Gender Atypical Organisation in Children and Adolescents: Ethico-legal Issues and a Proposal for New Guidelines

Ethics in Child and Youth Care Practice With Transgender Youth

“…Issues of autonomy include youth rights to privacy and confidentiality, arbitrary age requirements to access care, and emerging capacity to consent to care (Giordano, 2007(Giordano, , 2013Milrod, 2014;Stein, 2012;Swann & Herbert, 2009). Benefits of endocrine care include relieving psychological suffering and preventing the development of unwanted secondary sex characteristics, which, coupled with the low risk of harm from this treatment and the potential risk of causing harm by withholding care, make a compelling case in support of endocrine care for trans youth (Antommaria, 2014;Baltieri et al, 2009;Giordano, 2007;Holman & Goldberg, 2006;Stein, 2012;Vrouenraets et al, 2015).…”

“…Issues of autonomy include youth rights to privacy and confidentiality, arbitrary age requirements to access care, and emerging capacity to consent to care (Giordano, 2007(Giordano, , 2013Milrod, 2014;Stein, 2012;Swann & Herbert, 2009). Benefits of endocrine care include relieving psychological suffering and preventing the development of unwanted secondary sex characteristics, which, coupled with the low risk of harm from this treatment and the potential risk of causing harm by withholding care, make a compelling case in support of endocrine care for trans youth (Antommaria, 2014;Baltieri et al, 2009;Giordano, 2007;Holman & Goldberg, 2006;Stein, 2012;Vrouenraets et al, 2015). Some have questioned whether youth possess the maturity necessary to make decisions about endocrine care, especially given the lack of data on long-term outcomes and potential impacts on future fertility (de Vries et al, 2006;Vrouenraets et al, 2015); however, many have concluded that youth do, as in other areas of health care, have the capacity to make these decisions (Holman & Goldberg, 2006;Giordano, 2007;Kreukels & Cohen-Kettenis, 2011).…”

“…Some have questioned whether youth possess the maturity necessary to make decisions about endocrine care, especially given the lack of data on long-term outcomes and potential impacts on future fertility (de Vries et al, 2006;Vrouenraets et al, 2015); however, many have concluded that youth do, as in other areas of health care, have the capacity to make these decisions (Holman & Goldberg, 2006;Giordano, 2007;Kreukels & Cohen-Kettenis, 2011). Finally, systemic barriers that negatively impact access to gender affirming medical care for trans youth have been cited as issues of justice in the ethics literature (Giordano, 2007).…”

“…They set forth guidelines that include: providing accurate information and education to youth and families; connecting youth and families with community resources in order to reduce isolation; and acting as an advocate for clients. Other suggestions for practice with trans youth and families involve recognizing that there is a diversity of healthy genders, respecting autonomy, providing an informed consent process, balancing benefits and risks, and delivering equitable services (Giordano, 2007(Giordano, , 2013Holman & Goldberg, 2006;Roen, 2016;Stein, 2012;Vrouenraets et al, 2015). Swann and Herbert (2009) recommended that social workers practicing with trans youth pay careful attention to their own biases and belief systems.…”

Trans youth, science and art: creating (trans) gendered space

“…This is in contrast to a diagnostic situation which invites the speaking trans subject into being through adherence to a set of scripts that both social actors are arguably familiar with. A report published by an expert in the field of medical ethics (Giordano 2007(Giordano , 2008 critiqued medical practice in the UK, arguing that UK doctors are 'depriving children relief from "extreme suffering" caused by their condition, leading to self harm and suicide and forcing their families into seeking help outside the UK'. The publication of this report, and two subsequent conferences in 2008, led to considerable press attention, debate and activism around the treatment of 'gender variant adolescents'…”