Not Informed Consent!

California is considering doing something very clever. There is a bill now before the state Senate that would require informed consent before anyone could submit to therapy to change their sexual orientation. From the current text of the bill:

865.1. (a) No psychotherapist shall engage in sexual orientation change efforts without first obtaining the patient’s informed consent to therapy as prescribed in subdivision (b).

(b) To obtain informed consent, a treating psychotherapist shall provide a patient with a form to be signed by the patient that provides informed consent. The form shall include the following statement in size 14 font:

“Having a lesbian, gay, or bisexual sexual orientation is not a mental disorder. Sexual orientation change efforts have not been shown to be safe or effective and can, in fact, be harmful. The risks include, but are not limited to, depression, anxiety, self-destructive behavior, and suicide.

Medical and mental health associations that oppose the use of sexual orientation change efforts include the American Medical Association, the American Psychological Association, the American Psychiatric Association, the National Association of Social Workers, the American Counseling Association, the American Academy of Pediatrics, and the American Association for Marriage and Family Therapy.”

The American Psychological Association convened a Task Force on Appropriate Therapeutic Responses to Sexual Orientation and it concluded:

“Efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of sexual orientation change efforts practitioners and advocates.”

The American Academy of Pediatrics states:

“Therapy directed at specifically changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.”

The American Medical Association’s Council on Scientific Affairs prepared a report in which it stated:

“Aversion therapy (a behavioral or medical intervention which pairs unwanted behavior, in this case, homosexual behavior, with unpleasant sensations or aversive consequences) is no longer recommended for gay men and lesbians. Through psychotherapy, gay men and lesbians can become comfortable with their sexual orientation and understand the societal response to it.”

The National Association of Social Workers states:

“Social stigmatization of lesbian, gay and bisexual people is widespread and is a primary motivating factor in leading some people to seek sexual orientation changes. Sexual orientation conversion therapies assume that homosexual orientation is both pathological and freely chosen. No data demonstrates that reparative or conversion therapies are effective, and, in fact, they may be harmful.”

Well, now, look at that. Statements from the experts, specific harms, a statement about mental disorders straight out of the diagnostic criteria, plus a place to sign to get the treatment anyway, if that’s really what you want. Also a provision to keep this sort of “therapy” from being given to children under 18 despite anyone’s permission.

This is what we call classic informed consent, allowing people to make up their own minds in a meaningful way. Who would be against that?

Well, as it turns out, at least one “ex-gay” Christian thinks the whole idea is horrible.

I am passionate about stopping the harm that would come from this bill; in this case, the political is also personal. 25 years ago I was living in California and looking for help with same-sex attractions. My motivation wasn’t self-hatred or pressure from a “hetero-normative” society. I believed what the Bible says and the church teaches: God made sexual expression for marriage between a man and a woman. I knew there were grave health risks to homosexual sex, and I wanted a family.

Despite his passion, however, having to read and sign a grown-up permission slip would have absolutely made it impossible for him to go through with the “therapy”.

SB 1172 infringes on people’s ability to seek treatment for unwanted same-sex attractions.

And you thought I was kidding. No, this guy is really saying that this would stop the therapy for those who want it. He identifies some “issues” involved (Focus on the Patriarchy links removed):

1. Mental health professions consistently note that practitioners must respect client autonomy and self-determination – people’s right to control their own lives and therapeutic choices. This bill flatly tramples these and says, “The state knows what’s best for you.”

Actually, the state says, “Sign here if you know what the experts think and want this anyway.”

2. Mental health groups have also become more aware of the role of religion and faith in people’s lives. A Christian with same-sex attractions and biblical beliefs would be told, “Trying to change may damage you, so don’t pursue it.” And Christian minors with unwanted same-sex attractions would be completely denied the right to pursue change under this law – regardless of parental support to do so. So much for religious freedom.

Mental health is health. Period. Religious freedom is already restricted when it comes to children’s health. People manage to kill their children with faith anyway, but they don’t do it under the sanction of law. This bill wouldn’t change that dynamic. It won’t even keep churches from offering counseling from unlicensed practitioners. It will simply require that anyone who claims professional status act provide information like a professional.

3. The bill squashes parental rights. Parents have a God-given right to provide appropriate help and resources for their children struggling with unwanted homosexuality. Under this bill, counseling help would be denied to parents and their children.

Do you think he knows that 2 and 3 are the same argument?

4. Psychiatrists, psychologists, marriage and family therapists, social workers and other counselors have national and state boards that set standards for education, licensing, ethics and client care. These groups have regular channels for dealing with therapists charged with ethics violations. Basically, SB 1172 sweeps all this aside and puts the California legislators in control of how mental health professionals may deal with people with unwanted homosexuality.

Ah. So this type of “therapy” may involve ethics violations, but we shouldn’t let prospective patients know that up front. They should be ignorant to start with and only have the recourse of damaging a therapist’s career afterward. I see.

Frankly, every single one of those arguments is “Governments shouldn’t govern.” Less than impressive. But then he claims that there are reasons based in harm not to pass this bill. Think he does any better with these?

  • Imagine a man seeking counseling for unwanted same-sex conduct. He could be engaged in extremely risky, life-threatening or even illegal behaviors, such as anonymous sex, sado-masochism, public sexual activity or sex with multiple partners. Not all of them identify as homosexual. That counselor would have to tell this man, “I’m sorry, but therapy to stop having sex with men you don’t know might harm you.”

Whew, it’s a good thing no one can engage in any of those behaviors (most of which are simply not remotely alarming) with a partner or partners of the opposite sex! Oh, wait.

  • Some men begin these activities as minors. According to this bill, a counselor could not help a teen alter his sexual conduct toward people of the same sex – even if it was life-threatening.

Funny thing. While some of those behaviors could theoretically be done in a way that was life-threatening, the presence of a partner of the same sex isn’t what would make them so. “I engage in damaging sex with people of the same sex; I want treatment for the compulsion to have damaging sex” and “I engage in damaging sex with people of the same sex; I want treatment for my desire to have sex with people of my sex” are completely different statements. Only one of them (hint: it’s not the relevant one) falls under this bill.

  • Think of a priest with a counseling license leading a support group for people with unwanted homosexuality. A woman comes to the group; she’s just become a Christian and is wrestling with what the Bible says about her lesbian relationship. He would have to warn her that trying to live a chaste life could damage her.

Another funny thing. What he would actually have to do, by virtue of having become a professional, is act like one. He would have to disclose that he was unwilling to offer this woman any counseling aside from what his interpretation of the bible tells him he should. Then he would have to disclose to her that, as in many things, his religious views and the professional views of actual experts on the subject of therapy differ. Then he would have to offer her–gasp–a meaningful choice! Quelle horreur!

  • A church might have a pastor who is also a marriage and family therapist, and a teen boy caught up in homosexual pornography comes to him for help. As a licensed counselor, he could not legally help the boy stop his pornography addiction. After all, doing so change his attractions or conduct toward people of the same sex.

If the church has a professional counselor who thinks that any consumption of pornography is addiction, that church should, ethically, suggest the counselor undergo more modern training. However, for the sake of argument, let’s say that this hypothetical child consumes pornography in a way that is intrusive in the rest of his life. “Reparative therapy”, if successful, isn’t going to change that.

I hate to break it to our ex-gay friend, but there is heterosexual pornography out there too. If his own therapy were so successful, you’d think he’d know that.

One more time, there is nothing about this problem, to the extent it’s a problem, that has anything to do with being attracted to someone who shares the same plumbing you do. There is nothing about the treatment for any of these problems, to the extent it’s considered necessary, that would require “reparative therapy” or invoke the informed consent bill as it’s currently written.

Part of me is appalled that these are the best arguments that opponents of this bill can give. Most of me, however, is just nodding. The only real objection to this that the patriarchy shills can muster is that they don’t want to have to tell people that the crap they offer is exactly that. That I already knew.

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Not Informed Consent!
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16 thoughts on “Not Informed Consent!

  1. 1

    My motivation wasn’t self-hatred or pressure from a “hetero-normative” society. I believed what the Bible says and the church teaches…

    Right…it wasn’t pressure from a hetero-normative society, it was pressure from a hetero-normative religion that was inextricably woven into our hetero-normative society. Does this poor sod even realize he’s contradicted himself?

  2. 2

    I think the bill is addressing a really important issue, and one where public and consumer safety are paramount. However, I’m really leery of mandated informed consents, because I’ve seen them abused so much to misinform and bully women seeking abortions, and I’m having trouble reconciling with myself why this mandated-informed-consent is okay, while the reproductive health one is not. Of course, this one deals in medically accurate information (while the forced-pregnancy ones most *definitely* don’t!), but I don’t necessarily trust elected representatives to decide what medically accurate information is. Would requirements for licensure be a better way to address this issue?

    What are the fundamental principles that allow us to determine whether or not state intervention in medical care provision is warranted or not, independent of whether or not we agree with the goal? What are some standards in state requirements for health care providers that are analogous to this?

  3. 3

    Don’t let the anti-choice brigade sway your thinking on informed consent any more than you would let the push for Intelligent Design in the classroom make you leery of science education. Informed consent is the standard of care for medical care, from drug labelling to surgery, and it should be. The fact that they try to corrupt that for their cause only shows that they know how important people consider informed consent to be. It doesn’t reflect on that standard itself. Just insist that, like science education, it actually be based in the best scientific consensus we have.

  4. 4

    @LeftSidePositive
    Excellent point, perhaps in cases where informed consent bills are deemed necessary, the legislature should make the statement that it is so necessary and deem that 2 or more leading groups within the specific field determine the proper wording and revisit the required wording say… every 2 years.

    In this case, I LOVED the law, one of the best I have read in a while. The biggest difference between this one and the abortion ones, scientific bases including proper citations have been provided for the information given.

    Personally, I consider “reparative therapy” to be disgusting and an insult to all those who deemed “broken” by the existence of the programs. I would never consider one for myself. However, that does not mean that the choice, once informed properly, should not be allowed to each individual.

  5. 5

    If we start listening to experts now, the experts win! Lets show those experts what we think of their years of study and experience. My ignorance is every bit as good as their knowledge!

  6. 6

    @ LeftSidePositive:

    It sounds like reputable medical experts had plenty of input into this law. I think that’s why all those quotes from doctors and social workers are included in the text of the bill. They’re not part of the informed consent text, if I’m reading that punctuation right, and it’s not typical to find editorial comments by third parties in the text of a law. I think the legislature wanted to prove that they were simply adding the force of law to an existing expert consensus, rather than legislating their own uninformed opinions on what constituted good medical care.

    (And if those quotes actually are part of the informed consent form? So much the better! That means that medical experts actually did write most it.)

  7. 7

    Stephanie, I’m certainly not objecting to informed consent as a standard, I’m questioning how and when it is appropriate for the *state* to mandate it. How much is informed consent generally mandated by the state, as opposed to medico-legal precedent, and medical association policy?

    There are other dangers as well: scientific knowledge changes (although of course I don’t expect it to in this case), so even with the best of intentions putting the force of law behind medical best practice can be highly problematic. What if in the late-90s it became law that doctors must counsel their patients about the benefits of hormone replacement therapy? That was the genuine medical consensus at the time, but then it was discovered to do more harm than good–what if it were still the law to counsel people in favor of it? Not only would there still be interests, but the law doesn’t change fast enough even in the best case.

  8. 8

    Robert, the informed consent text name-checks all the relevant organizations, but the quotes are separate. Now, the name-dropping is really great and adds legitimacy, but there are also conservative counter-organizations with official-sounding medical names. For instance, there is an organization of forced-pregnancy OB-GYNs (I forget the actual name) that sounds like it would be the official organization for all OB-GYNs, but it is not actually the American College of Obstetricians and Gynecologists (ACOG), but a patient would hear the name and think they were getting relevant consensus medical info about reproductive health from the official body. I think there are also sham groups for pediatrics and psychiatry, too.

    Again, I think everything in this bill is great, but I just want to make sure we don’t get into end-justifies-the-means territory, or set precedents that can be abused.

  9. 9

    tynk, I think that’s a really promising solution (but at the same time I don’t put it past conservatives to try to have their sham groups be the ones who set the wording!).

  10. 11

    A woman comes to the group; she’s just become a Christian and is wrestling with what the Bible says about her lesbian relationship.

    Wouldn’t “what the Bible says about her lesbian relationship” be, AFAIK, “nothing”? Did someone slip a recognition of the existence of lesbians into the Bible while I wasn’t looking?

  11. 12

    LeftSidePositive, the difference is that the abortion restrictions have no merits in and of themselves. They’re just meant to be impediments, and the “medical statements” are always chock-full of anti-choice lies and misinformation, having been written by anti-choice legislators rather than actual doctors.

    The California case is almost the opposite, because the lack of merit is on the side of “reparative therapy” and its proponents. The state is trying to put accurate information and due diligence into the decision making process, which is a far cry from using unnecessary procedures, red tape and medically unsound statements as deterrents.

  12. 13

    Setar, I totally agree with you, but my concern is how to we reliably and externally verify what is accurate information? Yes, to us it’s damned obvious that this is accurate, but I’m not sure the political process is generally qualified to make those distinctions, especially on medical matters.

  13. 14

    LeftSidePositive,

    I now realise that there might be such a condition as “just too sceptical”. I am concerned that you may be attacking the wrong target.

    What you have above is the best information currently available, clearly expressed and having the support of a large body of professional people with the relevant knowledge. Informed consent should involve that quality of information being made available to the patient in every case. I repeat, in every case.

    Should later research and practice cause any of the professional bodies to change its mind at some point in the future then they will do what you would expect them to do – rewrite their advice on the subject and then politely lobby the intelligent legislators of California for an amendment. As you imply, though, that’s unlikely to happen any time soon.

    I fear that the purveyors of bullshit and misogyny may have caused confusion even in these august halls by putting together documents and proposed legislation which lack any basis in fact, any support from professional bodies, even any grasp of grade school biology, then trying to pass them off as part of an informed consent process.

    Any document should be judged on its own merits and not rejected for fear that some unidentified person out there might not be able to discern the difference between sound advice and arrant nonsense.

  14. 15

    Well, I think this is a terrible idea: This kind of dangerous therapy should be illegal, forget about informed consent.

    But I guess failing that, informed consent is a good step in the right direction….

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