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PaperclipPerfector  5mo ago (text post)   35282 thread views

Culture War Roundup for the week of November 11, 2024

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Removing obstacles from a path is not "putting them on a path". Do you object to roads, because they put criminals on the path towards bank robbery?

It sounds like arguing semantics to me. If one hand the public health administration is removing obstacles, and on the other the education system is telling kids they might be "born in the wrong body" if they don't fit into a given mold, and than hide the information about the child's transition from parents, that sounds like it all adds up to putting children on a path to transition.

Which "mutilations" had the minimum age requirements changed? What are the new requirements?

Draft of SOC8:

The following recommendations are made regarding the requirements for gender affirming medical and surgical treatment:

(...)

F. The adolescent has reached Tanner 2 stage of puberty for pubertal suppression.

G. The adolescent is the following age for each treatment:

  • 14 years and above for hormone treatment (estrogens or androgens), unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 15 years and above for chest masculinization; unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 16 years and above for breast augmentation, facial surgery (including rhinoplasty, tracheal shave, and genioplasty) as part of gender affirming treatment; unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 17 and above for metoidioplasty, orchidectomy, vaginoplasty, and hysterectomy and fronto-orbital remodeling as part of gender affirming treatment unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 18 years or above for phalloplasty, unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame"

H. The adolescent had at least 12 months of gender affirming hormone therapy, or longer if required to achieve the desired surgical result for gender-affirming procedures including, Breast augmentation, Orchiectomy, Vaginoplasty, Hysterectomy, Phalloplasty metoidioplasty and facial surgery as part of gender affirming treatment unless hormone therapy is either not desired or is medically contraindicated.

vs. published SOC8

6.12.f- The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated.

6.12.g- The adolescent had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.

There's also points A-E, but everything about minimum ages has been removed.

Edit: I think they mention the 18 years for phalloplasty when they elaborate on the chapter.

So, again, for starters: none of that is mutilation, just regular surgery.

Second, right there in the guidelines: this is the section for adolescents. Children is section 7. When your actual source makes the distinction between kids and teenagers, I feel like it's a bit disingenuous to keep calling them "kids"

Third, that's the section on "treatments requested by the patient". It's not putting someone on a path when they are already on that path and merely asking for help.

I don't see how this is different from anyone else trying to get medical treatment for their illness. Would you be horrified to learn that we also let children be treated for cancer and depression? Should there be a minimum age for those, too?

  • -15

So, again, for starters: none of that is mutilation, just regular surgery.

Unnecessary surgery that removes healthy body parts is mutilation, as are unnecessary hormonal treatments.

Second, right there in the guidelines: this is the section for adolescents. Children is section 7. When your actual source makes the distinction between kids and teenagers, I feel like it's a bit disingenuous to keep calling them "kids"

When people say "kids" they mean "minors", performing these treatments on even younger children is even worse, but a mastectomy performed on a 16 year old girl is still atrocious.

Third, that's the section on "treatments requested by the patient".

No one cares, the patient is a minor that doesn't know anything about what they're talking about.

I don't see how this is different from anyone else trying to get medical treatment for their illness.

There is no evidence that any illness is involved. The only criteria necessary to get a dysphoria diagnosis is:

  • Say you're trans

  • Don't change your mind for a few months

Even those loose criteria aren't always followed.

Would you be horrified to learn that we also let children be treated for cancer and depression?

Cancer has proper diagnostic criteria, so no on that, but if a doctor insisted I have to give drugs to 14 year old for "depression" (or "anxiety" or ADHD) I'd find it absurd.

Should there be a minimum age for those, too?

Probably. Psychology is very unrigorous, and we should not let these kind of doctors make decisions about children, that go against the wishes of parents.

we should not let these kind of doctors make decisions about children, that go against the wishes of parents.

What if the parents are wrong?

Not much.

Even in cases involving rigorous medicine, where we can be near-certain that a doctor is correct and the parents are wrong, informed consent and parental authority are recognized as necessary. Psychology is nowhere near that level of rigor and certainty, so I don't know on what grounds you wish to overrule parental authority or ignore the lack of informed consent from the child.

on what grounds you wish to overrule parental authority

On the grounds that a child or adolescent is not the property of their parents, because they are a human being, and a human being cannot be the property of another human being (Grant v. Lee, 1865).

I never said that they are, so I don't see how that implies a psychologist should get to overrule them.

Generally we allow people to refuse treatment, even if that will have negative consequences for them. We also generally recognize children lack the maturity to make long-term decisions, so we grant the power to make medical decisions about them to their parents (or whoever has custody of them). Even with adults, if someone is unconscious, it's their next of kin that generally make medical decisions for them, not the doctors. None of that implies owning another person as property.

Also how consistent are you with "rightness" overruling parental authority. If the evidence for pediatric transgender care is determined to be very poor, are you ok with a blanket ban on transgender care, even if the child, parents, and a bunch their doctor agree that it's right?

Generally we allow people to refuse treatment, even if that will have negative consequences for them.

When an adult refuses medical care for themselves, the negative consequences fall on the person making the decision. When an adult refuses medical care for a child, the adult does not experience those consequences.

We also generally recognize children lack the maturity to make long-term decisions, so we grant the power to make medical decisions about them to their parents (or whoever has custody of them).

And there are many examples of that going wrong, usually from parents who think of their children as their property and refuse to distinguish between 'my child's long-term interest/coherent extrapolated volition' and 'my personal preferences/non-universal ideology'.

Even with adults, if someone is unconscious, it's their next of kin that generally make medical decisions for them, not the doctors. None of that implies owning another person as property.

Because the next of kin is expected to make the decision based on 'what the patient would decide if conscious' and not 'what the next of kin wants'.

Also how consistent are you with "rightness" overruling parental authority[?] If the evidence for pediatric transgender care is determined to be very poor, are you ok with a blanket ban on transgender care, even if the child, parents, and a bunch [of] their doctor[s] agree that it's right?

  1. Overruling parents in the case of 'parents and child agree; we think both are wrong' should be a higher bar to clear than 'parents disagree with child; we think child is right and parents are wrong.'
  2. The case for giving any authority to parents rests on the assumption that they are usually right, for a value of 'right' that can be falsified, i. e. not defined as right a priori by dint of their status as parents. In cases where parents are often wrong, I believe society currently gives them too much unchallenged authority, and there need to be more checks and balances.
  3. What do you mean by 'the evidence for paediatric transgender care is determined to be very poor'? A literal reading would be 'the evidence seems to support it, but we have low confidence in that assertion.' akin to the evidence for ivermectin vs. COVID-19, or aducanumab vs. Alzheimer's disease. In that case, where we cannot predict long-term effects, we should do what results in the least immediate suffering. If you meant 'the evidence shows with strong confidence that it is harmful', akin to the evidence regarding 31 g of aspirin vs. the 1918 influenza, then I could be convinced to support a moratorium until experiments on adults show that they have found a less harmful method of changing genders.
  4. 'Blocking transgender care that is desired by a minor patient and approved by both parents and doctors' is not the mirror image of 'allowing transgender care that is desired by a minor patient and approved by doctors but opposed by the patient's parents'; the mirror image of that is 'blocking transgender care that is desired by the parent(s) but opposed by the patient and the doctors.' e. g. the often raised spectre of the blue-hair-and-pronouns parent attempting to transition their cisgender child in order to gain the status of 'ally to the trans community'. (I am not sure whether this has ever happened, but it would certainly justify overruling the parent's wishes, even in a society in which gender transition is instant, perfect, side-effect-free, and reversible.)

When an adult refuses medical care for themselves, the negative consequences fall on the person making the decision. When an adult refuses medical care for a child, the adult does not experience those consequences.

Not directly, but usually parents go through suffering of their own when something bad happens to their children.

And there are many examples of that going wrong, usually from parents who think of their children as their property and refuse to distinguish between 'my child's long-term interest/coherent extrapolated volition' and 'my personal preferences/non-universal ideology'.

Sure, but I don't think that's enough to have doctors override the decisions of the parents outside of extreme circumstances.

The bit about personal non-universal ideology is interesting. How is your idea on who should decide the child's treatment not based on your non-universal ideology?

Because the next of kin is expected to make the decision based on 'what the patient would decide if conscious' and not 'what the next of kin wants'.

And we give it to parents because we expect them to make the decision the child would have, if they were mature.

1. Overruling parents in the case of 'parents and child agree; we think both are wrong' should be a higher bar to clear than 'parents disagree with child; we think child is right and parents are wrong.'

So in a case like this, if the parents managed to convince the child that this treatment will help, would you say the state has no right to intervene?

2. The case for giving any authority to parents rests on the assumption that they are usually right,

I disagree. For one, it's an impossible standard to go by, because I don't know if we can agree on what's "right" between the 2 of us, let alone between a country of millions of people. But to the point, personally I'd say they have that authority by default, and you need a strong positive argument if you want to take it away.

3.What do you mean by 'the evidence for paediatric transgender care is determined to be very poor'? A literal reading would be 'the evidence seems to support it, but we have low confidence in that assertion.' akin to the evidence for ivermectin vs. COVID-19, or aducanumab vs. Alzheimer's disease. In that case, where we cannot predict long-term effects, we should do what results in the least immediate suffering. If you meant 'the evidence shows with strong confidence that it is harmful', akin to the evidence regarding 31 g of aspirin vs. the 1918 influenza,

I kind of see it as both. To the extend positive evidence exists it's low-confidence, and for many metrics it's just inconclusive / not enough to form any opinion. As to the harm, the problem here is that the intervention itself is inherently harmful - surgeries remove healthy body parts, hormones have many side effects, etc. The rationale here is that the benefits of addressing "dysphoria" are balance out the downsides, but I think that's the claim that needs to be justified, rather than skepticism of it.

4. 'Blocking transgender care that is desired by a minor patient and approved by both parents and doctors' is not the mirror image of 'allowing transgender care that is desired by a minor patient and approved by doctors but opposed by the patient's parents';

It might not be a mirror image, but if we're going by "they are usually right" I feel confident in my arguments that such treatment should be denied - children don't know what the hell they're talking about, normie parents mostly trust authority figures like doctors, but some doctors I can only describe as completely ideologically captured (they explicitly say dysphoria is not necessary to transition, and that transition is about expressing yourself authentically rather than treating any ailment) or certifiably insane (one go to example of mine was involved in the Satanic Panic back in the 90's, and now writes / gives talks about "gender angels" and hands out blockers to non-verbal autists), and the most prominent world-wide association of gender-care specialists has been caught red-handed hiding evidence that doesn't go their way.

I personally feel very strongly that treatment under these circumstances is wrong, but I don't know if I have the authority to step in here and tell people what treatment is right for their child. But since we're not living in the libertarian utopia where parents decide for themselves, I see no reason why I shouldn't lobby that my values are implemented.

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