The purpose of a system is what it does (POSIWID)

A typically incandescently brilliant barnstormer from Abigail.

There is a clash going on in Britain between two fundamentally irreconcilable ideologies.

The NHS, DHSC, and many other official institutions like courts view transition as a response to a medical problem they call ‘gender dysphoria’ or ‘gender incongruence.’ From this starting point it seems appropriate that trans people have to get permission to transition: transness is a medical matter with inherent risks that ought to be controlled by “specialists.” Sometimes those specialists delay or deny permission, but that’s just part of the job. It also makes sense to ask which treatments are “most effective at treating dysphoria” and explore alternative treatments through trials, reviews, consultations, etc. I call this view ‘Pathologization.’

According to Pathologization, past treatments like electric shocks simply failed to alleviate patients’ dysphoria. These days we have more effective methods, and one day we might discover a cheap way of treating it without transition- a silver bullet conversion therapy. Doctors and managers will determine when and whether adjustments to the system are needed. Ideally they’ll engage with trans people in “stakeholder groups” but if those groups don’t get what they want that’s not a dealbreaker. Patients who suffer or die waiting are unfortunate but hey, the NHS can’t save everyone.

On the other hand, the view of an increasing number- especially young people and trans people ourselves- is that transition is a bit like pregnancy. It’s a process that may require professional assistance to bring to the happiest possible conclusion (whether completion or termination), and for this reason it is appropriate and necessary that the NHS is involved. But whether, how, and when to do it should be up to you. From this starting point there should be as few obstacles as possible: the role of doctors and managers is to facilitate and advise but never delay or deny. Prompt, reliable access to transition is a civil rights matter.

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It is vital to realise that organisations can embody an ideology even if nobody working in them believes it. I think sometimes when people hear “Organisation X is institutionally discriminatory” they interpret that as “The leaders of Organisation X are bad people.” For example;

“The Metropolitan police are institutionally racist.”

“I’ve met some police officers and they’re lovely!”

This is a mistake. To say that an organisation is institutionally discriminatory makes no comment on the character of its employees, merely the pattern of its outputs. Not everyone who controls trans healthcare is a frothing bigot; again, I have no animosity towards Colonel Korn or his colleagues. My issue is with the outputs of the system they manage.

The basic idea behind the model of Systems Intentionality may be simply described, and applies equally to corporate and natural defendants. Diamantis has explained how natural persons commonly make use of “extended mind” supports, which are external systems or cognitive aids (such as recipes, maps and notes or records) to facilitate recall and decision-making. So too, I say, corporations adopt systems of conduct that enable them to make and implement decisions consistently and repeatedly, and respond purposefully to events. Indeed, having (unlike humans) no natural memory or cognitive capacity, corporations necessarily employ systems of conduct to direct, coordinate and manage the changing and fallible human (and other corporate) personnel that carry out corporate purposes, over time. The same holds true where human elements within the system are entirely replaced by self-executing (automated) processes.

The critical point is that, on my model, such systems exist in order to achieve some outcome (whether it be coordinated conduct, or consistent output). Thus, Australian courts have described the concept of a system as “an internal method of working”; “something designed or intended in its structure”.35 On this approach, a “system of conduct” is inherently purposive in nature: a “co-ordinated body of methods, or a complex scheme
or plan of procedure”. It is an organised connection of elements operating in order to produce the conduct or outcome.

Following this line of thought, once an adopted system of conduct is identified, it becomes possible objectively to assess the system to characterise the associated intention and other mental states. Here, the heart of the model is the proposition that corporations manifest their intentions through the systems of conduct that they adopt and operate, both in the sense that any system reveals the corporate intention and in the sense that it embodies or instantiates that intention. Another way of putting this is to say that corporations think through their systems—and so assessment and characterisation of the system enables us to know the corporate state of mind. No process of “inference” is required. The same is true of policies and practices, which may be understood as systems operating at higher levels of generality (in the case of policies) and as arising organically (in the case of practices). It becomes possible, from these humble beginnings, to determine from the nature of systems adopted by a corporate actor the spectrum of mental states commonly demanded by the law (such as general and specific intention, knowledge, mistake, recklessness, dishonesty and unconscionability).