Hong Kong medical profession remains in denial on coercive surgery for transgender people

Sam Winter says the city's medical bodies should align themselves with medical opinion worldwide and make their positions known to the government

PUBLISHED : Thursday, 29 October, 2015, 5:24pm
UPDATED : Thursday, 29 October, 2015, 5:24pm

It is now just over a year since the Legislative Council voted down the Marriage (Amendment) Bill, a bill that would have made sterilisation and genital construction a legal requirement for any transgender person intending to marry their loved one. The bill may have been defeated, but the policy is in place. The Immigration Department continues to demand such surgery as a precondition for issuing an identity card to a trans woman that will enable her to marry her fiancé, or to a trans man so that he can marry his fiancée.

The department website is very clear on what this surgery involves. For a trans woman, it is removal of the penis and testes, and construction of a vagina. For a trans man it is removal of the uterus and ovaries, and construction of a penis or "some form of penis". In effect, the government says to trans people: "You want the right to marry? You must give up rights over your own body, and your right to bear children".

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Let me be clear on this. I am not arguing against genital surgery. Some trans people experience great distress about their genital anatomy; an anatomy that fails to match their deeply experienced sense of their gender. For them, genital surgery can be a medical necessity. But this is not the case for all trans people. 

Some are relatively comfortable with their genital anatomy. For them, genital surgery may be, in Hong Kong, more of a legal necessity; a way of getting an ID card that will enable them to lead a reasonably regular life. A way of being able to open a bank account without endless complications, of getting a job and a home without encountering prejudice, and of being able to marry the one they love.

As time passes, more authorities in the world of health and rights add their voices to the chorus calling for an end to gender recognition policies, like Hong Kong's, that impose medical preconditions. They include the Office of the High Commissioner for Human Rights, World Health Organisation, UN Development Programme, Amnesty International, Open Societies Foundation, World Professional Association for Transgender Health, World Association for Sexual Health and the American Medical Association.

And now, the World Medical Association (WMA), representing 10 million physicians and 102 national medical associations - including the Hong Kong Medical Association (HKMA) - has added its voice. Through a policy statement issued at its general assembly in Moscow on October 18, it has spoken in favour of the right of all transgender people to self-identification - without coercive treatment of any kind, including forced and coerced sterilisation.

Every organisation I have listed says it clearly: surgical requirements for legal gender recognition are in violation of basic rights (including to health) and may constitute coerced medical practices.

I remember clearly a meeting last year at which representatives from Hong Kong's sexual and gender minority communities spoke with Secretary for Health Ko Wing-man on issues of health care. I remember commending Dr Ko on the Hospital Authority's commitments to transgender health care, but going on to suggest that (thanks to government policy) some of its work constituted coercive surgery. I guess Dr Ko went straight into defensive doctor mode. He rejected my suggestion. Now that the WMA (of which the HKMA is a constituent member) has spoken on the issue, I hope Dr Ko will rethink his position, and initiate a discussion with the Immigration Department to bring an end to this unfortunate situation.

But what about the HKMA itself? In August 2014, in the months leading up to the vote on the Marriage (Amendment) Bill, I wrote to the association asking them to speak out against the bill's provisions. I was informed that they had "not yet formed a view" on the issue, and that my inquiry would be passed on to the HKMA council for consideration. Silence ever since. It's time for the association's president, Dr Louis Shih Tai-cho, to end that silence, and to ensure his association now adds its voice to that of the World Medical Association.

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And what about the Hong Kong Colleges of Psychiatrists and Surgeons? Psychiatrists are implicated in coerced medicine whenever they set about assessing a person whose motivation for surgery is affected by the need for a new ID card.

Surgeons are, for obvious reasons, even more implicated.

In July last year, I wrote to the Hong Kong Academy of Medicine to seek its view, and the view of its constituent colleges, on medical preconditions for gender recognition. The academy dodged the question, informing me that its own view was the view of its constituent colleges. It later informed me (incredibly) that "the College of Surgeons is of the view that the issues addressed by you concern more about psychology and psychiatry than surgery".

And the College of Psychiatrists issued a public position paper that ended with the view that gender recognition issues go "beyond the medical perspective, and should be deliberated widely by society". It declined to contribute to those deliberations by sharing any views of its own.

So that is it really. A Hong Kong medical profession in denial or evasion. As the government's interdepartmental working group looking at legal issues affecting trans people plods on towards an interim report, it is high time for key bodies in the Hong Kong medical profession to consider the issues raised by medical requirements for gender recognition, hopefully align themselves with medical opinion worldwide, and make their positions known to the Hong Kong government.

Sam Winter is the sexology team leader at Curtin University's School of Public Health, Perth, Australia