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Lord Filkin: My Lords, I do not want to labour the point because we have given these issues considerable attention in Committee and today.

Such people who do not have surgery are few. There are usually good reasons for them not having done so. If the panel is not convinced that those persons are

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committed to living in a permanent state it will not grant them a gender certificate. However, to turn it the other way, for the state almost to say that unless people go through a process of bodily mutilation they will not have a legal recognition is wrong. I regret that we shall not agree on that issue.

I turn next to the composition of the panel. The medical member is not there to make a diagnosis. The diagnosis is to be provided by the person practising in the field of gender dysphoria. The medical member is on the panel to ensure that the medical evidence is properly understood and can be inspected or further inquires made if appropriate. The panel will be working with a list of medical practitioners and chartered psychologists who practise in the field of gender dysphoria.

With regard to there being several on the panel, few practitioners could be described as working in the field of gender dysphoria. Putting two on the panel would have significant disadvantages. It would also mean that they would frequently be seeking to make judgments on their own clinic or clinical work which, again, is clearly judicially flawed and, therefore, there would be further practical problems. So they are there to inquire into the medical evidence not to make the diagnosis.

On the interesting point about members of the medical profession raised by the noble Baroness, Lady Finlay, clinical psychiatrists are covered in Clause 3 under the term "registered medical practitioner". Chartered psychologists are members of the British Psychological Society, a professional body with which we shall work in developing the process. Having said that, I shall look further at what the noble Baroness said. If I have missed the point and dropped the ball, I shall come back to her before Third Reading.

I am sorry to have spoken at length but it is an important group of issues. I hope that I have stated clearly the Government's position.

Lord Chan: My Lords, I thank the Minister for that reply and all noble Lords who spoke. I accept that surgery is the end point and should convince anyone that the applicant is genuine. I concede that it would be difficult to make it a ground on which to provide a certificate. That would be seen to be cruel.

However, with regard to evidence and diagnosis, as I sought to outline, there are suspicions that within the medical profession medical opinions are given which may be extreme and not necessarily balanced because the medical practitioner is convinced of a certain point. With two medical members on the panel that issue would not arise.

Whether or not we like it, the ultimate issue is the diagnosis—being convinced—particularly if the applicant has not had surgery and there are other issues to consider. I admit that I am not familiar with the process and legal composition of a panel but that was the main purpose underlying Amendment No. 13. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Lord Chan moved Amendment No. 13:

    Page 14, line 7, leave out "one medical member" and insert "two medical members including—

(i) a registered medical practitioner recognised as currently practising in the field of gender dysphoria in the United Kingdom, and
(ii) a registered medical practitioner recognised as currently practising in the field of gender dysphoria in the United Kingdom, who has an entry in the specialist register held by the General Medical Council which confers their eligibility to practise as a consultant psychiatrist within the National Health Service."

The noble Lord said: My Lords, I beg to move.

On Question, amendment negatived.

Clause 2 [Determination of applications]:

[Amendments Nos. 14 to 18 not moved.]

Baroness O'Cathain moved Amendment No. 19:

    Page 2, line 10, at end insert—

"(4) The panel must reject an application under section 1(1) if the panel has issued a gender recognition certificate to the applicant on two previous occasions."

The noble Baroness said: My Lords, I tabled an amendment in Grand Committee which raised the issue of whether a person can go through the gender recognition procedure a second time in order to return to his or her biological sex. The Minister may remember that in Grand Committee on 14 January I moved a similar amendment. In dealing with Clause 9 I said that,

    "many people change their minds and revert to their real gender, or oscillate between the two".—[Official Report, 14/1/04; col. GC64.]

I quoted the Government as being behind that statement. The Minister cited a percentage figure of 1 per cent. Of course 1 per cent does not square with "many". I have since discovered that the source of the "many people" quotation was from page 5, paragraph 5.1 of the Home Office report of the Interdepartmental Working Group on Transsexual People published in April.

One does not have to look hard to find examples of people who wish they had never changed. The Sunday Telegraph Magazine of 15 November 2003 reported the case of a person called Claudia, who deeply regrets his decision to have reconstructive surgery and assume the identity of a woman. He said:

    "I changed for all the wrong reasons, and then it was too late . . . I was seen for 45 minutes by a psychiatrist in private practice, and I believe I was railroaded into thinking that an irreversible operation was the only solution. It made me feel they were just in it for my money".

He went on to say:

    "I feel like this sex change has just made me into some kind of freak. I'm not a real woman, I am a sex-change".

That is tragic. It is a side of the transsexualism debate that seems to be swept under the carpet, although I notice, as has been said already, that the Guardian of 20 January 2004 reported that the UK's best known "expert" in transsexualism is being investigated by the General Medical Council after claims that he sent patients for sex-change surgery without adequately assessing them. The Sunday

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Telegraph Magazine stated that the same person was involved, while running a private practice as well as working in the National Health Service,

    "in controversy over the condition known as body dysmorphic disorder, (BDD), where sufferers can experience a desperate urge to rid themselves of a limb".

Dr Russell Reid was one of the psychiatrists who referred two patients with BDD to a surgeon for leg amputations. The article continues:

    "'When I first heard of people wanting amputations it seemed bizarre in the extreme,' he said in a television documentary at the time, 'but then I thought, 'I see transsexuals and they want healthy parts of their body removed in order to adjust to their idealised body image,' and so I think that was the connection for me. I saw that people wanted to have their limbs off with equally as much degree of obsession and need.'

    But to what degree should doctors be acquiescent to the 'obsessions' and 'needs' of patients?"

It appears that the sex-change proponents have created all the running on this issue, yet there are genuine deep concerns by professionals which do not seem to be considered. The same article in the Sunday Telegraph Magazine referred to:

    "Dr Fiona Mason, a forensic psychiatrist with an expertise in gender issues, is seriously concerned about the practices of some private clinics dealing with transsexualism".

She said:

    "'I can't imagine assessing anyone suffering from a serious disorder in under three hours. It can take three years to assess patients with complex problems. The trouble with some private clinics is that the patients are just given hormones after an hour-long appointment, which can have an irreversible effect on the body.'

    Some critics are even going as far as to say that psychiatrists have not, in fact, 'discovered' transsexuals but created them. That is, that once 'transsexual' and 'gender-identity disorder' (GID) become common currency more people began interpreting their experience in these terms. Specialists working in gender-identity clinics made similar complaints about their patients as early as the mid-1970s".

Clearly, there will be some people who will go through gender recognition only to want to change back again.

In Grand Committee, the Minister assured me that the Bill already provides for that. However, it must be said that it is not clear on the face of the Bill. I know he will tell me that we must not put words into the Bill that do not need to be there, but we should have some reassurance, if only for people like Claudia, that it is possible to go back to your true sex in law, even if the surgery is not reversible.

My amendment would make it clear that reversal is possible at the same time as limiting a person to only two changes. That would allow a person to change his sex to a woman and then back to a man, or vice versa, but he or she could make no further changes after that. Otherwise, of course, it is possible that person could change back and forth throughout life. That would clearly be ludicrous, not to say very damaging for the person himself or herself. I know the Minister will say that the gender recognition panel will always be terribly sensible and it would never allow that, but we cannot be sure under the current wording. If he thinks a person should not be able to make multiple changes back and forth, he should be prepared to see a limitation placed on the face of the Bill. I beg to move.

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3.15 p.m.

Lord Filkin: My Lords, I thank the noble Baroness, Lady O'Cathain, for clarifying almost the double elements of this issue. The first element—and I do not think there is an issue between us about whether it is possible—is on the limited number of tragic cases where a person who might, after having gone through this enormously difficult and traumatic process, decide that they had made a mistake and wish to revert. Let me put it on record that while the number of such cases is likely to be extremely small, under the Bill it is completely open for the panel to grant the application to revert if it is convinced. The panel will be applying those three tests very seriously, and it will be applying them even more seriously because the person is reverting back.

On the second element, the noble Baroness suggested that we should put a provision on the face of the Bill to stop people making changes back and forth. I do not think that is necessary. The panel is there with expertise to make judgments. The central judgment it has to make in this respect is whether it is convinced that the person is committed to living permanently in that gender. I cannot think of circumstances—for example, in the extreme case of a person who has changed once and then has changed a second time—in which a panel would be convinced that it would grant legal recognition for a third change. I cannot conceive of a situation where a panel would be open to persuasion that that was possible.

One might ask, "Why not put the provision on the face of the Bill?" But why should we fetter the role and the duty of a judicial panel? We will give it clear criteria and through this legislation it should be left to get on with that job. Therefore, I think the law will allow exactly the change the noble Baroness wishes to allow. If the panel is convinced that a person has genuinely made a mistake then reversion is possible. I cannot see that there is a need to go further than that in the legislation.

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