XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Medical Ethics and Transsexuality

HALE, C. JACOB U.S.A.
E-mail: ZeroboyJH@aol.com

In this paper I will argue that there is no set of standards similar either in kind or in degree to those set forth in the Harry Benjamin International Gender Dysphoria Association’s Standards of Care that any other class of patients must meet to receive medical services. I will draw on ethical standards generally accepted within medical ethics in the contemporary United States to argue that the SOC’s eligibility requirements, as well as some other aspects of the SOC, are not ethically justified. Contemporary medical ethics can be seen as, primarily, a balancing act, in which considerations of the moral importance of respecting patient autonomy are weighed against considerations of the moral importance of avoiding doing harm to patients. A common principle used in medical ethics to balance considerations of autonomy with those of avoidance of harm is this: the greater the risk of doing harm, the more weight to be given to harm avoidance over autonomy. In order for the kind of restrictions imposed by HBIGDA’s SOC to be morally justified, consistently with the "greater risk" principle, then, the following claim must be justified: the risks of hormones and operations used by transsexuals are greater both in degree and in kind than the risks undertaken by any other class of patients that seek elective medical interventions. This claim, I will argue, is not justified, so the autonomy principle must ethically override the "do no harm" principle with regard to the hormonal and surgical interventions sought by transsexuals. I will examine the ways in which the SOC compromise patient autonomy. In no way will this paper be anti-medicine or anti-therapy. I will argue that the SOC’s diminishment of patient autonomy has negative consequences, specific to the forms it takes, not only for transsexuals but also for care providers. For example, the SOC puts mental health professionals in a position of dual agency, since they are required to serve as "gatekeepers" and to provide therapy to their clients. This role as dual agents impairs mental health professionals’ legitimate ethical and professional interest in providing therapeutic care, as well as making it more difficult for transsexuals to receive such care during a transitional period, which is often especially stressful. I will conclude by offering suggestions about the ways in which informed consent procedures can be used to protect the legitimate ethical and legal concerns of physicians and their transsexual patients alike.