Recent articles have looked at how the Model of Care (MoC) of the National Gender Service (NGS) came to be, who approved it and how some decisions were made without quorum. As someone who has been scrutinising Irish trans healthcare for a little while, these are not the only parts of the Freedom of Information (FoI) request that stood out.
Take for example this part of the minutes of the 31 May 2018 meeting of the steering group that went on to establish the NGS:
This is saying that this steering group has agreed on their own Terms of Reference (TORs), and includes implementing WPATH. Here that would mean the WPATH v7 Standards of Care (SOC) from 2012 as they were the current version at the time.
Both Dr. Paul Moran and Prof. Donal O’Shea attended this meeting:
In an email on 5 June 2018 this is confirmed and the Terms of Reference (TORs) for the steering group updated (the highlighting is original):
There’s only one further mentions of the TORs for the steering group, on the 28 June 2018 meeting where they are signed off:
Unfortunately the attendees of this meeting are not known and the minutes were not filed properly, possibly due to someone being out on sick leave.
The next mention of WPATH is in a statement to the CEO of TENI on 9 October 2018, as part of informing him of the creation of the NGS:
In context this is saying that the NGS is following WPATH guidelines, but with higher standards. As the WPATH SOC itself says:
So the NGS is saying that it is following WPATH v7 SOC.
It hurt herself in its confusion
You may be at this point scratching your head a bit, and wondering why the over-punctuated headline of this article? Why do these statements about WPATH stand out? Some doctors are taking some widely used guidelines and tweaking them in a way that they think will be better. This all seems rather banal.
Let’s start with a paragraph from a 2020 article by Stella O’Malley whom The Beacon has previously covered:
It seems that between 2018 and 2020 that Prof O’Shea’s opinion on WPATH changed.
A 2021 article adds to the confusion:
It seems that between 2018 and 2021 Dr. Moran’s opinion on WPATH has also changed. This calls into question the statement that was made to TENI that the NGS MoC follows WPATH.
Later in the same 2021 article:
So as far back as at least 2016 both Dr. Moran and Dr. O’Shea considered WPATH to be unsuitable, and the 2016 MoC which is the basis of current NGS MoC was not based on WPATH.
This leads me to wonder, why don’t the 31 May 2018 minutes of the steering group mention this disagreement? You would think that such a strong objection would have come up and at the least be minuted when the steering group was changing its TORs to mention following WPATH.
A September 2022 article indicates this disagreement goes back years:
So it would seem likely that even in 2018 that Dr. Moran held this opinion about WPATH, if not earlier.
There’s a little more context in an October 2022 article quoting an analysis circulated by Dr. Moran:
This gives me an excuse to talk about my favourite page of WPATH v7 SOC, which is of course page 35 as it covers informed consent based models of care:
As covered above the SOC is flexible enough to permit healthcare professionals to include MoCs such as the NGS’s as indicated in the letter to TENI, but also MoCs that involve less intensive practices. In essence the NGS appears to be rejecting WPATH SOC because other health professionals can use it to create different MOCs than the one they came up with.
This rejection from the NGS also seems to have missed the bit on page 35 where the WPATH SOC says a mental health assessment is important prior to prescribing hormones under an informed consent model:
Trying To Make Sense
By now I think you have some appreciation for my confoundment, and that in this case the multiple punctuation marks are not a sure sign of a diseased mind.
If you take the newspaper articles at face value it would appear that the two doctors behind the NGS’s MoC have not been fans of WPATH since at least 2016, and their opinion on this surfaced in the national media beginning in 2020. Despite this in 2018 they didn’t object when in the meeting where following WPATH was added to the steering group’s TORs, nor when TENI was informed that the NGS would be following WPATH but better.
Maybe some broader context of what was happening around trans healthcare around these timeframes will help us understand this situation.
The 2017 MoC led by Dr. Crowley was proposing a WPATH v7 SoC-based system, including a National Gender Identity Clinic in Loughlinstown where the NGS now is. It appears the 2018 funding for the NGS was allocated on this basis as mentioned in a previous article.
In February 2020 the Steering Committee on the Development of HSE Transgender Identity Services concluded its work, with its report being published in December 2020. It proposed developing a new TOR for NGS TORs, looking again at the WPATH-based 2017 MoC, and Department of Health guidelines. It was this report that also led to the letter at the core of a previous article.
The June 2020 Programme for Government includes implementing a new health policy for trans people based on WPATH.
It’s difficult to know what’s exactly going on here, but maybe you’ll have some of your own ideas about what’s happening.
Jessica Black (she/it) considers it intensely normal to have a favourite page of the WPATH v7 SOC.
Featured image via Flickr – Marco Verch Professional Photographer