Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Arch Sex Behav. 2024 May;53(5):1941-1956. doi: 10.1007/s10508-024-02850-4. Epub 2024 Apr 2.
In this essay, we consider the clinical and ethical implications of puberty blockers for pediatric gender dysphoria through the lens of "the child's right to an open future," which refers to rights that children do not have the capacity to exercise as minors, but that must be protected, so they can exercise them in the future as autonomous adults. We contrast the open future principle with the beliefs underpinning the gender affirming care model and discuss implications for consent. We evaluate claims that puberty blockers are reversible, discuss the scientific uncertainty about long-term benefits and harms, summarize international developments, and examine how suicide has been used to frame puberty suppression as a medically necessary, lifesaving treatment. In discussing these issues, we include relevant empirical evidence and raise questions for clinicians and researchers. We conclude that treatment pathways that delay decisions about medical transition until the child has had the chance to grow and mature into an autonomous adulthood would be most consistent with the open future principle.
在这篇文章中，我们通过“儿童享有开放未来的权利”这一视角来探讨青春期阻滞剂在儿科性别焦虑症中的临床和伦理意义。该权利是指儿童作为未成年人没有能力行使的权利，但必须加以保护，以便他们将来作为自主的成年人行使这些权利。我们将开放未来原则与性别认同关怀模式的信仰进行对比，并讨论对同意权的影响。我们评估了关于青春期阻滞剂可逆性的说法，讨论了长期益处和危害的科学不确定性，总结了国际发展情况，并研究了自杀如何被用来将青春期抑制作为一种必要的、拯救生命的治疗方法。在讨论这些问题时，我们纳入了相关的实证证据，并为临床医生和研究人员提出了一些问题。我们的结论是，最符合开放未来原则的治疗途径是将关于医学过渡的决策推迟到儿童有机会成长并成熟为自主的成年人之后。
