Saturday, 15 November 2014

Matthew/Chelsea/Matthew Attonley and issues arising

Here's a 'news' item from early October that I missed. Clearly I ought to read tabloid newspapers, and watch TV that carries ads, and not just rely on the BBC's national output for everything! If you are snooty and suspicious about non-BBC coverage you do miss an awful lot of stuff.

Well, I stumbled on  Matthew Attonley's story only a couple of days back. Here, for instance, are two links to look at:

http://www.dailymail.co.uk/news/article-2776090/Transsexual-10-000-surgery-NHS-wants-man-again.html
http://www.itv.com/thismorning/hot-topics/matthew-attonley-living-as-woman-chelsea-wants-to-be-a-man-again

So far as I can gather from the publicity, Matthew grew up feeling uncomfortable with life as a Derbyshire lad, had leanings towards feminine things, and in his twenties became a polished drag performer. Then, inspired by Katie Price, aka the (then) bosomy model Jordan, Matthew (by now Chelsea) embarked on transition using the NHS, and therefore obtained free treatment - the necessary hormones, and the coveted genital surgery. The figure quoted for the cost of the MTF surgery is £10,000. That's about right. A seriously large amount of money to many people.

But, it is reported, she found female life as Chelsea hard to keep up. It lacked fulfilment. And she had self-image problems, although, so far as looks are concerned, it's hard to see why. She looked great. I'm sure most would agree with that. But of course self-perception is everything, and she didn't see in herself the complete woman she wanted to be. Nor was she able to function socially and romantically as hoped for. I'm tempted to say that her expectations were too high; but a remark like that would be fair only if I knew her well.

So, reverting to Matthew again, he is now living in male mode and is seeking reverse genital surgery to help restore a male appearance. The figure reported for the reverse surgery is £14,000, which seems surprisingly low to me. But then if he'd had the standard NHS operation for MTFs, he'd at least have a recoverable tube of tissue that could be refashioned into a penis, even though it would lack most of the original filling. It might look quite good, and the surgery surely wouldn't be anything like as extreme as the horrendous cycle of ops necessary to create a penis out of nothing for FTM patients. So Matthew will (mostly) be physically restored. But £14,000...another small fortune.

And the surgery won't address that lingering identity question. If Matthew originally felt rather a misfit in the male role, then the old problems are bound to resurface. I'm thinking that while he may find life easier to cope with as Matthew, complete happiness will elude him. But let's hope the fix does work.

The Mail made a big thing about his expecting the NHS to fund the reverse procedure. So that he has clocked up not one but two free ops. Clearly it felt its readers would be outraged, learning that their taxes could be spent in this way. And that this person was coolly insisting on it, not caring what other NHS users might think.

Well, I do agree that this is a proper public issue, concerned with (a) what the NHS should be providing, (b) the proper use of public money, and (c) how to resolve conflicts of expectations and priorities.

Let's get away from Matthew himself, and consider the general issues of regret, reverse surgery, and who ought to pay for it.

Supposing I go to my doctor and beg him to fix my big nose - the nose that I insist is ruining my life - and he refers me to a specialist. And suppose I convince the specialist that only drastic nose surgery will transform my life and make me happy and fulfilled. And so the operation takes place, on the NHS and at no cost to me. My hooter becomes small, sweet and retroussée. Job done. I've got what I wanted.

But then it makes my life worse. People think my little nose is a joke. They laugh, and won't take me seriously. I can't cope. And so I return to my doctor, and insist on another operation to give me a nose with the noble characteristics of the original. I think it's my right. I am petulant, make a huge fuss, enlist the help of tabloid newspapers, appear on TV, and get my way. And so, with the NHS picking up the bill again, I get a restored conk. And let's say it was £5,000 for the first op, and now another £7,000 for the second. Quite big money.

Some important and deep points here.

Facial deformities and abnormalities can utterly ruin a person's self-confidence. So a very oddly shaped nose should certainly be dealt with on the NHS. And that means for free.

But who can say what is an odd nose? What if it doesn't look odd at all, but still causes distress?

Supposing I exaggerate this distress, consciously or not, to ensure that I get the operation that I sincerely believe will make my life better? Am I wrong to play up the agony and push so hard?

Is the NHS at fault if, impressed and convinced by my representations, it diagnoses 'severe nose dysphoria'?

Is it liable to pay for a corrective operation, if - later on - we come to realise that a nose fix wasn't really the solution to my personality problems, and that a misdiagnosis was made? In other words, even if it isn't in the normal remit of the NHS to fund a second operation, it is nevertheless liable to stump up compensation for a misdiagnosis - and, in that way, still pay.

Given the basic duty of the NHS, and its prime reason for existence, am I right to expect and insist on whatever medical treatment becomes necessary, even if it results from a change of mind, and costs rather a lot?

Is my intense use of medical resources any reason to consider the cost, and perhaps withhold treatment? Is treatment rationed? Are people allowed only so many lifetime operations on the NHS?

If I were denied whatever it took to fix my medical problem, where do other service users stand? Users who knowingly and repeatedly abuse their health through smoking or alcohol or dangerous sports, for instance?

Who decides? Is it all down to medical experts? Do the views of outsiders carry any weight here? Indignant Mail readers, for example?

Should one judge between cases? What is a 'deserving case', really? How do you decide that fairly and reasonably?

Big questions, all of them. Personally, I think there will always be the occasional transitioner who finds they have made a mistake. It's clearly very important for anyone who has gone through a major operation to be happy about the life that follows. Some won't be. It may then be right to give them a second chance. Does it really matter if Matthew Attonley is able get an expensive corrective operation out of the NHS? Would it really be a good thing if he were left as 'a male trapped in a female body', and forever depressed, out of work, and a burden on society?

If he is never happy, he won't be able to make others happy either. That's a point I kept in mind about my own transition. Make me the person I should be, and I can give something back. I will be much more confident, far more outward-looking, a force to be reckoned with. Someone who is their true self, who has that true self-assurance, can step forward and achieve. And eventually pay that £14,000 back in taxes.

1 comment:

  1. First - He has NOT had genital surgery. Second - at his request I went with him to Bangkok in Nov 2009 to have breast implants. He was never under the NHS for gender re-assignment. Third - he is causing untold problems for future Gender Dysphoric patients and maybe risking their lives.
    Penny
    PS - I have proof of all this.

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