumstances and in AB's best interests.

[16]         He explained the nature, consequences, and foreseeable risks and benefits of the treatment to AB, presenting a detailed consent form that laid out these risks. AB decided to proceed with the treatment, and signed the form. AB's mother, who supported him throughout this process, also signed the form.

[17]         Upon learning AB's father was not aware he was pursuing this treatment, Dr. GH postponed its start in order to present information to AB's father, CD.

[18]         CD emailed the clinic a few days later expressing his opposition to the proposed treatment.

[19]         From August to December 2018, a social worker at the clinic made "numerous attempts" to set up a meeting between Dr. GH and CD to discuss the proposed treatment. CD did not attend at the clinic and did not engage with the medical team.

[20]         On 1 December 2018, Dr. GH and social worker UV sent a letter to CD. The letter addressed CD's disagreement with the treatment and explained that, under s. 17 of the Infants Act, minors are permitted to consent to their own medical treatment.

[21]         The letter explained that the consent of a parent is not required to administer health care to a minor where the health care provider is satisfied the minor understands a treatment's nature and consequences, and has concluded the health care is in the minor's best interests. It informed CD that the BCCH medical team had assessed AB and found him capable, meaning CD's consent was not required for AB to proceed with treatment.

[22]         After litigation commenced, Dr. GH took further steps to ensure his capacity assessment of AB was correct. He asked for an opinion from the Provincial Health Services Authority (PHSA) Ethics Service, which examined his finding of capacity and agreed that AB demonstrated capacity to understand the treatment.

[23]         The ethics opinion suggested that, while not necessary, Dr. GH may wish to have an additional capacity assessment done by a provider outside the current care team in order to assuage CD's concerns and improve family dynamics.

[24]         Dr. GH referred AB to Dr. MN, a psychiatrist at BCCH in the BC Mental Health Centre, who assessed AB and found that he demonstrated a detailed understanding of the risks and benefits of the treatment. Dr. MN further assessed AB's mental status, finding he displayed reasonable judgment and insight.

If one was inclined to look for "radical gender ideologists" pushing children into getting irreversible medical treatments for gender dysphoria for ideological reasons, who are the most likely candidates here? I presume it's a combination of medical professionals and psychiatrists? Are those people operating independently, or are there a number of second opinions involved?

You will see from the facts above, a number of health care professionals are involved.  One would have to believe in conspiracy theories to conclude they are all in on it.  The only other option is to take the position that there is no such thing as gender dysphoria and the medical teams are just honestly mistaken.  I think it is the latter position that most of the anti-treatment sentiment comes from.  Hence BB's observation that he believes people will just grow out of it. 

[crazy canuck]

Having said that, my understanding is, that there is very little data and there have been very few long term studies - which experts in trans care for young people are calling out for. And is also why Tavistock's failures around record-keeping and follow up for over 30 years of specialist care is a huge shame. They have a view but it is, from what I've read, caveated with the need for more research. The caveating doesn't necessarily survive in the press releases or activism around what is appropriate care, which is exactly what you'd expect. And other medical experts have reached a different view - on the same lack of underlying long term research

Yes, more research would certainly be helpful and as I understand it is ongoing, at least in this Province.  But as you said in your post, there are minors now who are in need of the treatment.

[Jacob]

Sorry - not my intent, just laziness on quotes.

Sure. But imagine how galling it must be for BB to have his eloquence misattributed to someone like me.

Mainly the "rooted in". Those are weasel words to insinuate without publishing something actionable. Also cheaper than reporting on LGBT+ issues, because it's media commentary.

It's not media commentary, though. It's analysis of political rhetoric, political positions, and political activism.

I also think it is unhealthy, particularly in a democracy, to move from talking about the thing to talking about discourse. It is, in it's way, like Poilievre saying "radical gender ideology" or, say, talking about "cultural Marxism" or queer theory (which is, at least, a real thing). I think it's not a massive leap to conspiracy-mindedness, constantly de-coding what people are "really" meaning/where that discourse has come from. I think it's the path to Russian politics where everything is codes, conspiracies, discourse and meanings beyond the meaning. I think it's a really dangerous slippery slope.

I broadly agree. I just don't think that's what's happening here, in spite of the phrase "rooted in" being used.

Talk about the thing - and I think that's the challenge to Poilievre too. It should be about making him uncomfortable by asking what he means and on the details and the facts.

They are talking about the thing. They are not talking about codes, they are talking about what's happening in terms of legislation and physical actions in the world, and what arguments and rhetoric are being used to justify those actions:

In the United States, "gender ideology" and "indoctrination" rhetoric has inspired right-wing Republican governors like Florida Governor Ron DeSantis and Texas Governor Greg Abbot to pass restrictive education laws. Meanwhile, anti-LGBTQ+ groups like Moms for Liberty have campaigned to ban books from libraries and called police on librarians.

This has contributed to a culture of paranoia that appears to be inciting threats and acts of physical violence. For example, harassment, death threats and bomb threats targeting schools and children's hospitals have been linked to the targets of LibsofTikTok, a far-right account that aggregates content about teachers and the LGBTQ+ community.

... again, that's the thing right there.

This summer, ADL and GLAAD published a report that found hundreds of examples linking anti-LGBTQ+ rhetoric to incidents of violence and harassment.

"A large number of them were conducted by perpetrators who were directly citing tropes from this gender ideology narrative," Moore said. "We know these conversations happening online are directly translating into harm against these communities, whether that be in the form of bomb threats, whether that be in the form of death threats, or doxxing against teachers.

... that's also the thing.

In Canada, anti-vaccine activists and other anti-public health groups began disrupting school board meetings during the pandemic in opposition to vaccines and face masks.

But when the pandemic began to recede and public health measures started lifting, rather than return to the old normal, these groups simply pivoted to a new target.

...

In June 2023, out-of-town anti-LGBTQ+ activists, far-right livestreamers and right-wing media personalities organized rallies targeting three Ottawa-area schools in an event explicitly billed as an "education over indoctrination" or anti-"gender ideology" rally.

Campaign Life Coalition, Canada's biggest anti-abortion group, mobilized supporters to show up, linking it to efforts to "resist LGBT indoctrination in schools," while right-wing outlets like True North described it as a "protest against gender ideology."

... that's also the thing right there.

In no way is that anywhere near "codes, conspiracies, discourse and meanings beyond the meaning" as you suggest. It's taking about things that are happening right now - in our communities, at our schools - what people are doing to push a specific political agenda and the the rhetoric that the people using to justify that agenda and rallying support. And then the article shows how a specific  politician is using that exact same rhetoric.

This was an NHS clinic although money played a role in terms of state funding for that NHS Trust. The FT review with that section of that book (by a BBC journalist) on the Tavistock clinic, is good:
https://www.ft.com/content/a45a9a0b-5d2f-4c4a-b2ef-6a8796ea5d10

It has now been shut down partly because of failures in care, also in record keeping so once someone was treated by the clinic they were gone from the data. But also because the approach of having this single national centre of excellence in gender identity services for young people made sense when it was founded in 1989 - and even 2009 when it had under 100 referrals a year. When it was receiving thousands, it was clearly not working and the recommendation from the independent review which recommended it was closed is to establish specialist services distributed across the country (as well as better record keeping, better integration with counselling and other services and more research).

It's sadly not the profit motive (but it did becomoe a huge source of revenue for the trust because it appears to have started operating as a bit of a conveyor belt). Ideology I think plays a part - an activist charity (that I've actually organised a fundraiser for) seems to have been too involved to be healthy. But also a wider story of a funding crisis particularly for mental health treatments (it was in a mental health trust) and a huge increase in demand for this type of care and stretched staff.

I see, thank you for the clarification.

How big a part would you say "gender ideology" (radical or otherwise) was involved in events there? You make it sound like the place was shut down so the services could be redistributed rather than being an example of... something bad.

Medical authorities in the UK, France, New Zealand, Finland and Sweden (the latter lot all under left-wing governments) have recommended against certain treatments such as puberty blockers for people under 18. In all cases they've basically said it should only be prescribed in exceptional circumstances, or in a research setting until there's more and better data (particularly in the long term). In the UK those recommendations have not come from anyone political but specialist NHS reviews - my understanding is they have also been made independently by clinicians in those other countries too.

The challenge, of course, is that the kids who may benefit are here now. So it's a decision that is balancing potential harms.

Seems fine to me. But as you seem to imply, different doctors could reach a different conclusion of best practices without being driven by "gender ideology", I'd think.