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In an incredible recent Human Rights Tribunal decision, a British Columbia doctor, Dr. Henry Ajaero, was just fined $28,000 for refusing to administer puberty blockers to a child.
The very first sentences of the Tribunal decision immediately tell you what the outcome will be: “Child Q is a brave, sensitive, kind transgender girl. This complaint is about a visit to her family doctor, Henry Ajaero, when she was 14 years old. In late 2020, Child Q had come out as transgender and was struggling with puberty. Her mental health was very poor.”
Right off the bat, the decision frames this issue of the rights and health of a poor, sweet, innocent child against her big, bad family doctor. The decision heaps laudatory adjectives to describe Q (“brave, sensitive, kind”) that are immaterial to the case. It blindly accepts the gender identity of a 14-year-old child, despite the growing evidence that gender dysphoria in most children will generally go away naturally after puberty. It uses feminine pronouns throughout the decision to refer to a boy. It even “corrects” Q’s name and pronouns in Dr. Ajaero’s notes, stating that such language “demonstrates a lack of care, understanding, and sensitivity towards a vulnerable trans child.” And it amps up the victimization by noting her “very poor” mental health.
Q “came out as trans” in the spring of 2020 at age 13. Soon afterwards, he began to go through the natural maturation process of puberty. He didn’t want to be a boy, and his mental health declined. He visited a psychiatrist who referred him to the Gender Clinic at BC Children’s Hospital. There, he was prescribed puberty blockers, which must be administered every three to four weeks.
Neither he nor his mother was comfortable doing the injection, so they went to their family doctor to ask him to administer it in March of 2021. Dr. Ajaero refused, stating that would not administer sex-denying puberty blockers for “religious and cultural reasons.” When Dr. Ajaero relayed his inability to give the injection, Q’s mother “stormed out” and found a walk-in clinic to give the shot the very same afternoon.
Five years later, Q filed a complaint against Dr. Ajaero for “discriminat[ing] against her by denying her medical services based on her gender identity.” Q demanded money to remedy “lost wages, expenses, and compensation for injury to her dignity, feelings, and self-respect.” (One can only speculate why he waited so long to file a complaint.)
In deciding the case, Human Rights Tribunal member Devyn Cousineau writes, “The human rights analysis [for cases like these] proceeds in two well-known stages. First, the burden is on Child Q to prove that she was denied a service that Dr. Ajaero customarily provides to the public, and her gender identity was a factor in that denial. Second, the burden shifts to Dr. Ajaero to justify the denial based on a bona fide and reasonable justification. In this case, I must also address a third issue raised by Dr. Ajaero: whether a finding of discrimination would be a disproportionate limit on his right to freedom of religion under s. 2(a) of the Charter of Rights and Freedoms.”
The adjudicator had “no difficulty finding that Child Q has proven the elements of her case. Dr. Ajaero denied her medical services on March 5, 2021, and her gender identity was a factor in that decision.” But the decision gives no explanation of how Q had actually satisfied the burden of proof. Instead, she focuses on Dr. Ajaero’s justification for not injecting Q with a puberty blocker. Dr. Ajaero made two claims: “He does not administer Lupron because doing so would go against his religious beliefs [Religion Standard]; and he does not administer Lupron because it is outside his scope of practice and expertise [Expertise Standard].”
The Religious Standard
Cousineau rejects both reasons. She acknowledges that Dr. Ajaero is a Christian. “He goes to church every Sunday with his family. His religion is an important part of his life.” Dr. Ajaero testified that “I’m a Christian and… Christian religion is important to me. I believe [that] God created man and woman. And I find it difficult to be involved [in] anything against that [belief].”
For Cousineau, that isn’t enough evidence. Dr. Ajaero must give far more evidence for why this belief prevents him from injecting a child with puberty blockers, such as why “those services are sinful and to participate in them is sinful.” And so, she opines that Dr. Ajaero’s Charter-guaranteed right to freedom of conscience and religion could be safely ignored.
Cousineau further opines that “public interest” should trump “private belief”:
As a doctor, Dr. Ajaero is a member “of a regulated and publicly funded profession”, which is “subject to requirements that focus on the public interest, rather than [his] interests”. He has elected to practice in a profession “devoted to the service of the public”, which “necessarily gives rise to moral and ethical choices”. In navigating those choices, the Code imposes on him an obligation to ensure his services are provided without discrimination. He must consider the Code-related needs of his patients, and do everything reasonable and practical to meet those needs up to the point of undue hardship. This is an obligation properly placed on him as a provider of public services. His religion does not exempt him from it.
Part of her justification is a rather bizarre differentiation between “gender-affirming care” and “gender (re)assignment.” Cousineau claims that puberty blockers are a form of the former but not the latter. But in reality, “gender-affirming care” is part and parcel of “gender (re)assignment.” After all, why would a child need puberty blockers if he weren’t trying to change his body to align with his gender identity?
The Expertise Standard
Cousineau also dismissed Dr. Ajaero’s justification that he wasn’t experienced with administering puberty blockers and indeed had never treated a person who identified as transgender before. She opined that Dr. Ajaero should have forged ahead and provided a medication with which he was unfamiliar even though the shot isn’t a simple one. Earlier in the decision, Cousineau says, “Mother Q testified that none of the doctors they saw had ever administered a Lupron shot before. She describes it as a ‘weird shot’. It comes in two pieces, in a box with instructions. She says the doctors would look at it, read the instructions, and ‘figure it out.’”
The Implications of the Case
As a punishment for supposedly discriminating against Q based on her gender identity, Cousineau ordered Dr. Ajaero to pay $28,000: $8000 to reimburse Q for the costs of bringing a complaint to the Human Rights Tribunal, and $20,000 for “injury to dignity, feelings, and self-respect.” These “injuries” include being “publicly misgendered and deadnamed” by Dr. Ajaero’s assistant at his clinic, being denied puberty blockers, and feeling “helpless and scared.” These injuries were exacerbated because Q was “uniquely vulnerable,” a child with poor mental health, and subject to the “power” of Dr. Ajaero. (“Family doctors are ‘gatekeepers’ in a publicly funded health care system,” Cousineau commented, so that apparently brings a power dynamic into play. Of course, Q and/or his mother could have bypassed this “gatekeeper” by doing the injection themselves or going to someone else, which they did later the same day.)
If not appealed and overturned, this case will further discourage doctors from hesitating to provide sex-denying drugs. Cousineau found that Dr. Ajaero acted in good faith and had no intention to discriminate against Q. Yet she still found him guilty of contravening British Columbia’s Human Rights Code because intent to discriminate is not required for a finding of liability.
Cousineau continues to present “gender-affirming care” as the only caring treatment for gender dysphoria, ignoring the debate raging around the world about the harms caused by a medical gender transition. Furthermore, she also presents medical transitioning as a “right” under provincial human rights law that any person can demand from any medical professional. Doctors have simply become vending machines. Their conscience and clinical judgment are no longer given significant weight. All of this demonstrates how gender ideology has so deeply captured our health and legal systems in Canada.