12. The gulf between the APS Code of Ethics and current gender policy
The APS has an excellent Code of Ethics, and a reputation for supporting safe, careful and evidence-based practice. Unfortunately, current guidance and InPsych narratives put the APS and members on course for complicity in serious harm, litigation, and reputational damage. While our focus in this submission is on LGB, this lamentable lack of care and rigor applies equally to many other people vulnerable to ill-considered ‘auto-affirmation’ policy: people with ASD, ADHD, mental illness and trauma. Girls and young women are especially vulnerable, as are socially awkward boys, and young men with Autogynephilia. Current APS policies and InPsych narratives do not just jeopardise vulnerable people, they fail APS members by keeping them ignorant of risks, and by advising practices that contravene the Code of Ethics. These policies and communications expose the APS and its members to litigation.
We ask APS to examine your Code of Ethics:
“The general principle, Propriety, incorporates the principles of beneficence, non-maleficence (including competence) and responsibility to clients, the profession and society”
The Code requires psychologists to:
"anticipate the foreseeable consequences of their professional decision, provide services that are beneficial to people and do not harm them" and to "take responsibility for their professional decisions"
“Conduct' means any act or omission”
In relation to ‘omission’ we note that ‘automatic affirmation’ downplays or omits differential diagnoses, ignores risks specific to LGB and other people, and prescribes against exploratory therapy. APS advocacy for ‘conversion therapy’ laws in Victoria, Queensland and the ACT has compounded this.
Harms (maleficence) are likely to result from APS policy and communications that push ‘automatic affirmation’. These harms impact the collective - LGB people, and impact individuals.
12.1 Maleficence and ethical breaches at the collective level - human rights abuse against LGB people.
The APS Code of Ethics defines ‘peoples’ as a distinct human group with collective interests, and states that ‘psychologists engage in conduct which promotes the protection of people’s human rights. Legal rights and moral rights. They respect the dignity of all people and peoples”. Current APS policies for ‘auto-affirmation’ in ignorance of the vulnerabilities of LGB people represents an abuse of the human rights of LGB people.
Automatic affirmation, social transition and puberty blockers set young people on course for medical transition who would have resolved dysphoria through maturation. We know that under ‘watchful waiting’ most children resolve gender dysphoria. We also know that gender nonconformity and dysphoria in childhood is strongly correlated with maturation as LGB adults.
In effect, APS policies facilitate ‘Transing the gay away’ - the medical conversion of LGB children and young adults to make them ‘straight’. We view these policies and InPsych communications as unethical and deeply prejudicial to the wellbeing of LGB people. It is particularly distressing, since our history involves not just murder, brutal physical assault and ‘corrective rape’ for being homosexual. The bodies of homosexual people have been subjected to electric shock, induced vomiting, surgical excision of clitorises, lobotomies, incarceration and forced injection of hormones. These human rights abuses occur in many countries today. In Iran, gay men have a choice of ‘gender reassignment surgery’ or hanging from a crane by the neck. In this way, the state removes their organs and performs body modifications upon them to make them ‘straight’. The fact is that gender nonconformity in homosexual people is deeply challenging to sexual stereotypes and cultural expectations. Although legal discrimination has ended in most western countries, the accounts of detransitioners make clear that young people suffer from internalised discomfort with same-sex attraction, and in many cases from bullying.
In addition to persecutory laws noted above, LGB people have been subjected to dehumanising language. It is distressing to us that now the only words we have that describe our distinctive experience have been repurposed for queer ideology, and that health professionals who have been strong supporters of LGB people have uncritically gone along with this. The APS document Information Sheet: Sexual Identity and Gender Diversity has redefined homosexual people in such a way that denies same-sex attraction as the basis of our sexual orientation. Respectful engagement with lesbian and gay people must include recognition that we are people with a stable sexual attraction to people of the same sex. This refers to biological sex, not gender identities.
12.2 Maleficence - Individuals harmed following automatic affirmation
We recognise the experience of transgender adults for whom medical transition has been very beneficial. This submission is about those people for whom these interventions were damaging - interventions set in motion by ‘automatic affirmation’ or ‘affirmation only’ health services. Given the accounts of detransitioners, and the exponential surge in young people identifying as transgender, it is highly likely that the numbers of people harmed by ‘automatic affirmation’ will increase. Where this occurs, it is seriously injurious. It is maleficence:
The sterilisation of LGB and other people
Surgical removal of breasts, denying detransitioners the ability to breastfeed
Sexual dysfunction. Impaired sexual function from surgeries and hormones initiated when a child or young person was unable to give informed consent
Surgical removal of reproductive and sexual organs, and excision of erogenous zones
Irreversible body modification such as facial hair, male-pattern baldness, permanently deepened voice and enlarged clitorises
Increased risks of coronary heart disease, erythrocytosis and osteoporosis from cross-sex hormones
Negative health effects from binding may not show for years
Years spent suffering depression, anxiety and mental health problems because comorbidities were not properly assessed or responded to with appropriate therapies
Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health
A range of negative health outcomes from transition surgeries are outlined here and here.