Trans Lives in a Globalizing World by J. Michael Ryan

Author:J. Michael Ryan [Ryan, J. Michael]
Language: eng
Format: epub
ISBN: 9780367193348
Barnesnoble:
Publisher: Taylor & Francis
Published: 2020-10-01T00:00:00+00:00

Medical Norms Influencing Gender-affirming Surgeries

Generally, four basic medical ethical principles as defined by Beauchamp and Childress apply to the responsible conduct of medical care (Beauchamp and Childress 2001): autonomy (having the right to control one’s body), beneficence (acting in the best interest of the person seeking care), non-maleficence (doing no harm) and justice (responsible allocation regarding scarce resources). The practical implications of responsible conduct of care are operationalized in guidelines and standards of care. These documents are a synthesis of scientific evidence regarding effectiveness and safety of treatments, as well as expert opinions and clinical experience. Generally adopted by professional societies, guidelines and standards of care are consensus-based practical norms detailing which surgical treatments should be provided and under which conditions.

Gender-affirming surgeries encompass a wide variety of medical specialties, including urology, gynecology, (plastic) surgery and ENT-surgery. Non-surgical professional societies have published professional guidelines to assist clinicians in providing gender-affirming care. For example, the American Psychological Association has published guidelines for affirmative psychological practice (American Psychological Association 2015) and the Endocrine Society has published a (fully updated) guideline on puberty suppression in trans minors and sex-hormone treatment for individuals of 16 years and older (Hembree et al. 2017). Additionally, in some countries local guidelines have been established, e.g., Germany (Nieder and Strauss 2015), New Zealand (Oliphant et al. 2018) and the Netherlands (Alliance Transgender Care 2017). Yet, no such documents have been published by surgical specialties, although some position papers on optimal technical approach and organization of care are available (Colebunders, De Cuypere, and Monstrey 2015; Ettner, Monstrey, and Coleman 2016). Nonetheless, the legal status of these guidelines and training programs remain uncertain and the (non-surgical) guidelines are mostly developed by professional societies in the United States and are thus, for the most part, legally unbinding outside of that country. Another shortcoming of the existing guidelines is the relatively small body of evidence on the effectiveness of interventions in various geographical contexts and populations (Deutsch, Radix, and Reisner 2016); while the scientific evidence for the effectiveness of the most prevalent surgical procedures such as mastectomy and vaginoplasty on psychosocial outcomes is converging, little evidence is available for other surgical procedures, smaller populations (e.g., genderqueer individuals), and those from non-Western societies.

Furthermore, not only do medical norms and professional guidelines serve as the primary source of how treatment facilities are designed, but they serve also as a determining factor of who receives which surgical treatment and under which condition. Additionally, medical norms and professional guidelines serve as a means of training professionals novel to the field and policy makers and health insurance representatives are strongly influenced by the medical standards and biomedical evidence when deciding which surgical treatments are being reimbursed. Thus, understanding the ways in which cultural norms and policy guidelines interact with clinical guidelines and available care is critical.

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