Children and gender: ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence
Gespeichert in:
| 1. Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Oxford
Oxford University Press
[2023]
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| Schriftenreihe: | Issues in biomedical ethics
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| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | xviii, 291 Seiten |
| ISBN: | 9780192895400 |
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| adam_text | Contents Preface Acknowledgements List of Cases xi xvii xix 1. The Current Landscape 1.1 Introduction 1.2 Gender Incongruence inChildhood:Current Nomenclature 1.3 Epidemiology and Prevalence of Gender Dysphoria in Adolescence 1.4 Is Gender Diversity ‘Created’ by Society or by the Medical Diagnosis? 1.5 Is Gender Incongruence a‘New Phenomenon’? 1.6 Conclusions 10 13 16 2. Gender Incongruence and Gender Dysphoria in Children and Adolescents: Clinical Descriptions, Psychosexual Outcome Studies, Aetiology 2.1 Introduction 2.2 The WPATH, DSM-V, and the ICD-11 2.3 A Three Dimensional Issue 2.4 Psychosexual Outcome for Gender Diverse Adolescents 2.5 Aetiology of Gender Incongruence 2.6 Reflections on Aetiology 2.7 Conclusions 17 17 17 23 28 31 33 35 3. Gender Development 3.1 Introduction 3.2 The Biological Model 3.3 The Social Model 3.4 Gender and Sex Differences in Transgender Individuals 3.5 Biological Sex and Birth Assigned Sex 3.6 How Many Moons Are There? 3.7 Have Sex and Gender Had Their Time? 3.8 Conclusions 37 37 39 40 43 46 48 52 53 4. Gender Incongruence as a Condition Related to Sexual Health 4.1 Introduction 4.2 Gender Incongruence in the ICD-11 4.3 Location, Location, Location 4.4 Incongruence or No Incongruence? 4.5 Gender or Genital Incongruence? 55 55 56 57 59 60 1 1 5 7
viii CONTENTS 4.6 Additional Risks: The ‘Appropriate Medical Treatment’ 4.7 How Should Gender Incongruence Be Classified? 4.8 Conclusions 61 64 66 5. Clinical Guidance on the Management of Gender Diverse Youth: An Historical Account 5.1 Introduction 5.2 The Endocrine Society Practice Guidelines: An Overview 5.3 Changes to the 2009 Endocrine Society PracticeGuidelines 5.4 Comments on the US Endocrine Society Practice Guidelines 5.5 The WPATH Standards of Care 5.6 Behavioural Therapy 5.7 Psychological Therapies 5.8 Treatment for Parents and Group Therapies 5.9 Etherapy and Distance Counselling 5.10 The History of Combined Approaches 5.11 Royal College of Psychiatrists (1998) 5.12 The Harry Benjamin’s International Gender Dysphoria Association (1979 and Later) 83 5.13 The First US Endocrine Society Clinical Practice Guidelines (2009) 84 5.14 The British Society for Paediatric Endocrinology and Diabetes (2006) 86 5.15 Conclusions 6. The Early Stages of Clinical Management: Should Children Transition Socially? 6.1 Introduction 6.2 The Terminology Used 6.3 Why Is Social Transition Controversial? 6.4 Methodological Concerns 6.5 Early Treatment in Childhood 6.6 In What Way Are Desistance Studies Important? 6.7 Is Social Transition Psychosocial Treatment? 6.8 Does Social Transition Lead to Medical Transition? 6.9 Could Social Transition Steer Gender Identification? 6.10 Can Social Transition Cause Distress at Desistance? 6.11 Ethical Implications 6.12 Is It Ethical to Enable Children to Transition Socially? 6.13 What Are the Clinical and Ethical Implications of Desistance Rates?
6.14 Final Considerations on Persistence, Desistance, and Social Transition 6.15 Conclusions 67 67 68 70 71 72 74 76 78 78 79 81 87 88 88 89 90 92 94 96 98 99 100 101 104 105 106 108 110
CONTENTS 7. The 7.1 7.2 7.3 7.4 7.5 7.6 7.7 IX First Stage of Medical Treatment: Puberty Suppression 112 Introduction 112 Clinical Guidance: A Brief Recap 112 A History of the Controversies around‘Blockers’ 116 The Ethical Controversy 119 Suspending Puberty Is Playing God and Is Interfering with Nature 120 Gender Dysphoria Is a Social Problem, Not a MedicalProblem 121 Conclusions 126 8. Risks and Benefits of Puberty Suppression 8.1 Introduction 8.2 The Benefits of Puberty Suppression 8.3 The Risks of Puberty Suppression 8.4 Other Concerns 8.5 Conclusions 9. Are Trans Children Guinea Pigs? The Fear of Unethical Experimentation 9.1 Introduction 9.2 For Whom Is Puberty Delaying Treatment Prescribed? 9.3 The Problems of Off-label Use 9.4 Why Not a Randomized Controlled Trial? 9.5 GnRHa Have Unknown Long-Term Side Effects 9.6 General Problems in Researching Possible Side Effects 9.7 Conclusions 127 127 128 131 135 139 141 10. Can Valid Consent to Medical Treatment Be Given by Gender Diverse Minors? 10.1 Introduction 10.2 Consent and Pubertal Development 10.3 How to Secure Consent 10.4 Consent Is Not Voluntary: Social Media Coercion 10.5 Consent Is Invalid Because Information Cannot Be Provided 10.6 Information about Regret Rates 10.7 Capacity Concerns 10.8 Gender Dysphoria and Mental Health Concerns 10.9 Gender Dysphoria and Eating Disorders 10.10 Age, Maturity, and Competence 10.11 Infertility and Incompetence 10.12 The Determination of Best Interests 10.13 Concerns Around the Differential Diagnosis: Spurious versus Genuine Identities 175 10.14 Is Gender Dysphoria Just Being
Different? 10.15 The Decision Is Too Complex 10.16 The Conveyor Belt 10.17 The Possibility of Detransitioning 10.18 The Decision-makers Are Too Emotionally Involved 10.19 Conclusions 141 143 144 147 148 149 151 152 152 153 154 156 158 161 163 164 165 169 172 173 177 178 179 181 183 184
X CONTENTS 11. What 11.1 11.2 11.3 11.4 Should the Role of the Family and the Court Be? Introduction What Should the Role of the Family Be? What Should the Role of the Courts Be? Conclusions 12. Is It Ethical to Use Puberty Blockers in the Treatment of Gender Dysphoria? 12.1 Introduction 12.2 A Moral ‘Formula’ 12.3 The Omission Bias 12.4 The Equivalence Thesis 12.5 Equivalence Thesis and Medical Treatment 12.6 Ethical Decision-making 12.7 Conclusions 186 186 188 193 197 199 199 200 203 205 209 210 211 13. Ethical Issues in the Provision of Cross-Sex Hormones 13.1 Introduction 13.2 A Brief Recap of the Clinical Recommendations 13.3 Benefits and Risks of Gender-Affirming Therapies 13.4 Is the Evidence ‘Low’? 13.5 Ethical Issues in ‘the Age Threshold’ 13.6 Caution and Ageism 13.7 The Ethical Problems with ‘Eligibility Criteria’ for Gender-Affirming Therapy 13.8 Ethical Balance 13.9 Ethical Decision-making in Stage 2 13.10 Conclusions 212 212 212 214 216 219 220 14. Gender-Affirming Surgery: Ethical Issues around Age of Access 14.1 Introduction 14.2 Brief Account of International Clinical Guidelines on Surgery 14.3 Why Should Surgery Be Deferred until Adulthood? Legal Reasons 14.4 Why Should Genital Surgery Be Deferred until Adulthood? Clinical Reasons 14.5 Further Reasons to Defer Surgery until Adulthood 14.6 Why Gender-Affirming Surgery Should Be Available to Minors 14.7 Sex Change Surgeries ‘in the Shadows’ 14.8 Conclusion 228 228 229 Conclusion: Fast Emerging Trends and Upcoming Dilemmas Bibliography Index 222 224 225 226 233 236 237 240 245 247 249 255 289
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| adam_txt |
Contents Preface Acknowledgements List of Cases xi xvii xix 1. The Current Landscape 1.1 Introduction 1.2 Gender Incongruence inChildhood:Current Nomenclature 1.3 Epidemiology and Prevalence of Gender Dysphoria in Adolescence 1.4 Is Gender Diversity ‘Created’ by Society or by the Medical Diagnosis? 1.5 Is Gender Incongruence a‘New Phenomenon’? 1.6 Conclusions 10 13 16 2. Gender Incongruence and Gender Dysphoria in Children and Adolescents: Clinical Descriptions, Psychosexual Outcome Studies, Aetiology 2.1 Introduction 2.2 The WPATH, DSM-V, and the ICD-11 2.3 A Three Dimensional Issue 2.4 Psychosexual Outcome for Gender Diverse Adolescents 2.5 Aetiology of Gender Incongruence 2.6 Reflections on Aetiology 2.7 Conclusions 17 17 17 23 28 31 33 35 3. Gender Development 3.1 Introduction 3.2 The Biological Model 3.3 The Social Model 3.4 Gender and Sex Differences in Transgender Individuals 3.5 Biological Sex and Birth Assigned Sex 3.6 How Many Moons Are There? 3.7 Have Sex and Gender Had Their Time? 3.8 Conclusions 37 37 39 40 43 46 48 52 53 4. Gender Incongruence as a Condition Related to Sexual Health 4.1 Introduction 4.2 Gender Incongruence in the ICD-11 4.3 Location, Location, Location 4.4 Incongruence or No Incongruence? 4.5 Gender or Genital Incongruence? 55 55 56 57 59 60 1 1 5 7
viii CONTENTS 4.6 Additional Risks: The ‘Appropriate Medical Treatment’ 4.7 How Should Gender Incongruence Be Classified? 4.8 Conclusions 61 64 66 5. Clinical Guidance on the Management of Gender Diverse Youth: An Historical Account 5.1 Introduction 5.2 The Endocrine Society Practice Guidelines: An Overview 5.3 Changes to the 2009 Endocrine Society PracticeGuidelines 5.4 Comments on the US Endocrine Society Practice Guidelines 5.5 The WPATH Standards of Care 5.6 Behavioural Therapy 5.7 Psychological Therapies 5.8 Treatment for Parents and Group Therapies 5.9 Etherapy and Distance Counselling 5.10 The History of Combined Approaches 5.11 Royal College of Psychiatrists (1998) 5.12 The Harry Benjamin’s International Gender Dysphoria Association (1979 and Later) 83 5.13 The First US Endocrine Society Clinical Practice Guidelines (2009) 84 5.14 The British Society for Paediatric Endocrinology and Diabetes (2006) 86 5.15 Conclusions 6. The Early Stages of Clinical Management: Should Children Transition Socially? 6.1 Introduction 6.2 The Terminology Used 6.3 Why Is Social Transition Controversial? 6.4 Methodological Concerns 6.5 Early Treatment in Childhood 6.6 In What Way Are Desistance Studies Important? 6.7 Is Social Transition Psychosocial Treatment? 6.8 Does Social Transition Lead to Medical Transition? 6.9 Could Social Transition Steer Gender Identification? 6.10 Can Social Transition Cause Distress at Desistance? 6.11 Ethical Implications 6.12 Is It Ethical to Enable Children to Transition Socially? 6.13 What Are the Clinical and Ethical Implications of Desistance Rates?
6.14 Final Considerations on Persistence, Desistance, and Social Transition 6.15 Conclusions 67 67 68 70 71 72 74 76 78 78 79 81 87 88 88 89 90 92 94 96 98 99 100 101 104 105 106 108 110
CONTENTS 7. The 7.1 7.2 7.3 7.4 7.5 7.6 7.7 IX First Stage of Medical Treatment: Puberty Suppression 112 Introduction 112 Clinical Guidance: A Brief Recap 112 A History of the Controversies around‘Blockers’ 116 The Ethical Controversy 119 Suspending Puberty Is Playing God and Is Interfering with Nature 120 Gender Dysphoria Is a Social Problem, Not a MedicalProblem 121 Conclusions 126 8. Risks and Benefits of Puberty Suppression 8.1 Introduction 8.2 The Benefits of Puberty Suppression 8.3 The Risks of Puberty Suppression 8.4 Other Concerns 8.5 Conclusions 9. Are Trans Children Guinea Pigs? The Fear of Unethical Experimentation 9.1 Introduction 9.2 For Whom Is Puberty Delaying Treatment Prescribed? 9.3 The Problems of Off-label Use 9.4 Why Not a Randomized Controlled Trial? 9.5 GnRHa Have Unknown Long-Term Side Effects 9.6 General Problems in Researching Possible Side Effects 9.7 Conclusions 127 127 128 131 135 139 141 10. Can Valid Consent to Medical Treatment Be Given by Gender Diverse Minors? 10.1 Introduction 10.2 Consent and Pubertal Development 10.3 How to Secure Consent 10.4 Consent Is Not Voluntary: Social Media Coercion 10.5 Consent Is Invalid Because Information Cannot Be Provided 10.6 Information about Regret Rates 10.7 Capacity Concerns 10.8 Gender Dysphoria and Mental Health Concerns 10.9 Gender Dysphoria and Eating Disorders 10.10 Age, Maturity, and Competence 10.11 Infertility and Incompetence 10.12 The Determination of Best Interests 10.13 Concerns Around the Differential Diagnosis: Spurious versus Genuine Identities 175 10.14 Is Gender Dysphoria Just Being
Different? 10.15 The Decision Is Too Complex 10.16 The Conveyor Belt 10.17 The Possibility of Detransitioning 10.18 The Decision-makers Are Too Emotionally Involved 10.19 Conclusions 141 143 144 147 148 149 151 152 152 153 154 156 158 161 163 164 165 169 172 173 177 178 179 181 183 184
X CONTENTS 11. What 11.1 11.2 11.3 11.4 Should the Role of the Family and the Court Be? Introduction What Should the Role of the Family Be? What Should the Role of the Courts Be? Conclusions 12. Is It Ethical to Use Puberty Blockers in the Treatment of Gender Dysphoria? 12.1 Introduction 12.2 A Moral ‘Formula’ 12.3 The Omission Bias 12.4 The Equivalence Thesis 12.5 Equivalence Thesis and Medical Treatment 12.6 Ethical Decision-making 12.7 Conclusions 186 186 188 193 197 199 199 200 203 205 209 210 211 13. Ethical Issues in the Provision of Cross-Sex Hormones 13.1 Introduction 13.2 A Brief Recap of the Clinical Recommendations 13.3 Benefits and Risks of Gender-Affirming Therapies 13.4 Is the Evidence ‘Low’? 13.5 Ethical Issues in ‘the Age Threshold’ 13.6 Caution and Ageism 13.7 The Ethical Problems with ‘Eligibility Criteria’ for Gender-Affirming Therapy 13.8 Ethical Balance 13.9 Ethical Decision-making in Stage 2 13.10 Conclusions 212 212 212 214 216 219 220 14. Gender-Affirming Surgery: Ethical Issues around Age of Access 14.1 Introduction 14.2 Brief Account of International Clinical Guidelines on Surgery 14.3 Why Should Surgery Be Deferred until Adulthood? Legal Reasons 14.4 Why Should Genital Surgery Be Deferred until Adulthood? Clinical Reasons 14.5 Further Reasons to Defer Surgery until Adulthood 14.6 Why Gender-Affirming Surgery Should Be Available to Minors 14.7 Sex Change Surgeries ‘in the Shadows’ 14.8 Conclusion 228 228 229 Conclusion: Fast Emerging Trends and Upcoming Dilemmas Bibliography Index 222 224 225 226 233 236 237 240 245 247 249 255 289 |
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| spelling | Giordano, Simona Verfasser (DE-588)1163837717 aut Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence Simona Giordano Oxford Oxford University Press [2023] © 2023 xviii, 291 Seiten txt rdacontent n rdamedia nc rdacarrier Issues in biomedical ethics Sexuelle Orientierung (DE-588)7568353-2 gnd rswk-swf Medizinische Ethik (DE-588)4074672-0 gnd rswk-swf Jugend (DE-588)4028859-6 gnd rswk-swf Geschlechtsidentität (DE-588)4181116-1 gnd rswk-swf Transgender (DE-588)7619945-9 gnd rswk-swf Kind (DE-588)4030550-8 gnd rswk-swf Kind (DE-588)4030550-8 s Jugend (DE-588)4028859-6 s Transgender (DE-588)7619945-9 s Sexuelle Orientierung (DE-588)7568353-2 s Geschlechtsidentität (DE-588)4181116-1 s Medizinische Ethik (DE-588)4074672-0 s DE-604 Erscheint auch als Online-Ausgabe 978-0-19-264870-9 Erscheint auch als Online-Ausgabe 978-0-19-191621-2 Digitalisierung BSB München - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034610030&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence |
| title_auth | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence |
| title_exact_search | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence |
| title_exact_search_txtP | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence |
| title_full | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence Simona Giordano |
| title_fullStr | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence Simona Giordano |
| title_full_unstemmed | Children and gender ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence Simona Giordano |
| title_short | Children and gender |
| title_sort | children and gender ethical issues in clinical management of transgender and gender diverse youth from early years to late adolescence |
| title_sub | ethical issues in clinical management of transgender and gender diverse youth, from early years to late adolescence |
| topic | Sexuelle Orientierung (DE-588)7568353-2 gnd Medizinische Ethik (DE-588)4074672-0 gnd Jugend (DE-588)4028859-6 gnd Geschlechtsidentität (DE-588)4181116-1 gnd Transgender (DE-588)7619945-9 gnd Kind (DE-588)4030550-8 gnd |
| topic_facet | Sexuelle Orientierung Medizinische Ethik Jugend Geschlechtsidentität Transgender Kind |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034610030&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT giordanosimona childrenandgenderethicalissuesinclinicalmanagementoftransgenderandgenderdiverseyouthfromearlyyearstolateadolescence |