Banning conversion therapies
The Governor of California, Jerry Brown, has signed a Bill that will ban ‘conversion’ or ‘reparative’ therapies in that State. These are interventions that aim at ‘curing’ homosexuality or at least, controlling homosexual desires. There have been reported cases of exorcisms, shock treatment and aversive therapies not unlike those that were used in Stanley Kubrick and Anthony Burgess’ A Clockwork Orange.
There are interventions such as female genital mutilation that are banned in Australia, New Zealand and the United Kingdom and interventions such as Electro Convulsive Therapy that are subject to careful legal governance. So, one interesting feature of this judgment is that it has been made at State level, and that being deemed ‘unprofessional’ by a licensing body, as occurred in Australia a couple of weeks ago after a GP attempted to ‘cure’ homosexuality with Cyprostat, was not enough.
Brown is reported as saying “This bill bans non-scientific ‘therapies’ that have driven young people to depression and suicide. These practices have no basis in science or medicine and they will now be relegated to the dustbin of quackery.” These reasons are ones that can usefully be framed under the principles of beneficence and non-maleficence. The predictable and well-documented harms that are likely to result from such therapies and the lack of any evidence base for them mean that our standard expectations that health care professionals should not cause harm when there is insufficient reason to believe that there will be any benefit, appear to rule such therapies out.
The National Association for the Research and Therapy of Homosexuality (or NARTH) claim they will appeal this decision and do so on the grounds that it violates therapeutic freedom of choice. Their website reposts an article by Christopher Rosik that describes a number of prerequisites that should occur in order for conversion therapy to be ethically acceptable. Some of the discussion seems highly contestable and I won’t spend time here arguing about this, but there are two arguments that merit further debate. Rosik claims that a therapist should be careful to consider the reasons why a client wishes conversion therapy, to properly inform them. If this occurs then we should respect this as an autonomous wish and not disregard it simply because a client wishes to modify their sexual orientation.
While this appears on the face of it to be a strong argument, it is not for the reasons that I have already mentioned and led to such therapies being banned in California: the existence of knowable and predictable harms and the absence of evidence or efficacy mean that this therapy should not be offered even if there is an autonomous request.
Rosik argues that it is important to “respect people’s dignity, rights, and self-worth” and that this should be taken to include sensitivity to religious differences. He claims that allowing clients who seek conversion therapies to access them, respects their religious diversity. Failing to allow such clients access to therapies discriminates against them.
There appears to be something paradoxical at the core of this. One reason why I think physicians should not attempt to ‘cure’ homosexuality is because I think it is profoundly illiberal in that implies that homosexual orientation is immoral and ultimately fails to respect diversity. However, the objection here is that this liberal commitment ends up restricting the ability of some clients to pursue therapy for something that jars with their value system and this fails to respect diversity.
I’m inclined to think that the debunking of the evidence that was give in support of conversion therapies means that this latter argument is neither here nor there, in that it seems to be trumped by worries about harm and lack of benefit. However, that would be to duck what is an interesting challenge for my liberal argument. I’m not convinced for the following reason: if this is a case where a client wishes to alter his sexual orientation because it conflicts with a value set that sees homosexuality as immoral, then although this appears to be a private act, it is one that embodies values that fail to respect diversity. That would be a different case from one where a client wished to modify their orientation simply because they were committed to a heterosexual relationship, which would be consistent with respecting diverse sexual orientations.