Robles Monique
Children's Hospital Colorado, Colorado Springs, CO, USA.
Linacre Q. 2021 Aug;88(3):259-271. doi: 10.1177/0024363921989475. Epub 2021 Feb 17.
Since the establishment of the first transgender clinic in the United States in 2007, over sixty clinics associated with children's hospitals have opened across the nation and are seeing very young children and adolescents with a diagnosis of gender dysphoria (GD). Once known as gender identity disorder, GD has been redefined by the latest version of the , fifth edition (-5) not as a mental illness but as the distress experienced by individuals related to their biological sex. The widely accepted practice of gender-affirming therapy (GAT) to treat a vulnerable population despite the associated health risks, the lack of supportive scientific evidence for the pharmacological and surgical interventions, along with the unqualified claim that these interventions will decrease the rate of suicide in these individuals presents a significant bioethical dilemma. The growing trend of GD not only impacts the individuals diagnosed but also society, culture, and the integrity of the profession of medicine. This article utilizes the five-box method, an ethical decision-making framework, to address the implications of the proposed treatment. Once applied, it becomes clear that the hormonal and surgical approaches used are not scientifically or ethically justified. The patient's autonomy and preferences should be respected, yet constrained, if there exists a considerable risk to the well-being of the individual without proven benefits. The quality of life of those receiving this treatment has not been shown to be significantly improved long term, and the mental, physical, and spiritual health of individuals with GD is not thoroughly addressed in these clinics. The important social and contextual factors, on both microcosmic and macrocosmic scales, are minimized in favor of promoting an ideology. Ultimately, Catholic moral teaching reveals that this widely recommended treatment violates the body-soul union, disregards the principle of totality and integrity, and debases the dignity of humanity.
This article examines GAT, the paradigm used in treating individuals identifying as transgender, through the lens of an EDMF. Each stage of this widely proposed treatment - social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery - poses harms and risks that are not fully disclosed to minors and families, creating a bioethical dilemma. Dialogue utilizing science and reasoning must be encouraged to assist individuals who experience a gender identity that rejects their biological sex. This approach would also contribute to the well-being of society.
自2007年美国第一家跨性别诊所成立以来，全国已有60多家与儿童医院相关的诊所开业，接待患有性别焦虑症（GD）的非常年幼的儿童和青少年。GD曾被称为性别认同障碍，最新版《精神疾病诊断与统计手册》第五版（DSM-5）已将其重新定义，不再视为一种精神疾病，而是个体因其生理性别而经历的痛苦。尽管存在相关健康风险，但广泛接受的性别肯定疗法（GAT）用于治疗弱势群体，缺乏针对药物和手术干预的支持性科学证据，以及这些干预将降低这些个体自杀率的不合理说法，构成了一个重大的生物伦理困境。GD的增长趋势不仅影响被诊断的个体，还影响社会、文化以及医学专业的完整性。本文运用五盒法这一伦理决策框架，来探讨所提议治疗的影响。一旦应用，就会清楚地发现所使用的激素和手术方法在科学或伦理上都没有依据。如果对个体的福祉存在相当大的风险且没有已证实的益处，患者的自主权和偏好应得到尊重，但也要受到限制。接受这种治疗的人的生活质量长期来看并未显示出有显著改善，并且这些诊所并未全面解决患有GD的个体的心理、身体和精神健康问题。在微观和宏观层面上，重要的社会和背景因素都被最小化，以利于推广一种意识形态。最终，天主教道德教义表明，这种广泛推荐的治疗违反了身体与灵魂的统一，无视整体和完整性原则，并贬低了人类的尊严。
本文通过伦理决策模型框架审视了用于治疗跨性别者的性别肯定疗法（GAT）。这种广泛提议的治疗方法——社会肯定、青春期阻断、给予跨性别激素以及性别重置手术——的每个阶段都带来了危害和风险，但并未向未成年人及其家庭充分披露，从而造成了生物伦理困境。必须鼓励利用科学和推理进行对话，以帮助那些经历与自己生理性别不符的性别认同的个体。这种方法也将有助于社会的福祉。
