• autonomy
• sexuality/gender
• clinical ethics

Notini et al 1 offer a timely addition in the wake of a significant increase in young people identifying as transgender and gender diverse (TGD). The authors focus specifically on the case of 18-year-old Phoenix’s request for ongoing puberty suppression (OPS) to affirm a non-binary gender identity. A central issue raised by Phoenix’s predicament, and that I suggest we can extend to ethical consideration of requests for other types of medical intervention by binary and non-binary TGD individuals, is whether we should ‘affirm’ (along with the prevalent trend in ‘gender affirmative’ care) the claims made by TGD young people about what promotes their well-being.

As a clinician working with TGD young people who have undergone a range of medical interventions to align their bodies with their gender identity, my starting presumption is that it is important to respect what people think will help them: there are some TGD young people for whom, all things considered, medical interventions to affirm gender identity promote their well-being.

Well-being has become an important conceptual currency in ethical debates and lies at the core of the authors’ analysis of Phoenix’s case. While the authors do not ground their argument in favour of OPS in a specific theory of well-being, welfarist considerations (Savulescu and Kahane)2 appear to underpin …