Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria

Abstract

The increasing incidence of requests for medical services to support gender transition for children, adolescents, and adults has consequences for society, governmental institutions, schools, families, health-care professionals, and, of course, patients. The sociological momentum to recognize and accommodate to trans phenomena has posed ethical dilemmas for endocrinologists, mental health professionals, and sexual specialists as they experience within themselves the clash between respect for patient autonomy, beneficence, nonmaleficence, and informed consent. The larger ethical clashes are cultural and therefore political. There is a distinct difference between pronouncements that represent human rights ideals and the reality of clinical observations. Some interpret this clash as a moral issue. This article delves into these tensions and reminds apologists from both passionate camps that clinical science has a rich tradition of resolving controversy through careful follow-up, which is not yet well developed in this arena.

Notes

1 This dilemma is dramatically magnified when trans inmates facing long or indefinite incarceration seek endocrine or surgical treatment under their Eighth Amendment rights to avoid cruel and unusual punishment. Their trans identities, often crystallized during confinement, seem to emerge from early life family chaos, adolescent substance abuse, or school and vocational skill failures (Osborne & Lawrence, 2016). Their lives prior to sentencing were antisocial, and their diagnoses typically include character disorders. Ignoring past and current functioning and diagnoses, their attorneys argue that they have a serious medical disorder for which they have a right to treatment. Psychiatric experts duel over whether the diagnosis per se is sufficient to provide desired treatment or whether the treatments might actually harm these desperate individuals.

2 For an in-depth discussion of medical necessity, its history, and the criteria that they are theoretically based on, see Levine, 2016.