Organizational Safety Failure Case Study: The World Professional Association for Transgender Health Standards of Care

Abstract

An unusual form of safety failure is the sustained failure mode (organizational failure). This is a situation in which workers and/or clients are regularly exposed to dangerous conditions about which the organization is unable to address. Qualitatively, we discuss these characteristics with non-medical examples (I) decisions are made contraindicated by science, (II) scientific inquiry into the effects of those decisions is blocked, (III) reasoned dissent is suppressed and punished, (IV) authority has a conflict of interest, (V) there is insular training of authority, and (VI) clients and/or workers are received with hostility or malignant-condescension by authority. We then take the World Professional Association for Transgender Health’s Standards of Care publication as a case study into the nature of this failure. The size of the US population receiving gender medicine treatments is estimated to be 0.9 million patients, making this a significant issue. We inspect how this population is identified, how the Standards of Care publication is used in practice, evidence based medicine, medical ethics, and we focus on the eunuch chapter 9 for the failure characteristics previously discussed.