Lawyerly law stuff that's interesting


#502

I never said it can’t be beneficial, only that it’s not beneficial – or advisable - in all cases. Seriously, I think a lot of the antagonism here is because people interpret people as saying things they aren’t saying. My contention that gender dysphoria can in some cases be resolve solely with psychotherapy is not unreasonable.

I had a conversation with a friend who is a doctor (specializing in neurology and psychiatry, for what it’s worth) earlier today about this. His comments were that a doctor interviewing someone with gender dysphoria would not be to immediately shuffle them into hormone or reassignment surgery, but to try to establish the causes of the condition. In some cases, he suggested solving the issue could be accomplished by addressing the root of the dysphoria with psychotherapy.

Before people assume I’m lying because I have it out for transgender people, I fail to see how this is controversial or surprising to anyone here, since everyone here has admitted that not everyone with gender dysphoria should receive hormone therapy or reassignment surgery, and we’ve all agreed that psychotherapy is a key initial component of any treatment. Again, before rushing to assume antagonism, I really am not sure what anyone here can dispute about that.

The part you could dispute is my contention that therapy is unfairly maligned and is wrongly compared to gay conversion therapy. But based on this thread, I think I might be right there, too. The subject is just so politically charged that it seems recommending psychotherapy as a first and potentially final step, which is the accepted clinical practice, will nearly get you branded a bigot.


#503

I think it’s uncontroversial that gender dysphoria in some cases may be successfully treated without gender reassignment.

However, I object to the prescriptive approach that you keep suggesting, which is not supported by evidence. For instance:

This is no different than recommending radiation over surgery as a first and potentially final step for brain metastasis. Because wow, brain surgery is a major deal to be used only as a last resort!

It seems reasonable to someone who doesn’t understand brain tumors, but it’s ridiculous to anyone with a more nuanced understanding. Some patients should start with radiation, and others should begin by considering surgery. A one-size-fits-all approach is simplistic and doomed to fail.


#504

I don’t think I ever suggested that “one size fits all”-- in fact, I’ve said that cases are different, and some cases require different treatments. In fact, again, I don’t think we’re disagreeing, since it seems we agree that gender dysphoria can in some cases be treated with psychotherapy conducted by a mental health professional. The criticism I’ve been seeing – where people seem to interpret this as a claim that transgenderism always can be cured with therapy, or that I just want people to pray the gay away – combines with some worrying statistics and limited long-term data to make me feel that there may be a reluctance by patients to engage in psychotherapy, and doctors to pursue it. But I don’t know for sure. I appreciate what you are saying.


#505

At the risk of distracting from the core discussion with gman, Something I’ve thought a lot about is how the state of medical technology impacts the way that we decide to treat various conditions. So, for instance back in the good old days of Hippocrates’s humors, bloodletting was establushed as an effective treatment for…well, anything. Now, it didn’t actually work, but people didn’t understand how the body worked, and so even if they did stop the bloodletting, they would have been unable to come up with a more effective treatment. They just didn’t know enough to even start.

At this point, we understand how the physical body works pretty well. We understand how to manipulate flesh with surgery in a way that’s fairly safe and often beneficial. But we barely understand how the mind works at all. What understanding we do have is often tied up in very broad chemical processes (serotonin reuptake for depression, etc). So, if there is a potential answer to deprwssion that’s, like, “mind” based rather than physical, we don’t even know how to identify it.

It’s not purely technological. Our modern society also tends to privilege the mental self as, well, the “self” and the physical self as somewhat secondary. Contra a hypothetical physicalist view that may emphasize the physical form as, well, the primary expression of a person and the mind as a secondary expression. After all, the physical self is what others can see and interact with. To be clear, I think that the mind as self view is probably the only reasonable one with the evidence we have, but it isn’t necessarily “true”.

I guess I’m saying that in some sci-fi story, there would probably be an alien race that’s bewildered that we use surgery in this case, rathe than just having a mentalist adjust the patient’s [untranslatable], and being done with it. I don’t know if that is actually possible or not, but the fact is that our understanding of the mind and consciousness is so incomplete that we can’t say it isn’t possible, just that we don’t know how to do it, or don’t think we should.


#506

That’s not what you said before. You were suggesting doctors were not prescribing counselling, on a widespread basis, against their beliefs about the best interests of the patient. At which point I said:

To which you responded:

From which we conclude you are making that accusation, and that your shaky understanding of clinical statistics is your evidence for it.

This is quite different to your statements about how you ‘feel’ about the behaviour of patients. Maybe you have changed your mind, or realised this was not a sensible line of reasoning to pursue?


#507

This is a really interesting post. I think the unknowns around the psychological aspects of gender dysphoria (and others) may have made psychotherapy taboo among both patients and doctors – “I’m not crazy! Are you saying I’m crazy?!”

I quoted an NIH study saying there’s not a lot of data on the topic of long-term success. From the NIH in 2011: “There is a dearth of long term, follow-up studies after sex reassignment…” The study found: “The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex,.” The study concluded:

So yes, I think there’s a distinct possibility the “clinical statistics” aren’t final yet, and there’s also a distinct possibility that doctors are performing treatments that don’t seem to help in some instances. (Whether that’s legally malpractice seems dubious, but we were speaking colloquially). This is from the NIH, unless you think this study has been disproven since 2011, in which case I’d like to know why? Timex had a good article taking down a 2003 guardian article I posted, but no one has disputed this 2011 NIH study.


#508

Just to clarify:
What do you think this means?


#509

They seem to just be people they pulled off the street who have nothing to do with anything (ie, never presented with dysphoria). Again, I’m not saying the study shows that the treatment made things worse, which is something you helped me realize earlier. However, I am saying the study indicates explicitly a lack of great data on the long-term impacts.


#510

So at this point, what statement do you think your quote is even supporting? Certainly not the one you think it does.


#511

Like I said earlier, the treatment can “help” one issue while not helping other, just-as-significant mental health issues, which is what that study proposes may be happening. But there seems to be a lack of long term data on the topic, which the NIH says explicitly. Depending on the long-term data, it seems like it might be wise to adjust how often dysphoria is treated with surgery, right?


#512

That depends heavily on the what the alternatives are.

Besides, your logic here makes no sense. A treatment for one issue doesn’t help a second issue, therefore we should stop (or reduce prescription of) that treatment?


#513

Well if the treatment’s long-term effects are uncertain, that would seem to make sense to me. Certainly, it would make sense to approach the uncertain treatment a lot of caution.


#514

I recommend this discussion of the Supreme Court cake shop case:


#515

Don’t drag the NIH into this. They had nothing to do with this highly flawed study.

The long term effects of psychotherapy are equally uncertain. As are the long terms effects of doing nothing at all.

Patients, as usual, are forced to take action in the face of uncertainty.


#516

I missed this when it first came out but back in March, the UK court of appeal has found that software downloads are not goods, overturning the lower court’s ruling. Only tangible property can be goods, apparently.


#517

Will this affect refund policies? I’m thinking of distance selling laws etc.


#518

Not really, I don’t think. That’s covered under a separate directive, which unfortunately has a loophole which basically means everyone waives their right to a refund when they buy games digitally.


#519

What is the impact of software licenses not being “goods”? I’m not familiar with the legal context we’re talking about here.


#520

Read the judgment. It’s a fairly specific context in this case, but if the court had found otherwise it could have pretty wide ranging implications.


#521

Ya, I’m gonna admit to being lazy. I was hoping for a summary of the importance of the judgement.