Age, Autonomy, and Authority of Knowledge: Discursive Constructions of Youth Decision-Making Capacity and Parental Support in Transgender Minors’ Accounts of Healthcare Access

Shook, Alic; Tordoff, Diana M.; Clark, April; Hardwick, Robin; Nelson, Will St. Pierre; Kantrowitz‐Gordon, Ira

doi:10.1177/07435584221115351

Cited by 6 publications

(4 citation statements)

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“…For youth, guidelines recognize differences in legal age of consent and emphasize informed consent as a process and practice of shared decision making, "Ideally, treatment decisions should be made among the adolescent, the family, and the treatment team" ( 13), but do not provide guidance about standardizing or documenting youth participation or parental involvement. Studies examining the decision making process for TNB youth seeking gender affirming care note variability in power dynamics, parental support, and factors supporting informed decision making (40)(41)(42)(43)(44). Details about provider informed consent practices in various settings is still limited (43,45), with only one study assessing TNB youth's decision-making ability that notes specifics about the informed consent process in two Dutch gender-identity clinics indicating that the process is standardized, occurs over several sessions (mean of 8.8 months) and concludes with parents and youth signing an informed consent document (43).…”

Section: Discussionmentioning

confidence: 99%

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones

Taylor

Vullikanti

Nelamangala

et al. 2023

Front. Reprod. Health

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IntroductionTransgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth.MethodsAs part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH.Results21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth.ConclusionsThere was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth.

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Section: Discussionmentioning

confidence: 99%

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones

Taylor

Vullikanti

Nelamangala

et al. 2023

Front. Reprod. Health

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“…While most adolescents are unable to make decisions about their healthcare without parental consent, their competence to understand and decide is considered by healthcare professionals, usually making decisions triadic. 17,58 Autonomy is often defined as the right to act using one’s judgement regarding matters that affect one’s own life without interference or coercion 16 It is counterintuitive that during considerations of care, TGD youth are required to demonstrate their capacity by being entirely certain of themselves in terms of their gender, but conversely are hindered by the dominant perceptions that adolescents are too young to make autonomous decisions regarding care. 17 However, when they attempt to assert their autonomy, Littman 5 and Marchiano 6 feel they are being influenced by others, which to these authors is evidenced by the significant increase in their interaction with social media before announcing that they were gender non-conforming.…”

Section: Autonomymentioning

confidence: 99%

“…17,58 Autonomy is often defined as the right to act using one’s judgement regarding matters that affect one’s own life without interference or coercion 16 It is counterintuitive that during considerations of care, TGD youth are required to demonstrate their capacity by being entirely certain of themselves in terms of their gender, but conversely are hindered by the dominant perceptions that adolescents are too young to make autonomous decisions regarding care. 17 However, when they attempt to assert their autonomy, Littman 5 and Marchiano 6 feel they are being influenced by others, which to these authors is evidenced by the significant increase in their interaction with social media before announcing that they were gender non-conforming. They also believe this theory is supported by TGD youth seeking advice from the internet including how to make money for medications, how to hide treatment from parents that they may have accessed and discussions they could have with doctors to convince them to provide care.…”

Section: Autonomymentioning

confidence: 99%

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Respecting the free will, authenticity and autonomy of transgender youth

Crosse

2023

Nurs Ethics

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Transgender and gender diverse (TGD) youth are currently being targeted by global anti-trans legislation that would prevent their access to gender-affirming care even by healthcare providers willing to deliver it and who understand the importance of this support. It has been suggested in some studies that transness in young people is a result of peer contagion. As such their free will, authenticity and autonomy could be brought into question when accessing gender-affirming care. It is important to explore the relevance of these concepts concerning the provision of gender-affirming care to TGD youth by nurses and other healthcare professionals. Nurses should challenge the notion held by some that these young people are not capable of knowing themselves or the level of treatment they require. They can do this by practising gender-affirming care determined by aspirational ethical values of beneficence, non-maleficence, autonomy and justice.

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Ethical and methodological challenges conducting participative research with transgender and gender-diverse young people: a systematic review

Servais,

Vanhoutte,

Maddy

et al. 2024

International Journal of Transgender Health

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Ethical and methodological challenges conducting participative research with transgender and gender-diverse young people: a systematic review. Introduction: Research with transgender and gender-diverse (TGD) young people is essential to understand their experiences and to be able to propose, implement and adapt 'services' in the broadest sense to meet their needs. However, research outside clinical settings on current experiences and needs of youth under the age of 18 is limited which hinders the development of knowledge on TGD, as well as the development of research informed support practices. Acquiring parental consent for participatory research may present ethical and logistical difficulties, as it could jeopardize the safety, well-being, or confidentiality of adolescent participants. This creates a tension between the adolescent's right to autonomy, privacy, freedom, and all aspects related to the consent of the underage on the one hand, and the parents' right to protect their child on the other hand. This review aims to identify the methodological and ethical challenges associated with participatory research with transgender and gender-diverse young people. Methods: We systematically searched bibliometric databases for studies published between 2006 and 2022 and included 4 main conceptual groups: transgender and gender non-conforming, adolescence, qualitative research (including participatory research) and consent. This review was registered in PROSPERO (CRD42022368360) in November 2022.Results: Of the 3,794 articles initially identified, 291 met the inclusion criteria and 48 were examined. The selected studies were analyzed in the light of four main ethical tensions: involving parents or a trusted person in the consent gathering process, ensuring the protection and safety of young people while respecting confidentiality, and ensuring that spaces are created for transgender and genderdiverse young people to express themselves freely as part of an empowering research process. At the same time, several methodological challenges concerning public and stakeholder participation and recruitment, data collection and analysis as well as research integrity emerged from the selected studies. Conclusion & implications:The existing literature of participatory research involving young transgender and gender-diverse individuals underscores the intricate and conflicting aspects, especially concerning power dynamics, empowerment, and the researcher's role. The relevance of these findings extends 3 across various legal frameworks and is applicable to multiple contexts and countries.

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Age, Autonomy, and Authority of Knowledge: Discursive Constructions of Youth Decision-Making Capacity and Parental Support in Transgender Minors’ Accounts of Healthcare Access

Cited by 6 publications

References 57 publications

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones

Respecting the free will, authenticity and autonomy of transgender youth

Ethical and methodological challenges conducting participative research with transgender and gender-diverse young people: a systematic review

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