Beattie Cameron
Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
J Med Ethics. 2022 Jan;48(1):71-76. doi: 10.1136/medethics-2020-107055. Epub 2021 Feb 16.
Gender dysphoria (GD) is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it 'highly unlikely' that under-13s, and 'doubtful' that 14-15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to cross-sex hormone therapy and the 'life-changing consequences' of puberty blockers. In this article, I offer two concurrent arguments to dispute their reasoning. First, I argue that minors can be competent to consent to puberty blockers for GD, because the decision to undergo puberty blocker therapy is no more complex or far-reaching than other medical decisions that we accept a child should be able to make. Second, I argue that-irrespective of competence-such legal restriction for all children fundamentally contradicts the central ethical tenet of child healthcare: best interests. For these two reasons, the high court should not restrict access to puberty blockers for competent GD children.
性别焦虑症（GD）是指个体所表达的性别与被指定的性别之间存在临床上显著的不一致，且在儿童中的患病率正在迅速上升。英国高等法院最近对塔维斯托克一家以青少年为重点的性别认同诊所的服务提供情况进行了司法审查。高等法院判定，13岁以下的儿童“极不可能”有能力同意接受针对性别焦虑症的青春期阻滞剂治疗，而对于14至15岁的儿童，其“是否有能力同意”也“存疑”。他们的推理依据是，关于疗效的证据有限、发展为接受跨性别激素治疗的可能性以及青春期阻滞剂的“改变人生的后果”。在本文中，我提出两个并行的论点来反驳他们的推理。首先，我认为未成年人有能力同意接受针对性别焦虑症的青春期阻滞剂治疗，因为接受青春期阻滞剂治疗的决定并不比我们认为孩子应该能够做出的其他医疗决定更复杂或影响更深远。其次，我认为，无论能力如何，对所有儿童实施这样的法律限制从根本上违背了儿童医疗保健的核心伦理原则：最大利益原则。基于这两个原因，高等法院不应限制有能力的性别焦虑症儿童使用青春期阻滞剂。
