Simona Giordano

Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child’s quality of life and even save his or her life, then it is indeed unethical to defer treatment.

Gender Atypical Organisation in children and Adolescents: ethico-legal issues and a proposal for new guidelines

I was sitting beneath my mother’s piano, and her music was falling around me like cataracts, enclosing me as in a cave. The round stumpy legs of the piano were like three black stalactites, and the sound-box was a high dark vault above my head [. . .] On the fact of things it was pure nonsense. I seemed to most people a very straightforward child, enjoying a happy childhood. I was loved and I was loving, brought up kindly and sensibly, spoiled to a comfortable degree [. . .] by every standard of logic I was patently a boy. I was named James Humphry Morris, male child. I had a boy’s body. I wore a boy’s clothes [. . .](Morris, 1974, pp. 1–2)

The 2008 Declaration of Helsinki: some reflections

This paper reflects on some amendments to the Declaration of Helsinki in 2008. It focuses on former paragraphs 5 (now 6) and 19 (now 17). Paragraph 5 suggested that the wellbeing of research participants should take precedence over the interests of science and society. Paragraph 6 now proposes that it should take precedence over all other interests. Paragraph 19, and the new paragraph 17, suggest that research involving the members of a disadvantaged population is only justified if the clinical trial is likely to benefit them. In both cases, the recommendation is that the interests of the research subjects should prevail over the interests of third parties. This paper assesses the plausibility of these statements, and in order to do so, considers debates on the moral duty to participate in biomedical research. It is argued that, even if seen in the context of the Declaration as a whole, the statements contained in these paragraphs risk offering a misleading portrait of science and risk eroding some of the ethical principles that should form the basis of a satisfactory shared life, such as altruism and responsibility for our fellows.

Is the body a republic

The ethics of post-mortem organ retention and use is widely debated in bioethics and law. However, the fundamental ethical issues have often been inadequately treated. According to one argument, dead bodies are no longer “persons”. Given the great benefits dead bodies offer to human kind, they should be automatically treated as public property: when the person dies, the body becomes a public thing (a res publica, a republic). This paper articulates the ethical issues involved in organ and tissue retention and use, both in the case in which the deceased’s wishes are known and in the case in which the wishes are not known. It contends that a dead body is not a republic. The state should maximise availability of organs and tissues by inviting or requiring citizens to make an informed and responsible choice on the matter.

The Role of Mental Health Professionals in Gender Reassignment Surgeries: Unjust Discrimination or Responsible Care?

ObjectiveRecent literature has raised an important ethical concern relating to the way in which surgeons approach people with gender dysphoria (GD): it has been suggested that referring transsexual patients to mental assessment can constitute a form of unjust discrimination. The aim of this paper is to examine some of the ethical issues concerning the role of the mental health professional in gender reassignment surgeries (GRS).MethodThe role of the mental health professional in GRS is analyzed by presenting the Standards of Care by the World Professional Association of Transgender Health, and discussing the principles of autonomy and non-discrimination.ResultsPurposes of psychotherapy are exploring gender identity; addressing the negative impact of GD on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; promoting resilience; and assisting the surgeons with the preparation prior to the surgery and the patient’s follow-up. Offering or requesting psychological assistance is in no way a form of negative discrimination or an attack to the patient’s autonomy. Contrarily, it might improve transsexual patients’ care, and thus at the most may represent a form of positive discrimination. To treat people as equal does not mean that they should be treated in the same way, but with the same concern and respect, so that their unique needs and goals can be achieved.ConclusionsOffering or requesting psychological assistance to individuals with GD is a form of responsible care, and not unjust discrimination.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Anorexia and Refusal of Life-Saving Treatment: The Moral Place of Competence, Suffering, and the Family

Whether anorexics should be allowed to refuse life-saving treatment is an unresolved issue, which raises acrimonious disputes in ethics and law. I verify whether, and if so on what grounds, anorexics’ refusal of treatment should be respected. I use philosophical analytic methods of investigation, combined with discussion of clinical cases and public attitudes toward euthanasia. Whether or not anorexics should be allowed to die depends not primarily on their competence, as many claim, but on the extent of their suffering and on whether it can be alleviated. This implies that if the anorexic has reasonable chance of recovery, competent refusal of treatment can be overridden. The family should also be involved in end-of-life decisions. Although these conclusions represent a departure from accepted ethicolegal principles, a focus on tractability and on the family has ethical grounds and is in line with the feelings of many on end-of-life issues.

Risk and supervised exercise: the example of anorexia to illustrate a new ethical issue in the traditional debates of medical ethics

Sport and physical activity is an area that remains relatively unexplored by contemporary bioethics. It is, however, an area in which important ethical issues arise. This paper explores the case of the participation of people with anorexia nervosa in exercise. Exercise is one of the central features of anorexia. The presence of anorexics in exercise classes is becoming an increasingly sensitive issue for instructors and fitness professionals. The ethics of teaching exercise to anorexics has, however, seldom, if ever, been addressed. Codes of ethics and legislation do not offer guidelines pertinent to the case and it is left unclear whether anorexics should be allowed to participate in exercise classes. It is shown by this paper that there are strong ethical reasons to let anorexics participate in exercise classes. However, the paper also explains why, despite these apparently cogent ethical reasons, there is no moral obligation to allow a person with anorexia to take part in exercise/sports activities.

Ethics of Management of Gender Atypical Organisation in Children and Adolescents

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.

Eating disorders and the media.

Purpose of review In June 2015, the newspapers in England once again pointed at the media industry as responsible for the spread of eating disorders. Recent findings This article reviews this argument and previous research on the role of the media industry in the perpetration of images that may foster eating disorders. Summary It has been recently argued, coherently with previous research, that the media may be responsible for the spread of eating disorders. This article reviews this literature, and evaluates what the real role of the media in the spread of eating disorders is. The article argues that considering the portrait of thin models in the media industry as responsible for eating disorders is a misanalysis of the problem and evaluates some of the more profound reasons that may lead to the adoption of the disordered eating symptomatology.

Crimes and misdemeanours: the case of child abandonment

In 2002, a child was abandoned in a Burger King restaurant in Amsterdam by a Chinese woman, who hoped that the baby would be picked up by someone able to give the child a better life. She was convicted for child abandonment and imprisoned. Whereas some forms of child abandonment are criminalised, others are socially accepted and not even on the ethics agenda. This paper is an invitation to reflect on the inconsistency in the ways in which we prosecute, punish or try to correct some forms of child abandonment and yet make allowances for others.