Moving Beyond Mismatch

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This article refers to:

Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm

Notes

1. Here and throughout the commentary, I use “they” as a singular, gender-neutral pronoun. For philosophical reasoning behind this decision, see Dembroff and Wodak (2018).

2. For another example of a case where, it is argued, doctors should provide medical procedures to help patients cope with unjust social norms (while also working to change those norms), see Earp (2013).

3. For example, “For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her” (American Psychiatric Association (2013): gender dysphoria).

4. Priest (2019, XX): “PBT freezes the child in time physiologically. Hence, a transgender boy need not go through the horrors of developing breasts nor a transgender girl look in the mirror and see facial hair.”

5. While Priest could modify the concept of “mismatch” so as to explicitly concern the individual’s experience of mismatch, whatever it may be, Priest’s current illustrations of mismatch repeatedly rely on stereotypical social expressions of femininity and masculinity as matching (or mismatching) with female and male gender identifications.

6. Of course, one could run a purely harm-reduction argument for youth access to PBT without relying on the wrong-body model. However, this model is aptly suited for a harm-reduction model, as the term refers to the models used in diagnostic practices, all of which take “discomfort” and/or “dysphoria” as a necessary marker of being trans. For more discussion, see Engdahl (2014).

7. Chu’s focus is on denial of care when accompanying risks are deemed too high, but Chu’s point also applies to cases where risks of not providing care are deemed too low to warrant providing care.

8. My position here is compatible with, but weaker than, the line taken in Flanigan (2017), which argues that the right to informed consent justifies access to any pharmaceutical medication. While I agree with Flanigan that informed consent justifies access to treatment, and not only refusal of treatment, I here propose only the restricted claim that, given the history of anti-trans bias in the medical profession, an informed consent model provides epistemically more reliable justification for adolescents’ access to PBT than does the standard model.

9. Many thanks to Brian Earp, Zoe Johnson King, Cat Saint-Croix, and Daniel Wodak for feedback on earlier versions of this commentary.