Caspian’s detransitioning research and the ethics police

Here’s another moral controversy that seems to underline the moral importance of considering both misery and happiness in ethical debate. It has been widely reported by the BBC and most major UK newspapers that some promising and potentially important research on the psychological outcomes of sex change operations won’t happen because a research ethics committed felt it might cause arguments. Specifically, they anticipated that such research might be ‘politically incorrect’. Apparently someone in Bath Spa University’s ethics committee believes this phrase (which is in effect a popular euphemism for ‘boorish’ or ‘uncivilised’) can be used without irony. They believe consequent social media criticisms would cause harm to the University’s reputation, and might put the researcher’s ‘wellbeing’ at risk.

Coverage has been entirely based on the word of James Caspian, the disappointed would-be researcher who also happens to be a leading expert in psychiatric and medical treatments of gender dysphoria. A variety of issues are at stake here, but it’s worth noting that for both the research ethics committee and the researcher, it all turns on risk assessments, which are derived from speculating about harms rather than goods or benefits.

The ethics police believe his research is risky because it might cause upsets and arguments. Caspian believes that sex change operations are risky because they might be regretted and they are of course hard to reverse. And some generalised community of trans lobbyists are assumed (by the ethics committee) to be not only unreasonably and implacably opposed to anyone who dares to question the morality of medicalising – and medically treating – gender dysphoria, but also incapable of voicing this disapproval in a civil manner. (In other words, the research can’t be done because it would be seen as ‘rude’ by people who would then go on to say rude stuff about it. To be fair, some transgender lobbyists have been a bit rude to poor old Germaine Greer, but I reckon she can take it).

And whereas Caspian no doubt feels that the research committee are being unduly risk-averse, they probably feel that the people he will upset are those waiting for sex change operations. These vulnerable people already believe that the route to what they see as a salvationary treatment is already obstructed by too much cautionary advice. All three main parties to the dispute, therefore, seem to have focused on pathological considerations as the font of ethical decision-making. If my admittedly sketchy interpretation is roughly correct, they all share a miserabilist approach to ethics, one which draws our attention to possibilities of harm and – at their most positive – the possibility of harm avoidance.

Uncertainty, risks, and possible benefits

For the moment, let’s agree three things about risk:

  • that debates about gender dysphoria and its treatments are at an immature and volatile stage with high uncertainty, rapid change, and a dire need for research;
  • that like all moral debates they require consideration of happiness implications; and
  • that therefore neither therapeutic ethics nor research ethics can be done properly without paying attention to the likely benefits as well as likely harms of the proposed research.

If we are to argue well, in the hope of making good policies and reaching good decisions, we will need to pay more attention to happiness, or benefits, than is usually the case in such debates. Gender dysphoria is, first of all, a claim to have one particular source of unhappiness publicly recognized. Since both gender and happiness are important but diverse and hotly contested concepts, there’s ample scope for both debate and mutual misunderstanding.

The interesting debates are not about whether this form of unhappiness is real, but about how it may be possible to ameliorate the situation. How can gender-dysphoric people be successfully empowered to pursue happiness, with or without changing sex? When those debates get beyond the comparatively trivial arguments about toilets or pronouns, they are likely to be about the pros and cons of three very different treatment routes (or, more positively, happiness pursuits): mental (mind training through self-help and psychotherapy); sociocultural (adjusting culture, relationships, and gender expression); and biomedical (gender reassignment through hormonal and surgical treatments).

‘Positivity’ in ethical debates

My core concerns here are: does it matter whether we see these processes mainly as a flight from unhappiness or a pursuit of happiness? And when we take decisions about matters arising here, what difference does it make if we attend mainly to benefits and happiness, or mainly to risks, harms, and remedial work?

Although the emphasis of happiness discourse is ‘positive’, avoiding and coping with harms is part of the discussion of how to live well. So, for example, discussions of gender and happiness would include appreciation of the ways people enjoy being the gender that best matches the body they were born with. Aspirational gender planning would include celebration and promotion of gender differences, on the understanding that these are part of what make identities and relationships interesting and enjoyable. But happiness and gender research would also include, for example, recognition of gender dysphoria – the feeling of being trapped in the wrong body, and of suffering cultural pressures to perform one’s gender inauthentically. Without assuming that gender dysphoria necessarily makes someone’s life go badly, a responsible researcher would want to consider options for reducing such harms, whether through biological or psychotherapeutic or sociocultural interventions.

So what’s the ‘happiness’ story here then? Well, as with my previous post about institutional responsibilities for counterterrorism, one issue here is that a big public moral argument is being conducted as if it were all about rights and politics, when really a happiness lens is crucial to understanding what’s at stake.

A second issue that the committee also tried to justify their decision with reference to his ‘wellbeing’ – consciously claiming that they knew better than Caspian what was good for him. A third issue is that decisions concerning support for gender reassignment surgery also, by law, require relevant medical professionals to question whether applicants really understand what is in their own longterm interest.

So arguably both Caspian and the committee that has frustrated his research ambition would at least agree on this much: that sometimes, people need to be protected from their own hasty preferences.

Precautionary versus proactionary principles

And this is where the issue of principled risk assessment becomes paramount. Apparently, the University research ethics committee decided that the risk of toxic social media arguments justified prevention of the research. But did they explicitly weigh those risks against other risks, including a) possible life-changing harms of over-hasty and ill-informed gender-change surgery, and b) possible social and psychological benefits from enhanced understanding of post-surgery biographies? In claiming to protect Caspian’s wellbeing, did they also give due consideration of the wellbeing of people who apply for gender reassignment? If they didn’t, they may be guilty of naïve and dogmatic fear-mongery, abusing the ‘precautionary principle’ to justify a frankly immoral decision.

So here’s one ‘happiness lens’ response: when you make risk-based or fear-based arguments, you can’t expect people to take you seriously if you don’t compare the risk of doing harm with the risk of doing good. It can never be moral or rational to convert the ‘precautionary principle’ (‘look before you leap’, ‘better safe than sorry’) into an irrational dogma that says: ‘don’t do it if there’s any chance it might cause harm’. This absolutist move is made when people are too scared or too lazy to be bothered with rational discussion of the pros and cons of a decision. The ‘just don’t do it’ argument can itself be a form of blind risk-taking. Instead of dogmatically focusing on possible harms, you must rationally weigh up various uncertainties, including the possibility of benefits and the risk of failing to do good.

So rational risk analysis must look at the likelihood of benefits, not just the likelihood of harms. You must always consider the possibility that risk-averse behaviour might either cause harm (as for example when parents harm the long-term health of their children by over-protecting them from germs) or cause a loss of opportunities to do good (as when the DDT ban thwarted progress against malaria).

Yet this is exactly the mistake that lots of university research ethics committees make: they enquire into the likelihood of harm (and often, perversely, just the ‘possibility’ of harm is what they express an interest in), without any systematic attempt to weigh up those risks of adverse outcomes against the risks of missing out on benign outcomes. The British Psychological Society’s Code of Human Research Ethics includes a section optimistically headed: ‘Maximising benefit and minimising harm’: logicians on ethics committees may be forgiven for pointing out that it is of course logically impossible to successfully combine these two objectives. And even if you recognize this, you still can’t either ‘maximise benefit’ or ‘minimise harm’ unless you give up on any other objectives. In real life, what you actually have to do is think about how to promote the good as well as how to fight harm, and then consider how to deal with the inevitable trade-offs between these two.

In this instance, the potential benefits of enhanced understanding of sex change regret seem sufficiently compelling to justify any well-planned research that knowingly accepts the risks of controversy. To suggest otherwise is to show astonishing lack of compassion for people trying to work out how to cope with their gender dysphoria.

It is possible that a few transgender lobbyists may be pleased at Bath Spa’s decision. Some may feel that laws and practices for assessing gender dysphoria already err too far on the side of caution, and show too little professional respect for the subjective self-assessment of people suffering the condition. And they may feel it is fitting that Caspian, who is sceptical about the benefits of gender surgery, should fall foul of other people’s cautionary mistrust. Their schadenfreude aside, clearly research on the possible harms of sex change surgery is needed, and Caspian seems well equipped to conduct it responsibly and sensitively. But it is just as important to conduct research on the hopes, aspirations, and – yes – perhaps even the happiness that can be achieved through sex change.

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