Doctors' union votes for ‘identity-based care' despite warning over lawfulness
The doctors' union has voted for transgender patients to have 'identity-based care' and called for this approach to be embedded into training.
But the British Medical Association (BMA) has been warned the move risks going against the law, after the Supreme Court ruling in April that the terms woman and sex in the 2010 Equality Act 'refer to a biological woman and biological sex'.
At the BMA's annual representative meeting in Liverpool on Wednesday, a majority of members voted in favour of a motion said to centre on 'respect, safety and dignity' of LGBTQ+ doctors and patients.
In a speech in support of the motion, member Bethan Stanley described a 'blatant transphobia' in the current political climate, and insisted 'gender-affirming care is healthcare'.
Urging her fellow members to vote yes, she said: 'I feel it is a no-brainer that we should support care that is going to improve the welfare and wellbeing of our patients.'
To lengthy applause, she added: 'Trans women are women. Trans men are men.'
The motion called on the BMA to 'affirm the right of all LGBTQ+ patients and staff to identity-based care and working conditions – defined as care and policies that actively account for the individual's lived, intersecting identities (including sexuality, gender, neurodivergence, race, and cultural background)' and for guidance and a 'lobbying strategy to embed this principle into NHS equality standards, training frameworks, and institutional policies'.
Speaking against it, Louise Irvine said while it had a 'laudable aim of protecting LGBTQ+ and other people's rights to fair treatment' it also 'risks advocating that the BMA and other organisations adopt policies which are unlawful'.
She noted two cases of nurses suing their health trusts for providing changing rooms based on gender identity rather than sex and urged the BMA to study the legal implications of the recent Supreme Court judgment.
A group of nurses are challenging County Durham and Darlington NHS Foundation Trust over a policy allowing a trans colleague to use the female changing rooms at work, with their case due to be heard at an employment tribunal in the autumn.
Meanwhile, in Scotland, nurse Sandie Peggie is suing NHS Fife after sharing a female changing room with a transgender doctor, with that tribunal expected to resume in July.
Ms Irvine said: 'Lobbying for organisations to provide services on the basis of gender identity and not sex, means advocating that organisations disregard their public sector equality duty obligations.
'This could lead to legal liability for any discrimination or harassment experienced by service users expecting a single sex service.'
She added that the BMA lobbying for organisations to adopt policies for patients and staff based on gender identity instead of sex 'could put us at variance with the law, with all the risks that that carries'.
The vote reflected the 'deep passion within the profession for delivering truly personalised care', BMA representative body chair Dr Latifa Patel said.
She said the court ruling 'does not prevent healthcare that takes gender identity into account' and said the union will 'call for clear, national guidance and a real lobbying strategy that enable doctors to deliver identity-informed care, so that no one is left behind'.
The doctors' union has previously called for a delay to implementation of the Cass Review into children's gender services – which concluded gender care was an area of 'remarkably weak evidence' and young people had been caught up in a 'stormy social discourse'.
NSH England (NHSE) last year rejected the call for a delay, saying it has 'full confidence' in the Cass Review final report.
The BMA said it would carry out its own 'critique' of the report, which is yet to be published.
While initially stating this would be shared with its UK council at its January meeting, a BMA spokesperson said: 'We want to be as sure as we can be that data collection and analysis processes are as rigorous and robust as possible; this requires time, rather than be rushed.'
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Times
an hour ago
- Times
Palliative care doctors on assisted dying: he's for, his boss is against
Here at the end of the train line on the west coast, nestled a few hundred metres from the beach, is where the sun sets on Britain and on life. The hospice in Weston-super-Mare could hardly be a better place to go: the bedrooms have doors onto a lush garden and there is even a specially adapted hot tub I would like to book. But every week two of the palliative care doctors who work here, Fiona Chiplen and Adam Baker, are asked, 'Doctor, can you help me die?' Every week they are asked to do what is at present against the law, though maybe not for much longer. 'We got asked twice this morning,' Baker says. We are sitting in a quiet room with multiple boxes of tissues: this building is a mix of sunniness and abundant tissue provision. This room has hosted many a difficult conversation but today it's a new one. Chiplen, a consultant in palliative medicine and Baker's boss, stands on the other side of the assisted dying debate to him. She is against, he is for. For years these colleagues have agreed in private to disagree. Chiplen in particular is concerned that if she went public her views would have a detrimental effect on her relationships with her patients. Yet now MPs have backed the assisted dying bill, which is undergoing House of Lords scrutiny, they are willing to argue with each other, in public, in the most open, kindest possible way. This is to find a path through the 'polarisation', which Chiplen says doesn't help at deathbeds. 'We understand there's a huge amount of hurt on both sides of the law,' Baker says. I ask how many dying patients they have each cared for. Chiplen has nearly two decades in the field, Baker three years, and both estimate 'in the thousands'. Chiplen says that when she began, 'I used to keep a list of all the patients I had cared for' in memoriam, but that became impossible. If they, with their jobs, and their respect for each other's decency and care, can't wrangle across the divide to make things better for everyone in a new British landscape with assisted dying then, Chiplen says, 'Who can?' Chiplen, aged 48 and with a soft Scottish accent, was drawn naturally into palliative care. Her first complex ethical quicksand came as a junior doctor. 'We had to resuscitate somebody and it was successful but the person was paralysed from the neck down,' she says. 'Of course you try to help someone but it was really quite traumatic. It had a big influence on my view of resuscitation.' Baker's entry into palliative care was more dramatic. At 35 he had spent seven years as an emergency medicine doctor, and says, 'It was all I wanted to do.' But he burnt out and says that 'a big part of that was a number of really horrible deaths'. Patients could die in corridors, they could die in the back of ambulances waiting outside. 'It's awful and no fault of the staff, who are some of the best people I've ever worked with,' he says. 'The system just has so much pressure.' • Streeting: NHS can't afford assisted dying and MPs got it wrong One death he will never forget was soul-crushing. A woman's main blood vessel in her chest ruptured. Baker rushed to the sound of her emergency buzzer but a fellow doctor was already on the way out of her cubicle, telling Baker, 'I haven't got time for this.' 'It wasn't the fault of that individual,' he says. That doctor was being asked to prioritise in the most ghastly way. But for the moment of that woman's death to be low down on a list felt like a dehumanisation too far. He took a break from medicine and ended up rowing the Atlantic with his wife. Out at sea he looked to the horizon, and to the depths, and his humanity was allowed to surface. He heard about a farmer who, dying in a hospice, had a visit from his favourite cow (at Weston-super-Mare they have had visits from every kind of pet, including a donkey). He cried at 'how beautiful' that was. He realised that, unexpectedly, hospices are the places where doctors have the time and focus to value human life at its richest. He explains that it is no contradiction that over time he has become more sceptical of the opposition arguments to assisted dying. I ask them first to see if they can summarise each other's viewpoints. 'Interesting,' Baker says, and they both smile. 'I think Adam feels things are not equitable the way they are,' Chiplen says. 'We looked after somebody with motor neurone disease who was on a ventilator,' she adds. 'They were deteriorating, losing the ability to communicate, to look after themselves. They reached a point where they decided they wanted to have their treatment withdrawn. They were able to come into the hospice, where we withdrew the ventilator, made them comfortable, and they had a really peaceful death with their family around them. 'But another patient with pulmonary fibrosis, who was very poorly, didn't have that choice. We're able to help some people at a time they feel their life is no longer worth living, and we're not able to do it for other people.' Baker nods. 'Those two cases that Fiona highlighted really summarised it for me,' he says. 'Two patients, both wanted to end their life, but I'm currently legally only allowed to support one. Both came into the hospice and their very opening lines were that they wanted me to help them die. One was by stopping their ventilation, which is entirely legal. And the other, their request would have required me to administer medication, which is illegal, and I would have gone to prison and lost my licence. And I do acknowledge that those are different in law. But the more I look at it, I struggle to see on a personal level the difference.' Would the motor neurone disease patient have considered themselves lucky from this point of view? 'Quite possibly, yes,' Baker says. 'If we don't support assisted dying, we don't remove it from the equation,' he continues. 'It is available for British citizens but requires them to go abroad at a cost of over £10,000. So by not supporting our patients who might want to explore that, we just make it available to a small few who can afford it. That doesn't sit comfortably with me.' • MPs vote to pass assisted dying bill — as it happened The 'slippery slope' argument also doesn't seem substantial to Baker. 'Some big characters in the public domain use that but this idea that you can't have a stopping point for consistency has been shown to be a fallacy in law,' he says. For instance, in the case of abortion our country has reached agreed time limits without too much angst. What is Chiplen's main argument, I ask Baker. 'I think Fiona's concerns would be that people are exploring an assisted death because the money that should be going into palliative care isn't being made available,' he says. She nods. She is not so extreme as to say that this would take away all those wishing for help to die. 'I know one view put forward is that if only everyone had access to good palliative care, no one would ever request an assisted death,' she says. 'I don't think that's necessarily the case. I would a hundred per cent acknowledge that there are people who are distressed no matter how much we do. But I do think that people's unmet needs contribute to their wish to die.' She remembers another patient with motor neurone disease who, earlier on in her illness, talked to Chiplen about various milestones ahead that she felt would be completely unbearable, such as becoming incontinent or being unable to feed herself. 'And what was very humbling to see was that she reached those milestones where she had said, 'Life will be intolerable to me,' and yet it wasn't and she continued to find joy,' she says. This, for Chiplen, is a broader point: that some patients underestimate how much meaning they can find even when they are touching distance from death, 'whether that's somebody who's very poorly and bedbound or not. All people have value.' In the assisted dying bill patients must be judged to 'have capacity' to make the decision. She is concerned that patients would end their lives prematurely, worried to leave it too late and thereby be deemed too sleepy or confused. She also worries about those with depression, whose mental capacity may be muddled. Neither Chiplen nor Baker pretend that the other's points are simple to fix. They are now writing a book together on how thousands of dying patients can lead them to differing, and caring, viewpoints. I ask Baker whether this is partly a cost thing: is assisted dying cheaper than remedying our failure to offer everyone good end-of-life support? They both agree that palliative care — and their own hospice — struggles for funds. 'There are powerful financial arguments that are used to argue both sides but I might separate that from the patient experience,' Baker says. 'I've had so many conversations with people that want to talk of wanting it to all be over. None of them have ever come to me and tried to present that as a cost-saving equation.' If or when assisted dying becomes legal, will it feel difficult for Chiplen? 'It will feel really jarring,' Chiplen says. 'At the moment we have clarity. We are not allowed to do anything to hasten death. But when you look at other countries where assisted dying becomes legalised, I'm slightly shooting myself in the foot here, but there does tend to be a shift in acceptance.' • Where is assisted dying legal? How the rules worldwide compare In New Zealand assisted dying came into effect in 2021. Many hospices opted out of offering it for ethical reasons. Chiplen cites a study in the journal BMC Palliative Care in 2023, where one New Zealand medic argued that this opt-out was patronising: 'The organisation says we believe that people should have a good death, but only as we define what a good death is.' Chiplen and Baker agree that palliative care specialists should be the leaders on assisted dying, not some third party, as some have suggested. Her main fear is that the new system would not be funded enough to make it safe or compassionate. 'I'm fairly pragmatic,' she says. 'I would not judge anyone else for seeking assistance with dying and I can absolutely see why some people would go down this route. My role is to support the community we serve.' Neither of them are religious. Could Chiplen imagine any scenario in which she would want assisted dying? 'This is a very personal view. My frame of reference is my family. I find it hard to imagine choosing to leave them a second earlier than I have to.' What if life felt intolerable? 'Tricky to know,' she says. What about Baker? 'Like Fiona I worry about being public about this, as there's a lot of judgment about it, but yes, I can imagine considering it,' he says. He would like to die feeling as much 'himself' as possible. Meanwhile, they both say their jobs make them savour life. Baker has been inspired into extreme adventuring, such as polar ice swimming. 'It made me aware of my own mortality,' he says. 'Like a lot of people I thought, that will never happen to me. But we see people on the worst days of their life, when things happen very quickly. One minute, one week, they're well, and the next, they're here for end-of-life care. Nothing's given. I'd not necessarily be so clear on that if I didn't see it every week.' Chiplen is not, she says, doing any polar ice swimming. 'Sometimes this job puts pressure on you,' she says. 'Time's precious and you've got to make the most of it. But we all have to still put on the washing and get the kids to school. I try and just find joy in the little things every day.'
Times
an hour ago
- Times
The NHS can afford assisted dying, Starmer tells Streeting
Sir Keir Starmer has rebuked his health secretary over the funding of assisted dying as he insisted he was confident the NHS would be able to handle the new law. The prime minister said it was 'his responsibility' to ensure assisted dying could be carried out safely, after Wes Streeting said there was 'no budget' for the service to be introduced. Starmer, who voted in favour of assisted dying, said he was 'confident we've done [the] preparation' needed to ensure it could come into force. Streeting said in a statement to constituents at the weekend that 'setting up this service will take time and money that is in short supply'. He said the process could divert resources from the NHS and other public services.
The Guardian
2 hours ago
- The Guardian
Starmer pushes back at Streeting doubts over budget for assisted dying
Keir Starmer has insisted the government is prepared to deliver assisted dying legislation 'in all its aspects', pushing back against comments made by his health secretary, Wes Streeting, who claimed there was no budget to implement the new law. Streeting, who was previously a supporter of assisted dying but switched sides last year, said better end of life care was needed to stop terminally ill people feeling as though they had no alternative but to end their own life. Writing on his Facebook page, Streeting cited Gordon Brown's opposition to the move and expressed concerns about the ethics of offering an assisted dying service before significant improvements are made to the NHS. 'The truth is that creating those conditions will take time and money,' he wrote. 'Even with the savings that might come from assisted dying if people take up the service – and it feels uncomfortable talking about savings in this context, to be honest – setting up this service will also take time and money that is in short supply. 'There isn't a budget for this. Politics is about prioritising. It is a daily series of choices and trade-offs. I fear we've made the wrong one.' The prime minister backed the historic measure, which passed the Commons with a majority of 23. MPs were given a free vote. When asked on Wednesday if the bill must be implemented and the budget must be found for the legislation, Starmer told reporters ahead of the Nato summit: 'It is my responsibility to make sure the bill is workable, and that means workable in all its aspects. I'm confident we've done that preparation.' The assisted dying bill, which was formally introduced in the House of Lords for further scrutiny on Monday, gives terminally ill adults in England and Wales with six months to live the legal right to end their lives with medical support. This would be subject to approval by two doctors and a panel including a social worker, senior legal figure and psychiatrist. Kim Leadbeater introduced the legislation as a private member's bill, and the Labour peer Charlie Falconer is expected to lead on the legislation in the Lords. Falconer, who supported Leadbeater's efforts, said peers should not use procedural devices to block the bill. Sign up to First Edition Our morning email breaks down the key stories of the day, telling you what's happening and why it matters after newsletter promotion Leadbeater, the Labour MP for Spen Valley, hopes the bill will get its royal assent by October, allowing the start of a four-year process to formally implement it. Streeting will oversee the implementation of the law, as it will be carried out by the Department of Health and Social Care, although the day-to-day work will be handed over to the care minister, Stephen Kinnock, who backed the bill. Although Streeting's views on assisted dying are well known, he has told allies he will not seek to impede the bill's implementation. Given MPs were allowed to vote according to their conscience rather than along party lines, Starmer had been conscious of not wanting to appear to influence MPs' decisions. He had criticised Streeting for doing so earlier this year.
