De-sexing the Medical Record? An Examination of Sex Versus Gender Identity in the General Medical Council’s Trans Healthcare Ethical Advice
What do the terms sex and gender identity, or gender history, mean in a medical context? When does it matter to a healthcare professional whether a patient has male or female reproductive biology? How should a doctor approach a patient who does not wish for their biological sex to be openly acknowledged? The General Medical Council (GMC) advises doctors that transgender patients may have the marker for their sex amended to instead reflect their gender identity. This paper will attempt to critically examine two key points in the GMC trans healthcare ethical advice using Beauchamp and Childress’ Four Principles approach, exploring how doctors might consider an incongruence between sex and gender identity in clinical practice.
Introduction:
The General Medical Council (GMC) provides ethical advice for doctors on how to manage patients who are trans or transgender (i.e. patients who do not identify as their biological sex). Under ‘Confidentiality and equality,’ the GMC (2016) writes:
Respect a patient’s request to change the sex indicated on their medical records; you don’t have to wait for a Gender Recognition Certificate or an updated birth certificate.
Don’t disclose a patient’s gender history unless it is directly relevant to the condition or its likely treatment. It’s unlawful to disclose a patient’s gender history without their consent.
The GMC appears to suggest that some patients be allowed to change the marker for biological sex in their medical records, implying that their sex observed at birth should be ignored (or at least hidden) in a confidential medical history.
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