Abstract
An analysis of patient autonomy through the lens of the theology of vulnerability and the Trinitarian approach to holistic healthcare decisions.
Keywords: Autonomy, Vulnerability, Contemporary Bioethics, Human Dignity, imago Dei, Trinitarian Theology
Abstract
There is an urgent need for ethical, conceptual, and clinical clarity regarding the diagnosis and treatment of gender dysphoria and transgender identification. In this essay, I highlight ten critical concerns in this arena, namely, those involving: (1) conceptual parallels between sexual reassignment surgery and elective limb amputation; (2) the lack of long-term data that demonstrates reliable long-term relief from gender dysphoria in those undergoing hormonal or surgical treatment for gender dysphoria; (3) special problems with informed consent in the context of “gender affirming” treatments; (4) the importance of very high desistance rates of gender dysphoria and transgender identification, particularly in children, even without treatment; (5) the extensive differential diagnosis and the need for thorough and subtle assessments in the face of gender-related complaints; (6) a deep religiously based objection to transgender ideology involving the ordering of creation; (7) controversies concerning the existence of rapid-onset gender dysphoria; (8) the recent depathologizing of gender dysphoria; (9) the roles of genetics and environment in transgender identification and gender dysphoria; and (10) reflections on the role of psychotherapeutic treatment in patients with gender dysphoria and transgender identification.
Keywords: transgenderism, gender dysphoria, transsexualism, sexual reassignment surgery, gender affirming care
The term “value of life” can refer to life’s intrinsic dignity: something non-incremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life.