The Conscience Chronicles

UPDATE: As this was being readied for posting, the Standing Committee on Private Bills and Private Members’ Public Bills voted to recommend that Bill 207 not move forward in its current form, meaning that the bill will not be proceeding to the floor. I have elected to post this anyway, given the possibility that the proposal might be resurrected and amended at a later date.

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At a first casual glance, the stated premise of Alberta’s Bill 207, Conscience Rights (Health Care Providers) Protection Act, might sound reasonable: most people wouldn’t expect medical professionals who object to procedures like abortion to be required to perform them.

In practice, Alberta’s College of Physicians and Surgeons already allows medical professionals to opt out of medical procedures that they have a religious objection to (a status quo that is at times problematic), so long as they provide any referral or direction to comprehensive information needed, ensuring that their patient still receives care in a timely manner. Bill 207 removes the obligation to refer and / or ensure patient care — using the reasoning that providing a referral is sort of like participating in the procedure. Regardless of any urgency or medical appropriateness of care in any given situation, this change allows refusals to increase the time delay to accessing care (regardless of any urgency), put the burden of medical care back on the patient, and be a kind of barrier and discouragement, if not more. Indeed, it can be like making someone start over from scratch. Proponents of the bill say that because medical care is still available elsewhere, it isn’t really being denied, which is technically true… but the time, emotional and informational barriers cannot be discounted.

But while those advancing the bill claim it is only codifying that status quo in law, there are more things that Bill 207 does, many of which have received little attention by media.

The bill extends conscience rights to health care organizations, as well. While religious care organizations have already asserted conscience objections in many ways already, this codifies it in law. It also allows organizations to assert their conscience-based decisions over those of their facilities, staff and resources. By way of example, Covenant Health (Canada’s largest Catholic health care provider) owns 16 health care facilities throughout the province, including two major hospitals in Edmonton; its affiliate Covenant Care owns another seven assisted living and long-term care facilities. In some rural areas of Alberta, all or most facilities are religious-owned.

In short, this moves Alberta down a landscape in which anyone in the chain of service provision — from facility administration to lab technician and pharmacist — can create a roadblock to services, without consequence. This becomes even more concerning when one realizes the potential for administrative staff, clergy or even outside groups to apply pressure to doctors and clinics to deny services that they might not otherwise have initially had objections to.

In fact, by the text of the law, it is left entirely up to the health care provider or religious health care organization to determine if their conscientious beliefs would be infringed, and there really is no appeal process to see if there is some agreeable compromise. No record is kept, leaving no way to follow up to ascertain if the patient has ever received the care they needed or sought. Gathering statistics about patients denied care in order to inspect what consequences the law has had becomes impossible, as demonstrated elsewhere.

By the text of the law, if a regulatory body receives a complaint about denial of care having to do with conscience, the complaint must be discarded (there is a caveat that complaints or portions thereof that are not conscience-related are not discarded). They are not allowed to investigate or question the decision:

5(1)  On receiving a complaint in accordance with section 55(1) of the Health Professions Act, the subject matter of which is a health care provider’s decision not to provide a health care service based on their conscientious beliefs, the complaints director for the regulatory body that received the complaint must immediately

(a) dismiss the complaint, and

(b) provide notice of the dismissal to the complainant.

It also specifies that by law, “a health care provider’s decision to not provide a health care service based on their conscientious beliefs is not to be considered as unprofessional conduct,” and providers and / or organizations are immediately shielded from legal liability.

There is also an amendment to Section 7(1) of the Alberta Human Rights Act, to immediately shield any employee from termination or discrimination based on their conscientious beliefs. This amendment is not restricted in any way to the medical profession, and could conceivably provide a shield for harassment and abuse of one’s co-workers or customers because of one’s religious or conscientious beliefs.

The bill’s proponent, MLA Dan Williams, has promised a number of amendments to Bill 207, but in those proposed changes, none of these points is substantively changed. One of his proposals — to restore a duty to assist “if not providing the health care service would result in an imminent risk of death” — isn’t altogether reassuring about the thought that was put into the bill in the first place… but even with that change, there is no clarification on whether or how the legal shield and barriers to reporting and investigation might be changed in the event of a patient’s death (especially in cases in which it was not thought that there would be an “imminent risk”).

There are many hypothetical situations that one can suggest could arise as a result of this legislation. But this is not uncharted territory. It is very easy to look at places where “conscience” exemptions have been implemented or attempted — or where medical personnel or organizations have attempted to assert their conscience rights — and see how it has affected medical care for patients.

“I was nervous and excited about the consult for my first intrauterine device (IUD) at MedStar Georgetown University Hospital. After a brief conversation, Dr. Case (a pseudonym) asked me to get off the exam table and follow her to her office for a ‘chat.’ But in her office, when the door was safely shut, my excitement slowly started to fade. ‘Well, first things first, this is a Catholic hospital,’ she said in a mock whisper…”

Evann Normandin, writing at Rewire this past May, described what happened to her when hospital policy prevented her from getting an IUD. She left with a referral… and shaming. Although referrals don’t come with the added expense of multiple visits in Alberta, like south of the border, the expense of time and transportation remain, and can pale in comparison to the emotional cost of the refusal itself:

“… On my way out of the labyrinthian building, I scrunched up the unofficial paper in my hand. The ripped edges felt sharp against my skin. In the Uber ride home, after paying transportation to and from my apartment to a world-class hospital and forking over a $50 copay for unsolicited advice about my vagina, I cried…”

At Huffington Post, Ace Ratcliff described her fight with doctors over her need for a hysterectomy:

“My illness’ severity [hypermobile Ehlers-Danlos syndrome] led me to the conclusion early on that childbirth would irreparably damage my already broken body and would never be the right choice for me. My joints dislocate painfully and at random. I have difficulty swallowing food. I bruise like an overripe peach. I faint if I have to stand for too long. Wounds take much longer to heal on me than on a normal human.

“… Somehow, my personal autonomy, my health and my comfort didn’t rate high enough to outrank the desires of my future, then-nonexistent partner. And nothing I said could change my doctors’ minds [about a surgical hysterectomy], not the stories about my frequently dislocating hips, my mom’s complicated pregnancies or the increased rate of miscarriage and preterm labor for EDS patients…”

In another instance, the hospital’s policies would have allowed the removal of a dislodged IUD, but the doctor thought the policies wouldn’t, and refused care. The patient was sent home, limited in her options by her insurance company (not applicable in Alberta, but limits on options can occur because of other factors, such as rural accessibility), and she ultimately had to file suit:

“Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“… It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights…”

Something that Bill 207 does not address at all is any duty of physicians to discuss every option available to a patient. If referring is equated to participating in an objected-to procedure or medication, then one might tacitly assume that providing comprehensive information on that procedure or medication can be denied. Withholding medical information can have serious consequences:

“… a woman was traveling across the Midwest when she developed abdominal pain. She and her husband went to the nearest hospital, where she was diagnosed with a potentially fatal ectopic pregnancy. The doctors recommended immediate surgery to remove the fallopian tube containing the misplaced embryo, a procedure that would reduce by half her future chances of conceiving a child. They failed to mention that a simple injection of Methotrexate could solve the problem, leaving her fertility intact. (In fact, at a secular hospital she found on her smart phone, it subsequently did.) Why the omission? The Catholic hospital where she got diagnosed was subject to the “Ethical and Religious Directives” of the Catholic bishops, which state, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion…'”

In fact, denial of comprehensive information is a recurring issue when medical conscience exemptions are asserted.

Of course, some of these examples focus on the emotional impact, but that doesn’t mean that there aren’t serious physical consequences potentially at stake:

“After about 10 hours, the patient’s temperature soared to 102 or 103 degrees, Ralph recalled in an interview with Rewire in June, a few months after the incident. Ralph and her team gave the patient medication to induce labor. But Ralph could not administer mifepristone, which the American College of Obstetricians and Gynecologists (ACOG) considers part of the most effective drug regimen for such cases. The Catholic hospital didn’t carry the drug, which is commonly used for medication abortions—a failure Ralph believes was religiously motivated and needlessly prolonged her patient’s labor.

“… For more than 24 hours, the patient labored through painful contractions. She bled heavily, requiring at least one blood transfusion. Her lips and face lost their color. Finally, she delivered a fetus that had no hope of survival…”

The full extent of Bill 207’s reach isn’t understood either, until you realize that “medical provider” covers a wide range, as noted in an Edmonton Journal editorial:

“The list is long and includes emergency, primary and critical care paramedics; midwives, chiropractors, podiatrists, psychologists and psychiatrists; lab, respiratory, ultrasound and X-ray technologists; pharmacists, physiotherapists and physical therapists; opticians and optometrists; dieticians and nutritionists; anesthesiologists, surgeons, and social workers; audiologists, dental professionals and speech-language pathologists…”

The inclusion of pharmacists in that list raises the question about access to birth control, an issue that has already surfaced in Alberta and elsewhere in Canada:

“Joan Chand’oiseau of Calgary recently posted a photo on Facebook of a sign on her physician’s office door that read, ‘Please be informed that the physician on duty today will not prescribe the birth control pill…’”

It also raises questions about access to hormone therapy for trans patients, or the possibility of throwing in a bit of public humiliation for good measure:

“‘Sir, we canceled your prescription because we couldn’t figure out why a man would need female hormones,’ said the voice. ‘You’ll have to have your doctor call us to confirm this is correct because it doesn’t make any sense…'”

Indeed, trans health is just as likely to be impacted as reproductive health, and doesn’t even have to be about transition-related medical concerns. Trans people regularly report what they’ve nicknamed ‘Trans Broken Arm Syndrome‘ — that is, the refusal of care for basic health services just because they’re trans. And it does indeed happen in Canada:

“According to the College of Physicians and Surgeons of Saskatchewan’s charge of unprofessional conduct and the penalty presentation, the incident took place on Jan. 5, 2016, when Anderson saw a patient for “reasons related to bronchitis” — something completely unrelated to the patient’s transition to male from female.”According to the documents, the disciplinary hearing committee found it ‘probable’ that Anderson ‘launched into an unsolicited running commentary’ regarding transitioning. Anderson made statements ‘which were insensitive and unrelated to the reasons for which the patient requested your medical services,’ according to the charges against Anderson…”

It should also be asked what conscience protections might do to protect the still-persistent practices of reparative therapy in Alberta (albeit with coded language). But that aside, denial of basic care is something that all LGBTQ+ people have had to worry about, sometimes even with lethal effect in situations that didn’t initially seem to pose an “imminent risk”:

“Refusing to treat patients can be be deadly, as was the case in 1995, when Tyra Hunter, a transgender woman, lost her life after emergency medical technicians refused to assist her at the scene of a car accident. According to the Center for American Progress, had Hunter received care, her chances of surviving were 86 percent — she should have lived…”

Medical assistance in dying is another area in which medical access is an issue, and in this instance, access is even more seriously limited. It is estimated that the aforementioned Covenant Health (and affiliates) oversee up to 90% of the long-term care beds in parts of Alberta, and regardless of whether long-term care patients are healthy enough to be moved, doing so is sometimes necessary just have questions answered, because of facility policies:

“Covenant Health stated in May of 2016 that it has an ‘ethical and moral opposition to medical assistance in dying’ and that the organization’s ‘unequivocal position to not provide or explicitly refer’ must be recognized. Functionally, this means that any assessment of capacity, any answering of technical questions, and the act of assistance in dying itself would require a transfer away from a Covenant facility.

“… The case of Ian Shearer, an 84-year-old Calgary man living in Vancouver with palliative heart and kidney disease and severe chronic pain, brought attention to how transfers can do harm. Shearer was denied a request for medical assistance in dying from St. Paul’s Hospital, a Catholic facility near where he lived and where he’d been admitted for care. On the day he chose to die, his ambulance was delayed three hours and his medications were withheld to allow him to confirm consent. The ordeal, last August, was described by his daughter as ‘unnecessary… excruciating suffering…'”

Obviously, the out-of-province and out-of-country examples won’t exactly mirror what would happen in Alberta, because of circumstantial differences in things like medical coverage, but what this demonstrates is the extent to which individuals might be willing to abuse a conscience protection, and the twists of logic involved. From the firing of doctors for not adhering to an organization’s conscience policies, to the chilling effect on medical care caused by activism from anti-abortion groups against clinics just for hiring doctors who’ve performed abortions elsewhere in the past, to medical residents who openly vowed to give the wrong medications to specific groups of people, to some some truly backwards beliefs about medical interventions…

“Throughout the conference’s diverse and highly academic presentations, one discernible theme emerged, namely, that “brain death” has been invented to harvest viable organs from still-living people. Only when a person’s heart stops beating and their breathing ceases for a determinate amount of time can it be said that death has truly occurred…”

… the politics surrounding medical conscience exemptions raises a broad range of concerns.

It is likely that Alberta’s Bill 207 would not survive a legal challenge. Indeed, the same day that the bill was introduced in the Alberta Legislature, a similar policy was overturned in the U.S. Likewise, a ruling in Ontario last May affirmed patients’ rights to referrals when care is denied.

But getting there could be another long, legally costly process, with very real human collateral damage caused along the way.

Photo: Adobe Stock

(crossposted to rabble.ca)

The Alberta Advantage was Dependence

In the end, the “Alberta Advantage” was dependence.

And in retrospect, undoing that dependence on the oil industry — a mixture of real and perceived — needed to be the number one priority of the Notley NDP government. When Albertans (even to their own surprise) overthrew the 40-year Progressive Conservative dynasty in 2015, they were hungry for change, and they knew that change was both inevitable and urgent, given the realities of global climate change — something they had been increasingly experiencing (most notably when the third “one-in-a-hundred-year flood” in ten years ate High River and parts of downtown Calgary).

Instead, industry managed to keep the focus on oil development and pipelines, and sucked all of the rest of the political and economic air out of the room.

Of course, Alberta’s energy sector is well-versed in fostering and using the dependence on its jobs and products — whether manipulating gas prices, making punitive and excessive layoffs whenever an administration or policy it doesn’t like is in place, or dangling illusionary carrots, like job creation estimates that factor in a hundredfold of jobs that they imagine might be generated by their project (and which nobody ever follows up on to debunk). In reality, building a pipeline creates merely a small number of regionally-shifting jobs aimed at transporting the longer-term refining jobs out-of-country, but nobody really ever remarks on that, because of how overwhelmed with industry propaganda Albertans are, and their eagerness for what little crumbs industry is willing to toss their way.

Now, the rest of Canada might not be overly sympathetic to Alberta’s plight, right now, because the province has had a pretty good run, riding waves of oil prices over the past few decades to sustained prosperity, while labour markets elsewhere have dwindled, automated, and relocated to other countries. Consequently, Alberta may feel the coming change more acutely than the rest of Canada — but feel it everyone will.

Change is hard. It’s disruptive. And with the level of budgetary dependence on energy royalties and the perceived dependence (thanks to the hard work of neoliberal institutions like the Fraser, CAPP and corporate media) of everyone’s jobs on oil development, Alberta has had four years of reckoning that haven’t really done anything to assuage any of the associated fears that come with that change.

To be fair, that transition was never something that was going to be able to take place in a scant four years.

Additionally, the Notley NDP have tried to break some of that sense of dependence through diversification. It’s something that hasn’t been well-publicized, but it also needed to be more aggressively pursued. And diversification is only one step — job retraining and the economic support and optimism needed to get through it are more critical. Albertans looked to Rachel Notley to lead them into and through a transition, and somewhere along the way, industry convinced the government and the public alike that the transition was yet another pipeline.

Consequently, we find ourselves at a crossroads in which Albertans seem receptive to old, failed conservative policies of austerity and corporate giveaways, regardless of the ethical concerns with a guy who may have broken electoral laws in order to become party leader, and regardless of whether he has surrounded himself with lake-of-fire social conservatives and semi-open white nationalists. It’s why we’ve seen people who’ve never protested before come out to agitate for pipelines, and naively allowed themselves to get hijacked by and aligned with racist wingnuts who’d previously floundered on the fringe for decades. Despite the stereotype of the Albertan redneck, Albertans have always tended toward worrying about the money, and not caring about the social positions that have aligned themselves with it (which is, in a way, even worse).

But here’s the clincher: a pipeline isn’t going to slow or stop the one-in-a-hundred-year floods, or the summer seasons that might soon be renamed “Smoke,” or the fracking-triggered earthquakes. And electing a traditional oil crony is more likely to undo the first steps that Alberta has taken than to make those hard choices. Because the longer Alberta tries to forestall its transition, the more abrupt, disruptive, and devastating that eventual change is going to be.

(crossposted to rabble.ca)

Legislatively “Balancing” Human Rights

There is a simple, time-honoured rule about attempting to “balance” human rights classes in legislation so that it works out a particular way every time, and it goes like this:

You can’t.

That is a court’s role.  When two human rights classes are put into conflict in a way that creates hardships for both, a court becomes the arbiter, weighing the context of a given situation in order to determine which party has experienced the most undue hardship.

Legislating such a way that one party’s rights always supersedes the other creates a hierarchy of rights, and defeats the whole purpose of equal rights legislation.

Bill 10

That is what took place this week with Alberta’s Bill 10, which newly-crowned Premier Jim Prentice introduced to dump and replace Liberal MLA Laurie Blakeman’s Bill 202.

The latter bill sought to do three things:

• Give students the right to form Gay-Straight Alliances (GSAs) when and if they wanted to;
• Remove a section (s.11.1) of the Alberta Human Rights Act which called for parents to be notified and either evacuate their children or opt them into anything that taught tolerance of LGBT people (interesting trivia: Alberta is the only jurisdiction in the world that has a “parental rights” clause like this, and it took several years to implement because no one was sure how it could work); and
• Add a mention of the Charter of Rights and Freedoms and the Alberta Human Rights Act to the Education Act.

Premier Prentice’s new Bill 10 does this:

• Encourages school boards to allow GSAs;
• Allow the students to sue the school boards if they don’t (presuming they can find enough legal help, information, support and funding to cover the legal expenses to do so, and ride out the years of delay tactics at boards’ disposal);
• The bill also removes s.11.1 from the Alberta Human Rights Act, but makes changes to legislation which more or less negates the change, other than affecting the way complaints are addressed.

If at any point the Premier thought he had sliced through a Gordian Knot worthy of Alexander, he soon realized otherwise.  As the bill came up for Third Reading, several amendments were proposed by opposition MLAs, and Prentice is now said to also be considering some of his own.

There are two central conflicts within this debate, one that is discussed frequently during many debates on social issues, and another which has been barely remarked upon at all.

“LGBT Rights vs. Religious Freedom”

The first is the false equivalence between LGBT human rights and religious freedom.  The reason I call it a false equivalence is because what we’re really talking about is the complaint that the (“special,” as it’s sometimes called) right of lesbian, gay, bisexual and trans* people to have equal access to employment, housing, services and other forms of enfranchisement is trumping the (“perfectly ordinary everyday?”) right to deny LGBT people any or all of those things.  People retain the freedom to believe what they will, practice their faith, and speak their beliefs — all up to the point where doing so becomes harassing and disenfranchising to others.  In most of the situations that are framed as pitting LGBT rights against religious freedom, this sort of conflict can only be considered equally-matched if you believe that coexistence is a violation religious conscience.

But the “gay rights versus religious freedom” argument has been losing steam, partly because the public at large is starting to recognize it as a ruse, and partly because the cause of religious freedom opens the possibility that the proponents’ religion will be placed on an equal footing with other religions, such as Islam, Satanism, or even Atheism.  Hardline social conservatives like the American Family Association’s Bryan Fischer have spoken out about this within religious circles, and more are starting to follow.

Consider this candid rant by Scott Lively, the pastor who is widely credited with having inspired Uganda’s Anti-Homosexuality Act and Russia’s ban on “gay propaganda”:

“For about a year now I’ve been arguing against the use of “religious liberty” as a theme of Christian public advocacy. We retreated to that theme after SCOTUS Justice Hugo Black’s abandonment of the Bible’s authority in favor of a new “religious pluralism” standard in the 1940s-60s, starting with Everson v Board of Education (1947). That was the case that adopted Jefferson’s “separation of church and state” metaphor as a justification for declaring all religions to be equal with Christianity in America, and equally subservient to Secular Humanist authority…

“But God always provides a way of escape. (We’re only trapped if we accept the limitation of staying on their chessboard.) That narrow and difficult but God-honoring way is to stop arguing for “religious liberty” and resume our proclamation of the superiority of Christ and His Word over all opposing faiths (along with tolerance for people of other faiths — that‘s how it worked before Black). It’s goal must be nothing less than an official reaffirmation of the Bible as our legal and cultural foundation, which would require overturning Everson and its juridical progeny…”

It was never really about religious freedom.

“Parental Rights”

The other conflict that has been almost completely missed is the one between youth and parents.  The argument made for parental rights clauses is that parents should have (using the language of Bill 10) the right “to make informed decisions respecting the education of their children.”

No one was ever stopping parents from teaching their children what they believe and encouraging their kids to follow their lead.  What parental rights are actually about is the right to deny their children any information to the contrary.

And that only sounds like a good idea until you remember that the kids should have rights too.  But by enshrining parental rights in legislation, the Province of Alberta is essentially prioritizing the right of parents to deny their kids knowledge (and emotional support, if their kid happens to be gay or trans*) over the right of children and youth to know.  In some cases, it means that the attitudes of the narrowest-minded parents determine what everyone’s kids are allowed to know.

And when you say it for what it is, it doesn’t really sound like that brilliant a compromise.

On conscience-based medical exemptions

The College of Physicians and Surgeons of Ontario is currently reviewing its Human Rights Code policy on conscience-based exemptions for medical professionals, and their effect on access to medical services.

This review was sparked by a number of news reports of doctors in Ontario and Alberta refusing to prescribe birth control because of their religious beliefs. In some of those cases, patients were refused in clinics where there was only one doctor on duty.

Concurrently, south of the border, the United States Supreme Court ruled in favour of a corporation’s right to deny medical insurance to its employees when doing so would violate the owners’ religious beliefs — a case that was specifically about access to contraception. The Hobby Lobby case has been followed by several new attempts to widen the exemption, and calls to extend it to other sectors and in ways that would allow businesses to refuse service to LGBT people.

These events reflect a major shift in the way that conscience rights are being seen and applied in North America.  It is my hope that the experiences of trans* people in Alberta with conscience-based medical exemptions might provide some insights for those considering a conscience policy review in Ontario.

Alberta has had a policy for some time which allows a doctor to refuse to prescribe treatments that violate their religious beliefs in non-emergency situations. However, they are required to state that the refusal is because of their religious beliefs, and to provide a timely referral for patients to someone who will provide care, so that patients still receive service and experience a minimum of undue hardship (although to be fair, having to jump through referral hoops can be considered an undue hardship of itself, especially when one factors in the difficulties in scheduling time off from work and other real life concerns).  Ontario’s policy is similar, though not identical.

Alberta’s policy was created to protect medical professionals from having to participate in any situation that might lead to an abortion.  But in the past year, there has been an upsurge of discussion about the need for a religious or conscience-based exemption in every sector and every practice.  Access to birth control is one of the pivotal issues in play in that discussion, although it is not the only one.

As an advocate for transsexual and transgender people, I’ve needed to assist a great number of people over the years who’ve been denied medical services because they’re trans* under Alberta’s conscience exemption policy.  Sometimes people have even been denied services for things like urinary tract infections, routine checkups and cases of the flu.  To be fair, the conscience exemption is not the only factor: denials are sometimes made by doctors who say they’ve never been trained in trans* health — although this complaint is made not only in regard to trans-specific health concerns, nor does there appear to be a willingness to learn from many of those doing the refusing.

Most often, trans* people who are refused care are also not provided a referral to anyone else.  This exploits the public’s unfamiliarity with this part of the law, and that they’re entitled to a referral.  It is certainly not every medical professional who refuses to assist, but it occurs frequently enough that the trans* community has had to try to keep a list of “trans-friendly” doctors — a list that is constantly plagued by doctors no longer being able to accept new patients, or making changes in their practice or habits.  I’m always happy to add doctors to the list, with the only requirement be that they adhere to the WPATH Standards of Care (which is also the policy of Alberta Health Services).  Two years ago, someone obtained a copy of our records and stormed into the offices of several listed clinics in Calgary, raising a ruckus about doctors’ willingness to treat trans* patients, and this resulted in several requests to be removed from our list.

Although commentators sometimes note theoretical possibilities like a Jehovah’s Witness practitioner denying blood transfusions, I can say from experience that conscience policies already can and do result in people being denied access to the care they need… and are not always given “timely” alternatives.

I am sensitive to a person’s right to opt out of something because their conscience, and not just a religious-based conscience.  However, in practical experience, exemptions tend to be abused, and marginalized people pay the heaviest price.  If there is to be a conscience-based exception to medical care, a province also needs to have a much better way of coordinating timely and accessible care alternatives, and better enforce the responsibility to provide those alternatives.  In Alberta, this is difficult, since there is no centralized means of communicating with medical professionals and provide some forms of training after they’re already in the field, short of making laws — so strengthening things at a policy level proves difficult.

With the recent shift of thinking among the religious right toward making provinces “abortion-free” and denying access to previously uncontroversial things like birth control, this issue will worsen in coming years.  If there is to be a conscience-based exemption to medical care, provinces need to seek a solution to the policy quandaries this creates now.  For example, if a walk-in clinic’s only physician on duty  will not prescribe contraception, then it’s worth investigating what responsibility the clinic should have in providing a doctor who will, and in a manner that suits the patient’s needs, rather than the doctor’s.

Or what responsibility the province is taking upon itself by sanctioning health care exemptions.

(Crossposted to Rabble.ca)

The Shocking Dr. Levin

The long, twisty and sordid legal saga of Aubrey Levin has finally come to an end.  Originally found guilty on three counts of sexual assault in January 2013, Levin’s five year prison sentence was upheld by the Alberta Court of Appeal, Wednesday.

The case has garnered international attention, due to the Calgary psychiatrist’s past as a military psychiatrist in apartheid-era South Africa. It is often alleged that during this time, he was affiliated with or led a project aimed at “curing” soldiers of being gay, by subjecting them to electroshock therapy or worse — allegations he continues to deny.

The 2012/3 Trial

It is important to separate what was said to have occurred in South Africa from what he was charged with in Calgary, in the interest of clarity.

Levin was charged with 10 counts of sexual assault (one was later stayed), after an initial accusation in March, 2010 inspired as many as 22 former patients to come forward with allegations of abuse, in incidents dating back as far as 1999.  Levin was convicted on three of those counts and acquitted of two, with the jury deadlocked on another four (two of those four were retried, but that too resulted in a mistrial).  In the process, Levin’s wife Erica was charged with attempting to bribe a juror (and that case is ongoing).

The 2010 charges stem from incidents in which Aubrey Levin was said to have fondled patients’ genitals.  The first patient to have come forward was so concerned about being believed that he used a spy camera to record multiple sessions.

In his defense, Levin said that he was not fondling patients, but using a urological technique called bulbocavernosus reflex (BVR) procedure, which is used to address erectile issues.  In one of the videos, though, Levin is seen fondling the patient’s genitals for more than ten minutes, causing Calgary-area urologist Ethan Grober to dispute this claim, saying “What I saw was a prolonged … fondling of the penis.  This was not a simple elicitation of a reflex.”  And even if the technique could be characterized as a BVR test, there was no logical reason that Levin, a psychiatrist, should have been conducting it.

Levin’s trial was a circus of delays and confusion.  The length of time taken to bring him to trial was unusual in the first place — 2 1/2 years, while police followed up with several former patients to determine how many charges could be laid.  From the beginning, Levin’s attorneys sought extended delays because of health issues.  The first was a request for 3-month respite so Levin could get his fragile health in order.  Calgary Sun reporter Kevin Martin elaborated:

Two doctors testified Levin was in such poor health that he needed to get in shape before he could sustain the mental and physical strain of what was then to be a six-week hearing.

They said that perhaps in three months, should Levin be given the chance to rehabilitate his degenerating body, he’d be able to survive such an ordeal.

Had they seen Levin leaving court after his conviction — to a gauntlet of news cameramen — they might have thought his recovery miraculous.

Using his wheeled walker as more of a weapon than a crutch, the good doctor raced at the photographers with the agility of a much younger man, forcing those with cameras to evade being struck.

As that request failed, there were questions about Levin’s mental health, and claims of vascular dementia (Martin noted: “But once he was declared fit, Levin became a new man, taking notes and instructing his counsel”).  Then, a drop in heart rate precipitated a medical emergency for which he was briefly hospitalized.  Then, he fired his lawyers and began to represent himself.  Then, he seemed unable to represent himself (certainly unable to cross-examine), and a new legal team needed to be found.  The judge had to consult with the jury whether they could remain through the extensions, and there were fears the proceedings would collapse if they couldn’t.  All in all, the trial that was expected to last six weeks had been deferred from August 19th, 2011 to October 10th of the following year, and wrapped up three and a half months later.

In addition to attempting to undermine the credibility of his former patients, a key part of Levin’s defense was to claim that the things that happened between them were consensual (we’ll come back to this point), and then were later mischaracterized or maliciously distorted by his accusers.  It’s an argument that he and his legal teams argued successfully enough to achieve an acquittal on two charges and a mistrial on four others.  In this way, his case became difficult to prosecute even beyond the circus-style atmosphere of the trial.

Levin’s defense tried to cut down the complainants’ testimonies by focusing on their records or troubles, by accusing them of having ulterior motives (including one claim that they were motivated by money), or even alleging that the complainant who recorded the abuse had made passes at Levin, and then edited those parts out:

“I’m going to suggest to you … that portion of the video shows you taking out your penis and waving it at the doctor,” Archer said.

During the trial, all effort was made to keep Levin’s past from playing a part, but occasionally revelations slipped out.  On November 15, 2012 the Calgary Herald reported (page now offline):

R.B. said Levin would take down books from his shelves and show him “pictures of penises and vaginas. He would show me different parts that were sensitive for sexual acts.”

“Other times, he would tell me about his past, when he was in the army, forcing men to rape women,” he said.

Immediately, Wister cut off the witness and asked Court of Queen’s Bench Justice Donna Shelley to dismiss the jury. Following discussions, Shelley recalled the jury and told them that there will be inadmissible evidence heard in the court room and it should be disregarded.

“Not everything you hear will be admissible,” said the judge. “To the extent (R.B.) has said anything not relevant to what happened between 2001 and 2010, it is not relevant to these proceedings. It is not evidence. Disregard everything not related to these charges.”

Authorities feared that a complete mistrial was inevitable if the jury heard too much of the shocking nature of allegations made about his years in South Africa.

The Aversion Project

What has drawn international attention to this case is that Aubrey Levin was said to have led the South African military project in the 1970s and 1980s designed to “cure” military recruits of being gay — a program that allegedly included things like shock therapy (for which Levin was nicknamed “Dr. Shock”), chemical castration, and even forced genital reassignment surgery.  While there are no mentions of Levin or the Aversion Project by name in the Truth and Reconciliation Commission’s final reports, it’s generally accepted that something of an indeterminate nature took place at Ward 22, Voortrekkerhoogte military hospital, Pretoria.

The National Post had originally raised questions about these allegations, but quickly retracted them after Levin threatened to sue.  Other media took notice and avoided mentioning Levin’s rumoured South African activities over the years that followed, although this did not deter international publications like The Guardian in the U.K. and South Africa’s Mail and Guardian.

When he came to Canada, Aubrey Levin did not apply for amnesty — nor was he granted it — so he could have been subpoenaed to appear before the Truth and Reconciliation Commission… but TRC never chose to make the attempt.  While the allegations were raised on record, there was also considerable frustration among the public that the TRC did not pursue the line of inquiry.  For example, in the Health and Human Rights Project (HHRP)’s verbal submission on day 2 of the Health Sector Hearings on June 18, 1997, the group expressed some frustration that the Aversion Project was not being focused on:

“After those comments I just want to digress a little bit and particularly for the benefit of the lawyers who’ve trooped into this hearing, I think we, as the [HHRP] Project, want to register our concern for this whole process which has led to a situation where many of the cases that we have brought to the attention of the Truth Commission we cannot actually name the particular health professionals involved. We are not going to name those health professionals but we feel it is really a travesty of the process of truth to arrive at a situation where we cannot speak openly. We fought for many years for a situation where people will be free to speak the truth and it seems that legal mechanisms have been invoked to limit the extent to which the truth could be disclosed. We would like the TRC to take note of that, particularly the fact that as far as the Project was concerned we were able to supply the TRC with the names of the doctors as far as we understand within the required time.

“Just in that regard we can talk about the kinds of cases we would have discussed…

“We also raise issues around military health personnel and we particularly want to challenge the SAMS whose presentation yesterday did not touch on any of the issues that we’ve raised and I think Commissioner Ramashala has certainly posed the question to them, but we have presented evidence regarding programmes which involved the re-programming, the use of aversion therapy for gay men in the military and we believe that these cases require further investigation, and the TRC, we would hope, would follow up in that regard.”

The South African Press Association (SAPA) described the shock therapy allegations raised by the HHRP in 1997:

The HHRP said Levine was first named in a December 1986/January 1987 edition of the War Resister, a publication of the Committee of SA War Resisters.

According to the publication, Levin was chief psychiatrist at the military hospital at Voortrekkerhoogte near Pretoria in the 1970s, when he practiced aversion therapy with gay conscripts who were admitted to the psychiatric ward.

Electrodes were strapped to the arms of the subject and wires leading from these were in turn connected to a machine. The subject was then shown a picture of a naked man and encouraged to fantasise freely.

While he was doing this, he would be subjected to electric shocks.

“The increase in the current would cause the muscles of the forearm to contract – an extremely painful sensation,” the article said.

When the subject was screaming with pain, the current would be switched off and a colour Playboy centrefold substituted for the previous pictures.

“The pscyhiatrist [sic] (in most cases Levine) would then verbally describe the woman portrayed in glowing and positive terms. Sessions were held twice daily for three to four days.”

The HHRP said although the subjects had to give their consent, most were between the age of 18 and 24 and were still coming to terms with their sexualtiy [sic].

It said the practice of aversion therapy appeared to stop when Levine left the hospital.

The last comment is curious, as Aubrey Levin has denied participating in aversion techniques — yet some of the allegations seem to point to him having championed them.  The National Coalition for Gay and Lesbian Equality (NCGLE, now known as the Lesbian and Gay Equality Project and which asked for a commission to investigate the medical torture allegations) claimed to have:

two boxes of papers documenting the 1968 Immorality Amendment Bill. Item B106 is an eager letter from a loyal member of the ruling, pro-apartheid National Party who claims to have successfully ‘treated’ homosexuals and wants to be invited to address the all-white Parliament on this subject. The letter is signed by Dr. Aubrey Levin, “medical practitioner and psychiatrist in training.”

What is widely alleged is that as a colonel in the South African military and chief psychiatrist in Pretoria in the 1970s and 80s, Levin was in charge of a unit where electric shocks were administered to “cure” gay white conscripts. Levin was also claimed to have overseen the use of electroshocks and powerful drugs against conscientious objectors refusing to fight for the apartheid army in Angola or suppress dissent in the black townships.  From The Guardian:

Levin also treated drug users, principally soldiers who smoked marijuana, and men who objected to serving in the apartheid-era military on moral grounds, who were classified as “disturbed”.

Levin subjected some patients to narco-analysis or a “truth drug”, involving the slow injection of a barbiturate before the questioning began. In an interview with the Guardian 10 years ago, he did not deny its use but said it was solely to help soldiers suffering from post-traumatic stress.

Levin said he left South Africa only because of the high crime rate, and denied abusing human rights. He said electric shock therapy was a standard “treatment” for gay people at the time and those subjected to it did so voluntarily.

“Nobody was held against his or her will. We did not keep human guinea pigs, like Russian communists; we only had patients who wanted to be cured and were there voluntarily,” he told the Guardian in 2000.

Aubrey Levin Comes to Canada

In the dying days of apartheid in South Africa, anxiety was high about the nation’s transition to full democracy, about whether the transition of power could remain (mostly) peaceful, and about what the implications could be for people of authority (especially if English or Afrikaaner) under the old regime.  In 1994, a general election was held amid car bombings and other scattered violence, and the Truth and Reconciliation Commission (TRC) was proposed. The inquiry would commence the following year.

Whether or not he left South Africa because of fears of crime as he claimed, amid that tide of change, the colonel and chief psychiatrist at Ward 22 in the Voortrekkerhoogte military hospital in Pretoria (and former head of psychiatry at the University of the Orange Free State) did what anyone afraid of uncertain consequences might do: he fled to a place that he felt was most friendly to his worldview, and most willing to look the other way about anything he might be alleged to have done, regardless of whether those allegations were true or not.

And so, before he could be called to testify at the TRC, Aubrey Levin fled to Canada.  There, after a brief stint as regional director for the Regional Psychiatric Centre in Saskatoon, he became a professor of Forensic Psychiatry at the University of Calgary, and established a practice at the Peter Lougheed Hospital.

Canadian media continue to fear looking at the Aversion Project, due to the fact that the allegations remain untested in court.  But in looking at this past, some patterns emerge.

“Consent” and the Clinic

The Daily Mail and Guardian published a 132-page study entitled “The Aversion Project,” although it is now difficult to find it archived online.  In that report, we find the one peculiar link that does in fact connect what happened in South Africa (whether Levin was involved or directed the Project, or not) to the incidents of abuse in Calgary for which Levin was charged: a gross distortion of the idea of “consent” within a clinical setting in which patients didn’t genuinely have an option on whether to consent, and little to no information about what they’d be subject to.

The medical profession is reputed for pathologising any form of behaviour. For example, it is known that the military has a history of doing sex change operations— many sex changes were done in Military hospitals. One has to ask to what extent this was experimental. (Workshop 1999) Although in any medical advancement there is always a cutting edge of experimentation, in total institutions there is a captive audience. The question then reverts to one of ‘informed consent’ and whether the choices people are given are limited because they cannot say ‘no’.

In any total institution, one has a captive audience, and the medics have protective insularity through their profession, so the environment is open for abuses to take place. Therefore special care should be taken not to abuse people’s rights. The Bill of Rights perspective should not only be applied to homosexuals, but seen in a broader light. There is the problem of marginalising groups again, but on the other hand the issues of the minority group should remain visible.

In a July interview for the Mail and Guardian for that study (now offline but referenced by the Gully), Levin was said to have admitted participating in aversion therapy, but denied some even more shocking allegations of forced gender reassignment.  The Gully articles claimed that former army surgeons estimated as many as 900 surgeries took place (a number that seems to come from journalist Paul Kirk and writer Terry Bell, although it’s not certain if this number includes chemical castrations or other medical procedures that differ from contemporary sex reassignment).  It’s important to repeat that Levin has never been publicly charged with any of the things alleged here, and rumours and allegations should not be confused with convictions.

When Levin has referred to treatments administered at Voortrekkerhoogte, his claims that the treatments were given to consenting patients may seem true from his own perspective… if one overlooks the participants’ situational vulnerability, the lack of information given to them, and the many various things that they could be threatened with — dishonourable discharge, outing to families and communities, the potential for trumped up charges, rewards for co-operation, and even the manipulation of internalized homophobic guilt, stigma and shame (which would have been much more common and seemed more monolithic in the context of the 1970s and 1980s).

The question of whether one can consent when the subject is a captive audience is a profound (though circumstantial) link between the Aversion Project and Levin’s Canadian convictions.  Even if he were simply present at Voortrekkerhoogte during the practices that the Aversion Project is known for, the application of those practices could have provided Aubrey Levin with the strategies to carry out his later abuses in Canada.  And to him, they might have all seemed technically “consensual.”

The Captive Audience

The power disparity, too, cannot be discounted.

I’ve never been to Calgary’s Forensic Assessment Outpatient Service (FAOS), but I am familiar with its Edmonton counterpart, Forensic Assessment Community Services (FACS). FACS was the downtown clinic that dealt with many of the city’s “hard” cases — people who needed medication to manage psychosis, who were ordered by the courts to undergo psychiatric evaluation, who got into trouble and couldn’t afford reputable help, who had no money or community supports, or who had been referred by hospitals after attempting to self-harm.  In Edmonton’s clinic, it was also one of the two clinics in the Province of Alberta that treated transitioning transsexuals… so I became amply familiar with it.  It was a space thick with desperation and rage, a high-security clinic where the waiting room would at once be awash with tension and hopelessness and fear.  One had to be buzzed into the back where the therapists offices are, often escorted. I hesitate to portray the clinics too negatively, because many of the people there have been held down by poverty and strife, and sincerely try to rise above the circumstances that resulted in their treatment.  The clinicians, too, are often dedicated to their work, even if the extension of one hand in empathy is balanced with readying for conflict, with the other.  Yet, the setting can’t help but feel oppressive.  Some of the doctors were burned out; others had an intense dedication to their work, but the circumstances in which they practiced left them hardened, jaded.  When one is at a clinic like FAOS or FACS, it’s often because they have no choice, whether legal, economic or otherwise — one has nowhere else to go, and usually has several hoops to jump through in order to access the care that ones life is dependent on, in some way.

People are particularly vulnerable in a place like FAOS and FACS, and often not very respected when they go into care.  There are often conditions at every step, such as required follow-up reports to probation officers, or else subsidized housing or income (such as Assured Income for the Severely Handicapped support) are dependent on continued treatment.  It’s also a setting where small gestures easily put one into a dependence scenario.  In a clinic like FACS or FAOS, a therapist is in a position of control from which he could threaten to withdraw his support for a patient’s social assistance, or even terminate care in a way that would land them back in jail.  And although outside of the mandate at FAOS, it’s certainly possible that a therapist could increase patients’ dependence by providing some food or loose change — as happens, in that setting.  This was all in addition to the intimidation patients would experience by the visible respect forensic therapists had within the psychiatric and legal communities.  It’s obvious to me why the original complainant felt he had to record the sessions more than once in order to be believed by authorities (and why prosecutors found the trial particularly difficult).  When a therapist takes someone to the private examination room, they could be more or less helpless to do anything other than play along.  From the testimony of RB, the complainant (his name is under a publication ban) who secretly filmed two visits, and who was seeing Dr. Levin by court order:

“I didn’t know what to do, because I knew Dr. Levin could send me to jail by the snap of his fingers,” the man said.

“Now that I think about it I think he would say that I was delusional.

“I was scared that they would tell Dr. Levin that I said that … he would deny it and I would be in jail, or a straight jacket — who knows.”

Whether or not anything regarding Aubrey Levin’s alleged association with The Aversion Project can ever be substantiated, the overlapping similarities between those things that are known provide some important lessons.

What remains to be seen is whether anyone hears and learns from them.

(Crossposted to The Bilerico Project)

MP’s trans predator fearmongering escalates.

On Friday, Sun News commentator Brian Lilley interviewed Rob Anders, the Member of Parliament who has drawn condemnation for conflating transsexual and transgender people with sexual predators in a petition he has been circulating on his website, and to at least one church in his riding. In “Children’s bathroom bill reaches Parliament Hill,” both doubled down on conflating trans people with sexual predators, and suggested that granting human rights inclusion will somehow enable and legally absolve predatory acts.  Anders claims there is “all sorts of examples of this going on.”  Which is news to anybody else.

Lilley introduced the interview by once again calling for the defunding and privatization of CBC, the network which first broke the Anders story, and which Lilley has tried to portray as ludicrous for taking note of the petition.  During this time, though, Lilley has also been taking note of a Toronto District School Board (TDSB) policy that accommodates trans kids.  Like fellow Sun News Network commentators Michael Coren and Faith Goldy, he’s made that all about washrooms.  While discussing the TDSB policy with Anders, they arrive at this exchange:

LILLEY: We are going and changing all kinds of things that… I agree with you, could put people at risk of being exposed to perverts to fix something that is, what, one percent of one percent of one percent of a subset of a subset?

ANDERS: Yeah.  You know, why would we lower peoples’ natural defenses of a man going into a woman’s bathroom in order to “accommodate” [scare quotes added because at this, Anders appears to grin mockingly or suggestively]  this very very small, you know, part of the population.  In order to expose all sorts of women and girls to this…?

At that point, Rob Anders relates a phone call that told an anecdotal story of a crossdressed peeping tom who allegedly peered over stalls in the Canterra building in downtown Calgary four years ago.  Searching various media online, there appears to be no corroboration that it even occurred, let alone that it happened as related.  The network sensationalistically underscores this story with staged photos that are supposed to be representative of trans people in restrooms, including one featuring a urinal covered in police tape, and another showing someone with a long wig and a dress standing at a urinal.  Or at least I’m assuming they’re staged, because it would be concerning if someone is snapping candids in washrooms.

At an earlier point in this interview, Brian Lilley also points to one of the men accused of chaining and abusing a Nova Scotia teen — the attacker was said to have occasionally dressed in womens’ clothing.

Most Canadians either don’t know someone who is transsexual or transgender, or else aren’t aware that an acquaintance is trans (and given my experience as a community advocate, I suspect it’s more often the latter).  For this reason, Anders and Lilley float these examples as being representative of all trans people, and as justification for excluding those entire characteristic classes from basic human rights protections.

LILLEY: “Then he’s free and clear.”

Enter Bill C-279, An Act to Amend the Canadian Human Rights Act and the Criminal Code (Gender Identity and Gender Expression), which is a human rights bill addressing employment, housing, access to services and discrimination.

The bill says nothing about washrooms, which Lilley briefly acknowledges before calling washrooms a side effect of the bill, and then continuing to focus on them at the expense of all else.  C-279 also wouldn’t change the fact that trans people have already been using washrooms appropriate to their gender identity for decades.  But it’s at this point that Lilley and Anders claim that the bill would somehow essentially absolve the people in their examples of any culpability for their actions.

ANDERS: “Then he’s free and clear, that’s right.”

Readers are invited to find any example in which rape, molestation and other illegal and inappropriate behaviours were suddenly excused because the perpetrator was a member of a class listed in human rights legislation.  As equal human beings, we are all still responsible for behaving ethically and respectfully toward our fellow human beings, and to face the legal consequences if we don’t.

We also don’t exclude entire groups of people from public washrooms (let alone human rights) on the off-chance that one of them might be a sexual predator.

When I wrote about the history of the “Bathroom Bill” meme, one thing I didn’t mention is how opponents of trans rights initiatives tended to conflate trans people with predators, and then when called on it, would habitually backtrack to say it wasn’t trans people they were worried about, but that they thought trans-inclusive legislation could provide cover for actual predators to commit acts of sexual predation.  And then they’d go on talking about “transgenders” with hairy legs and skirts stalking children and doing unmentionable things in washroom stalls, as a reason to block human rights legislation.

But with the way Lilley’s interview is presented, there’s visibly no effort at all to make any kind of distinction.

And all of this, of course, completely overlooks the dangers to safety of going the opposite direction and forcing transsexual women to use a men’s room.  Or whether women would be happy having trans men in theirs.

Which brings us to Brian Lilley’s bottom line:

LILLEY: “Why do we have all these groups mentioned to get special treatment in the Human Rights Act, in the Criminal Code?  I thought we believed in treat all people equally and fairly in this country.  And why don’t we just get rid of all this nonsense and say all people are equal above and beyond [sic] before the law?”

Overlooking the fact that you just referred to equality as “special treatment,” Mr. Lilley, it is most likely because there is ample evidence that there are clearly bigoted attitudes and beliefs about entire groups of people, conflating them with abhorrent actions and behaviours — even to the point of circulating petitions, making comments on the floor of the House of Commons, and reporting them on television as fact — in ways that make discrimination against those groups likely or even inevitable.

Sun Media’s Brian Lilley interviews Rob Anders

(Crossposted to Rabble.ca)

Rob Anders, the transsexual bogeyman, and the weird phenomenon of MPs petitioning their constituents.

Rob Anders is on a mission.  Hot on the heels of having to halfway apologize for alleging that NDP leader Thomas Mulcair drove former NDP leader Jack Layton to his grave, Anders is now sending at least one church (possibly more) a letter asking them to petition MPs to oppose Bill C-279, which would (in its current form) extend human rights protections to transsexual and transgender people.  You’d almost think he needs an easy deflection, and trans people are the punching bag du jour.

It must be important, too.  For a Member of Parliament who has gained a reputation for falling asleep during Question Period in the House of Commons, allegedly napping through presentations about homeless veterans, and about whom fellow MPs have stated that “It’s a regular occurrence… I sit across from him when we meet in Ottawa and I’ve seen his neighbours poke him awake sometimes,” this must be pretty urgent, attention-getting stuff. After all, he’s staying focused on this one.

In his original letter, he raises the alarm:

“That Bill C-279, also known as the “Bathroom Bill”, is a Private Members Bill sponsored by B.C. NDP MP Randall Garrison and its goal is to give transgendered men access to women’s public washroom facilities.

“And that it is the duty of the House of Commons to protect and safeguard our children from any exposure and harm that will come from giving a man access to women’s public washroom facilities.”

Ah, he wants to protect women.  Hence his vote in support of M-312, which hoped to make government an arbiter of what reproductive health decisions women are allowed to make.  How chivalrous.

The Calgary West MP has stirred up controversy before, sending Canadian troops a Christmas message which read, “when in doubt, pull the trigger.”  He also made international news when he called Nelson Mandela a terrorist.  In 2010, 19 members of Anders’ riding association quit citing interference from the Conservative Party, with another 5 of the 32-member board following in the days afterward.

I’ve written before about washroom panic, and the historic use of this non-existent epidemic (considering that we’ve used public restrooms for as long as we’ve existed, and not seen any statistically notable number of instances of predation) to oppose all basic human rights inclusion for trans people, and have to admit that Anders’ comments pale in comparison (probably only because of brevity) to the rant that Niagara West-Glanbrook MP Dean Allison delivered right on the floor of the House of Commons this past April:

“I find this potentially legitimized access for men in girls’ bathrooms to be very disconcerting. As sexual predators are statistically almost always men, imagine the trauma that a young girl would face, going into a washroom or a change room at a public pool and finding a man there. It is unconscionable for any legislator, purposefully or just neglectfully, to place her in such a compromising position.“

Still, Anders is careful to make his talking points look original, although they are really not that different from Allison’s, the panic letters previously sent from LifeSiteNews, rants by Charles McVety, or the letter sent by MP Maurice Vellacott to his fellow MPs when the predecessor of this bill, Bill C-389, trekked through the previous session of Parliament, forwarding comments from a “constituent” who turned out to be Jim Hughes of the Campaign Life Coalition.  Or the editorial written by MP Blake Richards in the Rocky View Weekly as C-389 proceeded to Third Reading.  That bill passed, but died awaiting ratification by the Senate, when the election was called.

Rise and shine, SunTV

Anders’ comments also come as Sun News Network commentators Michael Coren and Faith Goldy are reacting negatively to the Toronto District School Board’s introduction of a policy that will allow trans students to use washrooms that are appropriate to their gender identity — even the Toronto Sun implies that trans identity is whim by phrasing it as using “whichever washroom they wish.”  The TDSB ruling is in response to a 2011 ruling by the Ontario Human Rights Commission, and addresses accommodating trans kids (something badly needed), but like Anders, Coren and Goldy fixate on potty panic.  Transcribed by the Huffington Post:

“Goldy was quick to make the issue personal. ‘I cannot but help but bring this story back to my 5-year-old god-daughter and the fact that when she goes to the bathroom by herself who knows what kind of creepo is now fully permitted, he has the right now, to be standing in that bathroom and doing God knows what,’ the reporter said.”

“Who knows what” is probably peeing, and trans people value their privacy during that as much as any other Canadian, thank you very much.

Goldy, like Anders, deliberately misgenders female-identified trans people.  We know that Anders isn’t referring to anyone else when he is petitioning about “transgendered [sic] men” because the trans men I know would generally not be wanting to use the womens’ room anyway.  Granted, womens’ restrooms tend to be cleaner, but those beards might raise questions.

I’ve seen that kind of deliberate misgendering a lot, and typically the objective is to portray trans people as being deluded at best or else outright fraudulent.  But when this kind of intentional disrespect comes from politicians and media figures, it especially needs to be challenged.

“I’m petitioning you to petition me…”

Although Anders’ comments are obviously not new, it signals a growing trend when Conservative MPs start actively lobbying their constituents to lobby them for petition signatures.  This is reminiscent of Jason Kenney’s recent letter to congratulate himself on his efforts as a champion of LGBT human rights, and his previous petition to petition his constituents to petition him to thank him for petitioning them to thank him (or something) on his valiant initiative to deny health care to immigrants.  With Anders, Vellacott, Allison et al actively stirring up fears of an imaginary transsexual bogeymonster in order to defeat human rights legislation, it signals a disturbing trend among legislators — in these cases, Conservatives — by attempting to manipulate the public conversation and skew public input in a way that would appear to support their personal agendas.

Which brings me back to a point I’ve made before, and made often:

Human rights protections are necessary exactly because this irrational fear persists.  It’s necessary exactly because trans people still get conflated with sex predators and child predators, or labeled as “sick,” “perverse,” and “freaks.”  It’s necessary exactly because people become so clouded with assumptions and myths that they argue for our deliberate exclusion from human rights under the pretext that granting them would be “dangerous” or “scary.” It’s necessary exactly because this bias is so entrenched that people think nothing about broadcasting it openly as though fact.  It’s necessary exactly because this “ick factor” response is seen as justification for not allowing an entire group of people to share the same space, to terminate their employment or to evict them.  It’s necessary exactly because it is so pervasive that discrimination becomes not only likely but inevitable — especially if there is no explicit direction in law to the contrary on the matter.

And especially if that irrational meme is so prevalent that it’s being loudly and embarrassingly parroted by legislators.

The sponsor of Bill C-279, Randall Garrison, has responded to Anders’ petition, saying that “what’s most offensive about his petition is that he equates transgendered people with sex offenders and pedophiles.  This petition is obviously based on ignorance, misinformation and fear, but that’s unfortunately what we’ve come to expect from Mr. Anders.”

Rob Anders, however, has been not responding to requests for comment.  Maybe he’s nodding off, after all.

(Crossposted to Rabble.ca)

Alberta reinstates funding for Sex Reassignment Surgery

The Alberta Government has announced that it will be reinstating health care funding for sex reassignment surgery (often called gender reassignment surgery, and abbreviated as GRS by the province and its clinicians), effective June 15th.

In the recent provincial election, Premier Alison Redford was returned to power by an electorate that appears to have been hoping her government would track back toward progressive politics.  Albertans have been watching to see if her government would indeed follow through, and in what manner.  An Angus Reid poll placed Ms. Redford as the second most popular Premier currently in power.

The province had cut funding in 2009 as a “cost savings measure” — however, the $700,000 savings (provided for approximately 16 people per year) wasn’t even a sliver of the provincial health budget.  Since then, the Province has been on shaky legal ground with the funding cut, since human rights tribunals have typically recognized the procedure as being medically necessary.  It was for this reason that the Province of Ontario ultimately reinstated funding, and B.C. abandoned an attempt to defund the surgery.  Judicial court rulings (eg.) in Canadian case law also indicated a likelihood that the medical necessity of GRS would be upheld.

The Trans Equality Society of Alberta responded to the announcement with a media release:

We are pleased that the current administration sees value in caring for all Albertan’s needs, enabling them to live happy, fulfilled lives.  The return of this coverage, who’s removal only saved Albertan’s $0.18 each annually, will give hope to those for whom GRS was previously out of reach.  While there are many other issues facing Trans-identified Albertans, this is a huge step in the direction of respect and dignity for the Trans Community by the Alberta Government. Thank you for taking this important first step.

The American Psychiatric Association and American Medical Association both stress that sex reassignment surgery is a medical necessity, and a 2008 resolution by the AMA emphasized that insurance companies should cover the procedure.

Most Canadian provinces have some form of coverage for GRS, although some have problematic quirks of process or costs that can create barriers to obtaining the procedure, and some still do not fund sex reassignment procedures for trans men.  In 2008, Nova Scotia’s Liberal Party added working toward GRS funding inclusion to their political platform, although it has not yet been accomplished in that province.

Internationally, several nations have also added coverage to their public health insurance programs over the past couple of years, including Cuba, Brazil, and Chile.  Argentina recently passed the most comprehensive policies on trans enfranchisement, which included GRS funding, new name change guidelines, anti-discrimination inclusion in their human rights code, and legal protections from hate crimes.  A number of Australian provinces are under renewed pressure to provide funding after an incident of attempted self-performed surgery in an act of desperation.  There have been (trigger warning) at least three other major self-mutilation incidents reported in international media in the past year, including one person in China who self-castrated and then jumped to their death because they couldn’t deal with the pain.  Although not all trans people decide that they require surgery, for those who do, it can be an absolute necessity.

Corporations have also been rapidly adding health plan coverage to their benefits programs, including Apple, Chevron, General Mills, Dow Chemical, Chubb, American Airlines, Kellogg, Sprint, Levi Strauss, Eli Lilly, Best Buy, Nordstrom, Volkswagen’s U.S. division, the University of Pennsylvania, Whirlpool, Xerox, Raytheon and Office Depot (note: some of these may not apply in Canada).  According to the Human Rights Campaign’s Corporate Equality Index (CEI), over 200 major U.S. businesses now include trans-inclusive health care coverage featuring surgical transition-related care, including 50% of Fortune 500 companies — an increase of over 1500% in that group since 2002.

Alberta’s 2009 announcement was followed by a mass filing of human rights complaints.  Due to changes in grandfather-through decisions, some of those complaints were negated when funding was given, and others are still in process.  Due to the backlash at the time of the announcement, the province had eventually conceded to provide funding for people already in transition prior to the cut, to a maximum of 20 per year.  A number of others who had not qualified for the “Phase Out” program (usually because of the timing of their first medical appointment after starting transition) had been typically offered GRS funding as part of a settlement during negotiation stages of their human rights complaints, but have not spoken to media due to confidentiality requirements.

Although this victory is huge, some concerns about medical access remain.  It can be difficult or near impossible to find trans-friendly (let alone trans-aware) medical practitioners in several regions of the province. This can make it hard to even find general practitioners willing to treat people for medical issues that are not trans-related.  For transition care, there is one clinic in Edmonton (therapy only, currently with an 18+ month waiting list) — in Calgary, there is also a once-a-month trans health clinic operated by a psychologist and a family doctor who’ve teamed up to try to help, but the need is one that is difficult to fill with a once-a-month model.  The previous Stelmach government had shut out attempts by the trans community to speak about these matters, and advocates are hopeful that this can now change.

On Wednesday, the Federal government voted to allow a human rights bill proposing protections for transsexual and transgender Canadians to committee for review and possible changes, toward a final vote.  The bill had passed in the previous Parliament, but died in the Senate upon the election call.

(Here is a full backgrounder on why GRS is medically necessary.  It is also available as a trifold brochure)

(Crossposted to The Bilerico Project Dented Blue Mercedes and Rabble.ca)

What to Expect from a Harper Government (In The Bedrooms of the Nation III)

Previously:

I: A Brief Canadian History of Political Forces

II: The Opponents of Social Progress: Roadmap to the Far Right

As Stephen Harper and the Conservative Party seek a majority mandate, there is no shortage of speculation on either side of the map as to what a non-progressive Conservative majority would look like in Canada.  By some accounts, we’d see a new capitalist utopia of crime fighting and McJob creation.  By others, we’d see a social agenda unleashed which, now completely unbridled, would rewrite Canada into a Christian Nationalist dictatorship.

But we’ve seen already how Harper is completely cognizant of Canada’s inclination for social progress, and having to tightrope in order to maintain the far-right extreme and the centrist support he needs to maintain power.  Stephen Harper is gaming, and he is not going to seek only a 4-year majority.  He is in it for the long haul, and that means tightroping for as long as he can.

In The Bedrooms of the Nation I: A Brief Canadian History and Political Forces

Social consciousness was in a state of flux.  Oral contraceptives had been available in the U.S. for several years but were banned in Canada.  Sodomy had been decriminalized in the U.K. in 1967.  Medical professionals and activists called for the legalization of abortion in circumstances where the pregnancy caused immediate danger to the mother.  And George Klippert was convicted of “gross indecency” for having consensual gay sex — and because he was determined to be “incurably homosexual,” he was sentenced to indefinite “preventive” detention (essentially a life sentence, which the Supreme Court of Canada later upheld).

On Dec. 21, 1967, Justice Minister and future Canadian Prime Minister Pierre Elliot Trudeau responded by introducing Omnibus Bill C-150, which amended the Criminal Code of Canada.  It decriminalized homosexuality, made abortion possible, legalized contraception, tweaked gambling and gun laws, and more.  It passed on May 14, 1969, coming into force on the eve of the Stonewall riots in New York City.  When introducing the bill, he famously told CBC,

“there’s no place for the state in the bedrooms of the nation.“

42 years later, it keeps trying.