Safeguarding or Gatekeeping? Historical, legal, and clinical perspectives on mandatory ethics involvement in gender-affirming care

Abstract: In 2024, Ohio proposed the mandated inclusion of a medical ethicist on interdisciplinary care teams providing access to gender-affirming care (GAC). While not appearing in subsequent rules, the proposal raised significant ethical questions about the appropriateness of mandated ethics involvement. This interdisciplinary panel examines how required ethics consultation can recognize ethical complexity, but may problematically frustrate justice in health care access, especially for marginalized groups.

Our first presenter will describe embedded support provided to adolescent and adult gender care teams and the impact of the recent passing of Ohio House Bill 68 and the proposed rules on gender care access and delivery. The second presenter will discuss the use of ethics consultations for GAC for transgender and gender diverse patients. They will draw on their clinical experience to identify cases where clinical ethics consultation has helped promote affirming care and instances where its use could obstruct these aims of health care equity. Presenter three will provide historical context of mandated ethics consultations in other areas of medicine, including neonatology, end of life care, and other domains of politicized care in law and institutional policy. They will provide critical analysis of how ethics consultations have played a role in politicizing areas of medicine and defining areas of ethical controversy. Presenter four and the panel’s moderator, will provide an overview of the concept of transexceptionalism and critique how it presents in contemporary bioethics literature on trans medicine, with a focus on work about ethics consultation.