Letter: Cost of sex change

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The Independent Culture
Sir: The decision by the Appeal Court to dismiss the appeal by a health authority seeking to restrict treatment in the NHS ("Transsexuals win right to surgery", 30 July) runs contrary to recent legal trends and sets a most worrying precedent. The implication is that the NHS must now treat anything which can in any way be described as medical.

There is not a country in the world that can afford such a policy. Even in the United States, a large segment of the population is simply denied access to any treatment and most insurance plans there exclude some forms of potential treatment.

As pressure on resources grows and demand increases remorselessly, our society will be obliged to face the issue of rationing, however much politicians refuse to use the word. Meanwhile, health authorities will face increasingly difficult ethical decisions, such as whether to fund treatment for highly immature babies at enormous cost or long-term ventilatory support at more than pounds 100,000 per annum.

This health authority did not "pick on" transsexuals: it included them in a list of treatments it decided not to fund. That list went out to public consultation and was based on a careful survey among local residents about treatment priorities. It was discussed by the health authority in public on at least two occasions.

Gender is determined at conception and can readily be verified by genetic testing. It is interesting that, whilst these individuals have been prepared to disclose intimate details of their medical histories, the public has never been told whether they are genetically female or just think of themselves in this gender. This is crucial information in judging the health authority's decision and in evaluating the wisdom of the Appeal Court.


Professor in Medical Ethics

University of Central Lancashire