On 25 September, the GMC updated its guidance on decision making and consent. This guidance comes into play on 9 November 2020.
It is recognised that consent, information sharing and joint decision making are key components of the doctor-patient relationship and are fundamental to the provision of safe and effective healthcare that suits individual patients’ needs.
The GMC has laid out seven key principles, and two of them are key to the care of transgender patients in the UK:
- All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
- Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care.
Involved in decisions
Patients have the right to be given care that suits them and that they request. This, of course, does not mean that any patient can simply demand an operation or a medication, and be given it. However, if a recognised treatment for a recognised medical need is available, and a patient understands the risks, benefits and side-effects of either having that intervention, or not having that intervention, then the patient’s wishes should be a key deciding factor.
The patient is an expert in their own body and mind, and the doctor is an expert in medicine and healthcare. This expertise must come together for the good of the patient. It is the duty of a doctor to give the patient enough information, in an understandable way, so that the patient is able to make decisions based on knowledge and fact. Rigid protocols and personal feelings must not prevent patients getting the care they are entitled to.
It must be presumed that adults have the capacity to make informed decisions made jointly with their doctor. This means that they do not have to be mentally or psychologically tested to make sure that they are capable of making rational decisions about their health. If there are any issues that arise which are cause for concern, then the doctor may feel the need to reassure themself that the patient is able to make sound judgements. This is not an evaluation as to whether the doctor thinks that the decision is a sensible one, but rather that the patient is unrestricted on making that decision.
What else is new?
Paragraph 17 states:
You should try to find out what matters to patients about their health—their wishes and fears, what activities are important to their quality of life, both personally and professionally—so you can support them to assess the likely impact of the potential outcomes for each option.
You must seek to explore your patient’s needs, value and priorities that influence their decision making, their concerns and preferences about the options and their expectations about what treatment or care could achieve.
Paragraph 21 states that doctors must give patients:
clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action.
The phrase “based on the best available evidence” is a new addition to this guidance. There are no published clinical guidelines for the treatment of transgender patients of any age in the UK. In the absence of any UK guidance, doctors should seek International, peer-reviewed publications.
There are recognised healthcare options available to transgender patients. They can undergo medical intervention to align their sex hormone profile, and surgical intervention to align their physical attributes, with the gender with which they identify.
These interventions should be readily available through joint decision making with healthcare providers. The patient must be guided by their doctor to make informed decisions for themselves. It should be presumed that patients are able to make the best decision for their situation, given correct and balanced information.
If you are a trans person, it is your right to access hormones and surgery on the NHS. It is your doctor’s duty to discuss the options available to you and to provide adequate information to enable you to make decisions about your care.