Why Transgender Extremism Is Worse in the United States

B ritain’s only transgender-youth clinic closed its doors after an independent review exposed serious safety concerns. Yet Boston’s Children’s Hospital — along with countless others — still aggressively advocates medicalized gender transitions for minors. “Why?” Rich Lowry asks, given that Europe is usually “at the vanguard of cultural insanity, with the U.S. only catching up later.”

Europe’s cultural insanity occurs mostly in the realm of individual rights. In recent years, freedom of speech and freedom of religion have been increasingly threatened by efforts to outlaw “hate.” During the pandemic, we saw how easily freedom of movement and freedom of assembly were curtailed during Covid lockdowns. These injustices exist in health care; everything from hospital workers being forced to be involved in abortion services, despite their conscientious objections, to the usurpation of parental rights as in the case of the terminally ill infant, Charlie Gard.

The U.S. Constitution protects its citizens against such abuse. Yet, while Britain is only too willing to use the state to subjugate its citizens, America has its own excesses. In his book, The Age of Entitlement, Christopher Caldwell argued that, since the Civil Rights Act of 1964, rights-based claims in America have been expanded to include anything on the progressive wish-list. In the American health-care system, trans-identifying patients claim they have a right to transgender drugs and surgeries — so much so that Biden would like to direct taxpayer dollars to fund them through Medicaid. Conveniently for doctors and drug companies, they stand to profit from this supposedly righteous cause.

In the U.K., the NHS-run transgender-youth clinic is now facing a class-action lawsuit on behalf of some 1,000 families who allege the clinic’s “failures in their duty of care toward young children and adolescents.” In the U.K., the doctor’s duty to the patient (as opposed to the patient’s “right” to obtain certain services) is the guiding principle. This may seem paternalistic, but when dealing with a vulnerable patient population — children, adolescents, or adults in mental distress — surely paternalism is warranted.

Whatever its faults, doctor accountability is baked into the British health-care system. The General Medical Council, founded in 1858, oversees the registration and education of doctors. Some of this is obviously burdensome. Since 2012, NHS doctors have been required to undergo “revalidation” every five years, which means they must show that their knowledge is up to date, that there are no concerns about their work, and that they provide a “good level of care.” Nevertheless, a doctor who exhibits recklessness or who acts “outside the limits of his expertise” can be banned from practicing, such as in the case of the husband-and-wife team Michael and Helen Webberley, who prescribed puberty blockers to minors through their private online clinic.

But this is not the case in the United States. As Michael Miller, a plastic surgeon, explained to me:

There’s no regulation, per se, for what a doctor can do. If he wants to offer a service and can get credentialed in a hospital to do it, he or she can do it. And the restraints that are on what a practitioner does is the threat of malpractice or if you are incompetent and you have colleagues who are willing to declare this, then a hospital can take your privileges away. But if you wanted to open your own shop, open your own hospital which some people do — they have their own surgery centers where they do their own thing there — you can’t stop that.

Another surgeon, speaking from within the field of transgender medicine, described the field as a “new Wild West” made up of “a bunch of solo practitioners, basically cowboys or cowgirls who kind of build their little house, advertise, and suck people in.” Moreover, the difficulty in pursuing malpractice lawsuits for transgender drugs and surgeries in the United States is that the standards of care have been effectively dictated by activists while the statutes of limitations for patients (whose complications and regret often take years to manifest) are often too narrow.

Obviously, some rights-based claims should be considered legitimate and important here. For instance, the defense against surreptitious child transitions at school has largely been mounted in terms of parental rights, which are constitutionally protected. Yet, in the U.K. — where pushback to transgender activists in schools has both government and grassroots support — this, too, is framed in terms of duties. Safeguarding children is a duty of parents, teachers, and the entire community. It may even mean safeguarding the child against himself.

The conservative philosopher Roger Scruton once explained the difference between classical liberals and conservatives as being that “conservatives believe in unchosen obligations (pieties), whereas classical liberals think that the only source of obligation is choice.” As critics of liberalism have noted, the latter tends to downplay the inevitability of human interdependence, forgetting that our choices do not arise in total independence but in the context of our social and political environments. American individualism and “rights-based” claims can, at times, have a blind spot for communitarianism and our duties to one another.

There are many other reasons why the United Kingdom has rejected transgenderism faster than the United States: for instance, the role of British feminism, and how it differs from American feminism. But those are columns for a later date.