By Richard B. Gibson.
In 2020, I published an article called No Harm, No Foul? Body Integrity Identity Disorder and the Metaphysics of Grievous Bodily Harm. The piece highlights the lack of definitional clarity within English and Welsh criminal law regarding what harm is, arguing that the concept’s open to varying interpretations. It uses metaphysics to show how a single action – in this case, therapeutic, healthy limb amputation in what is now known as Body Integrity Dysphoria (BID) cases – can be harmful or not, according to how one understands harm. The paper argues that because harm plays a central role in multiple criminal offences, including those concerning medical practice, consistently attributing criminality can be difficult. In short, if there’s uncertainty about what harm is, then there’s uncertainty about what grievous bodily harm is.
I assumed this would cause a stir as the paper posited that surgeons who justifiably amputate healthy limbs shouldn’t be charged with a criminal offence under section 18 of the Offences Against the Persons Act 1861, contravening traditional thinking regarding the justifiability of such drastic interventions. After all, many of us would consider a surgeon who removes a limb when there’s nothing medically wrong with it as undoubtedly committing a criminal offence. Indeed, surgeons have been found guilty of similar charges for comparable interventions.
What I did not expect, however, was that people pick up the work and start using it to support anti-trans arguments.
Now, I want to clarify that the work does not reference transgender healthcare in any context. Yet, despite the paper’s tight focus and theoretical nature, certain groups have begun employing it to delegitimise trans peoples’ affirming healthcare. This has chiefly revolved around issues of consent.
My paper notes that since R v. Brown, surgeons need valid consent and a public policy justification before operating to satisfy the reasonable surgical interference exemption. If they fail to do so, they risk committing grievous bodily harm.
It is this observation that is being drawn upon repeatedly by people holding anti-trans perspectives, with claims that because trans people are unable to comprehend the consequences of hormonal or surgical treatment fully (for which there is no evidence), any such interventions are done without consent. This line of argument has often been augmented with claims of doctors breaking Hippocratic Oaths. There have even been a couple of tactical screengrabs featuring sections of my paper but deliberately omitting key sentences and context to misrepresent my work. In other words, people are making it look like I argue one thing when, in reality, I’ve said the exact opposite.
Whether those using my work in this way have misunderstood what I’m arguing, have not read the article thoroughly, or have found that taking pieces of it out of context works to support their agendas, I cannot know. What I do know, however, is that they are seeing things in my work that are not there.
Unsuprinsgly, this isn’t what I wanted my work to do. The purpose of my piece was to highlight a problem with the legal system as it stands and, at the same time, provide a justification for surgeons who, when faced with a patient experiencing suffering resulting from BID, might consider offering therapeutic amputations. I had not, in any way, thought that the work might be weaponised against the already besieged trans community. This could very well be shortsightedness on my part. After all, there is extensive literature on the dual-use dilemma in biological and other sciences – that a single piece of scientific research can be used for both good and ill. With hindsight, it’s evident that the same danger exists for non-scientific work.
You might wonder, justifiably so, why I’ve decided to write a blog post about this. After all, doing so may increase the attention to the work and make it more likely that it’s employed in ways I had not anticipated and might vehemently disagree with. It might also draw more attention to the existing posts which misrepresent my work. I write this blog entry not hoping to change the minds of those who have already used my work in such a way (although that would be nice), nor expecting that drawing attention to it that it might prevent others from doing likewise. Instead, I want to urge all of us academics and practitioners to be conscious of how our work can be utilised by those we may not agree with for ends that we certainly don’t agree with to the detriment of those who are already vulnerable.
We’re all busy, and the idea of taking time to check the Altmetrics of our old papers can seem like a waste of time. But, if I hadn’t done it, I wouldn’t know how my work is being used. And if we’re putting these pieces out into the world, then we should, at the very minimum, be aware of the potential harm (and good) that such work might be doing.
Author: Richard B. Gibson
Affiliation: University of Texas Medical Branch
Competing interests: None declared
Social media accounts of post author: @RichardBGibson