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

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

I have thought since the very first day I heard about puberty blockers and trans ideology back in 2015. I was called a "disgusting conspiracy theorist". So strange how all our worst, initially dismissed and rubbished fears, continue to be realised as the years go by.

@EmbarrassingHadrosaurus

The notion of giving puberty blockers to an 11 year old is really sickening. It’s child abuse, plain and simple.

See also this "ethics round" article about possible long-term use of puberty blockers - it's the slightly older and less sanitised version I think:
publications.aap.org/pediatrics/article/145/2/e20191606/68237/Long-term-Puberty-Suppression-for-a-Nonbinary

Also definitely not hypothetical
In this Ethics Rounds, we present a case that combines features of several real cases that raised issues about prolonged pubertal suppression for a patient with a nonbinary gender.

So this isn't 'born in the wrong body', this is don't want to grow up.

How can anyone feel like the right way to treat that feeling is drugs?

I wonder how much there is a desire to score a first that gets masses of coverage in medical journals? Does that override the desire for ethical practice that is in the patients' best interests?

@Signalbox

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

Yes except with anorexia, medics are usually encouraging patients to eat. They want them to overcome their body dysmorphia of 'I am so fat' when in reality they are starving themselves to death.

Embarrassing Thank you for providing a better link - it is never great when posting links on the phone.

Maybe it was the Ashley X case that I was thinking of and all the coverage around it, but I was sure that a case had gone through the UK courts, I've tried to google but I can't find any reference.

I wouldn't want to draw too many similarities between the two situations, but the end result does seem to be the same - a young person who has had their development stopped or delayed. In the case of Ashley development was totally halted. Obviously in the treatment here there is the added level of disability and society's views on that, but there has been lots of papers and discussions for what is still seems to be a very small number of children. This seems to be in stark contrast to any research around treatments in gender clinics.

In case anyone is interested in the Ashley X situation here is some more information.

www.nytimes.com/2016/03/27/magazine/should-parents-of-severely-disabled-children-be-allowed-to-stop-their-growth.html

www.researchgate.net/publication/5403188_The_Ashley_treatment_A_step_too_far_or_not_far_enough

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.

How can any patient give informed consent to a medical procedure if they are not informed about potential harms resulting from that procedure?

Surely we don't actually know for certain that there will be harm as the studies haven't been done is a crucial reason to explain why 'Phoenix' could not make that decision !

Yes — when we have some of our regular visitors dropping in, who like to talk about the “lifesaving” effects of giving puberty blockers to “trans kids” so that they can surgery, I sometimes ask them if they are happy to apply the same logic to children who identify as non-binary and think they want “nullification”….

I never get an answer, presumably because the answer would be far too telling. Saying no reveals they don’t really think the treatment is harmless and reversible. Saying yes is clearly sinister and bonkers but it reveals a bit too much about the idea of using them for “trans kids” too.

Should 11 year olds be allowed to choose to take blockers because they think they will want to have nullification surgery later on…? It’s a good question. Would like to see the Maughams of the world answer that one.

HAs there ever been a medical ethics submission for this stuff?

I've never seen anything.

HAs there ever been a medical ethics submission for this stuff?

My impression is that the purpose of this paper is to be cited in that kind of documentation. They aren’t actually doing it yet but want to lay the groundwork by creating lots of “research” that can be used to position this as legitimate and ethical medical treatment.

Yet there's never been a Cochrane Review because the existing "evidence" is so flimsy it's basically creative writing.