To promote well-being
An item from the Journal of Medical Ethics:
In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous.
It’s interesting that a technical paper of this kind treats the term “non-binary” as transparent and “medical” – i.e. a straightforward descriptor useful to medical professionals and ethicists.
It later turns out that Phoenix is hypothetical, which reduced my tension a good deal. Having said that…
Phoenix, 18, was assigned female at birth but has identified as gender non-binary (not entirely/exclusively male or female) since age 5.
Wait. Children of 5 don’t know from “identifying as.” When I was 5 I identified as all kinds of people (and probably animals) I saw on tv. This is all adult ideology being insinuated onto children who don’t know wtf the growns are talking about.
Anyway Phoenix hated puberty, especially the start of breasts. I hated that too – I think it’s pretty ordinary and humdrum to hate it. It’s weird. Children of 14 or 12 don’t necessarily love weird things happening to their bodies. But anyway Phoenix hated it so puberty blockers, and then Phoenix wanted to stay on them forever.
Given Phoenix’s severe distress, Phoenix’s paediatrician agreed puberty blockers should be given, but informed Phoenix and their parents he was not prepared to prescribe long-term puberty suppression, as this is riskier than short-term suppression. The paediatrician stated that, when Phoenix turned 16 and had a better sense of their gender identity, they would meet to discuss whether Phoenix wished to discontinue the puberty blockers and (1) revert to their endogenous (female) sex hormones or (2) commence testosterone.
When Phoenix turned 16, they informed their paediatrician that they did not want option (1) or (2). Rather, Phoenix was confident they would identify as non-binary for the rest of their life and wanted to stay on puberty blockers ‘forever’ to ensure their body remained in a ‘genderless’ state. Reluctantly, the paediatrician agreed to extend Phoenix’s time on blockers for another 2 years.
People of 16 are confident about a lot of things that they change their minds about later. More urgently, puberty blockers don’t just make the non-binary person bulge-free in the body, they also block brain development. They make the non-binary person childish, immature, stuck at an early stage.
Phoenix’s doctor refers Phoenix to a psychologist, who confirms that Phoenix continues to have significant distress about their body, similar in degree to that experienced by binary trans patients that the psychologist has seen. Phoenix has regular counselling with the psychologist, who judges that Phoenix’s distress is significant and enduring, and is not a symptom of an underlying psychopathology. The psychologist also reports that she does not see any signs that indicate Phoenix has a fear of growing up.
Phoenix tells the psychologist that they highly value having a body that matches their gender identity. Alternative options, including low-dose testosterone, menstrual suppression and future ‘top’ surgery, are unacceptable to Phoenix because they do not believe these alternatives would accurately reflect their non-binary gender identity.
But what is a “gender identity”? It’s contested that such a thing even exists, that the words even name something real as opposed to a fantasy about the self akin to other fantasies about the self that don’t get adopted into the medical lexicon.
It’s just strange, the mix of formal academic language and assumptions about the reality of “gender identity” and “non-binary identity.” The University of Twitter Philosophy Department.
Is that psychologist blind? And stupid? The entire enterprise is to relieve Phoenix’s pathological distress about growing up.
So “binary trans patients” are now the gold standard for reality? Maybe I’m just a pig ignorant lay-person, but how can Phoenix’s “significant and enduring” distress not be a symptom of “an underlying psychopathology?” Never mind that the concept of “conversion therapy” has been turned on its head, such that talking someone like “phoenix” out of their distress and discomfort is considered abominably cruel, while putting them on a pathway of lifelong medicalization, and arrested development, is not.
Does Phoenix need to have their shadow sown back on? How’s their friend Tinkerbell handling all this?
This scenario starts with a lot of unethical medical decisions having already been made, like we’re already past a switch or two on a particularly bizarre iteration of the Trolley Problem.
No, it appears that the psychopathology is draped right over the top, holding sparklers and dancing the Can-can.
I remember when the goal of enlightened feminism was for women, and the society they lived in, to minimize the significance of their sex and emphasize instead the importance of their character.. Yes, you are a woman, but that says little to nothing about your interests, capacities, talents, and goals, which constitute who you are. To constantly worry about whether you are WOMAN ENOUGH in the way WOMEN SHOULD BE was unhealthy. That’s a restrictive box. Be yourself.
Yet here is Phoenix, barely able to function if they don’t get into the RIGHT BOX and look the RIGHT WAY and get the rest of the world’s approval and recognition that they’re doing it RIGHT so they can finally relax and maybe start to think about developing a personality. Assuming there’s any room left for one.
“Tell us 5 interesting things about yourself.”
“1.) I’m nonbinary 2.) I need to look nonbinary 3.) This is all I think about 4.) The distress is significant and enduring 5.) nonbinary means neither male nor female, but not in a intersex way, more like being neither describes my personality.”
But it’s shiny, new Brave and Stunning box that’s a recent invention of people who think sex isn’t real, or is a spectrum, or can switch from day to day, hour to hour. There aren’t a lot of guideposts for how one is supposed to look sexless, because, nobody is sexless. Unless one wishes to follow the examples of androgynaiety established by 80’s pop stars (but even they were playing with looks borrowed from the cultural norms [dare I say gender stereotypes] set for the opposite sex, not borrowed from completely sexless people. Then you’ll be looking for fashion tips and surgical ideas from robots and androids.)
I wonder if, in the case of the theoretical patient Phoenix, she could really be considered a legal adult at eighteen. Her brain has not been allowed to mature. She remains a child at eighteen.
What is the opposite of legal emancipation?
[…] a comment by Sastra on To promote […]
“This scenario starts with a lot of unethical medical decisions having already been made, like we’re already past a switch or two on a particularly bizarre iteration of the Trolley Problem.”
V good.
‘There aren’t a lot of guideposts for how one is supposed to look sexless, because, nobody is sexless.’
Weirdly, there are guideposts, and this is a huge part of the problem–fantasy characters, animated characters, Photoshopped images and special effects. These characters, and parasocial relationships with them, take up so much of their time and attention that they form a huge part of their (and, let’s be honest, all of our, to some extent) reality.
Yes, silly me, even though I referenced images of pop stars, I was thinking more of “real life” examples. Given the prevalence of anime/otherkin avatars amongst TA twitter posters, I probably shouldn’t have bothered.
When I think of clothing appropriate for the sexless, I picture the stunning outfits worn during Chairman Mao’s Cultural Revolution.
Wait a minute. Phoenix’s doctor
You mean, he admitted that there was such a thing as ‘risk?’ Wasn’t he packed off to Siberia on the spot?