Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical (...) care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care. (shrink)

By attending to how people speak about their gender, we can find diverse answers to the question of what it is like to have a gender identity. To some, it is little more than having a body whereas others may report it as more attitudinal or dispositional—seemingly contradictory views. In this paper, I seek to reconcile these disparate answers by developing a theory of how individual gender identity comes about. In the simplest possible terms, I propose that gender identity is (...) how we make sense of our gender subjectivity, the totality of our gendered experiences of ourselves. Gender identity is constituted by gender subjectivity, but this constitutive relationship is underdetermined. While gender subjectivity may narrow the range of inhabitable gender identities, it is always compatible with more than one. To arrive at a gender identity, we arrange gender subjectivity like building materials. My theory helps us understand how different people offer seemingly incompatible accounts of their gender identity without questioning their authenticity or validity. They simply arrange similar building materials differently. (shrink)

Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, (...) such as parents or judges, if lower level decision-makers are incapable of satisfactorily addressing the issue even with support and the higher level decision-maker is better positioned to satisfactorily address the issue than all lower level decision-makers. Because gender uniquely pertains to personal identity and self-realisation, parents and judges are rarely better positioned to make complex medical decisions. Instead of taking away trans youth’s authority over their healthcare decisions, we should focus on supporting their ability to take the best possible decision for themselves. (shrink)

A recent paper by Teresa Baron and Geoffrey Dierckxsens argues that puberty blockers and hormone therapy should be disallowed before adulthood on prudential and consent-related grounds. This response contends that their argument fails because it is predicated on unsupported premises and misinterpretations of the available evidence. There is no evidence that a large proportion of pubertal and postpubertal youths later discontinue medical transition. Meaningful assent is a viable and commonly accepted alternative to meaningful consent in paediatric bioethics. And finally, the (...) primary purpose of transition-related interventions is to actualise youths’ gendered self-image, not treat an underlying mental illness. (shrink)

In conversation with Hortense Gallois’ recent essay on the importance of bioethicists participating in public discourse, I suggest that speaking up is as fraught as it is important. Focusing on the anti-trans movement’s misuse of expertise, I highlight the fine line between correcting misinformation and inadvertently causing harm through ill-timed speech. Drawing on the work of Eva Feder Kittay, I suggest that knowing when to speak up and when to stay silent starts with understanding the communities we speak about and (...) the consequences that our words can have on them. (shrink)

Volume 19, Issue 6, June 2019, Page W3-W4.

In a previous article, I argued that assessment requirements for transgender hormone replacement therapy are unethical and dehumanising. A recent response published by the Journal of Medical Ethics criticises this proposal. In this reply, I advance that their response misunderstood core parts of my argument and fails to provide independent support for assessment requirements. Though transition-related care may have similarities with cosmetic surgeries, this does not suffice to establish a need for assessments, and nor do the high rates of depression (...) and anxiety justify assessments, especially given the protective role HRT plays towards mental well-being. (shrink)

This article analyses the legacy of Marsha P. Johnson as a heroine through the notion of labour, emphasising how heroine narratives are both a product of labour as well as a form of labour. After offering a short account of Marsha P. Johnson’s role in the Stonewall riots and STAR, we explore the development of trans communities’ ability to create, sustain and disseminate heroine narratives, emphasising Tourmaline’s pivotal archival role in establishing Johnson’s legacy. Then, we elucidate the role of heroine (...) narratives in creating and sustaining a collective identity. We argue that community attachment to Marsha P. Johnson reclaims the place of trans communities in LGBTQ+ history but is often done in a manner that obscures the whiteness of mainstream trans advocacy. We suggest that the recent increase in interest towards the life-sustaining labour of STAR House reflects the evolution of trans collective identity in the post-visibility era. (shrink)

How to account for participants’ psychological and emotional exhaustion with research has been under‐explored in the research ethics literature. Research fatigue, as it is known, has significant impacts on patients’ well‐being and their ongoing and future participation in studies. From the perspective of researchers and researched communities, research fatigue also creates selection bias and opportunity costs, negatively impacting the collective scientific enterprise. Institutional Review Boards should systematically consider research fatigue during the research approval process and strive to mitigate it.

Transgender conversion practices involve attempts to alter, discourage, or suppress a person’s gender identity and/or desired gender presentation, including by delaying or preventing gender transition. Proponents of the practices have argued that they should be allowed until proven to be harmful. Drawing on the notion of expressive equality, I argue that conversion practices are prima facie unethical because they do not fulfill a legitimate clinical purpose and conflict with the self-understanding of trans communities.

Volume 19, Issue 6, June 2019, Page W3-W4.