Journal of Medical Ethics 45 (12):1-2 (2019)

Authors
Bruce P. Blackshaw
University of Birmingham
Daniel Rodger
London South Bank University
Abstract
Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT.
Keywords Transgender  Informed consent  Gender dysphoria
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DOI 10.1136/medethics-2019-105611
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