Informed and calm debate on gender realignment needed

By Neil James, Executive Director of the Australia Defence Association

Recent media coverage concerning an ADF officer undergoing gender reassignment treatment has unfortunately tended to adopt sensationalist and often prurient themes. It should instead have stuck to the facts so we could have commonsense discussion of the possible implications for the individual concerned and our defence force.

Public feedback on talkback radio and in comments posted on blogs and newspaper websites has been particularly uninformed, emotive and too often just plain prejudiced. The vast majority of comments reflected little or no knowledge of the facts or context involved. This even includes how modern defence forces actually operate and are funded, and what conditions of service and citizenship rights defence force personnel are entitled to.

The position of the Australia Defence Association on this issue is based on the same principles we apply when objecting to the way tabloid newspapers occasionally purport to be outraged by breast reconstruction surgery for female defence force personnel (at a rate of about three a year).

First, all full-time members of our defence force have always received medical and dental treatment for illnesses, injuries and wounds at public expense. This is both a condition of service for the individual and a prudent investment by the nation in ensuring we have a healthy, fit and usable defence force. Whether it is a gunshot wound, a physical illness such as measles, or a psychological illness with few or no physical symptoms or effects, the principle is the same.

If the illness or injury prevents continued service in the defence force then a medical discharge may be necessary in the interests of both the individual and the ADF. If the reason for discharge was caused by military service, then the person concerned is entitled to continuing treatment and/or compensation at public expense ― as occurs in civilian life through rehabilitation and workers’ compensation arrangements.

Second, the ADF officer in this case is being treated for a medical condition diagnosed by an appropriate combination of physicians, psychiatrists and psychologists. It is simply invalid for others to second-guess such treatment, or query the need for it, when they do not have the professional expertise required and do not know any of the specific diagnoses, facts or circumstances involved.

Third, we need to note the precedent of surgery to reconstruct the breasts of female ADF personnel for reasons of injury or illness (both physical and psychological). This is not "cosmetic surgery" as the tabloid newspapers are wont to claim. Similarly, gender realignment is also medical treatment for a widely recognised psychological (and at times physical) condition, not merely a surgical procedure supposedly undergone for reasons of personal choice, whim, vanity or "perversity".

Fourth, defence force personnel do not somehow lose their rights and entitlements as Australian citizens when they put on an ADF uniform. As with breast reconstruction surgery, gender realignment surgery for genuine medical reasons is one of the 16 psychological conditions requiring surgery covered wholly or partially by Medicare anyway. Contrived tabloid or talkback-radio outrage at the supposed "waste of taxpayers' money involved" is invalid. In the case of ADF personnel, the defence force is effectively only acting as the taxpayers' agent for Medicare.

Fifth, the Australia Defence Association is also always wary when some ambitious journalist after a splashy headline, or talkback radio "commentator", claims or insinuates that psychological conditions are somehow not an illness and "do not deserve" treatment. This attitude, for example, stopped Post-Traumatic Stress Disorder (PTSD) among war veterans being treated properly for years. We are also very uncomfortable with how the psychological or physical recovery of the ADF personnel involved is ignored, often contemptuously, when inaccurate and insensitive media beat-ups about psychological conditions are aired.

Sixth, but not least is the question of maximising utility in operational and financial terms. It is generally much cheaper, and certainly much quicker, to retain someone in the Services than it is to discharge them and then have to recruit, train and develop their replacement over many years. The more experienced and qualified the person retained, the more money and time are saved, and wider operational inconveniences (through teamwork dislocation or capability displacement) avoided. In the case of possible discharges for medical reasons, if the cost of the medical treatment needed to retain the person is less than the financial, time and foregone operational flexibility costs of replacing them, then it would be a gross waste of the taxpayer’s investment in that person, and in the defence force as a whole, not to at least explore the option.

Finally, there is the matter of continued defence force service after the treatment is completed. Media and general public acceptance of this is important and, as recent media coverage and the reaction to it shows, cannot be assumed. Several other factors more specific or quite particular to the ADF also need to be considered:

• Does the person wish to remain in the ADF?
• Is their experience and age an issue?
• Would their continued service fall inside or outside established medical, psychological, physical fitness and deployability parameters?
• How might their current operational specialisation and employability be affected by a gender change?
• What might be the effects of the gender change on military teamwork, group dynamics, unit cohesion and operational effectiveness?
• What types of unit would be involved?

• Would the operational capabilities, conditions and readiness requirements of such units be affected?

Both during and after completion of the treatment it is likely that consideration of each person and their circumstances needs to be undertaken on a case-by-case basis. Such consideration should certainly not be influenced by ill-informed or prejudiced opinions espoused by some members of the public, particularly when whipped up by some in the media for their own commercial or careerist ends.

Neil James is executive director of the Australia Defence Association, the national public-interest watchdog organisation for defence and wider national security issues (see http://www.ada.asn.au)