Abstract
Atypical gender identity organisation (AGIO) is a serious medical condition in which the phenotypical appearance is experienced as alien by the person affected. AGIO is source of great distress, and obtaining medical treatment is for many a life-or-death matter. Many of those who cannot receive treatment are at high risk of suicide. AGIO is not only a problem of personal health, but also a public problem, because sufferers are often exposed to discrimination, abuse and violence, and each act of discrimination, abuse and violence is a public issue. Thinking about AGIO represents a great challenge for us all. It involves rethinking about gender identity in a more comprehensive way, inclusive of phenomena that go beyond the classic gender divide ‘male–female’, and thinking of ways of ensuring all citizens, whatever their gender identity, a secure and peaceful place in society. I explain what AGIO is, how it manifests itself, and provide a brief history of AGIO. I offer an overview of risks and benefits of available treatments. I analyse the ethico-legal issues that surround AGIO. In particular, ethics of interfering with natural development, competence in minors, validity of informed consent, role of the family, moral and legal responsibility of professionals for omission of treatment and ageism. I conclude that medical treatment should be offered, even to minors just after the onset of puberty, if the child has a profound and persisting AGIO, if she/he is competent to make a judgement on the matter, and if treatment is likely to enhance his/her quality of life. Deferring treatment till adulthood is not a morally neutral option, and it is indeed unethical, if the child is likely to be harmed by pubertal development.
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Notes
- 1.
I owe this original classification to Bernard Reed.
- 2.
I am grateful to Professor Mike Besser for this specification.
- 3.
The precise development can be measured by assessing testicular and breast development and levels of sex hormones (Delemarre-van de Waal and Cohen-Kettenis, 2006).
- 4.
I owe this clarification to Terry Reed.
- 5.
Private communication.
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Acknowledgements
I wish to acknowledge Amel Alghrani, Bernard and Terry Reed and John Harris for their invaluable comments on this work. Moreover, thanks to Domenico Di Ceglie, Russell Viner, Caroline Brian and Polly Carmichael for engaging into debate with me. Special gratitude goes to Peggy T. Cohen-Kettenis, Waler Meyer, Petra De Sutter, Mike Besser, Norman Spack, Peter Lee and Peter Clayton for offering clarification on endocrinological matters
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Giordano, S. (2023). Ethics of Management of Gender Atypical Organisation in Children and Adolescents. In: Boylan, M. (eds) International Public Health Policy and Ethics. The International Library of Bioethics, vol 106. Springer, Cham. https://doi.org/10.1007/978-3-031-39973-2_16
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