GESTIÓN EN SALUD PÚBLICA: BioEdge: Should governments overrule parents who oppose transgender puberty-blockers? Yes, says bioethicist

domingo, 24 de febrero de 2019

BioEdge: Should governments overrule parents who oppose transgender puberty-blockers? Yes, says bioethicist

BioEdge: Should governments overrule parents who oppose transgender puberty-blockers? Yes, says bioethicist

Bioedge

Should governments overrule parents who oppose transgender puberty-blockers? Yes, says bioethicist

by Michael Cook | 24 Feb 2019 | 4 comments

Parents should not be able to stop gender-dysphoric children from accessing puberty-blockers, a bioethicist argues in the latest issue of the American Journal of Bioethics. Furthermore, contends Maura Priest, of Arizona State University, government schools should publicise the case for initiating transitions from one gender to another. In a target article followed by comments from other bioethicists, she argues that:

... the law should clearly state that transgender youth (after having met appropriate diagnostic criteria) have a legal right to PBT [puberty-blocking treatment] regardless of parental approval. In addition to these legal parameters, the state should play a role in publicizing information about gender dysphoria and treatment via public schools, government-sponsored websites, and public service announcements.

Basically Priest argues that the harms of withholding puberty-blockers are too great to justify parental interference. Gender-dysphoric children who are not supported by their parents could commit suicide, suffer stigma and discrimination, become homeless, self-medicate in a dangerous way, and so on. Denying them treatment is a form of child abuse which requires state intervention, she implies.

Just as it is the state’s duty to step in when naturalist parents are refusing insulin to their diabetic son or antibiotics to their daughter sick with meningitis, so is it the state’s duty to step in when the parents of gender-dysphoric children are avoiding medically recommended treatment.

Transgender science is a controversial area and establishing watertight proof of these harms is difficult. But Priest says that the need for PBT is “based on the best available science and expert professional consensus”.

While most of the commentary by other scholars endorsed her argument, there was some disagreement. Three scholars from the University of Melbourne are broadly sympathetic, but point out that the physical harms of PBT are hardly negligible. They include reduction in bone density, with risk of fractures; loss of fertility; fewer option for future genital surgery if the children persist; and conflict with parents.

And three American writers (Michael Laidlaw, Michelle Cretella, Kevin Donovan) argue that “watchful waiting with support for gender-dysphoric children and adolescents up to the age of 16 years is the current standard of care worldwide, not gender affirmative therapy”.

Children and adolescents have neither the cognitive nor the emotional maturity to comprehend the consequences of receiving a treatment for which the end result is sterility and organs devoid of sexual pleasure function. To argue that all children who are self-declared as transgendered will be harmed psychologically and physically without puberty blocking treatments is false; the greatest number will be seen to not require this at all.

It’s hard to think of a more volatile topic than transgender transitions for children entering puberty. The number of kids demanding puberty-blockers so that they can transition to the opposite sex is exploding all over the developed world. It’s a mysterious and poorly understood phenomenon which involves a range of bioethical issues.

Is gender dysphoria really a medical issue at all? Or is it just a waystation on a spectrum of sexualities? How do we decide? Is it ethical to offer treatments which have yet to prove their efficacy? Is it ethical to offer treatments which will have negative side-effects? How can children make decisions which will affect their whole lives without understanding the medical, sexual and psychological implications? There is enough here to fill a library with contending points of view.

But this is far from being a theoretical issue. Children with gender dysphoria are suffering now. Who is to decide how can they be best cared for? A bioethicist writing in the American Journal of Bioethics effectively argues that parents are not the best judges. (See article below.) They are in the same position as loving, well-intentioned parents who want to use herbal remedies for their child’s cancer. Doctors, backed by governments, should decide. The state has to step in to save the child from suffering and even death.

It’s a controversial, even incendiary, point of view. But that is the way the debate is heading. We can expect to hear more, much more, in the future.