Katherine Zappone (Independent) | Oireachtas source

I move amendment No. 4:

In page 6, between lines 2 and 3, to insert the following:“ “general medical practitioner” means a medical practitioner who is registered in the Specialist Division of the register of medical practitioners under the medical speciality of “General Practice” or in the General Division of the register of medical practitioners;”.

I will speak to amendments Nos. 4 to 6, inclusive, and will leave other Senators to comment on the others. These amendments all relate to the effort to amend the Bill to include a general medical practitioner in the definition of the primary treating medical practitioner. Before I make a few arguments in that regard, because I have spoken about this previously, I want to say that this is not the ideal situation. Under international best practice and some of the best models of law, no form of medical certification is required to accompany a trans person's solemn and statutory declaration that they seek to live in their preferred gender identity. This is not a top-of-the-class type of amendment. It is a conservative amendment.

If a medical certificate is required to accompany a transperson's statement of intention, at the very least we should include a general medical practitioner as part of the definition of the primary treating practitioner. As the Minister of State knows, the Bill as currently formulated requires an endocrinologist or psychiatrist to certify that an applicant is transitioning or has transitioned to the applicant's preferred gender.

In Ireland the range of medical practitioners who may provide such certification is limited to a small number of specialists. This will lead to significant delays in obtaining appropriate certification. It will prove even more difficult for people who have undergone transition several years ago or abroad. Most transpersons I have spoken with do not have a regular treating endocrinologist or psychiatrist. These amendments would allow a person's GP to certify him or her as having met the requirements contained in sections 9 and 11 of the Act.

Where an applicant has a regular general practitioner, the GP will likely be more familiar with the applicant's current circumstances and situation, and will be well placed to provide the relevant certification for the applicant. The fact that the definition of the primary treating physician does not include a GP, is at odds with the HSE's view. The HSE has also put forward the view that a GP should be included in this definition, and that the language of the Bill without that is incongruent with current health practice. That is because a person's primary treating medical physician is almost always a GP.

The current emphasis on medical evaluation clearly suggests diagnosis, medical evidence and medical proof, and is restricted to the applicant. The HSE has also argued that if this legislation - concerning just the primary treating medical physician - draws solely on endocrinology and psychology, it will place excessive pressure on specialised and limited resources as the number of clinicians and health professionals with the relevant expertise in this jurisdiction is very small.

The HSE estimates that approximately 1,000 people will at some time, on the introduction of the legislation, seek a gender recognition certificate which will place unmanageable pressures on already scarce resources. That is the view of the HSE, in addition to my own view.

Hopefully, transpersons will be allowed to go to their GP. However, amendment No. 6, which is quite lengthy, is to ensure that the process for recognition is not made dependent on the applicant undergoing surgical, medical or psychiatric treatment, or an evaluation on physical or psychiatric grounds. The measure is simply to emphasise what the Minister of State has already confirmed, namely, that the applicant will not be required to undergo, or have undergone, any surgical or medical treatment, including hormonal or psychiatric treatment, as a precondition to gender recognition.

This amendment is simply codifying the ministerial promise. There is no legal guidance for medical professionals in filling out their form. If this kind of amendment, or a version of it, is not accepted I think that room will exist within the law for the medical person possibly to negate the human right to privacy and self-determination of the transperson, which should be at the heart of our legislation.