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Trans people are exposed to multiple human right violations in clinical practice and research. From 1975 on, gender transition processes have been classified as a mental disorder in diagnostic classification manuals, a classification that was removed recently from ICD, International Classification of Diseases, and continues in DSM, Diagnostic and Statistical Manual of Mental Disorders. Trans people in different world regions are forced to accept psychiatric diagnoses and assessment in order to get access to trans health care, subject to reparative therapies and exposed to transphobic institutional and social discrimination and violence. In many countries, gender identity laws include medical requirements, such as psychiatric diagnosis, hormone treatment, genital surgery, or sterilization. In the scientific literature, a frequent pathologization of trans experiences can be identified, by means of pathologizing conceptualizations, terminologies, visual representations, and practices, as well as ethnocentric biases. Trans activism and scholarship have questioned widely the pathologization of trans people in clinical practice and research. Over the last decade, an international trans depathologization movement emerged, demanding, among other claims, the removal of the diagnostic classification of transexuality as a mental disorder, as well as changes in the health care and legal context. International and regional bodies built up a human rights framework related to sexual, gender and bodily diversity that constitute a relevant reference point for trans depathologization activism. The Yogyakarta Principles, published in 2007 and extended in 2017 by means of the Yogyakarta Principles plus 10, establish an application of international human rights law in relation to sexual orientation, gender expression, gender identity, and sex characteristics. International and regional human rights bodies included demands related to depathologization in their agenda. More recently, advancements towards trans depathologization can be observed in the diagnostic classifications, as well as in the health care and legal context. At the same time, trans people continue being exposed to pathologization and transphobic violence. The Human Rights in Patient Care (HRPC) framework offers a human right-based approach on health care practices. The paper aims at analyzing the shared human rights focus and potential alliances between the trans depathologization perspective and the HRPC framework.

In the scope of the current revision process of the diagnostic manuals Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Other Health Problems (ICD), an international trans depathologisation movement has emerged that demands, among other claims, the removal of a diagnostic classification of gender transition processes as a mental disorder. The call for submissions launched by the American Psychiatric Association (APA) and World Health Organisation (WHO) seems to provide the opportunity for a participation of civil society in the DSM and ICD revision processes. These developments open up a number of questions for us that will be discussed in this article. We conducted a meta-narrative review to explore the trans depathologisation movement's contribution to the DSM and ICD revision process, uncover evidence of a 'democratised turn' in the process, and any depathologisation proposals implemented in trans healthcare practices, human rights frameworks and legal gender recognition processes. We argue that the trans depathologisation movement have had little impact on medical practices in trans health care. However, there is some movement in local health services towards an informed consent model for limited healthcare interventions. Within some European and South / Central American legal frameworks, the depathologisation movement's demands to free legal gender recognition from medical interventions and examinations have, in different degrees, been incorporated into legal recommendations and enacted in some recent gender recognition laws.

From 2007 on, the World Health Organisation (WHO) has been revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD), with approval of ICD-11 due in 2018. The ICD revision has prompted debates on diagnostic classifications related to gender diversity and gender development processes, and specifically on the 'Gender incongruence of childhood' (GIC) code. These debates have taken place at a time an emergent trans depathologisation movement is becoming increasingly international, and regional and international human rights bodies are recognising gender identity as a source of discrimination. With reference to the history of diagnostic classification of gender diversity in childhood, this paper conducts a literature review of academic, activist and institutional documents related to the current discussion on the merits of retaining or abandoning the GIC code. Within this broader discussion, the paper reviews in more detail recent publications arguing for the abandonment of this diagnostic code drawing upon clinical, bioethical and human rights perspectives. The review indicates that gender diverse children engaged in exploring their gender identity and expression do not benefit from diagnosis. Instead they benefit from support from their families, their schools and from society more broadly.

la necesidad de una aplicación diferenciada, 3. La importancia de una reflexión sobre la vivencia del proceso de investigación.Conclusiones: La aplicación de un instrumento de autoevaluación se identifica como una herramienta útil para valorar aspectos éticos, metodológicos y autorreflexivos en un estudio cualitativo con menores de edad. PALABRAS CLAVEOncología Pediátrica, investigación cualitativa, ética de la investigación, menores, investigación basada en las artes. ABSTRACTBackground: In the context of a qualitative research with health care users in Paediatric Oncology and their family members, a self-assessment tool regarding ethical and methodological aspects of the study has been designed and implemented.Methods: Qualitative research with health care users in Paediatric Oncology and companions, in four hospitals from the Andalusian Public Healthcare System. Development and implementation of a self-assessment tool. Descriptive, semantic and pragmatic content analysis and triangulation conducted by the research team.Outcomes: The members of the research team highlight: 1. The usefulness of a cartoon-style Informed Consent form in a qualitative study with children, within a broader approach to research ethics, 2. The favourable assessment of the creative techniques, stressing the need for a differentiated application, and 3. The importance of reflecting on the experience of the research process.Conclusions: The application of a self-assessment tool is identified as a useful tool for evaluating ethical, methodological and self-reflective aspects in a qualitative study conducted with minors.