Petition: Transgender care expansion rather than contraction!
Principle 17 is deeply concerned about the current abuses in transgender care. Therefore, we started the petition "Transgender care expansion rather than contraction" through Petities.nl. Below you can read the extended version of the petition, with a detailed explanation of all the points mentioned.
The undersigned note:
- Unacceptably long waiting times in transgender health care:
For years, transgender health care has suffered from a chronic shortage of capacity, resulting in long waiting lists and a total delay of two years (or more) between entry and medical treatment (according to Foundation Patient Organisation Transvisie, dated 9 June 2016).
- Needless care provided in transgender health care:
Transgender people are unnecessarily pathologised and medicalised. Psychological counseling is compulsory to apply for somatic care. This is in violation with human rights as stipulated in Yogyakarta Principle 18.
- Unnecessary expensive care in transgender health care:
The gender teams work according to a one size fits all protocol with fixed parts. Transgender patients are therefore forced to undergo medical treatments, that many often even don't agree with.
- Closure of clinics for transgender health care:
Dr. Kanhai at Northwest Hospital Group has to resign his unique work, because it would be "too fragile" that he is the only surgeon who can perform these specialised operations (according to the Northwest Hospital Group). Dr. Kanhai is performing these procedures for years, which was never a problem until recently.
The gender poli Curium-LUMC is closing, because the treating team would be "too small" (according to Curium-LUMC, dated 10 January 2017).
- Monopolisation of transgender health care:
As a result, the Center of Expertise on Gender dysphoria (KZcG) of the VU University Medical Centre in Amsterdam and the University Medical Center Groningen (UMCG) in Groningen acquires a monopolist position, which unable transgender people to consume their right to free choice of practitioner.
and are concerned about another limitation of transgender health care in the Netherlands, and therefore demand the following:
- Expension of health care to transgender people:
If the current situation proves anything, it's an urgent and sustained great need for expansion of transgender health care. To ensure health care in long term a need exists for investment in both jobs and education.
In 2014, health insurers made the reopening of the KZcG of the VU University Medical Center (VUmc) possible to new health care recipients (according to the VUmc, dated 23 May 2014). In previous years structural problems with waiting lists existed as well. Now the access is clogged again: waiting times to all parts are far beyond the standards of 6 to 8 weeks (see Treek standards). The solution is not in further concentration and monopolisation, but rather in decentralisation of care, such as the policy of recent years clearly shows.
- Free choice of practitioner:
Each patient in the Netherlands has the right to choose their own practitioner. This should also apply to transgender patients.
Transgender health care is regular care. Prescribing and monitoring hormone supply is a simple medical procedure, which any skilled (general) practitioner can perform. For transgender care recipients too this must be a regular possibility. In special cases may be referred to a specialist, as is done with other care recipients as well. The Standards of Care, the internationally recognised guidelines for transgender health care, are explicitly allowing this practice.
- Decentralisation of transgender health care:
Transgender health care mostly is very regular health care and therefore can simply be provided by local practitioners (such as the provision of hormones). Certain surgical procedures only require specific knowledge and skills.
Because transgender health care is regular care, this care can be easily decentralised, making it more easily accessible to people who need this health care. With decentralisation of transgender care, combined with training of interested clinicians, the current capacity shortage can be solved, easily and within a relatively short time.
- Introducing the principle of informed consent:
A clinician informs the transgender patient about the advantages, disadvantages and consequences of possible treatments, so they can make a considered decision, in consultation with the clinician. Abolition of compulsory psychological counseling.
All somatic care is covered without a mental health professional as a gatekeeper, with the notable exception of health care for transgender people. They would be "special", but no one is able to explain what would be this special about transgender health care. This practice is contrary to human rights as stipulated in Yogyakarta Principle 18.
- Introducing cultural competency training in (para) medical curricula:
Trainings should pay attention to dealing with transgender people, as it concerns about 4% of the population. This results in informed health care professionals and therefore wrong diagnoses and incorrect treatments belong to the past.
In education almost no attention is paid to dealing with transgender people, while they are about 4% of the population. In this way the knowledge gap and the lack of understanding by (para) medical professionals continue to exist, resulting in discrimination by ignorance, incorrect diagnoses, unnecessary or wrong treatments, care refusal, etc.