Monday 12 September 2011

Myth-Busting Monday - 'Abortion is the only procedure which requires 2 doctors' signatures'

Every Monday EFC busts myths and take names, cutting through the misinformation, disinformation, and straight up nonsense to bring you the facts.Today's blog was inspired by a recent tweet from @christineburns who pointed out that abortion is not the only procedure which requires the signatures of two separate doctors.

As Christine points out, during discussions of Nadine Dorries' failed amendments to the health and social care bill last week some MPs and commentators stated that abortion is the only situation whereby somebody has to obtain the signature of two doctors for the procedure to be granted legal. Abortion rights campaigners are keen to point out that no other medical procedure requires this level of intervention, but, as Christine rightly points out, this same requirement is true of gender reassignment procedures. The 2004 Gender Recognition Act makes legal recognition of a transsexual person's true gender dependent on reports from two doctors and this GIRES document offering guidance to transmen on genital surgeries states that "two referrals supporting your clinical need for genital surgery are usually required before a surgeon will undertake it. In the UK one of these must be from a medical doctor (a gender psychiatrist) and the other can be a psychologist, endocrinologist or GP for instance."

So it's simply not true that abortion is the only procedure which requires two doctors' signatures- thanks again to Christine Burns for highlighting this. Check out her blog Just Plain Sense here. And the RCOG's comments on the requirement of two signatures for legal abortion here.


  1. Thanks for the shout out on this.

    Actually trans people seem to get hit by this 'rule of two' on several occasions.

    The main occasion where it occurs is where a transsexual person requires referral letters from two clinicians in order for genital reconstruction surgery to be carried out. The rule doesn't apply to other surgeries involved in medical transition (e.g. breast augmentation / reduction, facial surgery or vocal / tracheal surgery), where one letter of referral is deemed sufficient.

    The practice dates from the 1950's and 60's, where clincians felt they were operating in such a controversial area that they needed to cover their backsides at every turn. There is no clinical evidence that such provisions enhance patient safety and, indeed, the main motivation seems to have been (historically) to protect surgeons from possible legal action by the patient. The application is also often irrational, as the second referral is often obtained from a clinician who has never met the patient before and has seen them for an hour or less.

    The second instance is the one you've cited, where evidence from two clinicians is required in an application to the Gender Recognition Panel in support of an application for legal recognition of the acquired gender. Usually one submission will come from the patient's GP (which poses problems if the GP is not cooperative) and one from a recognised gender specialist, who has to supply evidence about how they diagnosed 'gender dysphoria' in the patient and treated the patient through any surgeries.

    The insistence upon two of everything seems to reflect a mindset that there is something exceptional about these processes involving bodily integrity and personal autonomy (whether gender reassignment or abortion) which consequently require a higher burden of evidence than anything else.

  2. Wow, learn something new every day :-) Out of interest, does the two doctors rule apply to F to M reconstruction?

  3. Thanks for the comments. It seems the two doctors rule does apply to FTM procedures(see above link to GIRES doc).

  4. It has been pointed out to clinicians that the insistence on more than one referral letter for chest reconstuction could be construed as unlawful discrimination, given that a natal woman can obtain practically the same procedure privately (breast reduction) when it is not for gender reassignment, and a natal man can also be referred for breast reduction (for gynaecomastia) without a psychiatric assessment. This again points to a history of disproportionate conditions being imposed on anything to do with gender reassignment surgeries