Canadian’s euthanasia request highlights perils of gender-altering surgery

When an indigenous transgender woman in Canada, Lois Cardinal, made a passionate plea for death through euthanasia recently, the spotlight once again fell on the growing debate over gender-affirming care, a controversial topic now being ditched by a large section of medical experts as unscientific.

Cardinal – who once boasted of herself as a “sterilised First Nations post-op transsexual” – pleaded for lethal injection under Canada’s medical assistance in dying (MAiD) law, expressing deep regret over her gender transition surgery, which she said left her with constant pain and discomfort.

However, doctors turned her request down, citing that she did not meet the current MAiD criteria.

Cardinal, who underwent a vaginoplasty in 2009, shared her regret in social media posts, stating how the medical transition left her in constant pain.

“I am in constant discomfort and pain,” she said in an interview.

“It’s taking this psychological burden on me. If I’m not able to access proper medical care, I don’t want to continue to do this.”

MAiD in Canada

On July 26, Cardinal posted online the papers of her formal request under Canada’s MAiD law. “Based on current clinical information and consultations, [the patient] does not meet current MAiD criteria,” the doctors wrote.

Canada has been one of the most permissive countries in terms of both euthanasia and gender affirmation.

Since 2016, the MAiD programme has been available to adults with terminal illnesses, and it was later expanded to include those with severe and chronic physical conditions, even if that condition was non-life threatening.

There were 10,064 MAiD cases in 2021, accounting for 3.3 percent of all deaths in the country, with plans to extend the program to include those with mental illness.

However, the planned expansion of the MAiD programme has ignited controversy in the country, with concerns raised that it may be too easy for vulnerable individuals to choose death as a solution amidst a broken social safety.

As Canada navigates the complex intersections of end-of-life choices and gender-affirming care, an important question remains unanswered: how much is the country prioritising and making accessible and affordable professional psychological help over surgical interventions or lethal options for its citizens?

Gender-affirming care lacks evidence

As can be seen in the case of Lois Cardinal, the controversial topic of gender-affirming care, which includes hormonal interventions and surgeries for gender dysphoric people, has gained widespread acceptance within the international medical community in the US and Canada, despite the lack of medical evidence proving its benefits.

This approach is being promoted for individuals experiencing gender dysphoria, referring to the Washington-based medical organisation Endocrine Society’s claims about the state of evidence for gender-affirming care.

“More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide,” claims the president of the Endocrine Society, Stephen Hammes.

However, earlier this month, a group of 21 European clinicians and researchers published a letter in Wall Street Journal, saying that this claim lacks a systemic review of evidence.

They advocate psychotherapy as the first line of treatment, citing significant risks associated with hormonal interventions and surgeries.

“Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty,” the letter says.

“By contrast, the risks are significant and include sterility, lifelong dependence on medication, and the anguish of regret.”

The experience of Lois Cordinal highlights the significance of understanding the potential regret and life-long impacts individuals may face after undergoing medical surgery, as mentioned in the letter.

“For this reason, more and more European countries and international professional organisations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth,” stresses the letter.

This emphasises the urgent necessity for accessible psychological help and psychotherapy to be provided proactively, prior to irreversible transitions, not as an excuse to reject their euthanasia request.

In Cardinal’s case, we witness a now 35-year-old individual who regrets a decision she made 14 years ago.

Recent cases worldwide are even more concerning, as gender-affirming care, lacking robust evidence of its benefits, is being applied to young people as young as 15.

Moreover, amid the ongoing debate in European academic circles on gender-affirming care, there has been a notable rise in concern from diverse families in the UK, Canada, and the US who wants to protect their children from this unproven medical practice and its propaganda.

These families are becoming increasingly vocal about not only advocating against gender-affirming practices by medical professionals for minors under 18 but also about the normalisation of discussions surrounding gender transition and LGBT ideology among young children.

This normalisation effort involves the integration of various courses and readings on gender identity and LGBT topics into school curricula.

Despite the growing outcry from families and prominent clinicians critiquing the broad application of these practices, Western governments have thus far failed to take concrete steps in addressing this issue.

Gender-dysphoric youth

In the UA, Chloe Cole, who underwent gender treatments and surgeries as a teenager, recently testified in Congress, expressing deep regret and calling for action against such practices.

“My childhood was ruined.”

Cole’s parents sought advice from specialists who diagnosed their daughter with gender dysphoria and put her on puberty blockers and testosterone therapy starting at age 13. At age 15, Cole underwent a double mastectomy.

“My childhood was ruined, along with thousands of detransitioners that I know through our networks,” Cole said.

"What message do I want to bring to American teenagers and their families?” she asked.

“I didn't need to be lied to. I needed compassion. I needed to be loved. I need to be getting therapy to help me work through my issues. Not affirmed to my delusion that by transforming into a boy, it would solve all my problems," Cole said in her opening statement before a House Judiciary subcommittee hearing slated to discuss the “dangers and due process violations of gender-affirming care”.

In the face of Lois Cardinal’s heartbreaking plea for euthanasia and Chloe Cole’s impassioned testimony, the debate surrounding gender dysphoria treatment has reached a critical juncture.