Article Text
Abstract
In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.
- sexuality/gender
- concept of health
- clinical ethics
- autonomy
- philosophy of the health professions
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Footnotes
Twitter @briandavidearp, @juliansavulescu
Presented at Some of this work was presented by LN at the Australian Professional Association for Trans Health (AusPATH) Conference in Perth, Australia, on 26 October 2019 (title of presentation: ‘Forever young? The ethics of ongoing puberty suppression for gender non-binary youth’).
Contributors LN is the main author of the article, led the ethical analysis and planning of the paper, wrote the first draft, revised subsequent drafts based on feedback received from coauthors and prepared and submitted the original and revised manuscript for publication. All coauthors (BDE, LG, RJM, JS, MT, KCP) commented on the paper, made revisions and contributed intellectual content. All authors have approved the final version of the manuscript.
Funding JS was supported by the Wellcome Trust (WT203132/Z/16/Z and WT104848/Z/14/Z). LN is the recipient of an Early Career Researcher Grant awarded by the University of Melbourne (project title: ‘The ethics of ongoing puberty suppression for gender non-binary youth’).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement There are no data in this work.
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