Amy Hamm: Tribunal punishes doc for conscientious objection to puberty blockers

The British Columbia Human Rights Tribunal (BCHRT) has released another in its series of decisions that punish and publicly humiliate those who disagree with gender ideology.

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The latest: a family physician who declined to administer a single injection of a puberty-blocking drug to a 14-year-old transgender-identifying patient was found guilty of discrimination and ordered to pay $20,000 for “compensation for injury to … dignity, feelings and self-respect,” plus $8,100 for the cost of the claimant’s “expert report” and — most outrageously — was instructed to “cease the contraventions and refrain from committing the same or similar contraventions.”

Note that I do not include the physician’s name, as he wished to protect his professional reputation with a publication ban on his identity. The BCHRT refused to do this.

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At the request of the claimant’s mother, the physician referred the claimant, who’s referred to in the ruling as “Child Q,” to the Gender Clinic at B.C. Children’s Hospital in 2020, where Lupron, an injection used to suppress puberty, was prescribed. The teen did not wish to self-administer the drug and instead preferred that a physician do it. Administrative staff at the doctor’s office booked an appointment for one of the injections without the physician’s knowledge. When he realized what the appointment was for, he declined to administer the drug.

The doctor “was learning for the first time that the purpose of Child Q’s appointment was to receive a Lupron injection. He understood — wrongly — that this was part of a process for ‘gender reassignment therapy.’ He says that he had never had any experience with that branch of medicine. He testified that, because of his religion, he finds it ‘conflicting and difficult’ to be involved in any part of ‘gender reassignment,’ ” reads the ruling. In other words, the adjudicator claimed that puberty blockers don’t count as “gender-assignment therapy.” The physician testified that the patient’s mother “stormed out of the room” before he could offer any alternative. The child received the injection at a walk-in clinic later that day.

The family subsequently filed complaints with the College of Physicians and Surgeons of B.C. (CPSBC) and the BCHRT. In 2023, the CPSBC reprimanded the physician for “refusing to provide care related to gender transition to a patient on the basis of conscientious objection, without offering assistance to this patient in order that they could receive this care from another provider.”

The claimant was seeking $50,000 for the professed purpose of “making discrimination against transgender children in health care expensive.” The claimant also wanted the BCHRT decision to be “prominently” posted, in perpetuity, anywhere the physician works. Surprisingly, Devyn Cousineau, who wrote the decision, agreed with the impugned physician that this “would serve no purpose other than to punish him.” (Apparently publishing his name, fining him and demanding that he provide “gender-affirming care” in the future, under legal threat, was punishment enough.)

The claimant’s lawyer was non-binary-identifying trans activist Adrienne Smith, who also chaired the federal NDP convention last spring. Videos of Smith explaining the NDP’s equity card system, which allowed for delegates to jockey for speaking priority based on gender identity, skin colour or disability status, was criticized and mocked worldwide. Cousineau, meanwhile, is the same tribunal member who oversaw Canada’s infamous testicle-waxing discrimination cases. At the time, Cousineau notoriously wrote in a procedural ruling that transwomen receiving testicle waxing can constitute “critical gender-affirming care.”

In this latest ruling, Cousineau rejected the physician’s defence that administering puberty blockers was a violation of his religious beliefs or outside of his expertise or scope of practice. She also refused to admit the physician’s expert witness, Prof. Gary Goldsand, who specializes in medical ethics and intended to speak to the concept of conscientious objection in medicine. Cousineau wrote that she “can just as readily make findings of fact and draw inferences and conclusions without assistance from Prof. Goldsand.” She did, however, admit the claimant’s expert witness, Dr. Elizabeth Saewyc, the director of the University of British Columbia’s School of Nursing. (Who also happens to have been called as an expert to testify against me in my free speech hearing with the B.C. College of Nurses and Midwives. It’s a small world, after all.)

Cousineau’s ruling is fraught with several inaccuracies. First, she claims to have not required expert testimony on conscientious objection, when she clearly did. Health-care providers refuse to participate in or administer care all the time, typically related to euthanasia or abortion. This is explicitly permitted by health regulators and employers, including the CPSBC, which says that “licensees may make a personal choice not to provide a treatment or procedure based on their values and beliefs.”

The reason the CPSBC reprimanded the physician in this case was over his failure to have “any formal process in place” to refer patients like the claimant to another provider, if he conscientiously objected to providing care. Cousineau, on the other hand, found the physician guilty of discrimination merely for refusing to give the injection (though her ruling went on to discuss his failure to refer “for the sake of completeness”). She ordered the physician to “cease the contraventions and refrain from committing the same or similar contraventions” — in other words, to act against his conscience in the future.

Cousineau either doesn’t understand conscientious objection, or has imbued herself (and the BCHRT) with the authority to rescind this critical ethical right from health-care providers in the context of the “gender-affirming care” scandal. The message this sends to all health-care providers in B.C. is clear: provide trans health care to minors — or suffer the consequences.

Second, Cousineau misunderstands the concept of “scope of practice.” All health-care providers have a legislated scope that defines what they are legally allowed to perform in their roles. This scope is limited (among other factors) by an individual practitioner’s personal assessment of his or her competence to perform a given task. In the case of the Lupron injection refusal, Cousineau disagreed with the physician that he could not administer the drug because he is not familiar with, and does not provide, gender care. She minimized the treatment as a mere “intramuscular injection,” and wrote that, “The injection was not a specialized procedure or outside the everyday services of a family doctor.”

Using this logic, Cousineau could also argue that a physician must administer an abortion drug, or any of the intravenous medications used to euthanize Canadians via MAID. She also dismissively wrote that the physician “was not asked to prescribe the medication, or monitor its effects.” What she fails to understand is that health-care providers are legally responsible for the treatments they provide, no matter who prescribed it. “It was prescribed by someone else” is not an excuse for legal liability: providers are responsible for the drugs they administer and whatever effects those drugs produce.

Thirdly, Cousineau wrote that the physician’s “conduct was based on his misunderstanding that Lupron was for ‘gender assignment therapy’ and that it required him to have experience in that branch of medicine. In fact, although Lupron was part of gender affirming care for Child Q, it was not a treatment for ‘gender assignment.’ ” Cousineau made a distinction without a difference: we know from scientific data that around 98 per cent of children put on puberty-blocking drugs will go on to take opposite-sex hormones. Once children are set on the path of gender medicalization, they seldom get off it.

The claimant’s family physician had both the legal and ethical right to refuse to inject a child with “gender-affirming” puberty blockers. It is unconscionable that he has been punished for his refusal to participate in a known medical scandal, for religious reasons or otherwise.

In light of this and other rulings, including the grotesque $750,000 fine levied against former school trustee Barry Neufeld, the BCHRT seems to have taken up trans activism as its raison d’être. Undoubtedly, the BCHRT will continue to wield its power to bring financial and reputational ruin to its ideological opponents, until enough of us speak out. The question is: how much further are we willing to let this go?

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