You are here

Health – Surgeries to Modify Innate Sex Characteristics

Cassy O'Connor MP  -  Monday, 5 June 2023

Tags: LGBTI, State Budget

Ms O'CONNOR - Premier, as you know, the Tasmanian Law Reform Institute report, Legal Recognition of Sex and Gender was published in June 2020, three years ago. Recommendations seven, eight, nine and 10, relating to consent for surgeries to modify innate sex characteristics, have not been addressed by your Government.

In a letter to Amnesty International, you said you were advised, and I quote from the letter -

… that no surgeries to modify the sex characteristics of children are performed in Tasmania. We understand commonwealth health data from Medicare codes and sourced from the Human Services and Health website on procedures conducted in Tasmania indicates that at least 19 surgeries were conducted here from July of 2018 to July last year on children aged 14 and younger, which would be characterised as surgeries to modify innate sex characteristics of children.

Premier, can you confirm whether surgeries to modify innate sex characteristics are in fact performed in Tasmania on some children who have variations of innate sex characteristics?

Mr ROCKLIFF - We are committed to supporting the health and wellbeing of LGBTIQ+ Tasmanians. Our Government believes that all Tasmanians have the right to be treated with respect and have access to high quality health services regardless of where they live and their circumstance.

As I also hold the portfolio of Mental Health and Wellbeing, I understand the sensitivity of these matters and the deep impact that the history of these issues has had on the LGBTIQ+ community.

Our Government values the research and analysis undertaken by the Tasmanian Law Reform Institute. I thank them for their continued work. Given the complexity of matters addressed in the TLRI's 2020 report on the legal recognition of sex and gender -

Ms O'CONNOR - No, this about children with innate variations of sex characteristics and surgery to assign a single sex or gender to them. You might have been handed the wrong brief.

Mr ROCKLIFF - No. At my request the Department of Health has undertaken detailed analysis of the report's recommendations regarding surgical intervention to alter the sex characteristics of children with innate variations of sex characteristics. I've asked our department to examine these matters and provide comprehensive advice on the action required to respond. Our Government is committed to making decisions on the basis of expert advice with a priority focus on best practice and person-centred care.

Consideration has been given to the scope of issues related to relevant medical interventions, Tasmanian jurisdictional arrangements and the needs of the Tasmanian families. We will work collaboratively with community and clinical stakeholders to ensure that any changes to current arrangements are made to advance health and wellbeing outcomes for Tasmanian families. I will have more to say on this matter.

Ms O'CONNOR - When. With respect, Premier, the question was can you confirm whether surgeries to modify innate sex characteristics are performed in clinical settings in Tasmania? This is in the context of your letter to Amnesty International where you stated unequivocally that they were not, and then Medicare codes which indicate they in fact are. The children's rights are being breached because there are surgeries being undertaken on children with an innate variation of sex characteristics.

Mr ROCKLIFF - Okay, thank you. I did, on advice, write back to Honourable Meg Webb MLC to a very similar question. The answer I gave to that question is -

There is no concrete data about the prevalence of babies born with intersex variations in Tasmania. National estimates of prevalence of intersex conditions vary, though it is estimated at around 1.6 per cent of all births, noting that intersex traits may be identified at birth, during adolescence, or later in life.

Most infants born with intersex variations do not require surgical intervention, however, some babies are born with intersex variations which, if left untreated, can lead to serious health issues. This includes conditions such as congenital adrenal hyperglasia, which may be fatal if untreated. Conditions like these are considered medical emergencies and it may be necessary to perform surgical interventions on these patients to avoid adverse outcomes.

Paediatric surgery involving the genitals would only be undertaken in a Tasmanian public hospital if it was considered medically essential to restore, obtain or repair vital physiological function.

Ms O'CONNOR - Can I ask, Premier, in the absence of legislation that protects the rights of these children, in line with the UN joint statement on the human rights of intersex persons, the AMA, LGBTIQA+ health position statement of 2021, the Australian Human Rights Commission report about health and bodily integrity, what guidance or framework is in place in public settings in Tasmania's hospital system to surgeons who might argue that this is essential surgery when it may not be? Where's the guidance to surgeons?

Mr ROCKLIFF - I am advised that surgery to address innate variations of sex characteristics for infants and children is very infrequent in Tasmania. There are no formal policies, protocols, guidelines or frameworks guiding decision-making about surgery for minors in Tasmania's public hospitals -

Ms O'CONNOR - Did you say there are none?

Mr ROCKLIFF - other than Elective Surgery Procedures Not Routinely Performed which states gender reassignment surgery is not funded to be routinely performed by the Tasmanian Health Service unless there are exceptional clinical indications for surgery due to congenital abnormalities in children.

Ms O'CONNOR - Can I just check - did you just say there is no guidance?

Mr ROCKLIFF - No formal policies, protocols, guidelines or frameworks -

Ms O'CONNOR - Do you think that's a problem?

Mr ROCKLIFF - guiding decision-making for surgery for minors.

Ms O'CONNOR - Because no one can ask these babies whether they consent. That's the issue; which is why the Tasmanian Law Reform Institute (TLRI) recommended a suite of reforms, potentially including amendments to the Criminal Code.

Mr ROCKLIFF - I am advised, that's what we're working through. I have met with a person with lived experience in these matters as well, so I understand the heartache - to put it mildly - that's caused this particular individual.

Ms O'CONNOR - A final question on this round, Chair. This all sounds a bit casual -

Mr ROCKLIFF - No, it's not casual at all.

Ms O'CONNOR - There's no guidance for surgeons; there are no rules, apparently. There's an assertion you made in a letter to Amnesty, which appears to not be true.

Can you commit to the table today to progressing these TLRI recommendations as a matter of some urgency and, perhaps, start with clinical guidance to your surgeons?

Mr ROCKLIFF - Part of us working on this is meeting with people with lived experience, and I've met with some in the last 12 months.

Ms O'CONNOR - Yes, but there's still no guidance in place.

Mr ROCKLIFF - Dale, do you have anything to add?

Ms O'CONNOR - No, this is a question to you. Will you commit to treating this with the seriousness and the urgency -

Mr ROCKLIFF - I am treating it with seriousness.

Ms O'CONNOR - The report was handed down three years ago.

Mr ROCKLIFF - I am treating it with seriousness.

Ms O'CONNOR - What's the next step? Are you going to engage with your clinicians, your surgeons about this?

Mr ROCKLIFF - I will seek advice on the best way forward for these matters.

Ms O'CONNOR - It doesn't sound like it's really entered your thinking much.

Mr ROCKLIFF - I've met with people concerning this.

Ms O'CONNOR - Whatever.

Mr ROCKLIFF - It's not 'whatever'.

Ms O'CONNOR - Nothing's changed.

Mr ROCKLIFF - I've engaged with people who are advocates for change in this area and I will continue to work through those matters.

Ms O'CONNOR - Are you not prepared to treat it as urgent? You are too busy with the stadium. That's your problem.


Ms O'CONNOR - It's true.