Controversies surrounding puberty suppression in adolescents with gender identity disorder: moving forward the ethical debate and creating an international guideline
Projectomschrijving
Genderdysforie gaat over gevoelens van ongemak over, en zelfs afkeer van het eigen biologische geslacht.
In Nederland is het voor volwassenen mogelijk om het geslacht aan te passen. Bij jonge kinderen vinden geen medische ingrepen plaats omdat genderdysfore gevoelens meestal verdwijnen voor de puberteit begint. Wanneer de genderdysforie blijft bestaan, kan de puberteit worden onderdrukt, zodat secundaire geslachtskenmerken (zoals borsten, baardgroei), waar deze jongeren afkeer van hebben, zich niet (verder) ontwikkelen. Deze aanpak is controversieel en in sommige landen is men terughoudend.
In dit project worden behandelaars uit meerdere landen (voor- en tegenstanders van puberteitsonderdrukking), patiënten en ouders geïnterviewd om te achterhalen welke argumenten gebruikt worden om de behandeling te steunen of juist af te wijzen. Zo wordt bijgedragen aan het debat en wordt een richtlijn gemaakt hoe op een ethisch juiste manier te beslissen om puberteitsonderdrukking wel of niet aan te bieden.
Meer informatie
- Zie ook Mediator Special Ethiek (nov 2017): Omgaan met genderdysforie
- Lees ook: Als hij een zij is (Universiteit Leiden, 16 sep 2019)
- Lees meer over het onderwerp Gender
Producten
Link: http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2014.RE.19.SAT-0109
Auteur: Vrouenraets LJJJ. Fredriks AM. Hannema SE. Cohen-Kettenis PT. De Vries MC.
Magazine: Journal of Adolescent Health
Verslagen
Eindverslag
Samenvatting van de aanvraag
Gender identity disorder (GID) is a rare condition in which individuals experience their gender identity (the psychological experience of oneself as male or female) as being incongruent with their phenotype (their body’s external sex characteristics). A small number of the individuals with GID are children. Treatment for children is predominantly psychological. When GID persists during adolescence, the possibility of puberty suppression has generated a new but controversial dimension to clinical management. Puberty suppression is applied to relieve suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment. There is no worldwide consensus on the use of puberty suppression. In the Netherlands it is part of the treatment protocol. Elsewhere in Europe and in North America it is not standard of care due to various ethical concerns, including fear for harms of the treatment and doubts about children’s competence to make far-reaching decisions. Debate moves between extremes and discussions are emotion-laden. Proponents and opponents seem to have differing underlying ideas about an explanatory model for GID, the categorization of GID as a mental illness or as a social construct, child welfare, and the role of medicine, often without openly stating them. It is an essential task of ethics to elucidate these underlying considerations, in order to move forward the debate. In this project, an empirical ethical approach will be followed to evaluate the contexts of GID treatment disagreements and the underlying considerations of key players in the field. The project includes: (1) A literature study on ethical and epistemological issues concerning treatment of gender dysphoric youth. We will describe existing knowledge and theories on the etiology of GID and the concepts of ‘gender’, ‘child competence’ and ‘best interests’. (2) A qualitative study (semi-structured interviews and focus group) to identify considerations of key-informants (children with GID, parents, pediatric endocrinologists, psychiatrists, and ethicists) about the etiology of GID, and the concepts ‘gender’, ‘child competence’ and ‘best interests’. (3) Comparison of the interview-data with existing ethical and philosophical theories about gender, best interests and competence. For this purpose ‘reflective equilibrium’ (RE) will be used, an established method in empirical ethics. The outcome of the RE process will provide us with moral insights for a sound ethical practice concerning suppression of puberty in GID. (4) A guideline and implementation phase. Our aim is to develop an internationally supported guideline on ethical conditions for starting puberty suppression in GID. This guideline will include a tool to implement structural moral deliberation to discern ethical issues in day-to-day treatment decisions concerning children with GID.