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Current controversy
Medically assisted gender affirmation: when children and parents disagree
  1. Samuel Dubin1,
  2. Megan Lane2,
  3. Shane Morrison3,
  4. Asa Radix4,
  5. Uri Belkind4,
  6. Christian Vercler2,
  7. David Inwards-Breland5
  1. 1New York University, New York, New York, USA
  2. 2Department of Surgery, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  3. 3Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
  4. 4Callen-Lorde Community Health Center, New York City, New York, USA
  5. 5Department of Medicine, Division of Adolescent Medicine, Seattle Children's Gender Clinic, University of Washington Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr Shane Morrison, Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA; shane.d.morrison{at}gmail.com

Abstract

Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor doctrine and state intervention for neglect. Our discussion approaches this parent–child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors’ decision-making authority in certain medical situations.

  • sexuality/gender
  • right to healthcare
  • informed consent

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http://dx.doi.org/10.1136/medethics-2019-105567

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    Footnotes

    • Contributors SND, Dr ML, Dr SDM made substantial contributions to the conception or design of the work. Dr AR, Dr UB, Dr CJV, Dr DI-B contributed to drafting the work or revising it critically for important intellectual content. All authors had final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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    © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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