The peculiar case of the Standards of Care: Ethical ramifications of deviating from informed consent in transgender-specific healthcare

The peculiar case of the Standards of Care: Ethical ramifications of deviating from informed consent in transgender-specific healthcare
Practices and concepts
Lipshie-Williams
Ethics, Medicine and Public Health, April – June 2020; 13
Summary
In this article, we discuss the alternate model of consent that has become dominant for the provision of transgender-specific health care within the United States, referred to here as the Standards of Care model. This model, which requires medical professionals to provide official opinions on a transgender patient’s readiness to accept and undergo care, stands in contrast to the majority model of medical consent in the US, namely individually provided informed consent. Here, we review the informed consent model, including the basic ethical components of this model and the essential elements of medical decision-making capacity. We then consider the Standards of Care model. We situate its origins in pathological understandings of gender variance and review the current requirements of the model. Consideration is given to logical inconsistencies within the current Standards of Care model, which holds that gender variance is non-pathological and affirming care is medically necessary, but that adult patients requesting such care require psychiatric diagnoses and are unable to consent to their own care. We then consider the bioethical meaning of the Standards of Care model, which others have proposed cedes some of the patient autonomy offered by informed consent for an inflated reliance on nonmaleficence. We align ourselves with this position. We continue this interpretation to suggest that the Standards of Care model ultimately fails to deliver this proffered nonmaleficence.

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