The ethics of keeping an adult in a child's body - BMJ

[Clymene]

This is a paper about a (thankfully) hypothetical young woman who has identified as non binary since the age of 5 and began puberty blockers at 11. At 18, she has decided she wants to stay on them to reflect her non binary identity. The authors argue that she has capacity to make that decision despite the fact that her brain will not have fully developed, because we don't actually know for certain that there will be harm as the studies haven't been done. And besides, her psychological well being of being kept in a state of perpetual prepubescence is more important.

https://jme.bmj.com/content/46/11/743

Just who will benefit from adult women who look and think like children? It's certainly a bit of a mystery

Do they give consideration to their ethical position beyond the other person’s capacity for consent? Do think they can do medical experiments on people as long as they have consent?

(But I didn’t think ‘non-binary’ meant ‘child’ anyway?)

identified as non binary since the age of 5

@tabbycatstripy

Do they give consideration to their ethical position beyond the other person’s capacity for consent? Do think they can do medical experiments on people as long as they have consent?

(But I didn’t think ‘non-binary’ meant ‘child’ anyway?)

They seem to say that her determination that she will find puberty very distressing is enough to just go along with what she asks for.

Rather than suggesting therapy or some other kind of mental health support.

A woman trapped in prepubescence, able to consent but not enjoy sex, and unable to conceive. They seem to think whether she desires sex will mean she is able to control whether she has it or not. I think that she will be under enormous pressure to enter into sexual relationships and porn. Lots of porn.

@DomesticatedZombie

identified as non binary since the age of 5

I agree DomesticatedZombie. Non binary? I doubt any 5 year olds even know the meaning of that. Such a child should never be given puberty blockers...their actual body will take its natural course and they can 'present' how they see fit. Anything else is child abuse.

This reply to this 2020 Journal of medical ethics article (it's the BMJ group of journals the 2020 Phoenix article was not in the BMJ) raises pertinent points on why Phoenix doesn't want an adult sexuality jme.bmj.com/content/46/11/753

‘They seem to say that her determination that she will find puberty very distressing is enough to just go along with what she asks for.’

But that doesn’t take into account ANY of the (in my view serious) considerations as to the ethics of creating a class of child-adults.

“Your honour, I thought she was 25.”

“She looks ten.”

“Yessir, but puberty blockers...”

How can anyone consent to that? No one can possibly know what long term effects that will have on her body.

Looking at the Twitter altmetrics, it's not at all obvious that many people see this as a hypothetical case study.

bmj.altmetric.com/details/86624426/twitter

I'm linking to d'Angelo's exploration of Phoenix as I found it helpful.

With its narrow focus on gender identity as concrete, the clinicians and ethicists effectively ignore or even erase the complexity of Phoenix’s lived history and the context within their gender distress is constituted. The paper is striking for the absence of any sense of Phoenix, the person, even for a hypothetical case. Phoenix has effectively been reduced to a diagnosis or a gender identity to be treated. The reification of Phoenix’s non-binary identity effectively erases all personal meaning, the impact of the relational context and the sociopolitical surround. It constitutes a decontextualisation and dehumanisation, which is arguably profoundly unethical.
…
From a perspective that considers the whole person in context, ongoing puberty blockade (OPD) constitutes a therapeutic abandonment. While gender-affirming medical intervention aspires to help the individual actualise their true self, it potentially forecloses authentic self-discovery if not preceded by a thoroughgoing psychological exploration. Hopefully, Phoenix will discover answers to the question ‘Who is Phoenix?’ that are more complex than ‘non-binary’. Armed with deeper selfawareness, Phoenix will then be in the best position to decide whether OPD will indeed be liberating, or whether it will deprive Phoenix of true growth and freedom.

jme.bmj.com/content/medethics/early/2020/10/19/medethics-2020-106822.full.pdf

@DomesticatedZombie

identified as non binary since the age of 5

WTAF does this MEAN??

It’s grotesque.

As the mum of a DD that likes 'boys' stuff and clothes, I find this very worrying. To a certain extent all children are 'non binary' until they been hobbled by gender stereotypes and expectations.

I have always allowed my DD to pick what she likes and told her that she is allowed to like what she likes.

The whole idea of gender as somehow essential and sex as optional is so repressive to everyone that takes issue with gender stereotypes.

So is this all a massive 'job creation scheme'/(profit creation) for psychologists, university academics, drugs manufacturers, Diversity and Inclusion Managers, plastic surgeons, charities, politicians, pressure groups etc?

This is just the new anorexia isn't it? A medical way to permanently keep puberty at bay.

Christ, if someone had offered me the chance to avoid puberty aged 12 on the (accurate) grounds that I found it all very distressing I'd have bitten their hand off.

Fortunately they didn't.

In addition to potential distress associated with any physical harms that eventuate, there may be other psychosocial harms associated with OPS to make Phoenix look ‘more non-binary’. For example, Phoenix’s child-like body could mean they have trouble finding a romantic partner. A lack of sex hormones will also reduce Phoenix’s libido.

Hmm.

For example, Phoenix’s child-like body could mean they have trouble finding a romantic partner.

Awfully fucking coy, aren't they?

("They" the highly suspect individuals who wrote this, not they-Phoenix.)

if someone had offered me the chance to avoid puberty aged 12 on the (accurate) grounds that I found it all very distressing I'd have bitten their hand off.

I lived within a few doors of several brothels and in an area with a lot of sex workers. Men in the area (residents or 'transactional visitors') took that as wide-ranging permission to assume that all women and girls were plausibly up for al fresco sex work and that there were no consequences to attempting to grab you off the street and to pull you into a garage block.

I'd think a number of girls and young women would have been eager to bypass this part of our mutual development and social maturation had an option been presented to us…

It's terrifying.

I'm sure there was a high court case where a parent wanted their disabled child to have puberty blockers to try to prevent periods and to make their care easier to manage. It was thrown out, I should try and find the details.

This is 15 years ago, (and I don't think it was the one I was thinking of) but an interesting read nonetheless.

www.google.com/amp/s/amp.theguardian.com/world/2007/jan/04/health.topstories3

@tabbycatstripy

‘They seem to say that her determination that she will find puberty very distressing is enough to just go along with what she asks for.’

But that doesn’t take into account ANY of the (in my view serious) considerations as to the ethics of creating a class of child-adults.

“Your honour, I thought she was 25.”

“She looks ten.”

“Yessir, but puberty blockers...”

Yes, there is an awful lot going on here. It's terrifying really.

@JoanOgden

Christ, if someone had offered me the chance to avoid puberty aged 12 on the (accurate) grounds that I found it all very distressing I'd have bitten their hand off.

Fortunately they didn't.

You, me and many other children.

Some adults and their ideas are truly frightening.

[quote Whitefire]This is 15 years ago, (and I don't think it was the one I was thinking of) but an interesting read nonetheless.

www.google.com/amp/s/amp.theguardian.com/world/2007/jan/04/health.topstories3[/quote]
The above link didn't work for me but this one did:

The cause of the controversy is the "Ashley Treatment" - a course of surgery and hormone supplements devised for her at her parents' request and with the blessing of doctors - that will for ever keep her small. It involves surgical operations, including a hysterectomy, and hormone prescriptions that will, in effect, freeze-frame her body at its current size.

Although she has a normal life expectancy, she will, physically, always be nine years old
…
Jeffrey Brosco of Miami University has co-written an editorial in the Archives of Pediatrics & Adolescent Medicine criticising the procedure as an experiment without proper research controls. "This is a technological solution to a social problem. I work with severely disabled children and know how hard it is on families, but what we need most is better federal funding so that they can be cared for properly."

www.theguardian.com/world/2007/jan/04/health.topstories3

For example, Phoenix’s child-like body could mean they have trouble finding a romantic partner. A lack of sex hormones will also reduce Phoenix’s libido.

Bloody hell.

Even someone with the most basic safeguarding training should be able to unpick that one. How can I put it in jolly nice wankerybabble?

What concerns might be anticipated regarding the dating pool of adults sexually interested in a partner with a childlike body and little enjoyment of sex or sex drive?

And what quality of relational experience do we think Phoenix is at risk of receiving?

@jkrfan

So is this all a massive 'job creation scheme'/(profit creation) for psychologists, university academics, drugs manufacturers, Diversity and Inclusion Managers, plastic surgeons, charities, politicians, pressure groups etc?

It certainly looks like it, yes. I don’t know how some of these people can do these jobs.

I'm not actually reassured to learn that Phoenix is not wholly a thought experiment but rather a patchwork of real world patients and clinical scenarios.

In our Feature Article, we describe and analyse a hypothetical case scenario involving Phoenix, a non-binary 18-year-old who started puberty blockers soon after beginning puberty at the age of 11, and who wishes to stay on them throughout adulthood. Although this case is hypothetical, it includes features of several cases we have heard about from practicing clinicians….
…
Although Phoenix is not a real person, their story is not completely hypothetical. Lauren Notini has recently interviewed 14 clinicians from multiple states and territories across Australia who work with TGD youth. Twelve of the 14 reported that they have received requests for puberty suppression from non-binary young people. Some of these clinicians reported that some non-binary young people who start puberty suppression wish to continue it on an ongoing basis (i.e., into adulthood).

blogs.bmj.com/medical-ethics/2020/07/28/ongoing-puberty-suppression-should-be-an-available-treatment-option-for-non-binary-adults-but-case-by-case-analysis-is-also-needed/