Principle 17 is a collective of activists in the Netherlands who promote customized trans*care. Care if you need it, when you need it, the way you need it. They have named themselves after Yogyakarta Principle17: "Everyone has the right to the highest attainable standard of physical and mental health, without discrimination on the basis of sexual orientation or gender identity. Sexual and reproductive health is a fundamental aspect of this right."
In 2016 Principle 17 has conducted a survey about transgender care in the Netherlands. A stunning 43% of the respondents reported negative experiences with transgender care. People experience a strong rigidity in the medical process, and a lack of self-determination. Also the very long waiting times, disrespectful treatment (name- and gender designation) and little knowledge and insight about non-binary genders were reported. The report can be found at the site van Principle17.
In a reaction VUmc (who claim to handle 85% of all transgender care in the Netherlands) has stated that this image is not correct. Their reaction can be found in this article by RTLNieuws. Unfortunately we as activists see the same experiences and complaints several times year after year from more and more transgender people. As long as the VU doesn’t take our criticism seriously, they will never improve the way they work and complaints will keep on surfacing.
Because Principle17 still was deeply concerned about the wrongs in Dutch transgender care, they decided to start a petition. In the petition they ask for attention for the unacceptably long waiting times, the close-down of a clinic for transgender care, the monopolization of transgender care, and the problems around gatekeeping. At the second and third bullet in the petition they write:
Needless care provided in transgender care:
Transgender people are being pathologized and medicalized unnecessarily. Psychological counseling is compulsory to apply for somatic care. This is in violation with human rights as stipulated in Yogyakarta Principle 18.
Unnecessary expensive care in transgender health care:
The gender teams work according to a one size fits all protocol with fixed parts. Transgender patients are therefore forced to undergo medical treatments, which many often even don't agree with.
To prevent problems caused by gatekeeping they ask for:
Free choice of care provider:
Every patient in the Netherlands has the right to choose their own care provider. This should also apply to transgender patients.
Transgender care is normal care. Prescribing and monitoring hormone supply is a simple medical procedure, which any skilled (general) practitioner can perform. For people requesting transgender care this should be possible just the same. In special cases a referral to a specialist may be needed, just like this happens for other patients. The Standards of Care, the internationally recognized guidelines for transgender health care, explicitly allow this practice.
Decentralization of transgender health care:
Transgender health care mostly is very regular health care and therefore can simply be provided by local practitioners (e.g. prescription of hormones). Only certain specific surgical procedures require special knowledge and skills.
Because transgender health care is regular care, it can easily be decentralized, making it more accessible to people who need this care. Decentralization of transgender care, combined with training of interested clinicians, can easily and within a relatively short time solve the current shortage in capacity.
Introduction of the principle of informed consent:
A clinician informs the transgender patient about the advantages, disadvantages and consequences of possible treatments, so they can make a well thought-out decision, in consultation with the clinician. Abolition of the compulsory psychological consultations.
All somatic care is covered without a mental health professional as a gatekeeper, with the notable exception of health care for transgender people. They would be "special", but no one is able to explain what would be this special about transgender health care. This practice is in violation with human rights as stipulated in Yogyakarta Principle 18.
Introduction of cultural competency training in (para)medical curricula:
Medical education should pay attention to dealing with transgender people, as it concerns about 4% of the population. This results in informed health care professionals and therefore wrong diagnoses and incorrect treatments will be a thing of the past.
In education hardly any attention is paid to dealing with transgender people, even though they are about 4% of the population. In this way the knowledge gap and the lack of understanding by (para) medical professionals continue to exist, resulting in discrimination by ignorance, incorrect diagnoses, unnecessary or wrong treatments, care refusal, etc.
In the ten days between the start of the petition and the handover of the petition to the Tweede Kamer 1374 people had signed it already.
The Principle17 website features a nice "Frequently Asked Questions (FAQ)" about Informed Consent.