Ethics Is Not A Zero Sum Game

With Alberta's Catholic Bishops having stuck their oar into the secular sphere of public services several times in recent months, making hardline declarations about what their faith supports and does not support.  

Let me be clear, I don't really care if the Catholic Church wants to declare that being LGBT is some kind of mortal sin, or that Physician Assisted Death (PAD) is "morally corrupt".  Those are both moral positions within the context of their faith that the Church is perfectly entitled to ask its membership to abide by.  I may stridently disagree with the rationale they use, but that's another matter.  That isn't the topic I want to discuss today.

In both the matter of school safety for LGBT students and the PAD issue, the Bishops are making this an "all-or-nothing" proposition.  Essentially, they are placing their Church's moral dictates at the top of some imagined hierarchy of rights.  This is neither reasonable or appropriate.

The problem here is the idea that there is some kind of moral absolute involved which trumps everything.  This is far from being a reasonable approach to ethical issues.  The Canadian Medical Association's policy statement on Physician Assisted Death reflects the actual complexities involved. It reflects the fact that a physician must consider far more than their "deeply held faith" (or whatever phrase you want to throw at it).

1. "Consider first the well-being of the patient." This means that the care of patients, in this case those who are terminally ill or who face an indefinite life span of suffering or meaninglessness, must be physicians' first consideration.
2. "Provide for appropriate care for your patient, even when cure is no longer possible, including physical comfort and spiritual and psychosocial support."
3. "Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability."
4. "Respect the right of a competent patient to accept or reject any medical care recommended."
5. "Ascertain wherever possible and recognize your patient's wishes about the initiation, continuation or cessation of life-sustaining treatment."
6. "Recognize the profession's responsibility to society in matters relating to
. . . legislation affecting the health or well- being of the community . . ."
7. "Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants."

Consider these ethics statements for a moment.  They don't say "your faith trumps the patient", nor do they say that a physician must participate directly in a process that they disagree with, or feel is inappropriate.  Far from it.  Rather, the physician is obliged to weigh the entirety of the situation as they see it.

However, we have to recognize that in these situations that the patient is likely psychologically competent and capable of participating in those decisions.  These decisions are not entirely at the whim to the doctor.  The doctor has other considerations they must give weight to.

A physician should not be compelled to participate in medical aid in dying should it be become legalized. However, there should be no undue delay in the provision of end of life care, including medical aid in dying.

The importance of this one statement cannot be underestimated.  Although it does not stipulate that there is a duty to refer, it essentially is saying that the doctor's role is not to confound the patient.  So, if the doctor has reason to suspect that the patient is incompetent, or perhaps that  the desire to end their life is temporary, then the physician needs to act accordingly to ensure that the patient has appropriate psychological supports.  If this is not the case, and all other things being equal, the physician should not act in a manner which confounds the patient's wishes.  There is an important principle at play here - and that is the patient's ability to participate in informed consent.  There is a considerable difference between a patient who is suffering chronic depression that has become suicidal and a patient who is suffering from terminal illness who says "it's time to go", and wants to exert some control over the circumstances of their death.

Similarly, I consider the issue of LGBT supports in the schools another case of weighing the interests of the parties involved to be critical.  Calgary's Bishop Henry has argued that because the Church teachings reject the validity of (in particular) transgender identities, that the Catholic Schools should not be obliged to provide supports for transgender students.  Yet, as much as the Church is free to claim that it doesn't believe that transgender identities are valid, there is clearly a body of students within their schools who are transgender.  A little like Iran's former president saying that Iran has no homosexuals the denial is a bit like sticking one's head in the sand.

However, the role of a school is first and foremost to ensure that their students are appropriately educated.  Even a school with affiliations to a particular religious faith must ensure that the environment is conducive to learning for all of the students who go to that school.  (and yes, there are transgender people who are Catholic in this world, in spite of the Church's teachings)

So, we have an ethical issue here.  The Church's position and past conduct of school administrations has been identified as creating an environment which is counterproductive to the learning needs of LGBT students in general, and transgender students in particular.  So, should the Church's doctrine trump the stated needs of LGBT students to have a safe learning environment?  Do the Bill 10 and related policy guidelines that Minister Eggen has put forward prevent the teaching of Catholic doctrine in those schools?  These various interests exist in a state of mutual tension.  An absolutist position such as the Bishops in Alberta have put forward on the matter naturally compromises the creation of an appropriate learning environment for these students in favour of an insistence on all aspects of a Catholic school reflecting Church teachings.  In taking such a position, the Bishops are essentially telling school boards, teachers and administrators not to follow the ethical obligations of being educators for one particular group of students.  Are Catholic LGBT students not worthy of ethical consideration?  A more reasonable approach would be to acknowledge that these students do exist, and that the schools have a universal obligation to ensure that the learning environment is appropriate and safe.  There is nothing in providing such accommodations which precludes the teaching of Catholic ideals in the classrooms.  LGBT students may not like certain aspects of Church dogma as it relates to them, but the classroom and the church are appropriate places to stand up and challenge those teachings.

Religious Truth is a concept, and aspirational ideal at best.  It deserves to be considered as an aspect of the ethical decisions we all have to make in our lives, but not as a trump card every time a difficult issue comes.

A Little More For Alberta's Bishops To Stew On

Since Alberta's Roman Catholic Bishops seem to have something up their cassocks about transgender students, I thought it would be quite appropriate to post the following article that appeared in Huffington Post  in its entirety:

Two and a half years. That's the average wait time for a transgender child in my region to be seen and assessed by a psychiatrist who specializes in gender dysphoria. 

What can happen in two and a half years? 

I have a transgender child. My child was brave enough to tell me what was happening in his mind and body when he was 8 years old. He told me that nobody would ever love him, and nobody would ever marry him, because he wasn't really the girl he was born as.
He thought nobody would ever love him. He thought something was fundamentally wrong with him, that he was broken, that he was defective. At 8 years old, my child told me he felt he was worthless. No child should feel that way ever for any reason. 

What in the world does this have to do with LGBTQ support guidelines for educators?
Every teacher -- whether they knew what was going on with him or not -- that told him, "Oh, lots of girls go through a tomboy phase..." meant well. But what he heard is "Your brain is wrong. You're a girl." 

Every parent that said, "I'm just worried it will rub off on my child..." doesn't wish their child to go through hardship. But what my child heard is, "You are contagious."
Every time he was made to stand in the girls' line, he was told he was something he's not. Every time he was made to stand in the boy line, he was ostracized and taunted for being different and told loudly by the other boys, "You are not one of us." Every time he was allowed to choose which line to stand in, he was told, "You must show us all this very private thing you are coping with, this thing so huge and challenging half of us will never even attempt to understand it. Declare yourself. Male or female? Are you a weird, wannabe boy, or a freakish, failure of a girl?" 

Does that sound like a harsh interpretation?

What if we forced kids to identify by who had divorced or married parents? Or who had wet their pants beyond age 7? Or who still slept with stuffed animals? Or by financial status, or by who was adopted? 

Why in the world would we ever force children to publicly declare the thing that humiliates them the most, and then categorize and judge them based on those factors? 

Despite a staff full of teachers who meant well, who wanted to support my child's education but were unable to get enough support from their head office to help him the way he needed, I pulled my transgender child from public school. Because I was told that my child's ADHD was the only thing the division could actually help him with. Because it was not until a blog post of mine went viral that parents quit expressing their "concern" that my child was "too troubled" and "should stop calling so much attention to it." 

As if it was something I should just snap my fingers and fix. As if I wasn't doing everything in my power, alone, to try and get him some support, to comfort him when he came home sobbing, when he called me in the middle of the day to tell me he just couldn't take the anxiety anymore. When he was so distraught he couldn't even tell me what was wrong. 

Two and a half years means the difference between life and suicide for thousands of transgender children. If you woke up tomorrow with the wrong set of genitals -- and were then forced to publicly declare to your co-workers and boss that it had happened -- would that be humiliating? Would that impact your ability to do what you're there to do?

When you ask a transgender child to use a bathroom that doesn't coincide with their gender identity, that is exactly what you are doing.

I don't want school divisions to simply provide bathroom support for LGBTQ youth. I want every single staff member in contact with ALL children to be trained in compassionate care of LGBTQ youth. I want the education to be mandatory for staff, and I want parents of LGBTQ kids to have the opportunity to speak publicly and educate parents. No transgender child should ever be outed, publicly misgendered, belittled, dismissed or rejected based on his gender identity or how he presents himself to the world.

My child should never be categorized, labeled, judged and forced to identify based on his deepest, most private internal wars.

MY CHILD SHOULD BE SAFE AND PROTECTED AT SCHOOL.
My child's teachers only meant to help. But some of them lacked the training to reduce his anxiety and exposure as a person who was different. In the span of one school year, my child went from excited to show his true self to his peers -- in the form of a haircut and some new boyish clothes, not even a name change -- to telling me he wished he had never been born and it all could just stop. 

That isn't a far cry from a suicide wish. In just one school year. Now tell me what two and a half years can do. 

LGBTQ health must be prioritized in all areas of life. It is not a fad. It is not elective. If educators do not implement strong guidelines for supporting LGBTQ youth, teachers and parents in schools then children who already struggle to have the desire to keep living have even less hope to cling to. Passive attitudes in building these clear and inclusive guidelines contribute to youth suicide rates. And in ignoring the necessity of these guidelines, you will tell my child, in the absolute clearest terms, that he was right when he thought he didn't deserve the love and respect everyone else does. 

Things can change. LGBTQ kids can grow up with every comfort, safety and support as their cisgender heterosexual peers. The bathroom debate is about so much more than bathrooms. It's about proving to LGBTQ kids that they are as worthy of respect as every other child in each school. It's about proving that we love them, they are not broken and they are safe in school. The struggle won't end when we allow transgender kids to use bathrooms that match their gender, but it's certainly a solid place to start showing them from a very early age that we care, and we are listening and they are safe.

Let's be abundantly clear here.  This isn't about what Roman Catholic theology says about transgender people.  It isn't about what a bunch of adults who have decided to get all uncomfortable about the subject (the same adults who probably can't bring themselves to talk to their children about sex except in the most elliptical of terms, no doubt).  It isn't even about the Bishop's authority with respect to the Roman Catholic school system in Alberta.

This is about one thing, and one thing only:  ensuring that one of the most marginalized groups of students in our schools is able to attend school and learn in a safe, accommodating and welcoming environment.  An environment which singles them out for their "differences", or marks them to their peers as "lesser" beings for whatever reason is unacceptable.  No matter what the theology may say, these children are very real, very much a part of the schools, and they deserve to be treated with respect and dignity like EVERY OTHER MEMBER OF THE STUDENT BODY.