Ethical and evidential challenges in adolescent puberty blockade: why informed consent alone is not enough

In this viewpoint, I examine evidential and ethical issues regarding the use of puberty blockers for adolescent gender dysphoria, and analyse whether informed consent is functionally equipped to provide a legal and ethical justification for their use under conditions of clinical uncertainty. My normative analysis uses Beauchamp and Childress' framework of respect for autonomy, beneficence, non maleficence and justice to examine the informed consent model in light of current evidence regarding benefits, risks, capacity and voluntariness. I identify five interacting factors that arguably undermine valid consent: diagnostic uncertainty and limited differential diagnosis; very low certainty evidence of benefit; uncertainty regarding potentially serious or irreversible harms; developmental limitations in decision making capacity; and compromised voluntariness due to social and emotional pressures. I argue that, taken together, these factors require an unusually strong conception of autonomy to over-ride beneficence and non maleficence in paediatric care. While informed consent remains necessary, I suggest that it is insufficient as the primary ethical or legal justification for adolescent puberty blocker treatment and that additional safeguards and justifications are required.