Law, Medicine, and Minors: The Medicalization of Sex and Gender

Abstract: What is the role of the law in defining the limits of medical interventions involving the sex and gender of minors? We describe a physician practice that offers interventions that purportedly modify sexual orientation and gender identity in minors, toward straight and cisgender. We raise certain questions about professional responsibility in this undertaking, problematic language used by the physician, informed consent, and responsibilities owed to research ethics. We then consider this kind of effort against the backdrop of U.S. state law. In the name of protection of minors, some states prohibit healthcare providers from treatments to modify same-sex orientations; other states prohibit providers from hormonal or surgical treatments for gender dissonance. These laws are a patchwork across the United States, but some providers remain free to offer such treatments, no matter the intended sexual orientation or gender identity. We identify a moral tension between protecting sex and gender minorities through certain kinds of restrictions on practice and respect for the emerging autonomy of minors in matters of their own sexual interests and gender identities. On one hand, maturing adolescents are entitled to certain degrees of decision-making in their healthcare. On the other hand, the very interest in treatment for sexual orientation and gender identity can be an artefact of objectionable social values. We conclude that current legal prohibitions entail moral inconsistencies both in respecting autonomy of maturing adolescents and protecting their best interests.

Timothy Murphy, PhD – Professor, Dept. of Medical Education, University of Illinois College of Medicine at Chicago