Book Review: Banning Transgender Conversion Practices: A Legal and Policy Analysis

Several times each month, we are pleased to republish a recent book review from the Canadian Law Library Review (CLLR). CLLR is the official journal of the Canadian Association of Law Libraries (CALL/ACBD), and its reviews cover both practice-oriented and academic publications related to the law.

Banning Transgender Conversion Practices: A Legal and Policy Analysis. By Florence Ashley. Vancouver: UBC Press, 2022. xiii, 249 p. Includes glossary, bibliographic references, and index. ISBN 9780774866927 (hardcover) $89.95; ISBN 9780774866934 (softcover) $32.95; ISBN 9780774866941 (PDF) $32.95; ISBN 9780774866958 (ePUB) $32.95. <ubcpress.ca>.

Reviewed by Alexandra Kwan
Digital Services & Reference Librarian
Bora Laskin Law Library, University of Toronto

Conversion therapies encompass a wide range of interventions that aim to change or suppress a person’s sexual orientation or gender identity. Described as degrading, inhumane, and cruel, these so-called therapies “create a significant risk of torture” by pathologizing and attempting to erase the identities of non-heterosexual and gender-diverse individuals.[1] Florence Ashley is a transfeminine jurist, bioethicist, activist, public speaker, and doctoral candidate at the University of Toronto Faculty of Law. Banning Transgender Conversion Practices: A Legal and Policy Analysis is one of their many contributions to advocating for the elimination of these practices, which target gender-diverse individuals. Ashley defines trans conversion practices as “sustained efforts to promote gender identities that are aligned with one’s sex assigned at birth and/or to discourage behaviours associated with a gender other than the one assigned at birth” (p. 22). Survivors experience increased rates of planned and attempted suicide and Severe psychological distress (p. 12).

Widely denounced by trans communities as well as professional organizations listed in the book’s appendix, trans conversion practices are currently banned in Canada by provincial legislation (in Ontario, Nova Scotia, and P.E.I.) and by more recent federal legislation. As legislation had to be in force by July 2020 for inclusion in Ashley’s comparative analysis, An Act to amend the Criminal Code (conversion therapy), SC 2021, c 24 (in force on January 7, 2022) is only briefly mentioned but not evaluated. Other Canadian and international jurisdictions have yet to legislate protections for trans people from these harmful practices.

The book begins with the 2015 closure of the Centre for Addiction and Mental Health’s (CAMH) Gender Identity Clinic for Children and Youth after Ontario’s Affirming Sexual Orientation and Gender Identity Act, 2015, SO 2015, c 18 came into force. The recounting of the controversy surrounding the closure introduces the affected stakeholders: trans communities, health professionals and their organizations, courts, and lawmakers. This story sets the stage for Ashley’s argument that care should be taken to define and eliminate conversion practices, especially interventions masquerading as therapeutic treatments in legislation and clinicians’ professional practice. The story segues into Chapter 1, which provides definitions for gender terminology and trans conversion practices. From these definitions, Ashley explains how the CAMH Gender Identity Clinic’s “corrective approach” is included under those harmful interventions. Additional definitions are included in a glossary at the end of the book.

In Chapter 2, Ashley identifies the Affirming Sexual Orientation and Gender Identity Act, 2015 as an exemplar ban and uses statutory interpretation to determine the extent of the law.

In Chapter 3, Ashley provides a comparative analysis of jurisdictions that have legislative bans on trans conversion practices, including the three Canadian provinces, some American states, some Spanish autonomous regions, and Malta. To highlight the bans’ strengths and weaknesses, they analyze each group of bans in two ways: by textual lineages (i.e., the similarities and differences between legislative provisions and definitions) and by sanctions.

In Chapter 4, Ashley lays out and rebuts common arguments used by opponents of these bans, such as therapist’s freedom of expression, overbreadth leading to constitutional challenges, and autonomy and religious freedom.

Chapter 5 analyzes the benefits and limitations of the bans while addressing the desirability of bans from the perspective of trans communities. Ashley discusses how enacting bans could spark change in the professional practices of health practitioners and how legislation could spur cultural changes that benefit the mental health of trans communities. They also identify eight considerations that policymakers must confront to eliminate trans conversion practices.

In Chapter 6, Ashley argues for a culture shift in licensed health professional communities to accompany a legislative ban on conversion practices. The proposed culture change entails collaboration with the trans community to develop clear professional guidelines. Ashley also proposes the creation of accountability structures and paths to educate new and existing professionals about gender-affirming care and the harms of conversion practices.

The seventh and final chapter contains Ashley’s proposed model annotated legislation. The model legislation integrates the definitions and considerations described in prior chapters. Most importantly, Ashley eliminates the blank page problem by providing a template and detailed explanations for policymakers and legislators who wish to introduce or improve upon a ban.

Authored by an award-winning legal scholar, this book has an obvious home beyond academic law library collections. Ashley wrote this book for a wide audience, stating: “My goal in writing this book is to guide jurists, policymakers, healthcare professionals, scholars, and advocates in their thinking about how to best ban conversion practices” (p. 17). Transgender conversion practices can take a variety of forms, so solutions to eliminate them must be interdisciplinary. Thus, the book would be a helpful addition to health, government, parliamentary, and public libraries for those working to end conversion practices and move toward a more trans-affirmative future.

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[1] Victor Madrigal-Borloz, Practices of So-Called “Conversion Therapy”: Report of the Independent Expert on Protection Against Violence and Discrimination Based on Sexual Orientation and Gender Identity, UNGAOR, 44th Sess, UN Doc A/HRC/44/53 (2020) at 4, 21, online: <digitallibrary.un.org/record/3870697>.