First, I am a human being.

Second, I am a woman.

Everything else comes after that.

Before we are anything else, before the professional titles we carry, before the roles we have in relation to other people — mother, father, daughter, son, sister, brother, partner, friend — before our religious identities, whether we are Christian, Muslim, atheist or anything else, before our ethnicity or the colour of our skin, before our sexual orientation, our nationality, our social status or any other label we use to describe ourselves, we are human beings first and foremost.

That is the starting point for how I see the world.

That probably tells you more about why this website exists than a traditional biography ever could.

I Am A Humanist

I believe that if we want to build a better society, we need to begin with our shared humanity rather than with the categories that divide us.

That does not mean pretending our differences do not exist. They absolutely do. Sex, gender, race, disability, sexuality, culture, money, age and countless other differences shape the way we move through the world and the way institutions respond to us.

Being humanist, to me, means recognising those differences without using them as justification for treating one group as more entitled to freedom, dignity, autonomy or respect than another.

It means being capable of saying that men and women may have different bodies and different healthcare needs while still insisting that the underlying principles applied to them should be fair.

It means understanding that equality does not always require identical treatment, but that different treatment requires a defensible reason.

And it certainly should not mean that one person's informed decision is respected while another person's is treated with suspicion because of assumptions about their sex, their future desires or what somebody else thinks a meaningful life should look like.

I Care Deeply About Ethics

I am also an ethicist in the way I approach the world.

I care enormously about the distinction between morality and ethics.

Morality can easily become a collection of inherited beliefs about what people should do, what kind of life they should want, what choices are respectable, what choices are normal, and who somebody else thinks we ought to become.

Ethics asks harder questions.

What causes harm? What protects autonomy? What is fair? Who holds the power? Is that power being used responsibly? Is somebody being treated differently, and if so, can that difference actually be justified? Are people being given enough information to make their own choices? Are institutions being honest about how their decisions were reached?

Those are the questions that interest me.

This Was Never Only About Sterilisation

The immediate issue that started this particular fight was female sterilisation.

But that is not really what has kept me fighting.

What has kept me going is the principle underneath it.

Men and women contribute to the NHS. We are all supposed to live under a healthcare system built around principles of dignity, equality, informed consent and respect.

Yet my experience forced me to confront what happens when those principles look beautiful in policies and constitutions but become much harder to locate when an actual human being asks the system to honour them.

I was an adult woman asking to make a permanent decision about my own reproductive life.

I understood what sterilisation meant. I understood that it was intended to be permanent. I understood the risks. I understood the alternatives. I had been certain for years that I did not want biological children.

And still, my informed decision was not enough.

That is my problem.

I Should Not Need To Be Impressive To Have Bodily Autonomy

I happen to be a psychologist. I am educated. I run businesses. I know how to research. I can read academic papers, legislation, policies and committee minutes. I can write lengthy complaints. I can submit Freedom of Information requests. I can chase organisations for years when they would clearly prefer that I disappear.

None of that should matter.

I should not have more bodily autonomy because I can write a thirty-page argument defending it.

A woman should not need a degree, professional status, confidence, money, persistence or an unusually high tolerance for bureaucracy before the healthcare system treats her as competent to understand her own life.

That is one of the things that disturbs me most about this experience.

Because I could fight.

What happens to the woman who cannot?

My Problem Is With Power Without Accountability

The longer this case continued, the less it became about whether somebody would eventually change a sentence in a policy.

It became about power.

Who gets to make decisions affecting thousands or millions of people? What evidence are they required to use? Who checks whether they actually followed the rules? What happens when they did not? Who is personally responsible for assurances given to patients and the public? What happens when an investigation exposes significant failures?

And perhaps most importantly: what happens to the people responsible afterwards?

That question has bothered me enormously.

We are very good at writing new policies. We are very good at saying lessons have been learned. We are very good at creating another procedure, another committee, another review and another set of assurances.

What I am increasingly interested in is what happens when the people occupying positions of power fail to live up to the responsibilities attached to those positions.

Do we examine their judgement?

Do we examine their integrity?

Do we examine whether they should continue being entrusted with greater responsibility?

Or do we simply rewrite the procedure and move everybody along?

I Am Tired Of Participation Trophies For Leadership

One of the things I have found genuinely difficult to stomach throughout this experience is watching senior professionals continue progressing through systems of status, recognition and responsibility while serious questions about the consequences of their work remain unresolved.

People can appear in awards lists. They can accumulate impressive titles. They can move into larger positions. Their biographies can talk about leadership, values, transformation, patient care and public service.

Meanwhile, somewhere underneath those professional profiles can be a patient who spent years trying to get somebody to answer a straightforward question.

I do not think leadership should be judged only by what somebody says about themselves, what their organisation says about them, or what award somebody nominated them for.

Leadership should also be judged by what happens when somebody challenges you.

Do you listen?

Do you check?

Do you admit when something is wrong?

Do you correct it?

Do you tell the truth when the truth is uncomfortable?

Do you protect the institution, or do you protect the principles the institution supposedly exists to uphold?

Why Accountability Matters To Me So Much

I think we are losing something important when people begin to believe that nobody is really responsible for anything.

A policy failed, but nobody failed.

A complaint was mishandled, but nobody mishandled it.

Evidence was not properly considered, but nobody was responsible for considering it.

A patient was given inaccurate or inadequate answers, but somehow those answers simply emerged from “the organisation”.

I do not accept that way of thinking.

Systems are created and operated by people. People make decisions. People sign letters. People approve policies. People supervise departments. People hold executive responsibility. People chair boards. People decide whether something deserves investigation and whether somebody else should be held accountable.

I think the absence of meaningful accountability creates fertile ground for bad systems, poor judgement and unethical behaviour to survive.

And I think that is dangerous.

Some Of This Experience Felt Emotionally Abusive

I also want to be open about something that formal descriptions of complaints processes rarely capture.

The emotional experience of navigating a bureaucracy like this can be brutal.

A system does not have to scream at you to hurt you.

People can remain perfectly polite while repeatedly failing to answer what you asked, giving vague responses, sending you towards another procedure, expecting you to understand complex organisational structures, requiring you to chase information, and presenting confident assurances that you cannot reconcile with the evidence in front of you.

To me, parts of that experience felt emotionally abusive.

That is my description of how I experienced it. Readers can examine the correspondence and decide what they think.

But I reject the idea that institutional conduct becomes respectful simply because the email ends with “Kind regards”.

Respect is demonstrated through honesty, clarity, responsibility, transparency and a willingness to take another human being seriously.

This Is Why I Am Creating A Permanent Record

I am tired of important things disappearing.

I am tired of accountability being trapped inside private correspondence.

I am tired of policies saying one thing while people's lived experience of those systems says something completely different.

And I am tired of institutional memory being short enough that an organisation can say it has learned something, change a few words and eventually carry on as though the underlying problem never happened.

So I am creating a record.

Not because I expect everyone who reads it to agree with me.

Not because I think I have behaved perfectly through every moment of a years-long fight.

And not because I want this website to become a monument to me.

I want the evidence to remain accessible because accountability becomes much harder to erase when people outside the institution can see the record for themselves.

This Is Bigger Than Me

I am the person whose name appears on this website because I happened to be the person who kept going.

But I do not want the larger story to become about Leah Spasova.

The question is what kind of society we want to live in.

Do we want healthcare institutions that trust competent adults with informed choices about their own bodies?

Do we want public officials who understand that authority comes with accountability?

Do we want policies built from evidence rather than assumptions?

Do we want people who challenge institutions to be treated as inconvenient problems, or as an essential part of discovering where systems have gone wrong?

Do we believe that equality, dignity and autonomy are principles that apply when they are easy, or particularly when they are inconvenient?

Those are much bigger questions than whether I personally ever receive one medical procedure.

And Beyond All Of This...

Yes, there are many other things I could tell you about myself.

I am a psychologist specialising in sexuality and relationships. I am an entrepreneur. I care deeply about animal welfare. I love books. I am a cat mum. I enjoy archery, photography, nature, travelling, ideas, difficult conversations and understanding why human beings behave the way they do.

Those things tell you something about my life.

But none of them should determine how much respect, freedom or autonomy I deserve.

If I had no degree, no businesses, no professional expertise and no ability to research NHS policy, the principles at the heart of this case would be exactly the same.

Because before every title, identity and biography, I am a human being.

And I think wanting to live a life in which my body is treated as mine, my informed decisions are respected, institutions deal honestly with me, and the people entrusted with power are accountable for how they use it is not an unreasonable demand.

I think it is the minimum any of us should be able to expect.

Explore The Story

If you want to understand how these beliefs collided with the reality of NHS policy and accountability, you can follow the Chronicles, explore the Evidence, or meet some of the public officials and professionals involved on The People Involved page.

If you are a journalist, researcher, lawyer, campaigner or organisation interested in the case or the wider issues it raises, you can find my details on the Contact page.