Identity, well-being and autonomy in ongoing puberty suppression for non-binary adults: a response to the commentaries

Lauren Notini,Julian Savulescu,Michelle Telfer,Lynn Gillam,Ken C Pang,Brian D Earp

doi:10.1136/medethics-2020-106942

Abstract

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...

Highlights

In this paper, we identify and analyse the key ethical issues relevant to Phoenix’s case, a hypothetical yet realistic case based on clinical experience
Does offering ongoing puberty suppression (OPS) to medically affirm non-b inary gender identities align with the proper goals of medicine? Second, does equity require offering OPS to non-binary adults as a group? And, third, how should clinicians respond to individual requests for OPS from such adults? The first two questions are hurdle questions which must be addressed before establishing how clinicians should respond to individual requests
We have argued that it is ethically defensible in principle for clinicians to offer OPS to non-binary adults as a group, as OPS can promote patient well-being and is consistent with the proper goals of medicine

Summary

Introduction

We identify and analyse the key ethical issues relevant to Phoenix’s case, a hypothetical yet realistic case based on clinical experience. Phoenix’s request raises novel ethical questions which have not previously been analysed. Requests for ongoing puberty suppression (OPS) from non- binary adults raise three key ethical questions. Third, how should clinicians respond to individual requests for OPS from such adults? The third question relates to how clinicians should decide whether OPS is ethically justifiable in any given case. We argue that it can be ethically justifiable for clinicians to offer OPS to non-b inary adults as a group. Using a broadly principlist approach,[3] we argue that whether OPS is ethically justified in any given case will depend on contingent and specific details that will vary with each non-b inary adult who requests this intervention.i

Background

Findings

Conclusion