Transgender Conversion Therapy

Neale Hanvey Excerpts

Monday 13th June 2022 Westminster Hall

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)]

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate the hon. Member for Carshalton and Wallington (Elliot Colburn) on the sensitivity of his opening remarks. He set the scene incredibly well. He talked about access to justice. Justice as a concept means something different to each of us. I wholeheartedly agree with the hon. Member for Thurrock (Jackie Doyle-Price): to do this work properly, we must extinguish the term “therapy” in any legislation, because it sanitises a practice that is absolutely not therapy. That is something I think we should approach with real sincerity.

Perversely, in some respects I am glad that the Government made the decision to withdraw the trans community from the Conversion Therapy (Prohibition) Bill—not necessarily because of their position on that, but because that led to the petition, which led to this discussion. Discussion has been absent for so long, and the absence of sensitive discussion has been deeply damaging. To really understand how we move forward, we must listen to some of the messages and understand them with sensitivity, rather than getting on our high horse and take a polarised position. We must harness our experience and insights, wherever they come from, to ensure that we make the right decision. Our job as legislators is to interrogate the legislation and ensure that it is fit for purpose and will deliver on its intent.

My perspective comes down to information. When I grew up in the ’70s and ’80s, and started my nursing career in the ’80s, Scotland was not the beacon of equality that it has become. It was a tough gig, to say the least. One of my first placements was on a surgical ward. A bus driver was brought in with abdominal pains and was rushed to surgery for a laparotomy. Surgeons opened him up and discovered that he had extensive cancer, before stitching him back up and sending him back to the ward. That was the end of the discussion with him. He was not told; his family had decided that he should not be told the truth, and everybody was quiet about it. Back then, it was not abnormal for the patient not to have that information.

That has fundamentally changed. We now have the concept of informed consent. When I worked in adolescent psychiatry, we did not affirm that the dysmorphia of dysmorphic anorexics was real; we gave them therapy to help them resolve the challenges that they faced.

[Nadia Whittome]

The hon. Member will correct me if I am wrong, but it sounds as though he is suggesting that being trans, which is to do with somebody’s identity, is as harmful as anorexia—the most deadly psychiatric condition.

[Neale Hanvey]

Absolutely not. I am not making that parallel at all; I am talking about information and consent.

During my clinical practice and academic research, I conducted primary research into the supportive care of adolescents as they went through their cancer journey. That grounded theory framed supportive care as care that maximises personhood by considering all aspects of that individual, maximising who they were as they went through that journey and ensuring that they were supported to be the best version of themselves despite the trauma of intensive treatment.

Informed consent is something that children and young people are incredibly capable of dealing with. I have had conversations with young people about how and where they would like to die, and whom they would like to be there with them. I have had conversations with young people who have come in at the start of their cancer journey about sperm and ovarian tissue cryopreservation. [Interruption.] I do not know why that is funny; it is quite a serious issue. Those conversations have been handled in an incredibly capable way by young people, who are absolutely able to deal with difficult and complex information. They could be guided through that process in an absolutely natural and capable way. Certainly, in my experience, young people’s ability to deal with such information should humble everyone in this place.

Many of the late effects of cancer are a rich gold mine that we should look at when considering the impact of puberty blockers, because there are parallels. When somebody makes the decision to detransition, what impact will it have on later life? When somebody has high-dose chemotherapy, all their rapidly replicating cells can be deeply damaged, so they can completely lose their fertility. That is why sperm and ovarian tissue cryopreservation are really important and one of the important questions that we need to ask ourselves on this important matter.

The next part of consent is when it is not possible.

--- Later in debate ---

[David Mundell (in the Chair)]

I am told that the technical issues have been resolved, so we can resume. Mr Hanvey, please start where you left off.

[Neale Hanvey]

It is now a pleasure to serve to under your chairmanship, Mr Mundell. I was making a point about the provision of information to assist in decision making in complex situations. Encouraging somebody down a path that could lead to irreversible medical decisions without the provision of such information and the opportunity to consider all possibilities is an unforgivable dereliction of professional duty. In her interim report, Dr Cass states that:

“Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.”

I agree with that fundamental principle.

I should make it very clear that I am drawing a distinction between someone who has arrived at a clear, considered position of a trans identity and someone who is embarking on the exploration of that. Those are two entirely different things. We have a duty of care to understand that the therapeutic need within that process must be supportive. I agree with every point that has been made that that process should not be coercive on either side. It must be balanced and therapeutic, and it must always be patient-led. Patients must lead the direction of conversation. They should not be influenced in either direction to arrive at a particular position.

Many Members have made the point today that we are talking not about therapeutic interventions from professionals, but about quackery. This debate has satisfied some of my deep concerns about what the legislation would mean. As I remarked at the beginning of my speech, I am glad that the Government have made this decision and that the petition has been raised, because we are having this conversation. My experience of asking questions about this legislation, based on my considerable clinical experience, is being accused of being a transphobe and even a homophobe—that would be a surprise to my husband. We have been together for 28 years, so it would be news to him.

I have gone on a little bit longer than intended, so I will wrap up. I cannot imagine what it must be like for someone to be told that their identity is wrong when they know deep in their heart and soul that that is who they are. Conversion therapy is an absolutely abhorrent practice and should be ruled out, but we must make it clear what therapy is and what quackery is. These are the fundamental questions I have asked myself about what the legislation means. What we must not do is come down on either side, where there is coercion against trans identity or unquestioning affirmation. It is vital that young people who are questioning their identity have the kind of support and guidance that was denied me as a young gay man growing up in the 70s and 80s.

[David Mundell (in the Chair)]

I call Dame Nia Griffith, and I add my congratulations on her inclusion on Her Majesty’s birthday honours list.