Thomas Johnson

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.

We examined participants' reading and recall of informed consent documents presented via paper or computer. Within each presentation medium, we presented the document as a continuous or paginated document to simulate common computer and paper presentation formats. Participants took slightly longer to read paginated and computer informed consent documents and recalled slightly more information from the paginated documents. We concluded that obtaining informed consent online is not substantially different than obtaining it via paper presentation. We also provide suggestions for improving informed consent-in both face-to-face and online experiments.

As a descriptive theory, moral fictionalism proposes that moral claims are typically based on the fundamental error of attributing moral values with an objective, independent status that they cannot possess. This illusory belief in the reality of moral values has been aptly described as naïve moral realism. Yet, the assumed prevalence of moral realism, however naïve, is a crucial question that has not been adequately defended by proponents of moral fictionalism and is found to be inconsistent with much empirical research in moral psychology that reveals a much more sophisticated understanding of the meanings of moral beliefs and judgements. In addition to these empirical weaknesses, moral fictionalism tends to rely on a naïve interpretation of: (1) the conceptual validity and scope of the cognitivivist/non-cognitivist distinction (2) the categoricity of moral judgements (3) the descriptive language of moral discourse These serious flaws provide good reason for describing the theory itself as naïve moral fictionalism.