Safeguard or Constraint? An ethical analysis of the Criteria for the Treatment of Gender Diverse Minors

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This is one of two research projects studying the ethical aspects of medical treatment for gender diverse young people. The University of Manchester is the home institution for this project. To view the Melbourne-based partner project, click here.

The clinical management of gender-diverse children and adolescents is highly contentious, high on the policy and political agenda and subject to an increasing legal, clinical, ethical social and cultural debate.

Due to the controversial nature of the gender-affirming treatment, particularly for minors, gender-diverse young people wishing to access hormone treatment must meet a number of eligibility criteria: for example, they must present a marked incongruence between experienced gender and sex characteristics, a long-lasting and intense pattern of gender incongruence or dysphoria; any physical or mental health concern must be reasonably well controlled; they must engage socially, attend regular medical appointments.

Adolescents who do not meet these eligibility criteria might not be considered suitable candidates for medical treatment. In Australia, overall the criteria are less prescriptive and more open than in the UK, especially in relation to hormones for puberty suppression.

This difference between the UK and Australia is a key to this project, as it will provide a diversity of lived experiences and make it possible to provide a nuanced normative analysis of the current routes to access to gender-affirming care and how they are experienced by patients.

This project will investigate the impact of these access criteria on young people. The PhD candidate will interview young adults who accessed or sought access to gender services when they were under 18. The purpose of these interviews will be to elicit their lived experiences and their reflections on those experiences some years later.

This data will enable us to explore whether the way eligibility criteria are framed and understood may cause unhelpful psychological pressure and may lead young people to try to conform to what they think is expected, rather than expressing their genuine feelings about their identity, and discussing with clinicians their true wishes around medical treatment.

This will be the first project of empirical bioethics to examine the ethics of current eligibility criteria for gender-affirming treatment based on the patients’ lived experiences. The information collected will be used to formulate an ethical use of eligibility criteria to access gender-affirming care.

This research fills up a gap in the literature: no study has yet examined the ethical issues around the implications of eligibility criteria for access to treatment. By using the methods of empirical bioethics, this project will give voice to the experiences of those stakeholders who are most directly touched by current clinical access criteria.

This research is vital for both patients and service providers. Patients should not be burdened with numerous barriers to accessing care, as this is potentially harmful and inequitable. At the same time, service providers must ensure that potentially vulnerable minors are provided with safe, high-quality services and not given medical interventions which are not in their interests long-term.

This research will help to navigate this potential tension and examine ethical ways to interpret and understand eligibility criteria, in a way that facilitates the genuine expression of need without causing undue pressure for young people.

Project goals

The specific objectives of this project are:

  1. To identify the ethically relevant aspects of current eligibility criteria for access to gender services for young people under 18;
  2. To explore the experience of young people in accessing gender services;
  3. To critically analyse the implications of their experience, based on key ethical considerations identified in objective 1; and
  4. To use this analysis to formulate an ethically justifiable approach to use of eligibility criteria for access to gender services by under 18s.

Supervision team

The University of Manchester: Professor Simona Giordano

The University of Melbourne: Professor Lynn Gillam

*Click on the researcher's name above to learn more about their publication and grant successes.

Who we are looking for

We are seeking a PhD candidate with the following skills:

  • Demonstrated experience in the field of paediatrics/nursing practice.
  • Demonstrated experience in empirical bioethics.
  • Demonstrated ability to work independently and as part of a team.
  • Demonstrated time and project management skills.
  • Demonstrated ability to write research reports or other publications to a publishable standard (even if not published to date).
  • Excellent written and oral communication skills.
  • Demonstrated organisational skills, time management and ability to work to priorities.
  • Demonstrated problem-solving abilities.

Further details

The PhD candidate will benefit from the combined expertise of the project supervisors, and the embedding into two research environments.

This PhD project will be based at the University of Manchester with a minimum 12-month stay at the University of Melbourne.

The candidate will be enrolled in the PhD program at the School of Social Sciences at the University of Manchester and in the PhD program of the Department of Paediatrics at the University of Melbourne.

Professor Simona Giordano and Professor Lynn Gillam are world-leading bioethicists and will ensure that the candidate will produce high-quality research that will lead to publications in the best peer-reviewed international journals. The Centre for Social Ethics and Policy was founded in 1987 and is the oldest Centre of its kind in the UK. Since the 1980s CSEP has run innovative postgraduate programs in healthcare ethics and law which are consistently rated second in the world (after Georgetown University Law Centre, USA). The Children’s Bioethics Centre, a collaborative endeavour of the University of Melbourne and the Royal Children’s Hospital, is one of three pre-eminent centres for paediatric bioethics in the world.

The PIs and co-supervisors on this project are committed to equality, diversity and inclusion (EDI) priorities. At the very core of this project is respect for diversity in gender identity, and this respect is extended to all forms of diversity. People from diverse backgrounds are encouraged to apply; flexible work practices designed to integrate personal, family, cultural and religious aspects of your life into your academic work, are available.

To apply for this joint PhD opportunity, and to view the entry requirements, visit How to apply.

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