TRANSforming Autonomy: Transgender Healthcare and the Politics of Choice Under Oppression

Abstract: This panel explores and troubles the normativity of autonomy in accounts of decision-making about gender-affirming care. Presenter 1, a health services researcher, will use empirical evidence to argue that autonomous decision-making is highly constrained by administrative burden and a range of material conditions that structurally undermine access to needed gender-affirming care. Efforts to improve patient understanding of informed consent are unlikely to enhance the autonomy of decision-making about gender-affirming care due to the structural barriers to such care; trans people respond to this context by justifiably pursuing DIY care. In an examination of the “informed consent model” of gender-affirming healthcare, Presenter 2, a science and technologies studies scholar, will clarify how the informed consent model of trans medicine reveals an intrinsic normativity to conventional bioethical accounts of autonomy. Rather than merely reform systems that endeavor to enhance autonomy, we ought to interrogate the work that aspiring to autonomy itself does by requiring the demonstration of individuated, capacitated, and informed subjectivity. Presenter 3, a philosopher, offers an account of autonomy based on the situated knowledge of transgender people. Some have claimed that trans people pursue gender-affirming care as an adaptive preference and therefore are not autonomous when they choose gender-affirming care. Presenter 3 claims that arguing against autonomy of trans people is an instance of epistemic silencing, and furthermore, that the main problem is not autonomy in the normative sense. This session will invite attendees to question the quotidian use of autonomy in transgender medicine and in broader bioethical inquiry.