The care and treatment of young people in relation to their gender identity

Over a series of meetings in autumn 2019, we explored the ethical challenges involved in providing care and treatment for young people in relation to their gender identity.

A summary of what we heard is now available.

We listened to a range of people. This included people or representatives of people who have experiences of using gender identity services in the UK, medical practitioners and others involved in the provision of these services, and researchers with expertise in this area.

There were some clear areas of agreement among the meeting participants. Participants broadly agreed that:

• the needs and well-being of young people should always be the central focus of any discussion about their care and treatment. All participants wanted young people to have the care and support that would best support their health and happiness
• the current NHS model of care for young people in relation to their gender identity needs to develop to respond to the needs of young people and their families today and changing social contexts
• media reporting in relation to gender identity in young people can be misleading and convey contradictory messages that can be upsetting and confusing for young people and others to hear.

There were also some areas of disagreement. These include:

• what kind of evidence on the long-term effects of puberty suppressants would provide ethical justification for their use in young people with gender dysphoria
• how young people who are questioning their gender identity should be supported by parents, schools and healthcare professionals.

Hugh Whittall, Director at the Nuffield Council on Bioethics, said:

“It was a privilege to meet and talk to all the people who took part in our meetings, and we are very grateful for their willingness to engage with us and their openness and honesty.”

“It’s encouraging that people are not so far apart in their views as media headlines can suggest, and that it can be possible to find some common ground. However, there are a number of unresolved ethical challenges involved in providing care and support for young people in relation to their gender identity. We would like to help find a way forward, and these meetings have given us a basis on which to plan some further work in this area.”

“We will continue to engage widely as we progress our work. At the heart of this is young people and talking to a range of young people directly will be particularly important to any further work we undertake.”

For more information, please contact bioethics@nuffieldbioethics.org.

Read the summary of exploratory meetings.

Reactions to our exploratory work:

Paul Jenkins, Chief Executive of the Tavistock and Portman NHS Foundation Trust, said:

“We very much welcome the initiative the Nuffield Council on Bioethics has taken to bring a thoughtful analysis to an important and evolving area of care. We hope this will be the start of a more mature and respectful debate about how services should develop in the interests of children and young people and takes account of emerging evidence as well as the voices of patients, and addresses the genuine distress we see not only in our young people, but often in their families too. We are committed to working with others to improve the evidence base and to make the findings of research more accessible.”

Jay Stewart, CEO and Co-founder of Gendered Intelligence, said:

“This initial exploration carried out by Nuffield Council on Bioethics is absolutely welcomed by Gendered Intelligence. I am very hopeful that this will lead to further research and raised awareness of the lives of young gender diverse people. We need research that goes on to directly benefit young gender diverse people. Research about young gender diverse people should involve those people and be at the centre of any research carried out. Hence, I also welcome the recommendation that research listens to the views of young gender diverse people.”

Dr Heather Brunskell-Evans, Medical Humanities Academic Researcher and author, said:

“The Nuffield Council on Bioethics has initiated a much needed independent inquiry into the bioethics of medically transitioning children. I hope it carries on with deeper inquiries as part of a larger move by society towards transparent public debate free from the fear of silencing and censure by interested parties. My own view is that we may look back at paediatric gender identity medicine and wonder at a society that once found such practices morally right.”

Simona Giordano, Professor of Bioethics at the University of Manchester, Centre for Social Ethics and Policy, School of Social Sciences, Law School, said:

“I thought that the Nuffield Council on Bioethics’ work in this area is extremely valuable, and the impressive breadth of participants suggest that is also welcome and needed. The Council has acted here as a barometer, registering and unpicking how the situation has come to evolve over the years. They made it possible for people and groups with different concerns and expertise to share their experiences without fear of repercussions or of causing further polarisation.”

Susan Bewley, Emeritus Professor of Obstetrics and Women’s Health, King’s College London, said:

“The Nuffield Council has done a good job in a difficult area of delineating the areas of agreement and disagreement regarding medical involvement with gender diverse people. Their report will be illuminating for those who are unfamiliar with the details, or who disparage people who don’t agree with them. Clearly, many people of goodwill are presently working to support children, young people and their families, but many other people of goodwill have well-founded concerns about the evidence on which healthcare delivery depends. How the yawning gaps in world views can be traversed remains to be seen. I’d hope to see more challenge, more evidence and more collaboration in the future. Collectively, we need to provide better, robust support to address the many varied needs of children, young people and their families rather than ‘one simplistic view fits all’.”

Joanna Holmes, Children, Young People and Families Lead, Policy & Public Affairs at the British Association for Counselling and Psychotherapy, said:

“The meeting provided a platform for professionals and organisations to have an open discussion around best practice considerations when working with gender identity whilst keeping the well-being of children and young people at the heart of the dialogue. From a counselling practice perspective, it felt important to be part of this process and we readily await any recommendations that may impact on future policy considerations to support children, young people and families and those working with them.”