Gender reassignment in children: ethical conflicts in surrogate decision making

Parents, as surrogate decision makers for their infants, are generally expected by health care providers to act in the child's "best interest." However, when the wishes of the parents are contrary to those of the medical profession, an ethical dilemma occurs. Whose decisions are best for the infant? Whose recommendations are in the child's best interest? This article explores an issue that may not involve a life and death decision, but one in which the parents clearly refuse expert medical recommendations for what the providers believe are in the best interest of the infant. Specifically, the case study explores the parents' refusal to proceed with gender reassignment to female for their genetic XY baby born with micropenis and nonpalpable testes. The issue calls into question the possible limits of surrogate decision making. The ethical principles of beneficence, respect for persons, nonmaleficence, and justice are addressed in relation to this particular case.