This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, given that such a refusal would mean clinics losing £5,000 a pop, one does wonder how rigorous these assessments are. Is the entire industry just profiting off insecurity bordering on dysmorphia?

In Warshak's case, the government had used a retrospective process to gain access to prospective messages. The SCA does allow the government to issue "preservation" requests, but these apply only to existing records that might be at risk of deletion; they do not apply to future messages. The Department of Justice's own surveillance manual made this clear even at the time, reminding agents that preservation requests "have no prospective effect....[Preservation] letters can order a provider to preserve records that have already been created, but cannot order providers to preserve records not yet made."


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