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Bioethicist: Impose Puberty Blocking over Parental Objection

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Wesley J. Smith
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Transgender ideology has advanced so far that serious proposals in the most respected medical and bioethics journals are being made to push parents out of the way if they oppose their child’s transition.

The latest example comes to us from the Journal of Medical Ethics — not a fringe publication but one based at Oxford University and published by the British Medical Journal. The journal has published several articles favoring OPS — ongoing puberty suppression — for transgender children, even though there can be significant physical consequences, such as reduced bone density.

Why? Subjective inner turmoil matters more than objective medical harms. From “LGBT Testimony and the Limits of Trust“:

Psychological illness, like physical illness, might be life-threating. So prioritising physical over psychological health cannot be grounded in the former’s severity or permanence. Moreover, there is no logical nor empirical evidence suggests that physical suffering must be worse than psychological suffering. Blanket prioritisations of physical over psychological healthare conceptually and scientifically unfounded.

Hence:

OPS for non-binary patients seems warranted provided that, (1) patients understand the treatment and risks and (2) patients testimony that the benefits outweigh the costs. Patients, not physicians, have something to both lose and gain. Moreover, only patients have direct access to the subjective upsides.

That might well be true of such body-altering decisions in adults. But we are talking here about pre-pubescent children! They can’t get their ears pierced without parental permission because the law justly recognizes that they are not sufficiently mature to make that decision.

What about doctor objections? Child-patient desires rule!

Medical risks must be weighed against (largely psychological) benefits, yes. Physicians are well situated to educate patients about the former. Only patients have direct access to the latter. Thus, a clash between a patient’s and a physician’s cost/benefit analysis in itself implies that the latter understands the patient better than the patient does themselves. Given medicine’s history with LGBT patients, this is not only implausible, but arrogant and ethically suspect

Could the refusing doctor be punished for refusing to apply the intervention? The author doesn’t say, but there is enough advocacy in the professional literature against medical conscience rights that physician compulsion would seem the logical expectation.

And what about parents? Because some will approve OPS and others won’t, it would be wrong to allow parents to thwart fulfillment of their child’s internal desires when another gender-dysphoric child will be enabled to obtain it. In other words, if a doctor thinks the psychological risk is sufficiently serious, block that puberty regardless of what parents want for their child!

The aligning of the parental stars can thus determine whether adulthood begins with either, (1) a confidence inducing, gender affirming body or (2) a confidence-undermining body that intensifies gender dysphoria. Two non-binary teens desiring comparable treatments are like cases, hence justice demands like treatment. Guardian veto power over identify-affirming care thus results in injustice whenever such power means one trans child is denied the care that another receives.

This exemplifies the profound threat posed by the “equity” agenda. Equal outcomes trumps all, apparently. Back to the article:

This veto power also conflicts with the principles of non-maleficence, autonomy and beneficence. Autonomy is infringed because medical options are forever closed off to those who (through no choice nor fault) miss PS in adolescence. Frustrating a trans person’s desire to affirm identity is harmful, that is, in tension with nonmaleficence. Lastly, parental veto power over PS forever keeps many identity-affirming benefits out of reach, thus failing compliance with beneficence.

I’ll tell you what: Let’s produce equity by refusing all OPS, which is unethical human experimentation. (After all, the interventions used in puberty blocking are “off-label” uses of drugs approved for physical puberty pathologies.) In that way, children with gender dysphoria can receive the psychological help and compassionate support they need without the potential adverse consequences of OPS — for which there is actually “very low evidence” of benefit. And remember, some children with gender dysphoria regret transitioning, as 60 Minutes amply demonstrated, and may be stuck with the physical consequences of the “treatment” for the rest of their lives.

Besides, how would imposing OPS over parental objections be effectuated? It seems to me the only way to ensure that a child received OPS would be to remove the child from the home of the objecting parents or compel the parents to give the drugs/hormones under threat of criminal sanction.

Something approaching this has already happened in Canada, where a father has been jailed for contempt of court because he refused to call his child “he” or his “son.” Transgender ideology and equity advocacy both lead to profoundly authoritarian places.

And don’t think it won’t happen here. Discussions in the professional journals often precede imposition of radical ideas into public policy and medical ethics. That is why it is important to see what our betters in the ivory tower have planned for us so we can prepare our defenses.