Justice Committee on Dec. 1st, 2020

[Ghislaine Gendron]

Thank you, Dr. Cantor.

I'd like to thank the committee members for having invited our organization, Pour les droits des femmes du Québec, or PDF Québec.

In September 2019, PDF Québec received an email from a young woman who wanted to inform us of treatment she had undergone for gender dysphoria and about how it had affected her life once she reached adulthood. She asked me to read the following evidence on her behalf:

During adolescence, my periods were so painful and frequent that they interfered with my education. My doctor was not helping me obtain appropriate care. It's also around that time that my borderline personality disorder surfaced. I was given psychiatric treatment after frequent hospitalizations. I was obsessed by the idea of being perfect, and I became very hung-up about my appearance. I didn't feel like a proper woman. After learning about gender identities on the Internet, I found an escape route from my complexes and periods: transitioning. I was given access to hormone blockers, testosterone, and a mastectomy. The psychiatric team treating me had noted increased aggression and some suicide attempts. Rather than accepting myself, I chose it as a way to escape who I was. I stopped taking hormones after three years, but some side effects are not reversible. I went into debt to pay for breast implants. Going back is not as easy as the initial transition.

This young lady was still a minor when she underwent a mastectomy and biomedicalization. Her personality disorder had been diagnosed before she took steps to receive gender affirmation therapy. Her case is unfortunately similar to what has happened to many young ladies who show up at gender clinics. Dr. Cantor, who is with me here today, can explain it better than I could.

How would a practising psychologist who meets this young lady tomorrow be regarded under Bill C-6?

Would the psychologist be criminalized for asking a child about her perception of her condition or her self-diagnosis of gender dysphoria?

Twice as many girls as boys are affected by gender dysphoria, though the ratio has been reversed in recent statistics. In the legislative summary for Bill C-6, the subject is neither addressed nor explained.

We had to change our opening statement this morning at the very last minute, and I would like to apologize to members of the committee and to the interpreters. That's because barely three hours ago, the BBC broadcast information of crucial importance to this topic. I'll tell you about it.

The High Court of the United Kingdom ruled today that children under the age of 16 with gender dysphoria are unlikely to be able to give informed consent to treatment with puberty-blocking drugs or cross-sex hormones.

The young Keira Bell, who detransitioned in adulthood, won her case in England against the Ministry of Health. However, our health department does not appear to have been mentioned in the bill.

Thank you for your attention.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for your remarks.

We'll go into our first round of questions, starting with Mr. Moore for six minutes.

Go ahead, Mr. Moore.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

Thank you to each of the witnesses who are appearing here today on Bill C-6. We appreciate your taking the time to give your perspective on this piece of legislation.

For our part, we want to make sure that we get this legislation right and that it does what it says it's going to do.

Dr. Zucker, I want to ask you a question. You mention the definition and challenges with the definition. That's something we've identified. When this bill was introduced, the minister gave lengthy remarks about what the bill doesn't do. He says that it doesn't criminalize many things, including expression of “views on sexual orientation, sexual feelings or gender identity...such as where teachers, school counsellors, pastoral counsellors, faith leaders, doctors, mental health professionals, friends or family members provide support to persons struggling with their sexual orientation, sexual feelings, or gender identity.”

We're starting to get feedback from different stakeholder groups throughout Canada. One of the concerns that have been raised is that if this is what the bill purports not to do, if this is what the minister says it doesn't do, then we should fix or strengthen the language and the definition so it more narrowly focuses on what our goal is, which is to make sure that people are not subjected to conversion therapy.

Can you maybe explore a little further your thoughts on the definition and what you see as faults with the definition as it's currently construed? It's our job as parliamentarians to make sure that we get this bill right. The committee level is where we get that feedback and can perhaps have amendments that would improve the bill.

[Dr. Kenneth J. Zucker]

Sure, I'll try to answer that.

In science, we have a term called “operational definition”, meaning that we have a particular term and then we have to define it in a way so everybody can agree on what one is actually measuring.

My point about Bill C-6—it's very similar to all prior legislation, including Bill 77 in Ontario—is that there's this “does not apply” clause, which I read out to you. It does not include practices, etc. that relate to a person's exploration of their identity.

That is a completely vague descriptor. It does not give clinicians clear guidance on what is considered acceptable in terms of exploration. I think that is a fundamental problem. It's frightening to parents, because they worry that they're going to be accused of taking their kids for conversion therapy, whereas any well-trained clinician, as I said earlier, does not coercively try to change a child's or an adolescent's gender identity.

I think a well-trained clinician engages in all kinds of exploration. The problem with Bill C-6 is that it doesn't define what that means or doesn't mean. I think that is a very serious issue.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Doctor.

This question is maybe for Dr. Cantor or Dr. Zucker.

You're saying in your testimonies that the language is too vague and not certain enough, so that we don't know what is or what is not captured. If there's a reluctance on the part of the government.... We had the minister here in a prior session and I asked him if he'll accept an openness to amendments that would help to narrow in on what exactly we're talking about in the definition.

Is there a concern on your part, either one of you, that there would be a chill in health care professionals when it comes to dealing with young people who are trying to navigate, for example, gender dysphoria?

[Dr. James Cantor]

I think that's probably the most likely outcome, that we will indeed see a chill effect. Psychologists especially are, in their way, a relatively conservative group. People will say “Uh-oh”, if there's a lot of trouble. If there's a lot of activist language about it, a lot of political angling going on, many practitioners will simply resolve not to become involved. They will say, “I'm not expert enough to really make this an issue” and will just shy away from seeing any of these clients.

We will end up with clinicians, exactly as you put it, with a chill effect, simply unwilling to deal with this kind of issue; the service will become unavailable. Without a clear indication of what counts as an “exploration” and exactly what that means, anybody would have trouble going into this with the kind of confidence that a clinician needs in order to help their client.

To say that we're exploring or that a client is exploring their gender identity is to assert that there exists a concrete gender identity and we merely need to shut up and observe. There's no evidence for that for gender identity. We have evidence for that for sexual orientation, but we cannot treat gender identity as if it's the same thing.

[The Chair, Liberal, Iqra Khalid]

Thank you.

We'll now go to our next round of questions, with Mr. Virani for six minutes.

Go ahead, sir.

[Arif Virani, Liberal, Parkdale—High Park, ON]

First of all, Mr. Ashcroft, I just want to say thank you. Thank you for your candour, and thank you for your courage in presenting here and elucidating a lot of important thoughts for us to consider.

I want to voice some agreement with some of what I've heard, particularly from Dr. Wells. Even the term “therapy” seems a bit of a misnomer here, because what we're talking about is forcible, imposed treatment on individuals, and that's not therapy at all from my perspective either.

What informs this, particularly when we're talking today, on World AIDS Day—and we've talked about historic discrimination in respect of that issue for the LGBTQ2 community.... What we're talking about here is just the freedom to be who you are and to love whom you want to love. That's what informs everything we're doing.

Mr. Wells, I want to ask you a few questions, and I would ask you to take just 30 to 45 seconds for your responses.

From my perspective, this bill is quite clear in terms of what is an offence. It is an offence under the code pursuant to this bill, if it passes, to force someone to undergo something that they're not consenting to, regardless of age.

Does that provide the clarity that people need, including medical practitioners, Mr. Wells?

[Dr. Kristopher Wells]

I don't think the issue is around forced conversion therapy or associated practices, but this notion of whether someone can consent to what is inherently a fraudulent practice, such as conversion therapy. There isn't scientific evidence that supports its efficacy to change someone's sexual orientation or gender identity. How do you consent to something that is unscientific and that is based in an anti-LGBTQ ideology? That's why many people want the inclusion of adults. The notion of “consenting adults” is just a complete misnomer.

Likewise, let me say briefly, the problem with the legislation is that it says that in some cases conversion therapy is not acceptable for minors, but in other cases it can be acceptable for adults. It really sends a mixed message about the harms and dangers of conversion therapy by creating these artificial distinctions based on age.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Just further on the point of consent, from a medical practitioner's perspective, as long as consent is obtained—I presume medical practitioners do this all the time, obtain consent for various treatments, this treatment or others—there would be immunization from prosecution, I would have thought.

Is that a fair assessment?

[Dr. Kristopher Wells]

The way this legislation is currently worded, and that is a concern from the LGBTQ community....

I'll give you the example of a young adult, aged 18 to 25, who is in a vulnerable situation. They may be forced to undergo conversion therapy because of pressure from their family, from their cultural community or faith community. They are not consenting to the practice, but they know what their choice is: they undergo this, or they get kicked out of their home. We know that the LGBTQ community is vastly overrepresented in the homeless population, and a large reason for that is the lack of family acceptance.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Okay, let's talk a bit about that, because a lot of people have said this is going to somehow criminalize conversations with parents, etc.

We've heard about the notion of a list; it was covered extensively in the last session with the ministers. I'm personally of the view that the second you wade down into enumerating a list, you risk not capturing an individual. The point was raised earlier that people such as music instructors or soccer coaches aren't included in the list that was apparently on the website at one point.

What is the danger of enumerating a list, as opposed to targeting a practice, treatment or service?

[Dr. Kristopher Wells]

Certainly. As the minister has said, it's what's not listed, then, that somehow gets deemed as permissible or acceptable.

I think people are missing the point in the conversation about a list. If your practice is that your conversations are objective and neutral and don't have a predetermined outcome, then you really have nothing to worry about, because you're not engaging in conversion therapy. Often those who are engaged in conversion therapy are the ones speaking the loudest for this kind of list or these kinds of exemptions.

The legislation the government is proposing here is not that different from what has been proposed and been in operation in Canada in different provinces or territories and at municipal levels. I think what the City of Calgary has is a great example. They have very clear legislation, and then they develop their frequently asked questions and put those on their website. This is where you could get into the specific kinds of examples to show how this legislation might be interpreted in practice.

I agree that it doesn't need to be enumerated in legislation.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Thank you.

Just quickly to Mr. Ashcroft, you gave us very compelling testimony about your own personal experience. We knew that a lot of the evidence also indicates that people who are forced into conversion therapy often experience depression and even suicidal ideation.

Could you comment on that, on the importance of the actual life-and-death nature of this kind of treatment and on what stopping it can do to prevent suicide?

[Matt Ashcroft]

I'll give you an example of my story. When I went to a conversion therapy camp, I saw somebody re-enact somebody else's rape in front of my eyes. I can't get the screams of that man that I mentioned in my testimony out of my head. It does cause depression. It does cause suicidal ideation. It's documented.

It's quite scary that we have to be in spaces like this in order to bring equity and justice to queer, trans and non-binary folks.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you.

Thank you, Mr. Virani.

We'll now move to Monsieur Fortin for six minutes.

Go ahead, sir.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Thank you, Madam Chair.

My question is for Ms. Gendron from the Pour le droit des femmes du Québec organization.

Ms. Gendron, based on my understanding of your evidence and the evidence from Dr.^x Cantor and other witnesses, you are in favour of the idea of prohibiting conversion therapy. That would be what the new clause 320.101 of the Criminal Code defines as follows:

320.101 ...conversion therapy means a practice, treatment or service designed to change a person’s sexual orientation to heterosexual or gender identity to cisgender, or to repress or reduce ... attraction...

However, practices, treatments and services for gender transition and the exploration and construction of identity are excluded. What is excluded is rather similar to what is prohibited. That's also what I have understood from the evidence, and it strikes me as a sort of contradiction.

Would your organization not be more at ease with the idea of adding an exclusion for honest non-interventionist conversations about gender transition and the exploration and development of identity?

What I am talking about is honest conversations that are not aimed at any intervention, as opposed to allowing certain practices, treatments and services.

[Ghislaine Gendron]

No. Based on our understanding of paragraph 320.101(b), conversations are covered. Conversations are not the problem—at least I don't believe they are—but rather exploratory psychotherapy.

As Dr. Cantor and Dr. Zucker Explained, children ought not to be self-diagnosing gender dysphoria. They need to have access to psychotherapy, which does not necessarily include biomedicalization.

In other words, our major concern is that parents and children should have access to psychotherapy which does not necessarily include biomedicalization. We would like such psychotherapy, without biomedicalization, to be permitted and not criminalized by the bill.

Many young ladies who suffer from autism or personality disorders end up in gender clinics. They represent a new clientele. I would also like to hear Dr. Cantor on this subject. They self-diagnose gender dysphoria. The bill would appear to indicate that a psychologist has no choice but to corroborate this information, even though patients might be suffering from something else.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

In your brief, Ms. Gendron, you mention not wishing to criminalize non-affirmative psychotherapy.

[Ghislaine Gendron]

That's right.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Conversion therapies are allowed. The're prohibited when the're carried out against a person's will or on a minor.

What I understand from your position on minors, for example, is that you would like them to have access to psychotherapy, but to non-affirmative psychotherapy not designed to alter their gender identity or sexual orientation.

Have I understood you correctly?

[Ghislaine Gendron]

No, you have not quite understood. Sorry.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

You don't need to apologize.

[Ghislaine Gendron]

Unlike non-affirmative psychology, affirmative psychology willingly corroborates the gender identity presented by the child, and initially suggests social transition, puberty blockers, cross-sex hormones and perhaps even surgery. What we are proposing is that parents and children should be able to have access to these. We're afraid that anything that is not "affirmative therapy" and that does not immediately corroborate a child's identity will be labelled "conversion therapy". We consider this a major problem in this bill.

Needless to say, we are absolutely against conversion therapy of the kind Mr. Ashcroft underwent. However, sexual orientation and gender identity must not be confused. Gender identity is a mental health diagnosis that leads to therapy—that requires therapy. Homosexuality is not a mental health diagnosis. Not at all.