Informed Consent in the Medical Care of Transgender and Gender-Nonconforming Patients

Abstract

Informed consent as a model of care has evolved as an alternative to the standard model of care recommended by the World Professional Association for Transgender Health's Standards of Care, version 7, which emphasizes the importance of mental health professionals' role in diagnosing gender dysphoria and in assessing the appropriateness and readiness for gender-affirming medical treatments. By contrast, the informed consent model for gender-affirming treatment seeks to acknowledge and better support the patient's right to, and capability for, personal autonomy in choosing care options without the required involvement of a mental health professional. Clinicians' use of the informed consent model would enable them both to attain a richer understanding of transgender and gender-nonconforming patients and to deliver better patient care in general. IntroductionInformed consent is a concept that is familiar to clinicians. On a practical, day-to-day basis, informed consent is often implied rather than explicitly ensured, and whether explicit or implied, informed consent is the ethical and legal basis for most patient care decisions. It requires that clinicians or someone administering treatment, such as a pharmacist, effectively communicate anticipated benefits and potential risks of a treatment, as well as the reasonable alternatives to that treatment. It relies on the patient's capacity for understanding and weighing these options. Integral to the practice of informed consent is the principle of respect for patient autonomy-that is, respect for a person's right of self-determination-and the belief that clinicians will work to facilitate patients' decisions about the course of their own lives and care.

Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women’s healthcare experiences in sex-segregated jails and prisons

“…For patients who are gender dysphoric, providers can utilize the criteria in version 5 of the Diagnostic and Statistical Manual to diagnose patients (APA, 2013) and provide appropriate treatment (e.g., mental health counseling, hormone therapy) (Coleman et al, 2012). Since a mental health diagnosis should not be required for transgender people to access medically necessary care, regardless of incarceration status, primary care providers can follow the informed consent model of care, by informing transgender patients of the risks and benefits of hormone therapy, and prescribe hormones following patient consent (Cavanaugh et al, 2016). If restricted by institutional policies requiring verification of prior hormone use, providers could test for elevated-levels of cross-sex hormones in the blood (Hembree et al, 2009).…”

Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample

“…[12,20] Implementing informed consent protocols for treatment will bring physicians into greater contact with transgender patients, including those who present with diverse gender identities and presentations. [60] Demographic measures of gender identity that include binary and non-binary response options are recommended to inform future research and clinical care with transgender populations.…”

“What's the right thing to do?” Correctional healthcare providers' knowledge, attitudes and experiences caring for transgender inmates

“…Once incarcerated, current hormone levels can be evaluated by a simple noninvasive saliva swab (Hofman, 2001), which can then be used to tailor medically necessary gender-affirming medical care. For inmates who wish to initiate hormone treatment, primary care providers can follow the informed consent model of care by informing transgender patients of the risks and benefits of hormone therapy and prescribing hormones following patient consent (Cavanaugh et al, 2016). While budget is a consideration in expanding access to hormone therapy, the costs of auto-castration (Maruri, 2010), severe mental health issues (Insel, 2008), and suicide (The Howard League for Penal Reform, 2016) outweigh the relative affordability of hormone therapy.…”