I’m planning to do a series of posts on sessions from the World Professional Association for Transgender Health—starting with this Saturday morning session on the subject of “the dignity of risk and the right to regret”—which is an enlightened way of saying “some patients are going to regret this but here’s why that’s no big deal!”
I try to talk to people about this and sometimes I feel its like I went back to the 1950s and I tell people, "You are not gong to BELIEVE what's going on at the Tuskegee Institute. They are taking black men with syphilis and instead of giving them penicillin, they are giving them placebos without telling them so they can study the effect syphilis has on the body!"
And people's reaction:
"Well, let's not be the one to judge..."
"How are we going to learn about syphilis if we don't study it.?"
"Let's not be judgemental" was an early step in the mass grooming of society to accept the mind virus. Judging right from wrong and having a conscience used to be part of early childhood training.
Yes, "judgemental" has only its negative connotation, despite judgement being the major part of using intelligence. It's like "discrimination", which is now mere hate crime. To be "discriminating" used to mean to be wise, have good taste or judgement. Apparently children aren't taught how to think nowadays, and haven't been for a long time, just which opinions to hold. Since we got a Labour Government in the UK, they've started sending police officers into schools to teach primary school kids about "hate crime". We're sliding towards socialist totalitarianism, or a far-right backlash.
This is a bizarre inversion of adolescent psychology. The strange paradox is that the speaker suggests that childhood itself is a social construct, but also that the magical thinking of childhood must be prolonged indefinitely.
Also apparently the developmental retardation of the adolescent body, sterilized, mutilated, poisoned & lifetime chemical dependence, no wonder young @ risk victims are dying.
Sadly, they are… most recently I'm thinking of Griffin Sivret (died recently after phalloplasty complications she couldn't get medical help for). I don't know how these doctors can live with themselves…
I am still hopeful that our society will become truly inclusive of all the ways we show up. Back in the 70s and 80s (as a GNC teenager) I thought we were almost there. No one really bothered about my male identity and name… I was allowed to find out for myself that I wasn't really a boy, and because no one told me I would kill myself, or that I could actually become a boy, I came to see that pretending to be a boy was a suit of armor against further sexual assault, and I grew out of it as I progressed through puberty.
I understand that 'growing out of it' is not the case for everybody, and am not trying to generalise my experience to all people (although using old statistics, it surely applies to many).
Here in Toronto we get a million people out for Pride🌈, street party that didn't used to exist, we've come a long way. Of course, several years ago BLM hijacked a million people & prevented our black chief of police from finishing his opening dedication ceremony, so we still have long way to go.
I'm sorry, but what the hell kind of twisted up, nonsensical excuse-making garbage is this??
Teens make bad decisions and take risks they regret all the time. Yeah. Of course. But we don't go out and buy them the alcohol for their underage drinking, have the government buy cars for them to drive too fast in, have doctors give them weed to try, have government campaigns encouraging them to get bad boyfriends, and start nonprofits to help them say stupid stuff they later regret.
Deciding to transition isn't a hot decision based on emotion and urgency? How can that not be when they tell these kids and their parents they'll commit suicide if they don't transition? It's got to be a cold decision made on rational adult thinking because it took time and planning? Well, so do mass shootings, terrorist attacks, money laundering, and joining a cult. The time they've "known" they were trans proves it's cold cognition? Flat earthers and Scientologists have spent years carefully studying and believing their material, so they must definitely be on the right track with their cold cognition.
And all this about all the different labels and gender identities and boxes and embodiment goals...just say it. It's cosmetics, not medical necessity.
It's so obvious they realize they've gone too far with all this and can't justify what they're doing or claiming anymore, not even close. This speaker sounds like exactly what she is: desperate and floundering and grasping at straws to come up with anything that can defend an obviously nonsensical, indefensible, and terrible idea. Defending this immediately makes you lose all credibility on this issue.
Side note: I always read Eliza's posts, but this morning I used the Substack AI reader and listened on my commute. I was so confused at first because it was so full of "rights?" and "likes" and sounded like a caricature of a teenage girl talking. I thought, "This doesn't sound like Eliza. Why is she writing like this? Is she trying to be snarky or sound like this on purpose to make a point?" Then I realized these were long quotes from the presentation that weren't clearly marked as quotes when the voice was reading it because the voice can't express the difference in formatting Eliza uses to separate out long quotes from her own writing. It's crazy that a "professional" sounded so immature, unprofessional, and silly that I thought it was Eliza writing mocking satire or being snarky at first
Glad I could provide a laugh in the middle of all this craziness! I was genuinely so confused and it took me longer than I'd like to admit to figure out what was going on
That speaker is making me so angry. She has *no idea* what it feels like to feel broken in your body. Literally broken, in a way that can't be reversed, that you have to live with until the day you die, and that you chose (and the doctors enabled).
"And so we want adolescents to take risks, appropriate risks that don't cause irreparable harm...".
- Transition regret IS irreparable harm FFS!
"We have all done things where we're like, oh, that was not great, right? But that's part of being a person and part of learning and growing."
- Unless that thing you regret is so irreparable, and the distress so intense, that it STOPS further growth.
I often wonder what medical ethicists are saying about this topic of pediatric transitioning. I want to ask “where are the medical ethicists?” as so many have asked “where are the feminists?” with regard to the sexism inherent in gender ideology. I know that feminists, in fact, have said and continue to say a lot about gender ideology, but they don’t get platformed in mainstream media, so it’s hard to blame people for thinking feminists have been silent. Are medical ethicists speaking out about “gender medicine,” particularly the pediatric variety? This area of medicine creates objective, iatrogenic impairments on otherwise healthy bodies, which begs for ethical inquiry. Why am I not seeing any of this inquiry in anything I read? Are the medical ethicists being silenced or de-platformed? Are they afraid to speak out for fear of losing their livelihoods or professional standing?
Hi Barb, I can address this. I belong to a listserv of about 1000 clinical ethics consultants and there are a few (very few) voices asking that exact question. But please remember who bioethicists are, apart from the Catholic or Orthodox Jewish variety who work within the moral framework of a religious tradition. Bioethicists are people who have graduate degrees from good universities, including medical, legal, philosophy and specialized bioethics degrees, who work in professional and academic settings with lots of other advanced-degree-holders. Which in turn means of course they're going to go along with the consensus of all decent people on these issues. I can tell you in another clinical ethics group I belong to there was regnant snark about the very idea of conscientious objection for healthcare workers when it comes to abortion or gender-affirming medicine. Do not expect bioethics to be your ally in bringing common sense to gender medicine, in the same way you would not expect the humanities faculty of any good college or university to be your ally.
Having said that, "dignity of risk" is an entirely valid concept in clinical ethics with lots of good articles supporting and explicating the idea. It's usually used when an adult with decision-making capacity wants to do something that the clinical team thinks is unsafe or stupid. A classic case would be a homeless person wanting to be discharged to the streets even though they'd be far "safer" in a nursing home. It's risky to have a condition that needs follow up care and live in an alley, but hospitals are not prisons, and we can't keep people against their will. "Dignity of risk" is NOT about situations where patients lack full decision-making capacity- like minors! - and by definition it can't be about a proposed treatment whose risks and benefits are unknown, because then you can't give full informed consent.
Yes, there's the double whammy: the intelligent and highly-educated are disproportionately susceptible to conformity, and also clever enough to rationalize that which strikes ordinary folks as bat-shit crazy. Philosophy, including ethics, is subjective at base, too, so it's able to take anything as its axioms. There are no correct answers to things like the trolley problem, and there's a strong argument that all reasons supervene on deeper personal emotions and drives. Ethics is good long grass in which to lose a medical scandal.
Well, there's an entire branch of philosophy called metaethics which addresses the question of moral realism- that is, can we call moral judgments facts, is it a real thing to say X is right or wrong? I would also push back on "there are no correct answers to things like the trolley problem." There may be more than one correct answer, and that answer should be subject to transparent, rational deliberation, but there are certainly wrong answers.
But it seems like the "dignity of risk" doesn't necessarily extend to actually getting the treatment rather than refusing it, no? If a patient says "I know this hasn't been ever proven to work but I still want this" - does it still fall under dignity of risk and are doctors ethically obligated to provide? (I am talking about adults now, not children).
see above, not sure why my comments are out of order. There's a podcast called Bioethics at the Margins which has a good episode on the concept of dignity of risk, which was actually something that came out of world of caring for the developmentally challenged. The idea was we can keep them safe at all times but what does it do to their dignity not to allow them to try things with uncertain outcomes?
@njoseph - thanks for this explanation. You confirmed one of my suspicions, viz. that medical ethicists are embedded in institutions of higher learning, which have been captured ideologically.
Many bioethicists (broader term generally used these days) are in academic institutions but part of my job is doing clinical ethics consultation in a teaching hospital (we have residents) that is not an academic medical center connected to a university. Lots of little community hospital systems have ethics consultants who deal with end of life issues, consent and capacity problems, conflicts over goals of care, stuff like that. The gender stuff is controversial but that's not the bread and butter of hospital work. Thanks again Eliza for a great article.
See the recent essay by Alex Byrne & Moti Gorin on this question of “where are the philosophers?” Gorin is a bioethicist who is writing on pediatric gender “medicine.” In fact, one of the biggest frauds, Jack Turban, emailed his department chair at his university to try to create trouble for Moti. Turban, ever the coward, didn’t even respond to Moti’s questions about a recent article of his, which Moti had emailed him. Turban just went straight to his boss to try to intimidate him.
I can't remember the exact incident, because it happens so often. But a trans identified boy won a girl's track meet in Massachusetts and his Dad was head of medical ethics at a Boston Hospital
“Soren” Stark Chessa, in southern Maine. His mother is a philosophy professor at Bates & his father a medical ethicist at Maine Medical center in Portland.
Gynecologists don't correct trans women so I wouldn't look to medical professionals for guidance, my parents were both killed by their doctors, another friend died recently unnecessarily being misdiagnosed, fatal human error.
Eliza, how I'd love to be able to subscribe to your wonderful Substack! I keep it on my radar, but currently it's out of my spare-cash bracket. Thinking about this, though, I realise I could link to your work in other places a lot more. I'll do that. Thank you for this decision to share this series freely, as well as all your other work.
Your analysis of these passages is on point. A few other bits that occurred to me follow. It's staggering to me that after all this shirking of responsibility and misrepresenting everything in the field, she manages to say: "You know, informed consent, you know, just making sure everyone knows the benefits, the risks, alternatives to whatever treatment options they may be seeking, that they're voluntarily able to choose what is best for them and that they truly understand, that they're able to demonstrate understanding of the risks and benefits of potential treatments or non-treatments."
Well, that would be great, wouldn't it, but since exploring "the benefits of [...] non-treatments" fully and honestly is essentially equivalent to what they call, "conversion therapy," and its risks are too often cited as potential suicide, that's where it's failing (not to mention the WPATH leaking that they know children can't really assess these, and most often parents can't either).
And then she has the gall to continue, "Truth-telling, I think is important for us as providers, really being honest about [...]"
I noticed all the, Right?s in there too, and the You knows tumbled out in that last part. You said, "My guess is that she’s suppressing the suspicion that her comparisons—broken hearts/stupid comments/regretted hormonal and surgical interventions—don’t stand up to scrutiny." Yes, but I also got a weird sense she might also be projecting self-forgiveness to her future self by establishing this putative "right to regret". This could be a little projection of her nightmare scenario when she wakes up from her delusion in the cult:
"It's the right to do something where later you're lying awake at night 10 years later going, oh, God, that was terrible. It's the right to say something and then later just feel like vomiting because you're so ashamed of your previous behavior, right? But without that right of being deeply ashamed in the future, you don't learn about how you feel about things."
- Don't blame me, I'm just figuring things out, and later might regret all of this and have some sleepless nights and feel queasy, but I'm human...
"And also recognizing that sometimes we bump up against the medical reality that we can't always achieve everybody's embodiment goals."
That's just f-ing mental. How can these people say these things and not realise medicine doesn't include providing people with whatever bodies they want?! Do they imagine people are disembodied spirits arriving on Earth, and once they're here we need to sculpt their bodies to whatever they fancy looking like? The sooner these people are banned from practising medicine, therapy, and maybe talking ;) , the better.
Interesting interpretation. To me it more reads as denial. A complete inability to acknowledge and reckon with what regret might really mean, because of what it implicates her in. She can’t face what she might have done to these young people and so she has to be flippant about it, to hand-wave it away, to convince you and herself that it’s not really that bad or different from anything else.
“to each according to their need,” OMG, she is actually quoting KARL MARX in an argument defending her decisions as a DOCTOR??!! She is not even hiding it! Wow.
Hi everyone thanks for good discussion on this topic. Let me clarify that to my knowledge, there are definitely situations where treatments are offered without full knowledge of their risks and benefits, but we don't, AFAIK, call that "dignity of risk" when discussing adults. (I've not heard the concept applied to children but I don't work in a hospital where that would come up.) The first situation is when someone has a life-threatening or fatal condition and doctors want to try a medical device or procedure even though that device or procedure isn't approved for that condition. That's called a humanitarian device exemption, and it's similar to what are called "right to try" laws or policies which allow very (very) sick people to try something that might be dangerous, because what's the harm if you're terminal anyway?
The second condition under which people get meds of uncertain benefits are in clinical trials. My understanding- and someone correct me if I'm wrong- is that puberty blockers and cross-sex hormones are FDA approved but not for gender dysphoria per se. Doctors are, in many cases, allowed to prescribe medicines "off label" if they think it will help, but the problem with gender medicine is that people don't really understand that they're getting off-label prescriptions. If, on the other hand, gender clinics prescribed say puberty blockers as part of a clinical trial, they'd have an informed consent package 20-30 pages long that's been lawyered to the last comma for liability reasons. I think parents would be much less likely to consent under those circumstances, but some would. The other reason all the gender clinics should be prescribing under clinical trial rules is that every IRB approved clinical trial has strict inclusion/exclusion criteria so the data stays clean.
Both humanitarian use and clinical trials are situations where people give informed consent without knowing the risks and benefits- because that's what we're trying to find out- but they are vastly different situations than "dignity of risk" as understood in the bioethics literature, again, AFAIK.
"So it's normal for adolescents to take risks, it's normal for humans to take risks. And one of those things we do is we talk about the risk-benefit analysis that can only be completed by the person who is making the decision. And the individual, when it comes to risky decisions, has a right to choose how much risk and what type of risk they find acceptable, regardless of their age. Necessarily, with some exceptions, right? Like we don't let two-year-olds drive cars."
Surely the way this applies to GAC would be something like handing a drunk teen the keys to a car and then claiming the risk-benefit analysis was entirely up to the teen? Depending on their age their capacity to consent is unclear, depending on their comorbidities their capacity to consent is unclear. Depending on the state of the evidence and the transparency by which the evidence is conveyed to them, their capacity to consent is unclear. They cannot weigh the risk and benefit if no one knows and no one is communicating the uncertainty to them clearly.
We cannot draw the obvious line of disallowing 2 year olds from driving cars without fairly acknowledging the way the current state of affairs would be fairly characterised using the driving analogy. We also don't allow teens to take their driving test when they've personally decided they're ready. We don't let anyone drive drunk regardless of age, and when they do, they're punished. If someone knew they were drunk and encouraged them to drive, that person would also very likely be culpable and would, hopefully, have some repercussion via the law.
Any talk about the "dignity of risk" is fatuous considering the impossibility that anyone today could give true informed consent to so-called gender affirming medical therapies. It should be "the credulousness of physician-assisted blind faith."
Just wow. The WPATH practitioners (how can we call them doctors?) have read and thoroughly digested George Orwell's Animal Farm, but in exactly the wrong way. I'm hoping a detransitioner with a YouTube channel will read a few of their sentences, then, in his or her own words, tell the horrors they went through, back and forth, perhaps with translations of Stalin scattered in. I honestly think these people should be named. It's as if they're saying about a different medical malpractice scandal, "But some pregnant women took thalidomide and nothing happened to the baby. They didn't have morning sickness." In my data on 64 trans widows' experiences, there are a couple of ex-husbands who completely detransitioned. So WPATH can add our suffering through abusive sexual demands, poverty after leaving and their community's defamation of us. Just incredible. I'm communicating with a teen boy who reached out to me to confirm his doubts about this cult and to gather advice about feelings that his face isn't growing into manly proportions yet. I'm not doing "conversion therapy" or even therapy, but the good folks over at YouTube immediately put the blue nanny box under "Paul is not Trans! The Wellness Checklist." If he tells me he's going to the gender clinic, despite adding some of my eating, sleeping and exercise suggestions, I'll gently tell him our letters have come to an end. But if he wants to know what the "experts" are saying, I'll send him these quotes.
I try to talk to people about this and sometimes I feel its like I went back to the 1950s and I tell people, "You are not gong to BELIEVE what's going on at the Tuskegee Institute. They are taking black men with syphilis and instead of giving them penicillin, they are giving them placebos without telling them so they can study the effect syphilis has on the body!"
And people's reaction:
"Well, let's not be the one to judge..."
"How are we going to learn about syphilis if we don't study it.?"
"Why do you care?"
"Its only 500 men"
"Let's not be judgemental" was an early step in the mass grooming of society to accept the mind virus. Judging right from wrong and having a conscience used to be part of early childhood training.
Yes, "judgemental" has only its negative connotation, despite judgement being the major part of using intelligence. It's like "discrimination", which is now mere hate crime. To be "discriminating" used to mean to be wise, have good taste or judgement. Apparently children aren't taught how to think nowadays, and haven't been for a long time, just which opinions to hold. Since we got a Labour Government in the UK, they've started sending police officers into schools to teach primary school kids about "hate crime". We're sliding towards socialist totalitarianism, or a far-right backlash.
Brilliant!
This is a bizarre inversion of adolescent psychology. The strange paradox is that the speaker suggests that childhood itself is a social construct, but also that the magical thinking of childhood must be prolonged indefinitely.
The innocent blood has the most power to please Moloch, see
That sounds batshit crazy, but less crazy than what is being quoted in the article.
Good point.
Also apparently the developmental retardation of the adolescent body, sterilized, mutilated, poisoned & lifetime chemical dependence, no wonder young @ risk victims are dying.
Sadly, they are… most recently I'm thinking of Griffin Sivret (died recently after phalloplasty complications she couldn't get medical help for). I don't know how these doctors can live with themselves…
Was bullied for being femme boy & friends died during AIDS era, but we weren't murdering children.
I am still hopeful that our society will become truly inclusive of all the ways we show up. Back in the 70s and 80s (as a GNC teenager) I thought we were almost there. No one really bothered about my male identity and name… I was allowed to find out for myself that I wasn't really a boy, and because no one told me I would kill myself, or that I could actually become a boy, I came to see that pretending to be a boy was a suit of armor against further sexual assault, and I grew out of it as I progressed through puberty.
I understand that 'growing out of it' is not the case for everybody, and am not trying to generalise my experience to all people (although using old statistics, it surely applies to many).
Here in Toronto we get a million people out for Pride🌈, street party that didn't used to exist, we've come a long way. Of course, several years ago BLM hijacked a million people & prevented our black chief of police from finishing his opening dedication ceremony, so we still have long way to go.
More than half a probably straight but calling themselves "queer" in some imagined sense
I'm sorry, but what the hell kind of twisted up, nonsensical excuse-making garbage is this??
Teens make bad decisions and take risks they regret all the time. Yeah. Of course. But we don't go out and buy them the alcohol for their underage drinking, have the government buy cars for them to drive too fast in, have doctors give them weed to try, have government campaigns encouraging them to get bad boyfriends, and start nonprofits to help them say stupid stuff they later regret.
Deciding to transition isn't a hot decision based on emotion and urgency? How can that not be when they tell these kids and their parents they'll commit suicide if they don't transition? It's got to be a cold decision made on rational adult thinking because it took time and planning? Well, so do mass shootings, terrorist attacks, money laundering, and joining a cult. The time they've "known" they were trans proves it's cold cognition? Flat earthers and Scientologists have spent years carefully studying and believing their material, so they must definitely be on the right track with their cold cognition.
And all this about all the different labels and gender identities and boxes and embodiment goals...just say it. It's cosmetics, not medical necessity.
It's so obvious they realize they've gone too far with all this and can't justify what they're doing or claiming anymore, not even close. This speaker sounds like exactly what she is: desperate and floundering and grasping at straws to come up with anything that can defend an obviously nonsensical, indefensible, and terrible idea. Defending this immediately makes you lose all credibility on this issue.
Side note: I always read Eliza's posts, but this morning I used the Substack AI reader and listened on my commute. I was so confused at first because it was so full of "rights?" and "likes" and sounded like a caricature of a teenage girl talking. I thought, "This doesn't sound like Eliza. Why is she writing like this? Is she trying to be snarky or sound like this on purpose to make a point?" Then I realized these were long quotes from the presentation that weren't clearly marked as quotes when the voice was reading it because the voice can't express the difference in formatting Eliza uses to separate out long quotes from her own writing. It's crazy that a "professional" sounded so immature, unprofessional, and silly that I thought it was Eliza writing mocking satire or being snarky at first
This made me laugh!
But it truly was very confusing. Punctuation matters.
Glad I could provide a laugh in the middle of all this craziness! I was genuinely so confused and it took me longer than I'd like to admit to figure out what was going on
Puberty is our natural transition when allowed.
That speaker is making me so angry. She has *no idea* what it feels like to feel broken in your body. Literally broken, in a way that can't be reversed, that you have to live with until the day you die, and that you chose (and the doctors enabled).
"And so we want adolescents to take risks, appropriate risks that don't cause irreparable harm...".
- Transition regret IS irreparable harm FFS!
"We have all done things where we're like, oh, that was not great, right? But that's part of being a person and part of learning and growing."
- Unless that thing you regret is so irreparable, and the distress so intense, that it STOPS further growth.
I'm afraid I wasn't able to carry on reading.
I often wonder what medical ethicists are saying about this topic of pediatric transitioning. I want to ask “where are the medical ethicists?” as so many have asked “where are the feminists?” with regard to the sexism inherent in gender ideology. I know that feminists, in fact, have said and continue to say a lot about gender ideology, but they don’t get platformed in mainstream media, so it’s hard to blame people for thinking feminists have been silent. Are medical ethicists speaking out about “gender medicine,” particularly the pediatric variety? This area of medicine creates objective, iatrogenic impairments on otherwise healthy bodies, which begs for ethical inquiry. Why am I not seeing any of this inquiry in anything I read? Are the medical ethicists being silenced or de-platformed? Are they afraid to speak out for fear of losing their livelihoods or professional standing?
Hi Barb, I can address this. I belong to a listserv of about 1000 clinical ethics consultants and there are a few (very few) voices asking that exact question. But please remember who bioethicists are, apart from the Catholic or Orthodox Jewish variety who work within the moral framework of a religious tradition. Bioethicists are people who have graduate degrees from good universities, including medical, legal, philosophy and specialized bioethics degrees, who work in professional and academic settings with lots of other advanced-degree-holders. Which in turn means of course they're going to go along with the consensus of all decent people on these issues. I can tell you in another clinical ethics group I belong to there was regnant snark about the very idea of conscientious objection for healthcare workers when it comes to abortion or gender-affirming medicine. Do not expect bioethics to be your ally in bringing common sense to gender medicine, in the same way you would not expect the humanities faculty of any good college or university to be your ally.
Having said that, "dignity of risk" is an entirely valid concept in clinical ethics with lots of good articles supporting and explicating the idea. It's usually used when an adult with decision-making capacity wants to do something that the clinical team thinks is unsafe or stupid. A classic case would be a homeless person wanting to be discharged to the streets even though they'd be far "safer" in a nursing home. It's risky to have a condition that needs follow up care and live in an alley, but hospitals are not prisons, and we can't keep people against their will. "Dignity of risk" is NOT about situations where patients lack full decision-making capacity- like minors! - and by definition it can't be about a proposed treatment whose risks and benefits are unknown, because then you can't give full informed consent.
Yes, there's the double whammy: the intelligent and highly-educated are disproportionately susceptible to conformity, and also clever enough to rationalize that which strikes ordinary folks as bat-shit crazy. Philosophy, including ethics, is subjective at base, too, so it's able to take anything as its axioms. There are no correct answers to things like the trolley problem, and there's a strong argument that all reasons supervene on deeper personal emotions and drives. Ethics is good long grass in which to lose a medical scandal.
Well, there's an entire branch of philosophy called metaethics which addresses the question of moral realism- that is, can we call moral judgments facts, is it a real thing to say X is right or wrong? I would also push back on "there are no correct answers to things like the trolley problem." There may be more than one correct answer, and that answer should be subject to transparent, rational deliberation, but there are certainly wrong answers.
But it seems like the "dignity of risk" doesn't necessarily extend to actually getting the treatment rather than refusing it, no? If a patient says "I know this hasn't been ever proven to work but I still want this" - does it still fall under dignity of risk and are doctors ethically obligated to provide? (I am talking about adults now, not children).
see above, not sure why my comments are out of order. There's a podcast called Bioethics at the Margins which has a good episode on the concept of dignity of risk, which was actually something that came out of world of caring for the developmentally challenged. The idea was we can keep them safe at all times but what does it do to their dignity not to allow them to try things with uncertain outcomes?
@njoseph - thanks for this explanation. You confirmed one of my suspicions, viz. that medical ethicists are embedded in institutions of higher learning, which have been captured ideologically.
Many bioethicists (broader term generally used these days) are in academic institutions but part of my job is doing clinical ethics consultation in a teaching hospital (we have residents) that is not an academic medical center connected to a university. Lots of little community hospital systems have ethics consultants who deal with end of life issues, consent and capacity problems, conflicts over goals of care, stuff like that. The gender stuff is controversial but that's not the bread and butter of hospital work. Thanks again Eliza for a great article.
See the recent essay by Alex Byrne & Moti Gorin on this question of “where are the philosophers?” Gorin is a bioethicist who is writing on pediatric gender “medicine.” In fact, one of the biggest frauds, Jack Turban, emailed his department chair at his university to try to create trouble for Moti. Turban, ever the coward, didn’t even respond to Moti’s questions about a recent article of his, which Moti had emailed him. Turban just went straight to his boss to try to intimidate him.
Love your name Mama Ain't Playin'
Turban single handedly is responsible for so much damage.
I can't remember the exact incident, because it happens so often. But a trans identified boy won a girl's track meet in Massachusetts and his Dad was head of medical ethics at a Boston Hospital
“Soren” Stark Chessa, in southern Maine. His mother is a philosophy professor at Bates & his father a medical ethicist at Maine Medical center in Portland.
Helen Joyce said "Often very clever people can deceive themselves in ways that would never occur to a not so clever person"
To use the technical ethics term: oy vey.
Gynecologists don't correct trans women so I wouldn't look to medical professionals for guidance, my parents were both killed by their doctors, another friend died recently unnecessarily being misdiagnosed, fatal human error.
Eliza, how I'd love to be able to subscribe to your wonderful Substack! I keep it on my radar, but currently it's out of my spare-cash bracket. Thinking about this, though, I realise I could link to your work in other places a lot more. I'll do that. Thank you for this decision to share this series freely, as well as all your other work.
Your analysis of these passages is on point. A few other bits that occurred to me follow. It's staggering to me that after all this shirking of responsibility and misrepresenting everything in the field, she manages to say: "You know, informed consent, you know, just making sure everyone knows the benefits, the risks, alternatives to whatever treatment options they may be seeking, that they're voluntarily able to choose what is best for them and that they truly understand, that they're able to demonstrate understanding of the risks and benefits of potential treatments or non-treatments."
Well, that would be great, wouldn't it, but since exploring "the benefits of [...] non-treatments" fully and honestly is essentially equivalent to what they call, "conversion therapy," and its risks are too often cited as potential suicide, that's where it's failing (not to mention the WPATH leaking that they know children can't really assess these, and most often parents can't either).
And then she has the gall to continue, "Truth-telling, I think is important for us as providers, really being honest about [...]"
I noticed all the, Right?s in there too, and the You knows tumbled out in that last part. You said, "My guess is that she’s suppressing the suspicion that her comparisons—broken hearts/stupid comments/regretted hormonal and surgical interventions—don’t stand up to scrutiny." Yes, but I also got a weird sense she might also be projecting self-forgiveness to her future self by establishing this putative "right to regret". This could be a little projection of her nightmare scenario when she wakes up from her delusion in the cult:
"It's the right to do something where later you're lying awake at night 10 years later going, oh, God, that was terrible. It's the right to say something and then later just feel like vomiting because you're so ashamed of your previous behavior, right? But without that right of being deeply ashamed in the future, you don't learn about how you feel about things."
- Don't blame me, I'm just figuring things out, and later might regret all of this and have some sleepless nights and feel queasy, but I'm human...
"And also recognizing that sometimes we bump up against the medical reality that we can't always achieve everybody's embodiment goals."
That's just f-ing mental. How can these people say these things and not realise medicine doesn't include providing people with whatever bodies they want?! Do they imagine people are disembodied spirits arriving on Earth, and once they're here we need to sculpt their bodies to whatever they fancy looking like? The sooner these people are banned from practising medicine, therapy, and maybe talking ;) , the better.
Her flippancy about regret is verging on the sociopathic imo.
Interesting interpretation. To me it more reads as denial. A complete inability to acknowledge and reckon with what regret might really mean, because of what it implicates her in. She can’t face what she might have done to these young people and so she has to be flippant about it, to hand-wave it away, to convince you and herself that it’s not really that bad or different from anything else.
This is how it seems to me, too: trying to "convince you and herself that it’s not really that bad or different from anything else."
Puberty is a Human Right.
“to each according to their need,” OMG, she is actually quoting KARL MARX in an argument defending her decisions as a DOCTOR??!! She is not even hiding it! Wow.
Excellent analysis. Thank you for keeping us updated on this new way of abdicating responsibility on the part of clinicians.
It’s just shocking, that’s literally all I can say right now… just horrifyingly shocking.
There is zero sunlight between this doctor's reasoning and the reasoning of the pedophile lobby. At this point it's impossible not to notice.
Hi everyone thanks for good discussion on this topic. Let me clarify that to my knowledge, there are definitely situations where treatments are offered without full knowledge of their risks and benefits, but we don't, AFAIK, call that "dignity of risk" when discussing adults. (I've not heard the concept applied to children but I don't work in a hospital where that would come up.) The first situation is when someone has a life-threatening or fatal condition and doctors want to try a medical device or procedure even though that device or procedure isn't approved for that condition. That's called a humanitarian device exemption, and it's similar to what are called "right to try" laws or policies which allow very (very) sick people to try something that might be dangerous, because what's the harm if you're terminal anyway?
The second condition under which people get meds of uncertain benefits are in clinical trials. My understanding- and someone correct me if I'm wrong- is that puberty blockers and cross-sex hormones are FDA approved but not for gender dysphoria per se. Doctors are, in many cases, allowed to prescribe medicines "off label" if they think it will help, but the problem with gender medicine is that people don't really understand that they're getting off-label prescriptions. If, on the other hand, gender clinics prescribed say puberty blockers as part of a clinical trial, they'd have an informed consent package 20-30 pages long that's been lawyered to the last comma for liability reasons. I think parents would be much less likely to consent under those circumstances, but some would. The other reason all the gender clinics should be prescribing under clinical trial rules is that every IRB approved clinical trial has strict inclusion/exclusion criteria so the data stays clean.
Both humanitarian use and clinical trials are situations where people give informed consent without knowing the risks and benefits- because that's what we're trying to find out- but they are vastly different situations than "dignity of risk" as understood in the bioethics literature, again, AFAIK.
"So it's normal for adolescents to take risks, it's normal for humans to take risks. And one of those things we do is we talk about the risk-benefit analysis that can only be completed by the person who is making the decision. And the individual, when it comes to risky decisions, has a right to choose how much risk and what type of risk they find acceptable, regardless of their age. Necessarily, with some exceptions, right? Like we don't let two-year-olds drive cars."
Surely the way this applies to GAC would be something like handing a drunk teen the keys to a car and then claiming the risk-benefit analysis was entirely up to the teen? Depending on their age their capacity to consent is unclear, depending on their comorbidities their capacity to consent is unclear. Depending on the state of the evidence and the transparency by which the evidence is conveyed to them, their capacity to consent is unclear. They cannot weigh the risk and benefit if no one knows and no one is communicating the uncertainty to them clearly.
We cannot draw the obvious line of disallowing 2 year olds from driving cars without fairly acknowledging the way the current state of affairs would be fairly characterised using the driving analogy. We also don't allow teens to take their driving test when they've personally decided they're ready. We don't let anyone drive drunk regardless of age, and when they do, they're punished. If someone knew they were drunk and encouraged them to drive, that person would also very likely be culpable and would, hopefully, have some repercussion via the law.
Any talk about the "dignity of risk" is fatuous considering the impossibility that anyone today could give true informed consent to so-called gender affirming medical therapies. It should be "the credulousness of physician-assisted blind faith."
Just wow. The WPATH practitioners (how can we call them doctors?) have read and thoroughly digested George Orwell's Animal Farm, but in exactly the wrong way. I'm hoping a detransitioner with a YouTube channel will read a few of their sentences, then, in his or her own words, tell the horrors they went through, back and forth, perhaps with translations of Stalin scattered in. I honestly think these people should be named. It's as if they're saying about a different medical malpractice scandal, "But some pregnant women took thalidomide and nothing happened to the baby. They didn't have morning sickness." In my data on 64 trans widows' experiences, there are a couple of ex-husbands who completely detransitioned. So WPATH can add our suffering through abusive sexual demands, poverty after leaving and their community's defamation of us. Just incredible. I'm communicating with a teen boy who reached out to me to confirm his doubts about this cult and to gather advice about feelings that his face isn't growing into manly proportions yet. I'm not doing "conversion therapy" or even therapy, but the good folks over at YouTube immediately put the blue nanny box under "Paul is not Trans! The Wellness Checklist." If he tells me he's going to the gender clinic, despite adding some of my eating, sleeping and exercise suggestions, I'll gently tell him our letters have come to an end. But if he wants to know what the "experts" are saying, I'll send him these quotes.
https://www.youtube.com/watch?v=fDNnXPaqSaI