BMJ: parents don't get a say in treatment of minors

[NeurotrashWarrior]

https://sci-hub.tw/downloads-ii/2020-01-06/afc5/dubin2019.pdf

Conclusions
*
Despite the absence of clear clinical guidelines for transgender minors seeking medical treatment in the absence of parental consent, there is sufficient ethical precedent and clinical data to conclude that treatment should not be withheld when a minor is at risk of undue suffering. Because there is evidence to suggest dysphoria and associated comorbidities would be relieved by treatment, this logic aligns with Diekema’s criteria for over- riding parental consent and Mill’s Harm Principle. Although guidance is not law, the capacity of a transgender minor should be strongly advocated for in a matter consistent with a provid- er’s general treatment of adolescents in any other medical decision-making settings such as STI services and contraception. The clinician should consider the decision to pursue hormone therapy or surgery in relation to current guidelines, risks to the individual patient and the child’s decision-making capacity.*

I wonder what Kiera would have to say about this article? So many detransitioned women talk about the strength of feeling they had as a teen.

And yet, parent's opinion doesn't count.

Because there is evidence to suggest dysphoria and associated comorbidities would be relieved by treatment

Again, not what Michele Moore has found. In fact the opposite.

Watson, a detransitioned woman, talking to Benjamin Boyce about how each stage of treatment did not solve her difficulties - and she was an adult.

(Rabbit and lots about the historical pamphlet wars in first 5 mins, which is interesting in terms of the comparison but you need to continue watching to get to her story.)

This could happen in any family. Life changing decisions in the hands of children. What could go wrong?

Michele gives an example of a young girl with anorexia who then was diagnosed with gd and her parents told this would solve the anorexia; it hasn't.

She makes the point at 18 mins around how risk of suicide is a factor and also, if a child a school is at risk of suicide, why aren't the parents being told?

Why aren't children allowed to divorce their parents? Because a pre-teen and teen has never ever said 'I hate you, I wish I'd never been born, I wish you were dead' did they?

As Mayo said 'What could go wrong?

Michele describes that the girl with anorexia was influenced by two other girls at the clinic who were "trans."

She also describes a young man with psychotic episodes involving dressing up in robes ended up with sex reassignment surgery, but mh deteriorated. He had more surgery and then ended his own life.

I hope this gets some news coverage. Preferably complete with an interview with a detransitioner.

I don't think many people realise how far this has gone, and almost no one will like it when they find out.

This makes me feel sick (I have a child edging this way). The way 'gender-affirming' is used throughout - that's such a political way to put it, it doesn't come from any scientific evidence that 'gender' is even a real thing, let alone something that must be 'affirmed' by surgery. What is a phrase like that even doing in a supposed scientific article? And they might be able to dismiss concerns about detransitioning as having been 'denounced' but what are parents supposed to think - that all the detransitioners speaking out are what? Fake?? They clearly exist! How are we supposed to have confidence that our child won't be one of those, when the people advocating transition are unwilling even to try to learn from people who have detransitioned?

I'd be banned if I wrote what I thought about this.

Not in my name.

The conclusion does not surprise me. The principle of parents not being required to give permission for medical treatment if minors are deemed able to consent, is already well established in law.

Doctors not only removing parental rights but deciding that children / teenagers are competent enough to make life long decisions about removing their fertility, their potential sexual feelings and their body parts.

Who are these people?

Women in their 30s struggle to get a hysterectomy or to be sterilised by choice as they know they do not want children.

And yet children and teens can make this decision to be sterilised?

Sort of related- I’m a member of the Bayswater Support Group and they had this published in the BMJ today about the role of parents:

www.bmj.com/content/368/bmj.m215/rr-0

Contributers to the OP paper published in BMJ are all based in USA:
from paper affiliations & footnotes:
Samuel Dubin New York University, New York, New York, USA
Megan Lane & Christian Vercler Department of Surgery, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
Shane Morrison Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
Asa Radix & Uri Belkind Callen-Lorde Community Health Center, New York City, New York, USA
David Inwards-Breland Department of Medicine, Division of Adolescent Medicine, Seattle Children's Gender Clinic, University of Washington Medical Center, Seattle, Washington, USA

Ethics approval The authors deemed this paper exempt to ethics approval given that is critical review.

jme.bmj.com/content/early/2019/12/31/medethics-2019-105567

And a response from Damian Clifford (psychiatrist who has spoken out on the issue) has also now been posted on the BMJ:

www.bmj.com/content/368/bmj.m215/rr-1

Medical Law Review paper, 'The Medico-Legal ‘Making’ of ‘The Transgender Child’
Dr Heather Brunskell-Evans
Medical Law Review, Volume 27, Issue 4, Autumn 2019

Abstract concludes:
"Medicine and law construct the ‘transgender child’ rather than that the ‘transgender child’ exists independently of medico-legal discourse. The ethical issue of whether the child and young person can ‘consent’ to social and medical transition goes beyond legal assessment of whether a person under16 years has the mental capacity to consent, understand to what s/he is consenting, and can express independent wishes. It shifts to examination of the recent making of ‘the transgender child’ through the complex of power/knowledge/ethics of medicine and the law of which the child can have no knowledge but within which its own desires are both constrained and incited."

academic.oup.com/medlaw/article/27/4/640/5522968?guestAccessKey=ba15f531-f2ff-4b63-a348-2a8d58652cb9

Because there is evidence to suggest dysphoria and associated comorbidities would be relieved by treatment,

What evidence?

Thank you rodgmum The statistics in that response from Damian Clifford are reassuring as is this:
....though GPs may be overworked and many not equipped to deal with this issue, they are also averse to referring patients for inadequate care, the results of which, for many patients, will be unsatisfactory and as a result GPs will be picking up the pieces for years to come

It's reassuring to see that so many GPs are putting their patients first rather than an ideology.

Paid American plastic surgeons are very keen on plastic surgery. Who'd have thought it?

Did anyone see the photo of the surgeon celebrating his top surgeries with a cake doing the rounds the other day?

There is a case in the offing regarding over-zealousness in the transitioning of children.

www.womenarehuman.com/woman-sues-child-gender-clinic-over-too-speedy-transition/

Chilling.

rodgmum did you see that there was also a response by Helen Webberley?

All the responses are here.
www.bmj.com/content/368/bmj.m215/rapid-responses

If you click on the 'article' tab on the second link, it might get you past the paywall to the whole article.

OldCrone good grief, she has. She is simply awful! And she makes it sound like prescribing testosterone is like prescribing migraine tablets. Given that she’s been suspended by the GMC, I’m a bit surprised they ran her response- and also accepted her “No Competing Interests” statement.

I see a Scottish GP has also responded giving her concerns.

@givethemseeds posted the full article on Twitter today if Old’s suggestion doesn’t work and you want to see the whole article.

Thanks for all the links

An autistic girl with her breasts cut off is still autistic, still struggling to understand society.

A sexually abused girl with a beard and vaginal atrophy is a survivor of sexual abuse, still needing to heal emotionally.

Are autism and surviving sexual abuse considered co-morbidities? Are they even considered?