Transsexual goes to High Court over operation ban

BMJ 1996; 312 doi: (Published 22 June 1996) Cite this as: BMJ 1996;312:1560

A “woman trapped inside a man's body” won leave in the High Court last week to challenge a blanket ban by a health authority on sex change operations. Mr Justice Tucker ruled that the transsexual, who can only be named as W, had “an arguable case” to seek judicial review of Gloucestershire Health Authority's refusal to pay for her gender reassignment surgery.

The case is the latest in a series in which transsexuals are challenging decisions by health authorities not to fund such operations as part of health care rationing. Lawyers for 30 year old W, who is unemployed and on legal aid, argue that a blanket ban contravenes NHS legislation, the Sex Discrimination Act, and a European directive on equal treatment in social security matters.

The judge ordered an expedited hearing for the case, which is expected to be heard before the end of July. It will be the first case to reach a full High Court hearing on the issue, although leave for judicial review was granted in two earlier cases.

In one, Wolverhampton health authority agreed to reconsider its decision but is still refusing to pay for the surgery. In the second, against Somerset Health Authority, the transsexual decided to pay for the operation privately.

W's solicitor, Madeleine Rees of the Birmingham law firm Tyndallwoods, said: “Continuing to treat transsexuals by psychiatric counselling, support, and care is vastly more expensive than the operation. There is also a high degree of suicide among transsexuals refused treatment.”

Stephanie Harrison, representing W, told the court that the case raised important general issues as to whether health authorities are legally entitled to refuse NHS funding for all gender reassignment surgery. “This woman is living what can only be described as a nightmare. She is unable effectively to carry on with her life.”

W was diagnosed four years ago as suffering from gender identity dysphoria. Since 1992 she has been following a course of NHS treatment, including hormone therapy, electrolysis, and speech therapy, and has lived as a female since September 1993.

The health authority told her consultant psychiatrist that it was policy “not to fund surgical intervention for gender identity problems” because of financial constraints and the fact that such surgery did not have “a sufficiently high priority.”—CLARE DYER, legal correspondent, BMJ

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