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This research project aims to:
- Identify the ethically relevant aspects of current eligibility criteria for access to gender services for young people under 18
- Explore the experience of young people in accessing gender services
- Critically analyse the implications of their experience, based on key ethical considerations identified in objective 1
- Use these analyses to formulate an ethically justifiable approach to use of eligibility criteria for access to gender services by under 18s.
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.
The graduate researcher on this project is: Meaghan Storey
First published on 29 March 2022.
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