Citation

Gorin M. Hastings Cent. Rep. 2024; 54(3): 35-50.

Copyright

(Copyright © 2024, Institute of Society, Ethics and the Life Sciences)

DOI

10.1002/hast.1583

PMID

38842886

Abstract

The original "Dutch Protocol"-the treatment model comprised of puberty blockers, cross-sex hormones, and surgery-was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions' effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, leading to significant international differences in what treatments are offered to youth. Against this backdrop, a different argumentative approach has emerged in support of gender-affirming care. This approach appeals not to reductions in patient morbidity or mortality but to patient autonomy, where medical intervention is pursued as a means to the satisfaction of a patient's "embodiment goals." In this article, I raise objections to autonomy-based justifications for pediatric gender-affirming care, concluding that these arguments misunderstand the place of autonomy in clinical decision-making and, consequently, put patients at risk of medical harm.

Language: en

Keywords

Humans; Child; Female; Male; Adolescent; Personal Autonomy; autonomy; bioethics; *Gender Dysphoria/psychology/therapy; cross‐sex hormones; Dutch protocol; embodiment goals; gender‐affirming care; pediatric medicine; puberty blockers; transgender medicine; Transgender Persons/psychology