Gender Dysphoria: Bioethical Aspects of Medical Treatment (original) (raw)

A Bioethics Perspective on Sex Reassignment Therapy

Transsexualism (or Gender Identity Disorder/Gender Dysphoria) is a relative uncommon condition, but many hormonal and surgical treatments are available to help transsexuals remodel their bodies according to their sense of who they really are. However, those treatments may be invasive and irreversible. Well-informed and thoughtful decision-making about which, if any, to undertake, is therefore of the greatest importance. Yet there are many uncertainties, ranging from whether the condition is a disease for which medical procedures are appropriate, to the long-term risks of particular treatments. And, the intense mental pain that may accompany it may also interfere with patients’ capacity to choose treatments that are in their best interests. So the burning bioethics questions are whether therapies of this kind should be available, and if so, who should control access to them. Given the concerns about safety and efficacy of current approaches, it is also worth asking whether a true remedy might exist and what it might look like. I speculate that eradicating the sex/gender system might do so.

Gender reassignment surgery : medical issues and legal consequences

2000

Gender reassignment procedures are performedfor the treatment ofthe gender dysphoria syndrome (transsexualism). Although this modality of treatment is therapeutic in nature and therefore not contra bonos mores, the legal status ofthe post-operative transsexual remains that ofhis/her previous sex. The purpose ofthe gender reassignment procedures is that of acceptance within the community as a person ofthe sex indicated by his/her changed appearance. Nothing will be achieved by the successful completion oftreatment ifthe person's changed sexual appearance is not recognised by the law as a change in sexual status as well. The law, by keeping aloofofthe problem ofthe post-operative transsexual, has created a legal "vacuum" where there is social andjudicial acceptance ofreassignment procedures, but a refusal to give legal effect to the change in status that the transsexual obsessively desires and the operation simulates. This work will analyse the medical issues associated with gender reassignment procedures. The legal status ofthe transsexual after reassignment procedures will be explored, and in doing so, the human rights violations with which such people have to contend, will be highlighted. The constitutionality ofthe lack ofa legal recognition ofthe post-operative transsexual's sexual status will be examined. It will be shown that there are compelling reasons for legislation to be introduced as a matter ofurgency to safeguard the fundamental rights ofthe post-operative transsexual.

Treatment for gender dysphoria in children: the new legal, ethical and clinical landscape

Summary - Gender dysphoria is a condition in which a child's subjectively felt identity and gender are not congruent with her or his biological sex. Because of this, the child suffers clinically significant distress or impairment in social functioning. - The Family Court of Australia has recently received an increasing number of applications seeking authorisation for the provision of hormones to treat gender dysphoria in children. - Some medical procedures and interventions performed on children are of such a grave nature that court authorisation must be obtained to render them lawful. These procedures are referred to as special medical procedures. - Hormonal therapy for the treatment of gender dysphoria in children is provided in two stages occurring years apart. Until recently, both stages of treatment were regarded by courts as special medical treatments, meaning court authorisation had to be provided for both stages. - In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to the first stage. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. - The new legal developments concerning treatment for gender dysphoria are of ethical, clinical and practical importance to children and their families, and to medical practitioners treating children with gender dysphoria. Medical practitioners should benefit from an understanding of the recent developments in legal principles. This will ensure that they have up-to-date information about the circumstances under which treatment may be conducted with parental consent, and those in which they must seek court authorisation.

GENDER DYSPHORIA GENERAL THEORETICAL CONSIDERATIONS AND BIOETHICAL ASPECTS OF MEDICAL TREATMENT

International Journal of Advanced Studies in Sexology, 2022

The concept of being transgender or gender variant goes back to Asia and India where there was a third recognized gender, Hijra. More recently, there has been a significant increase in the awareness of people who are not comfortable with the sex assigned to them at birth and who choose to assume gender roles of the opposite sex, and even resort to medical treatments or surgery to change their sex. assigned in the opposite sex. In recent centuries, this topic has been treated differently, for example, in 1972 an educational book for children, William's Doll, was published by an influential American writer, Charlotte Zolotow, about a boy, William, who desperately wants a doll. to love despite his father's persistent desire to play with traditional male toys. In addition, over the next four decades, children's books have been developed on this topic, such as how to approach boys who wanted to wear dresses. To understand this disorder in the broader context of sexual disorders, we first ask ourselves: What is gender dysphoria? As a general definition, gender dysphoria can be presented as a condition that causes a person discomfort or suffering because there is a mismatch between their biological sex and their gender identity. Or, as otherwise defined, a condition in which the gender of a person assigned at birth and the gender with which he identifies are incongruent. (Davy, 2018). Until the adoption of the ICD-11 (International Classification of Diseases Review 11) by the WHO, it was called a sexual identity disorder and later the condition was renamed and moved from the Mental and Behavioral Disorders section to get rid of the stigma associated with the term disorder. Along the same lines, in the 5th edition of the Handbook of Diagnosis and Statistics of Mental Disorders, the American Psychiatric Association changed the diagnosis of gender identity disorder into Gender Dysphoria (DG). In the literature, this initiative has been praised, precisely for excluding the term "disorder" (Davy, The DSM-5 and the Politics of Diagnosing Transpeople, 2015).

The Lawfulness of Gender Reassignment Surgery

American Journal of Legal History, 2017

In the common law world, both the medical and legal professions initially considered gender reassignment surgery to be unlawful when first practised and discussed in the first half of the twentieth century. While most medical procedures are covered by the medical exception to the law governing serious offences against the person, many doctors and the lawyers they consulted doubted that this exception applied to gender reassignment surgery. In this article I trace the differing and changing interpretations of the medical exception as applied to gender reassignment surgery, and the shift towards legal acceptance in the two common law jurisdictions which led the way in both performing gender reassignment surgery and debating its legality, the United States and the United Kingdom. Although this shift occurred without formal legal intervention through either legislation or judicial decision (for example on a test case), inferences of legality drawn from related civil law decisions bolstered the legal acceptance of gender reassignment surgery. By increasing the suffering of patients and potential patients, the criminal law played both an important and primarily malign role prior to the eventual public, professional and legal acceptance of GRS. A real threat of criminal prosecution  Professor of Law, Centre of Medical Law & Ethics, Dickson Poon School of Law, King's College London. I am grateful to the conference participants at 'Transforming wrong(s) into right(s): The power of 'proper medical treatment' held at the University of Manchester, to the Wellcome Trust for a research expenses grant in their medical humanities programme which supported this research, and to the anonymous reviewers of this journal for their extremely helpful comments.

Ethical Conflicts over the Management of Transsexual Adolescents-Report of Two Cases

Journal of Sexual Medicine, 2009

Introduction. The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. Aim. To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. Results. Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. Conclusions. We propose "harm reduction" as a means of coping with this dilemma in some cases. Baltieri DA, Cortez FCP, and de Andrade AG. Ethical conflicts over the management of transsexual adolescents-report of two cases.

Gender identity and the management of the transgender patient: a guide for non-specialists

Journal of the Royal Society of Medicine, 2017

In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between ...