Answer to the Minister of Health, Welfare and Sport

Principle 17 is pleased with the letters from Minister Schippers of 15 June 2017, but also criticizes them.

Breast implants
We are certainly happy that the unfair and indecent removal of breast implants from the health insurance now is being undone. But is emancipation the right budget to pay for it? After all, it is a medical necessity for the persons in question.

Disappointing response to petition
To be frankly, we consider the reaction to our petition as disappointing. Here we see that there is still a considerable gap between the science that is heavily influenced by heterosexual and cisgender principles and the experience of the trans community. Traditional views count heavier than well-founded complaints from those who are concerned, who need the health care.

Waiting times
As far as waiting times are concerned, we see a positive development and we hope that the standards are as strict as in other cases. That the minister indicates that there are no objections to expansion and decentralisation of health care is good. But to leave this to the market, seems to be undesirable to us, because transgender people are a marginalised group. It is not a popular subject in medicine and the number of experts is low. It seems desirable to us that the ministry takes control of this change.

Reaction informed consent remarkably
The answer of health care and government as soon as informed consent is discussed, is remarkable. In reactions it is immediately stated that thoughtful health care is required, and that this concerns complex health care. However, this does not have to be a reason to stay with the current model. In the development towards informed consent, Argentina, Denmark, Malta and parts of the United States are currently at the forefront: here the heealth care recipient is not subject to an assessment psychologist.
The WPATH Standards of Care also contradict the referenced complexity of health care. Nor does the literature indicate that trans people want to change their body in a flash. Rather the opposite is the case. We suspect that this attitude is related to the long-term inclusion of transgender in psychiatric categories. This leads to a paternalistic approach.

"Yes, unless" is better
The current "no, unless .." attitude is replaced by a "yes, unless .." approach, if it is up to us. Unless there are insurmountable problems, health care provision continues. Where necessary, we work together on adherent health care. The perspective of the health care recipient must be central, because it concerns theír body and theír life. A layered approach that starts as low as possible and as individual complexity grows, offers room for customisation. What health care always is.

Trans health care is tailor-made
It is important to recognise that there are (many) more than two genders: there are also non-binary, gender fluid, queer and non-gender identities, for example. With all those variations of genders and also the many personal differences in what health care is needed at what time, tailored care fits.
This also fits well within the current legal framework: see, for example, the Medical Treatment Contracts Act (WGBO), Article 448, paragraph 2c, on the joint search for the best health care alternative. That doctor and patient together seek and together determine which health care is needed, fits to our sense better in transgender health care than the current rigid thinking and working method of the assessment psychologists. Unfortunately, these psychologists often sell their methods with a reference to thoughtfulness and prudence, as if the Informed Consent protocol of the Callen-Lorde Center were not accepted by the international professional association WPATH and would not be thoughtful and/or careful.

Star protocol violates human rights
We also wonder: if we have the right to adjust our gender identity almost without external intervention, why should we still be so dependent in medical terms? Transgender Europe also is clear about this, and the by the government supported Yogyakarta principles are too, where we get our name and inspiration from. It is fundamentally wrong.

Cultural competence
Concerning cultural competence the letter states that this lies with MBO Council and NFU. But also that the minister will check how this theme is picked up. We hope that this will lead to a smooth and thorough improvement of vocational education in this.

In summary, Principle 17 is, together with TNN, pleased with the improvements, but also displeased with the government's paternalism. That is all the worse, because every other type of health care recipient has to be independent, and transgender health care recipients are put to extra trouble. That does not fit.

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