Ethical problems with the mental health evaluation standards of care for adult gender variant prospective patients

Perspect Biol Med. 2007 Autumn;50(4):491-505. doi: 10.1353/pbm.2007.0047.


The World Professional Association for Transgender Health's "Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons" (SOC) set forth standards clinicians must meet to ensure ethical care of adequate quality. The SOC also set requirements gender variant prospective patients must meet to receive medical interventions to change their sexual characteristics to those more typical for the sex to which they were not assigned at birth. One such requirement is that mental health professionals must ascertain that prospective patients have met the SOC's eligibility and readiness criteria. This article raises two objections to this requirement: ethically obligatory considerations of the overall balance of potential harms and benefits tell against it, and it violates the principle of respect for autonomy. This requirement treats gender variant prospective patients who request medical intervention as different in kind, not merely degree, from other patient populations, as it constructs the very request as a phenomenon of incapacity. This is ethically indefensible in and of itself, but it is especially pernicious in a sociocultural and political context that already denies gender variant people full moral status.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Female
  • Gender Identity
  • Humans
  • Male
  • Mental Competency / psychology
  • Mental Competency / standards*
  • Mental Health Services / ethics*
  • Personal Autonomy
  • Plastic Surgery Procedures
  • Quality of Health Care
  • Transsexualism / psychology*
  • Transsexualism / surgery
  • United States