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How Should Clinicians Navigate Decision Making About Genital Reconstructive Surgeries Among Intersex and Transgender
Frances Grimstad1, Jessica Kremen2, Elizabeth R Boskey3
1Pediatric and adolescent gynecologist at Boston Children's Hospital in Massachusetts and an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.
AMA Journal of Ethics
|June 7, 2023
Summary
Genital reconstructive surgeries (GRS) offer options for transgender and gender diverse (TGD) individuals and those with intersex traits/differences in sex development (I/dsd). Ethical decision-making and informed consent for GRS must prioritize patient autonomy for equitable care.
Area of Science:
- Medical Ethics
- Surgical Innovation
- Gender-Affirming Care
Background:
- Genital reconstructive surgeries (GRS) serve diverse populations, including transgender and gender diverse (TGD) individuals and those with intersex traits/differences in sex development (I/dsd).
- While outcomes may be similar, decision-making processes for GRS vary significantly between TGD and I/dsd individuals and across different life stages.
Purpose of the Study:
- To analyze the ethical considerations in genital reconstructive surgeries (GRS) for transgender and gender diverse (TGD) and intersex/differences in sex development (I/dsd) populations.
- To advocate for reforms in clinical ethics to enhance patient autonomy in the informed consent process for GRS.
Main Methods:
- Review of ethical frameworks governing genital reconstructive surgeries.
- Analysis of decision-making processes in GRS for TGD and I/dsd individuals.
- Examination of sociocultural influences on GRS ethics.
Main Results:
- Current ethical approaches to GRS are heavily influenced by sociocultural views on gender and sexuality.
- Significant disparities exist in the informed consent process for GRS between TGD and I/dsd populations.
- Patient autonomy is not consistently centered in GRS decision-making.
Conclusions:
- Reforming clinical ethics is crucial to center the autonomy of TGD and I/dsd individuals in GRS informed consent.
- Ensuring justice in healthcare requires equitable GRS decision-making and consent processes for all sex and gender diverse individuals.
- Ethical guidelines for GRS must adapt to fully support the rights and choices of TGD and I/dsd individuals throughout their lives.
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