Denying kids treatment could be a form of child abuse

Parents should not be able to stop gender-dysphoric children from accessing puberty-blockers, a bioethicist argues in the latest issue of the American Journal of Bioethics. Furthermore, contends Maura Priest, of Arizona State University, government schools should publicise the case for initiating transitions from one gender to another. In a target article followed by comments from other bioethicists, she argues that:

… the law should clearly state that transgender youth (after having met appropriate diagnostic criteria) have a legal right to PBT [puberty-blocking treatment] regardless of parental approval. In addition to these legal parameters, the state should play a role in publicizing information about gender dysphoria and treatment via public schools, government-sponsored websites, and public service announcements. 

Basically Priest argues that the harms of withholding puberty-blockers are too great to justify parental interference. Gender-dysphoric children who are not supported by their parents could commit suicide, suffer stigma and discrimination, become homeless, self-medicate in a dangerous way, and so on. Denying them treatment is a form of child abuse which requires state intervention, she implies. 

Just as it is the state’s duty to step in when naturalist parents are refusing insulin to their diabetic son or antibiotics to their daughter sick with meningitis, so is it the state’s duty to step in when the parents of gender-dysphoric children are avoiding medically recommended treatment. 

Transgender science is a controversial area and establishing watertight proof of these harms is difficult. But Priest says that the need for PBT is “based on the best available science and expert professional consensus”.

While most of the commentary by other scholars endorsed her argument, there was some disagreement. Three scholars from the University of Melbourne are broadly sympathetic, but point out that the physical harms of PBT are hardly negligible. They include reduction in bone density, with risk of fractures; loss of fertility; fewer option for future genital surgery if the children persist; and conflict with parents.

And three American writers (Michael Laidlaw, Michelle Cretella, Kevin Donovan) argue that “watchful waiting with support for gender-dysphoric children and adolescents up to the age of 16 years is the current standard of care worldwide, not gender affirmative therapy”.

Children and adolescents have neither the cognitive nor the emotional maturity to comprehend the consequences of receiving a treatment for which the end result is sterility and organs devoid of sexual pleasure function. To argue that all children who are self-declared as transgendered will be harmed psychologically and physically without puberty blocking treatments is false; the greatest number will be seen to not require this at all.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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