Pilgrim and Entwistle, 2020

The authors place the ethics of medical interventions on gender dysphoric adolescents in a broader context of debates over male and female personhood and the freedom to express views that others find personally challenging.

Pilgrim is a clinical psychology professor at the University of Southhampton. Entwistle is a clinical psychologist in private practice and formerly a clinician at the Gender Identity Development Service (GIDS) in the UK.

The authors raise concerns on health policy and clinical language that implies a person can change sex through medical intervention. Such statements may have begun as a well-intentioned attempt to ease suffering, but this language has now become embedded in health policy. When used in a clinical context — they give an example used at GIDS — it may provide the dysphoric child with an unrealistic impression of the ease and benefits of medical interventions.

Discussing puberty blockers, the authors point out that while a dysphoric child cannot legally consent, in practice, they participate in the choice of treatment, and this brings ethical challenges:

Asking a child or adolescent to make a decision on whether they wish to put at risk their fertility, their genital development, their capacity for full sexual function and their brain development, in a context of an expressed need to resolved their immediate distress is thus ethically problematic. This leap in faith could only be unambiguously ethical if medical transition ensured a life better than the status quo for the patient.