Saturday, December 12, 2015

Helping Transgender People Have Children: An Ethics Report That Could Have Been Stronger

The Ethics Committee of the American Society for Reproductive Medicine has offered advice that fertility clinicians make their services  available to transgender people. To support this recommendation, the Ethics Committee reviews some of the standard worries about transgender people as parents. One of those standard worries is that transgender people are 'disordered," which view was in fact the prevailing view in medicine until very recently.

The Ethics Committee is free to defend cross-sex identities against the label of ‘pathology.’ The Committee notes that neither the American Psychiatric Association nor the American Psychological Association any longer consider cross-sex identification in itself as evidence of a disorder. (The shift from 'gender identity disorder' to 'gender dysphoria' is significant: what matters is not the cross-sex identification but the distress that involves; treat the distress, not the cross-sex identity.) Not only that, but the Committee points to research that shows that “transgender persons can be highly educated, stably employed, sustain long-term partnered relationships” and that “they do not exhibit mental disorders more often than any other group.”

It is worth noting, however, that even if -- even if -- one considers cross-sex identification as a disorder in some sense, it does not follow that the disorder would by itself disqualify transgender people as parents. By itself, cross-sex identification is a very narrow ‘disorder" in the sense that it involves one's interpretation of one's sex. Transgender people need not otherwise have any cognitive or emotional deficits.

Certainly, it does not follow from the mere fact of a cross-sex gender identification that anyone would be unable to understand the nature or consequences of parenting, any more than certain other psychiatric/psychological disorders disqualify people as parents. Unless there were some other disease/disorder present, someone with the ‘disorder’ of a cross-sex identity could still very well-qualify as a responsible and able parent. Even under the older designation of cross-sex identities as disorders, some of the people  would have been “highly educated, stably employed,” and in “long-term relationships.”

What I'm saying here is that clinicians might well have obligations to help transgender people even if they consider cross-sex identities as disordered. Not all psychological disorders disqualify people from having children or from securing help in having children. In short, the defense of helping transgender people have children is much stronger than the Ethics Committee of the American Society of Reproductive Medicine lets on.

(The report:  Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender persons: an ethics committee report. Fertility and Sterility 2015 (104): 1111-1115.)