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Age—not sex or gender—makes the case of Ellie Anderson Complex
  1. Elizabeth Lanphier1,2,
  2. Shannon Fyfe3,4
  1. 1 Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  3. 3 Philosophy, George Mason University, Fairfax, Virginia, USA
  4. 4 George Mason University Antonin Scalia Law School, Arlington, Virginia, USA
  1. Correspondence to Dr Elizabeth Lanphier, Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; elizabeth.lanphier{at}


In ‘The Complex Case of Ellie Anderson’, Joona Rasanen and Anna Smajdor raise several ethical questions about the case. One question asks, but does not answer, whether Ellie faced discrimination for being transgender when her mother was not allowed access to Ellie’s sperm following her death. In raising the question, the authors imply anti-trans bias may have influenced this determination. However, this inference is not supported by current ethical and legal guidance for posthumous use of gametes, with which Ellie’s case is consistent. We consider the authors’ responses to their other ethical queries, and how their suggestions for what options might have been available to Ellie and her family are instructive for addressing attempts in the USA and UK to restrict minors’ access to gender-affirming medical treatment, including puberty-blocking therapy.

  • decision-making
  • ethics
  • living wills/advance directives
  • minors/parental consent
  • rights

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  • Contributors EL proposed the initial draft. SF made substantive additions and revisions. Both authors edited the complete paper, approved the final manuscript as submitted, and agree to be held responsible for all aspects of the work.

  • 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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