In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the ethical defensibility (...) of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)

We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...) conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer. D’Angelo,2 Lemma3 and Wren4 highlight the importance of considering Phoenix as a ‘whole person in context’ 2 prior to initiating treatment or care. In this way, they advocate for a process of ‘therapeutic exploration’,4 which includes taking sufficient time to explore Phoenix’s personhood with them so as to support them in achieving an ‘authentic self-discovery’.2 We agree with these authors that identity development is a complex, life-long process that is influenced by biological, psychosocial and relational aspects, all of which may contribute to an individual’s desire to pursue gender-affirming interventions. To explore the various factors—both conscious and unconscious—that might be motivating Phoenix’s decision to pursue ongoing puberty suppression, D’Angelo,2 Lemma3 and Wren4 describe a comprehensive psychological approach to working with transgender and gender diverse individuals and propose questions to guide such discussions. Consistent with this approach, we stipulated that Phoenix had undergone regular psychological counselling and that the psychologist had judged that ‘Phoenix’s distress is significant and enduring…not a symptom …. (shrink)

Bioethics, Volume 35, Issue 7, Page 696-703, September 2021.

In this study, the levels of knowledge, awareness, and acceptance of research misconduct were investigated among the Pharmacy academics and students in Malaysia. A cross-sectional study using an online questionnaire was carried out. A total of 393 pharmacy academics and students in Malaysia were involved. Perceived research misconduct, as defined in this study as the perception of any research misconduct performed or observed by the respondents at their institution, was captured and further analyzed. The data was analysed using PLS-SEM to (...) assess the hypotheses which were formulated prior to the survey. The findings show that there is a statistically significant positive relationship between the awareness of terminologies regarding research misconduct and perceived research misconduct in the workplace of respondents. However, the acceptance of unethical practices in research demonstrates a negative correlation with perceived research misconduct. Knowledge and awareness regarding research misconduct have no statistically significant relationship with perceived research misconduct in this study. Both awareness of terminologies and acceptance of unethical practices explained a 10.8% variance in perceived research misconduct. Therefore, our study indicates that the awareness, knowledge, and acceptance of research misconduct might not be the main predictors of questionable conduct of research among pharmacy academics and students. Future study on the relationship between other factors which might contribute to research misconduct is highly recommended to investigate the significant contributing factors of irresponsible conduct of research among the Pharmacy academics and students in Malaysia. (shrink)