Same-sex marriage and the role of the GP College

Same sex marriage

During my medical training in Amsterdam I witnessed many of the effects of the Dutch liberal policies such as the legalised practice of euthanasia and their model on cannabis. The Netherlands was also the first country in the world to legalise same-sex marriage over 15 years ago.

When it comes to same-sex marriage I support this. Not so much because of health reasons but simply because I believe it is fair.

I acknowledge that LGBTIQ communities (Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning) have had a lot to endure. I also respect that there will be people who disagree with me and may have other opinions.

In Australia we now have the odd situation of the voluntary Australian Marriage Law Postal Vote, where we are asked to vote on the question: Should the law be changed to allow same-sex couples to marry? 

The RACGP position

The postal vote has created healthy debate but also vigorous campaigns by the ‘yes’ and ‘no’ camps. Organisations and businesses are being asked by their members and customers to take side and the health sector is no exception.

Unfortunately there have been inappropriate and hurtful comments on social media and elsewhere. It seems to me that these unintended consequences of the postal vote are doing more harm than good.

The Royal Australian College of General Practitioners (RACGP) has a diverse membership of more than 35,000 GPs with a range of views. The RACGP Council believes that members should make their own, personal decision about marriage equality.

This position does not imply that the RACGP is against same-sex marriage, or for, and it does not mean that the College or general practitioners do not acknowledge the many challenges facing the LGBTIQ community.

It also does not mean that the RACGP president is personally neutral on this topic – I know that he supports same-sex marriage.

The background

To better understand the position of the RACGP Council it is good to look at the history and the role of the College. For many years the organisation has mainly focused on training, education and quality standards. In recent years the RACGP has moved into advocacy to improve support of and recognition for the provision of quality general practice care.

The RACGP has invested heavily in a large database of guidelines, standards, policies and position statements driving general practice care. However, there has not been strong demand from members to advocate on public policy issues such as climate change, sugar tax, alcohol sale, refugees or marriage equality and as a result the College has not developed a position on many of these topics.

The RACGP recently sent out a poll asking members if they would like the RACGP to advocate on a wider range of public policy issues, and one of the examples given was marriage equality. The response: One hundred members participated and one third stated that they did not think this was a role for the College.

This is only a very small sample and clearly more debate is required. The direction of the College will ultimately depend on what the membership wants. Traditionally the Australian Medical Association (AMA) has been doing this kind of advocacy very well, but perhaps there is a role for the Colleges?

Social responsibility 

An important argument for change is that it would increase the College’s social responsibility. As family doctors we come in contact with all of life’s challenges so we may as well participate in the various debates.

On the other hand, it will be difficult for the College to be everything to everyone. It may create more disputes. A broader role description will also require prioritising resources. Putting out a position statement is one thing, but driving it home and making the change often takes effort (including from RACGP members) and ideally members need to be on the same page.

For GPs who feel strongly about this issue: please continue to put topics on the RACGP agenda via the Faculties or the Convocation process at the annual conference.

Lastly, various RACGP sources including the Standards for General Practices affirm and underline respectful and culturally appropriate patient care and, in accordance with the law, strongly condemn discriminatory treatment of people based on their personal characteristics.

I’d urge everyone to be kind and considerate and show respect for others in this important debate.

Addendum 02/10/2017: RACGP Council has today issued a statement in support of marriage equality.

Edwin Kruys is Vice-president of the Royal Australian College of General Practitioners (RACGP).

Effective feedback

12 thoughts on “Same-sex marriage and the role of the GP College

  1. Reblogged this on karenpriceblog and commented:

    Very well said. Being an individual and stating an opinion but it requires more to be an organisation and do the same thing. Notwithstanding a non discriminatory policy under pins all of medical practice.
    Stay safe with the dialogue I say. This is good dialogue Dr Kruys. Than you.

    Liked by 3 people

  2. There are three ways of looking at this issue, one is ‘heterosexual’, simple, ‘common-sense’, and commonly religious. The second is the viewpoint of the ‘gay’ community – that gender does not matter any more. The third is biological and clinical.

    When a child is born (now, commonly before) a matter of singular importance is gender. Determined, as I began medical practice, at birth, simply by the observing the presence of a penis or vulva. (I make no apology for stating the obvious. Human birth is always a ‘raw’ event. And before the advent of ultrasound, one did not know before birth the gender of a child. It was the genitalia that decided – rightly or wrongly – the issue). In most circumstances that identification would prove to be life-long, determining the choice of a female or male name, a name that provided an unequivocal societal gender identification. The orthodox view was – and is – that anatomic identity determines the clothes worn, the public toilet the person will visit. Traditionally (and this is seen as ‘commonsense’) a couple to be married will be female and male. It is basic biology that sperm must fertilize an ovum for a child to be conceived. The intent of marriage has been to have children and create a family. And the societal, legal definition of marriage has arisen from that biological truism.

    But truism no longer. Homosexual couples now want the rite of marriage – and the right to marry. Forms of biological adoption have enabled homosexual couples to create families, with children. They want that rite and that right to be ensconced in law – with no discrimination between their circumstance, and the circumstance of heterosexual marriage. I consider what they really want from ‘marriage equality’ is ‘marriage equivalence’, and then there be no societal or linguistic discrimination at all. It will be bad form to talk about ‘traditional marriage’. Ultimately it may be impolite to ask the gender of the person that one ‘dates’. It may not be evident from the way they dress, indeed one may be taken by surprise. Will one be expected to cope?

    The clinical, biological viewpoint considers: anatomy, the genetic makeup of the individual, the effect of hormones – in particular the balance between testosterone on the one hand, and follicle stimulating and lutenizing hormones on the other. Importantly, the psychological ‘sexual orientation’ of the individual. What is the gender they have been taught they are, what gender have they grown up to be, what gender do they contemporaneously recognise? For most people the answers to these four aspects are consistent and unambiguous. For a minority they are not.
    Are these exceptional people ‘abnormal’? Is their condition a ‘clinical syndrome’ or disease? Certainly they are medically treated as such. But there are deeper questions. Do we treat these people with civility, respect – even congeniality and affection? Are we comfortable with their choice of toilet to attend? Certainly they, for numbers of reasons, are less likely, possibly much less likely, to be fertile. If being fertile is normal, indeed desirable, then their infertility, and the biologic underpinnings of that infertility, is a biologic anomaly. But the human question is even more important. Can these people be part of a ‘family’? If so – what ‘family’?

    In our present society, with its technologic underpinnings, and chemical anomalies, the inherent fertility of all males appears to be deteriorating. Will our environmental degradation bring us to biologic grief? And will an increasing proportion of adolescents find themselves emotionally and sexually attracted to their own gender?

    I suggest these are matters of even greater importance than whether the ‘Yes’ or the ’No’ vote wins the plebiscite.

    Liked by 2 people

  3. As a follower of Jesus, my conscience is affected by euthanasia, termination of pregnancy, and by not acknowledging that some doctors (like me) continue to honor a traditional view of marriage, when bodies representing many doctors, including myself, do not. The argument is not a clinical one nor a clear cut one, otherwise the decision would have been made without so much debate. Why not remain neutral for the sake of the seemingly silent minority?

    Liked by 1 person

  4. Thanks Edwin – this is refreshing to read. I follow the various GP groups on FB and find these conversations often become divisive, disrespectful even. Having one position affirmed as the “right” position often leads to people in these social media groups accusing doctors of not believing in science or evidence when they have different personal positions. I thought what united us in those groups (and professional associations) is what we hold in common – that we are GPs striving to provide good clinical care to our patients, regardless of our personal beliefs and values on a range of matters.

    Liked by 2 people

  5. Thank you for your words. Primum non nocere.
    With that oath I hope to “do good” or to “do no harm.” By my support of same sex marriage I want my colleagues and patients to have the same rights as I do.
    Sometimes our inaction causes harm. It is often done with the best of intention but with unforeseen consequence.
    RACGP has traditionally been an academic college for its members and their patients. It is increasingly involved in advocacy and social justice. With this comes an expectation that the college will participate in dialogue and support membership against discrimination. A contemporary RACGP has the opportunity to lead in this debate.
    ” There are risks and costs to action. But they are far less than the long range risks of comfortable inaction” John F Kennedy
    Be kind x

    Liked by 2 people

  6. I agree with Nicole, and I think that when it comes to important issues that affect the rights of others, the College should be clear where it stands, particularly as these issues affect the mental health of a significant percentage of our population. The RACGP should stand on the side of equality and it’s a pretty poor effort if it doesn’t come out and state this clearly. Would it have baulked at standing up for inter-racial marriage, or allowing our indigenous people to vote, too?

    Liked by 2 people

  7. Hi Edwin

    Lots of interesting points.

    Interested in the poll about which you say: “One hundred members participated and one third stated that they did not think this was a role for the College” – if it went out to the entire membership that’s a terrible response rate (which says something in itself) but I presume that means the remaining two thirds did think it was a role for the college?

    I can’t see why advocating for equality and standing up against the discrimination that affects our LGBTIQ community/our patients wouldn’t be a role for our college. We are talking about people who are living with discrimination day in, day out. A neutral stance is effectively a kick in the teeth for those of our patients affected by this.

    I feel embarrassed to be an RACGP member in light of the college’s stance in this and I do hope the RACGP reconsiders its position asap.

    Best wishes
    Jacquie

    Liked by 2 people

  8. Edwin – thank you for explaining the background the RACGP’s stance.

    I fully understand how the decision was reached. However, I still believe that council made the wrong decision, and that many patients and colleagues are profoundly hurting because of it.

    I’ve submitted my feedback also via my state faculty chair.

    I hope the council will reconsider and take the opportunity to condemn institutional discrimination while still supporting the rights of every member to vote as they see fit. The two are not mutually exclusive.

    Liked by 3 people

  9. As a medical professional I am concerned at the intent of some of LGBQTI, possibly some of the ‘no’ campaign, to deny me a basic human right. The right to differ from other’s opinions and perspectives, to state my opinions and perspectives, without immediate and simplistic condemnation, derogation and insult. The perception that there is only one ‘correct’ perception, and all other perceptions are deviant, inappropriate and false. That ‘you agree with me’, or you are ignorant and foolish. At times this message is direct, blatant and intimidating. At other times it is subtle, insinuating, but no less insulting. What it misses is the opportunity to dig down and understand another’s real concerns, their basic fears, their perception of what can go wrong. What might be the unintended consequences.

    I wish the right to the common and accepted usage of words, including the right to discriminate different meanings of words in the manner of a thesaurus. Human language is complex. Particularly the English language. Words have a wealth of nuance, as is demonstrated by any thesaurus. We should be entitled to acknowledge, explore and utilise those nuances – in our own use of the language. If language is to change, if the meanings of words is to change, we cease to speak the same language if each side does not acknowledge the shift in meaning. The dictionary, the thesaurus must be re-written. Both sides must acknowledge and accept the change. What happens when one side wishes to change the meaning, and the other side does not? I suggest this is the very essence of the present debate, the question of the plebiscite. What is the meaning of the word ‘marriage’? What should it mean in the future? What right does a minority have to demand that the majority accept the change they wish to impose? This question is not just a matter of ‘semantics’. The words of a community’s language create and enable that community. Without a language there is no community. Changing the language changes the community. Changing the community changes the language. And silently, in the middle of each of those statements is the concept of ‘meaning’. A language expresses meanings – events and relationships. It is those meanings, those events and relationships that define and elaborate the community.

    The meanings of words can – and do change. For the Apollo project, in the late 60’s, early 70’s, a ‘computer’ was a human being. Most of them were females. Very good at computation. Utterly necessary, considering the simplicity of the silicon chip technology of the time. As this example demonstrates, the changes that occur in language are commonly evolutionary, dictated by circumstance, and agreed by consensus. It is uncommon that a plebiscite is needed to determine whether the meaning of a word will remain, or will change. And a plebiscite may be unnecessary, even superfluous. Ultimately there may be a new – or a continuation of the old – consensus as to the meaning of the word ‘marry’. There probably will be an interval when both sides of this debate continue to use their own preferred meaning, and attempt to shout down what they consider is the inappropriate meaning. And add an adjective to prevent ambiguity. In which case, it is probable the meaning of the word ‘marriage’ will broaden, imprecision will enter the ‘usage’, and use of qualifying adjectives will become the norm – even necessary. And that circumstance will become the consensus.

    And it may be that that consensus is reflected in the law, as that law finally moves to provide to homosexual couples the legal privileges and rights that contemporary ‘marriage’ entitles heterosexual couples. Depending on the vote of the plebiscite, either the legal meaning of the word ‘marriage’ will be extended to encompass homosexual relationships; or another word – such as ‘union’ – will be adapted to describe the present rights and privileges of ‘marriage’, both to extend them to formal homosexual relationships, and to re-encompass formal heterosexual relationships. In that case the word ‘marriage’ will lose any legal meaning, will – by consensus – be returned to a diffuse and ambiguous ‘vernacular’. To mean whatever the speaker or writer wishes it to mean, whatever their listeners or readership interpret them to mean.

    So why all the ‘heat’? Obviously the fight is over the word to be used to define the legal privileges and rights of a couple in a consensual relationship. Those privileges and rights are already established. It is the word to define them that is in dispute.

    Is it sensible that the RACGP take a formal position in this argument? Over the appropriate word to use?

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