There is currently a Bill before Parliament to ban conversion therapy. It has passed its second reading, and only seven Members voted against it: Simon Bridges, Simeon Brown, Melissa Lee, Simon O’Connor, Shane Reti, Louise Upston, and Michael Woodhouse. They are all members of the National Party. That party allowed its members to vote according to conscience, rather than voting as a block. I do not know if any members of other parties would have voted against this Bill, had they been given the choice. They did the right thing, and I today am writing to them to thank them, and to encourage them in their stand. That letter (which I will send to them) is shared here.

No, I don’t want to see gay people coerced into torturous therapy, or indeed any therapy against their will (like anyone else). Who does? This Bill, however, would do far more than ban such treatment, which is already illegal. Conversion therapy, according to the Bill, is:

Any practice, sustained effort, or treatment that—
(a) is directed towards an individual because of the individual’s sexual orientation, gender identity, or gender expression; and
(b) is done with the intention of changing or suppressing the individual’s sexual orientation, gender identity, or gender expression.

So, why don’t I want to see a new Bill that bans this passed into law? Read on. My letter to these seven member of Parliament follows.

Dear ________

Thank you for voting against the Conversion Practices Prohibition Legislation Bill. You knew that you would be attacked for doing so, and you knew the sorts of false and vicious things people would say about you, as they are now. But you did the right thing, and I am grateful.

It is quite certain that this Bill will become law, which is deeply unfortunate. There are very good reasons to oppose this Bill, and I am sure that you have reflected on them as you considered your vote. I want to encourage you in your stance, and to offer some considerations that you might find useful as you discuss this Bill with colleagues and constituents.

The Bill is redundant

There is obviously something admirable about the Bill’s stated twofold purpose of preventing the harm that is caused by at least some of the things that would be classified as conversion therapy, and promoting respectful and open discussions regarding sexuality and gender. The Bill does, however, fall short in the latter, as discussed below. But good intentions do not good legislation make.

We should always resist over-legislation. The accumulation of law is never-ending, as very little of it is repealed. What is more, New Zealand legislation already prohibits the sorts of practices that are being described when this Bill is brought up in daily conversations, that is, the sort of things that should really be banned. Therapeutic practices are covered in various places in New Zealand law, but in particular in the Health and Disability Commissioner Act 1994. There (in Part 2), the Commissioner is instructed to prepare a Code of Health and Disability Services Consumers’ Rights. That Code stipulates that every consumer has the right to be treated with respect, to be free from discrimination, coercion, and exploitation, to dignity, to receive care that complies with ethical and professional standards, to be able to give informed consent, to be entitled to an opinion from another provider, to refuse services and withdraw consent, to have a support person or people, and to make complaints.

Ethical and professional standards here are those standards set out in codes of practice for therapists such as counsellors or psychologists. The Code of Ethics for the New Zealand Association of Counsellors is already clear. Counsellors must not discriminate on the basis of gender or sexual orientation (5.2). Similarly, the Code of Ethics of the New Zealand Psychological Society, New Zealand Psychologists Board, and the New Zealand College of Clinical Psychologists requires all members to act with respect and sensitivity towards clients’ gender and sexual orientation (Principle 1). Existing legislation requires that such professional and ethical standards be upheld.

If the proponents of this Bill believe that it is possible to engage in anything that can be called conversion therapy while meeting all of these standards, then it is unreasonable to prohibit that therapy. If they believe that conversion therapy always violates some of these rights, then further legislation against it is unnecessary. For example, Section 9 of the Bill now before Parliament stipulates that it is an offence to carry out conversion therapy on an adult and cause serious harm, or which is reckless as to whether or not it would cause harm. But this is exactly the sort of thing health and disability consumers’ rights law protects consumers against. The sorts of stories that people relate about conversion therapy to gain sympathy for this Bill are things like gay people being medicated and receiving electroconvulsive shocks to stop them being gay, or “queer people being tortured,” making reference to therapies that were carried out long before existing healthcare consumer rights existed. It is therefore highly misleading for anyone to use such experiences as a rationale for requiring additional legislation in 2022 to make such behaviour illegal. It already is, as is any type of therapy designed to influence the sexuality or gender of people who do not wish to change.

The Bill prohibits too much in a free society

Generally speaking, in a free society people should be able to do as they wish, even if we don’t agree with them doing it.

Concerns about this Bill and who it might affect are sometimes dismissed by its proponents, who suggest that people who raise these concerns simply haven’t read the Bill. This is false. It is because we have read the Bill in its entirety that we have these concerns.

Prohibiting responsible care

Gender transition is a term and concept thrown about so much that it may seem to some like no big deal, a simple matter of choice that nobody should question or push back against. But the potential consequences are enormous, including hormone therapies with permanent effects on young bodies, as well as permanent body-altering surgery. Some advocates of transition were buoyed by the study of Bränström & Pachankis (2019), which purported to find that “the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.” The study has been eagerly cited more than a couple of dozen times in the literature, without critical analysis. But the Journal in which this study was published was bombarded with letters from researchers and medical professionals highlighting major flaws in the study, whose data did not support its conclusion. No fewer than eight such criticisms were published (although it is not known how many more were received). The faults were so significant that the original authors accepted the criticism and retracted their conclusion, granting that “the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison” (Bränström & Pachankis, 2020). Not only that, but the study only purported to look at the very short-term impact of surgical transition which, although somewhat useful if it had been done accurately, is a small part of the picture.

Reliable studies that investigate the impact of surgical transition on death by suicide make for distressing reading. To the extent that people who experience gender dysphoria do so as a comorbidity of other mental health conditions, they will also be more at risk of suicidal ideation (since that is a risk of those other conditions, e.g. major depressive disorder or generalised anxiety disorder). The mistake is sometimes made of thinking that this is a risk of gender dysphoria itself, as though transition is a way of reducing the risk of suicide for young people with gender dysphoria. The evidence, however, shows two important things. First, as demonstrated by Biggs (2022), suicide rates for people experiencing gender dysphoria are not as high as activists might like to suggest, weaponizing suicide as an argument for transition. Instead, the rates are not obviously different what might be expected of people experiencing depression or similar conditions – a rate that, obviously, we all want to address and reduce. Even studies that find higher suicide rates for those with gender dysphoria (controlling for comorbidities), it is clear that causation cannot convincingly be established (Marshall et al., 2016). Secondly, the same study by Biggs found that suicide rates among people experiencing gender dysphoria or who surgically transition for any other reason do not decrease. They markedly increase. Rather than being an exceptional finding, it is well-known in the literature, and the longer the period studied after transition, the clearer the impact becomes. One of the most robust studies on this issue was conducted in Sweden (Dhejne et al., 2011). In the long term, morbidity from all causes was higher for people who had undergone hormonal and surgical transition (including neoplasm and cardiovascular disease), but the astonishing difference between those who underwent transition and the control group is that those who transitioned died by suicide at a rate 19 times greater than that of the control group.

Although I obviously cannot give personal details, I have spoken with a number of people to whom surgical solutions were suggested as soon as the professional working with them became aware that they had issues with gender dysphoria. In one case, a young female (16 years old) protested that she was not seeking this path and she wanted her other mental health issues addressing, but the professional insisted that she was only having those issues because she needed to transition to be healthy, sending her home with pamphlets about sex reassignment surgery. This behaviour is fine as far as this Bill is concerned, but if a professional attempted to apply the brakes when a young person, due to any number of influences, is enthusiastic about pursuing surgical transition, they can very easily be construed as acting to “suppress” a person’s gender identity. This is absurd, dangerous, and represents legislators inserting themselves into situations in which they simply do not belong.

Some allege that hormone treatments in the form of “puberty blockers” for adolescents represent a much safer reversible option. But, organisations that made this claim, such as the NHS in the UK, no longer do so, after attention was drawn to the fact that there is no good evidence for it in the wake of court decisions defending children (who cannot give informed consent) from their use. The NHS now acknowledges that little is known about the long-term effects of using puberty blockers, including effects on bone development, brin development, and psychological wellbeing (Transgender Trend, 2020; BBC News, 2020). Other researchers have found and acknowledged that puberty blockers can permanently affect fertility (Cheng et al., 2019). Anyone who has invested much time and effort into surveying the literature on hormone blockers will have realised that the confident claim that they are “fully reversible” is a tell-tale sign that they are reading something at least partly authored by an activist.

When it comes to the prospect of any such therapy, it should never be an offence against the law for responsible parents, ministers, counsellors, therapists, or anyone else to at least encourage a young person to accept their body, love themselves, and take care of their bodily integrity. This is all the more true when the most frequent outcome of children experiencing gender dysphoria is that they eventually desist (80% of cases). As Kaltiala-Heilo et al. (2018) note, “whether GD will persist or desist will probably be determined between the ages of 10 and 13 years.” How irresponsible, then, to effectively make illegal any therapeutic response other than affirmation, setting a young person up for life-altering treatments as well as psychological and social consequences.

Without taking seriously what we know about the long term impact of transition, as well as what we know – and don’t know – about hormone therapies, politicians are trying to pass legislation that places hurdles and even threats in the way of anything other than unquestioning acceptance of decisions that most young people are not in a position to fully evaluate. This is a completely unacceptable restriction on what caring, responsible parents, religious leaders, mental health professionals, or anyone else can do.

Restricting free decisions

Apart from the fact that there may be good reasons for responsible people to at least slow down or challenge a person’s rush to risky or irreversible treatments, there is a more general concern here about freedom. It seems trivially easy to think of plausible situations where people’s choices should be respected, but which would fall afoul of this Bill and leave people vulnerable to prosecution. For example:

Chris, a 17-year old male, is a highly intelligent young man in his final year of high school. He is a devout Christian, with a deeply held desire to live in a way that he believes pleases God and creates as little conflict as possible with the beliefs and values he holds dear. He also experiences what he describes as sexual attraction to people of both sexes. Both of these things – his beliefs, values and intentions on the one hand, and his experience of attraction on the other, are elements of his life. He places supreme value on pursuing a faithful Christian life, so he asks a Christian counsellor involved in his church to meet with him to help him work on self-control, which effectively amounts to suppressing some of his sexual attraction, which he views as temptation to do things he believes he should not.

It is quite obvious that any counsellor, minister, or other person who agrees to help Chris in the way he wants to be helped would be breaking the law, if this Bill were to be passed, and they would be committing an offence under section 8, which it makes an offence to have these sorts of conversations with anyone under 18. Section 10 stipulates that the fact that a person gave consent is not a defence. But it is also obvious to anyone with a basic respect of people and their right to self-determination that such conversations between Chris and a counsellor should not be made illegal. The same would hold if we swapped out the issue of bisexuality for the issue of gender dysphoria, in a case where Chris felt himself experiencing many of the symptoms of people who say that they are transgender, but who wanted help to prioritise his desire to live in a way that suppressed or helped to remedy those feelings (dissatisfaction with his body, dissociation from what he perceives “manhood” to be, etc).

If Chris had turned 18, such conversations would become legal, provided they cause no serious harm. This, however, simply reminds us of the law’s redundancy, since any therapist who caused serious harm to Chris on account of his sexual orientation, coerced or exploited him, failed to show regard for his dignity or who fell short of ethical or professional standards is already falling afoul of the law. Unless a talking therapy did cause Chris harm as an adult, the law should have nothing to say about it. Legislators are welcome to their opinions about the sorts of life changes an adult wishes to make, but there is no excuse for writing them into law, as though legislation is some sort of mouthpiece for their beliefs.

The Bill is grounded in ideology, not public reason

This Bill ostensibly prohibits therapy that is designed to change or suppress a person’s sexual orientation or gender identity. However, Section 5(2) describes examples that are not included as conversion therapy. These include assisting an individual who is undergoing or considering undergoing a gender transition and assisting an individual to express their gender identity. Why are these exceptions called out? In particular, why is there specific protection for someone who is affirming somebody’s transition (regardless of what they believe about gender and gender identity), but no protection for someone who is supporting a person through detransition – a process that takes place when a person who has transitioned to live as the opposite sex believes they have made a mistake and wishes to transition back to identifying with their birth sex? This is, after all, a change in gender expression, as that term is used in the Bill. What makes one of these conversion therapy while the other is not?

It would make no sense to say that the omission is because detransition does not happen, or is rare. Transition itself is a rare enough thing at the population level of statistics (certainly rarer than gender dysphoria), and detransition is clearly a phenomenon – and a difficult one at that, where detransitioners report receiving little support, to the point that the growing phenomenon is barely even acknowledged by those who advocate for transgender rights. It is as though the Bill was written from the ground up to consider every case to be a case where gender transition is healthy and without doubt the right decision, so that nothing must ever get in its way, and there should never be any going back. Even those who accept a transgender view on gender surely cannot sensibly hold this view.

What is more, the state does not, and by its very nature should not, hold a view on the nature of gender or gender identity; what it is, what causes it, its potential harms (e.g. gender as a product of social stereotypes), or even whether such things should be preferred explanations of self-identity and expression. But it is obvious that the Bill expects every person to share the same view on gender and gender identity, to the point where anyone who questions it or does not embrace it in the way they help people is liable to prosecution. Private beliefs of Members of Parliament, without the sorts of good arguments and evidence that would qualify them as “public reasons,” are being written into law.

It is a source of despair to see our Members of Parliament clambering to support this Bill in the name of being with the times, caring, non-discriminatory and so on. There is a read lack of critical reflection on the content of this Bill, its need, its place (or lack thereof) alongside existing legislation, and its consequences. It is all very well and good for a politician to parade their self-perceived virtue and wokeness, if they insist. Changing the law as means of doing so is a catastrophic failure to properly understand their role as legislators.

Thank you for being an exception.

Kind regards

Glenn Peoples, PhD

References

BBC News. (1 December, 2020). Puberty blockers: Under-16s ‘unlikely to be able to give informed consent.’ BBC News. http://www.bbc.com/news/uk-england-cambridgeshire-55144148

Biggs, M. (2022). Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom. Archives of Sexual Behaviour. https://doi.org/10.1007/s10508-022-02287-7

Bränström, R, & Pachankis, J., E. (2020) Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. American journal of psychiatry, 177(8):727-734 https://doi.org/10.1176/appi.ajp.2019.19010080

Bränström, R, & Pachankis, J., E. (2020). Correction to Bränström and Pachankis. American journal of psychiatry, 177(8) https://doi.org/10.1176/appi.ajp.2020.1778correction

Cheng, P. J., Pastuszak, A. W., Myers, J. B., Goodwin, I. A., & Hotaling, J. M. (2019). Fertility concerns of the transgender patient. Translational andrology and urology, 8(3), 209–218. https://doi.org/10.21037/tau.2019.05.09

Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. Plos One, 6(2): e16885. https://doi.org/10.1371/journal.pone.0016885

Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics, 9, 31–41. https://doi.org/10.2147/AHMT.S135432