Ethical issues arising in the provision of medical interventions for gender diverse children and adolescents

Abstract

The care of children and adolescents whose experience of the body is at odds with their gender feelings raises a number of questions that are as much ethical as medical or psychological. In this article I highlight some areas of ethical concern from the point of view of a senior clinician at the nationally commissioned UK Gender Identity Development Service (GIDS). I make the assumption that ethical deliberation is relational and grounded in the natural, social, political and institutional worlds in which the ethical questions arise. I try to show how matters of empirical fact, alongside an appreciation of broad social contexts, and historic and current power relations, provide an essential framework for the ways that ethical choices are framed by key groups of people as they take up different, sometimes opposing, ethical positions. I argue that practising ethically in such a service is not helpfully reduced to a single event, a treatment decision aimed at achieving the morally ‘right’ outcome, but an extended process in time. In the charged debate surrounding the recognition of these young people’s needs, we must do more to promote responsible debate about the scope of sound ethical practice.

Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth

“…Even though I experience gender dysphoria vis-à-vis my beard, my conscious decision not to continue with electrolysis has allowed me to develop a stronger sense of myself as a person outside the binary – although I remain well shaved most of the time. In her article in the present issue, Wren claims that clinicians ‘are obliged to consider whether more time for exploration is needed by any child or family before embarking on a medical intervention, given the impacts of (partly) irreversible treatments years after they were initiated’ (Wren, 2019). 1…”

“…A golden thread running through Wren’s article is the view that exploration, as a process, must precede transition, because transition forecloses future life possibilities (Wren, 2019). 2 In this article, I will argue that such a conception of exploration is mistaken and propose an alternative view of exploration.…”

Can evolutionary thinking shed light on gender diversity?

“…This affirmative, but cautious, approach is not always well received by young people and families, who may see the problem as a simple biological ‘mistake’ that can be rectified by hormonal interventions and surgery. There can be a powerful pull to reduce complexity and simplify children's experiences – a pull seen in many of the polarised stances from which these issues are often argued (Wren 2019a, 2019b).…”

‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties

“…The dilemmas around how and when to respond to requests for medical intervention come alive in particular ways when working with these young people. These are inherently ethical questions, as well as medical and psychological ones and views are often polarised (Wren, 2019). A number of concerned parent groups characterise the willingness to provide such intervention to young people as the medicalisation of psychological and social ills.…”