Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
J Med Ethics. 2020 Nov;46(11):743-752. doi: 10.1136/medethics-2019-106012. Epub 2020 Jul 24.
In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient's request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual's context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.
在本文中，我们分析了一个非二元性别成年人 Phoenix 的新案例，他们请求持续进行青春期抑制（OPS）以永久性地防止第二性征的发育，以此来肯定他们的性别认同。我们认为：（1）OPS 的目的与促进健康的医学的适当目标一致，因此原则上可以向非二元性别成年人提供；（2）还有基于公平的额外理由向非二元性别成年人群体提供 OPS；（3）促进非二元性别成年人个人的 OPS 请求在伦理上的可辩护性，还取决于其他相关考虑因素，包括对该特定患者的潜在益处与危害的平衡，以及患者的请求是否具有实质性的自主性。虽然我们采取的广义原则伦理方法可以用于分析除我们评估的案例之外的其他非二元性别成年人请求 OPS 的案例，但我们强调，结果必然取决于个人的背景和价值观。然而，这种 OPS 的临床提供最好是在有长期随访和结果公开出版的适当设计的研究中进行。
