The Impossibility of Informed Consent for Transgender Interventions: The Risks

Apr 30, 2020 by

by Jane Robbins, Public Discourse:

Dr. Stephen Levine highlights biological, social, and psychological (mental health) risks in medically “transitioning.” Without explaining these risks and determining that the patient fully understands them, a medical practitioner has failed to obtain informed consent—if such consent is even possible. The second of two essays.

In yesterday’s essay, I explained the state of so-called “gender-affirming treatment” (GAT) and the rocky landscape of ethical considerations for GAT practitioners. In his two papers, “Informed Consent for Transgendered Patients” and “Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria,” Dr. Stephen Levine lays out the risks that patients should understand.

Levine describes three categories of risk that must be explained before administering GAT: biological, social, and psychological (mental health). Without explaining these risks and determining that the patient fully understands them, the practitioner has shown inadequate respect for patient autonomy and has violated the ethical obligation of avoiding harm.

Biological Risks

A significant problem with explaining physical risks of GAT is that many are as yet unknown. This, of course, calls into question the ethics of physicians who are willing to administer GAT without understanding long-term dangers. But much is known about real and potential consequences, and Levine lays out what every patient must be told.

Some of the risks can be easily explained but are highly unlikely to be processed by patients, especially children and adolescents. Two of these are loss of reproductive capacity (infertility/sterility) and impairment in physiological sexual capacity in the future. Young patients—especially those who are convinced they are living in the wrong body and need to transition immediately—simply cannot grasp the enormity of these losses. What twelve-year-old seriously understands the void that could come from childlessness, or the frustration of never being able to achieve intimacy with a loving partner? Levine thus points out that even discussing these consequences will probably not achieve real understanding, and therefore interferes with informed consent.

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