Gender reassignment is becoming a very sensitive topic nowadays and relevant to the rights of people who are transgender. Gender identity disorder found in children is also known as gender dysphoria or incongruence. The disorder is used by physicians in the description of children who are discontented with their biological gender. There is a unique opportunity for physicians and nurses to give information about treatment and transition procedures for those in need. Sometimes we should think of how those children who are seen different gender from the whom they were born. Sometimes we ask ourselves whether it is ethical to have children undergo an operation for a sex change or have puberty blockers and how we can support the children with the gender identity disorder. Those questions that keep running in our minds will be viewed in the paper. Between 2-6% of boys and 5-12 % of girls have cross-gender behavior and some will change their gender while around 25% of the children will not change the gender according to American Psychological Association (Weston, Brewer & Peterson, 2012).
The American Psychological Association have outlined some ethical principles and a code of conduct that we as nurses follow. We use the principles while in our work so that all our actions can be guided. That helps us in supporting our patients and guide them that no harm can be done to them. since we nurses are responsible for the respect of our patients then the autonomy principle is very relevant to the topic I chose. We also have a responsibility to respect the patients' right to choose the names they want to use or to be called. There needs to be respect for them to choose the treatment they want like operations or puberty blockers and give them resources to help them in making the best decision. Benevolence principle also fits in this topic since as nurses we need to do to our patients well. Through this principle, we also offer the patients a safe environment to discover their gender as well as listening to the concerns they have and their parents' too. The principle of benevolence is considered the core of our patient advocacy by the American Nurses Association (Weston, Brewer & Peterson, 2012).
All we want is to support the rights of our patients as well as their fair treatment like avoiding construction of gender-specific bathrooms in our healthcare facilities. Non-maleficence also is one of our principles since we avoid harm for our patients. Forcing a person like children to change their gender through talking or a conversation is considered harmful according to the children's psychology of well being. Therefore parents need to be educated about it and how to talk to their children about their gender identity. Moreover, there are health consequences that come with the puberty blockers or operations that are done with an aim of changing one's gender which are considered as harm on the patient. Lastly, loyalty or fidelity to our patients is also another principle where we treat our patients with a lot of care, equality, and fairness regardless of gender.
Several outcomes come from the gender reassignment ethics. Mostly, they are negative outcomes that result from the puberty blockers or from operations that are done with an aim of changing the gender of patients. I have experienced patients loose fertility, have reduced bone mineralization and some have slow growth and maturity due to the puberty blockers. However, some people decide to transition their gender at adulthood rather than using puberty blockers. In reverse for puberty effects they have to be operated like; to remove breasts for those who want to be male but were born female. While at the hospital I have experienced a case where a child undergoes psychological and social disturbance since he or she has developed all the way through puberty in a gender that they are not identified with. There is a need for treatment for such children since they are likely to face physical or verbal abuse thus subjecting them to depression, stress or attempts of suicide (De Vries, McGuire, Steensma, Wagenaar, Doreleijers & Cohen-Kettenis, 2014). Also, before and after using puberty blockers on a patient counseling should be done so that the patient can be ready with the side effects. I have seen a girl who underwent a transition to be a boy due to pressure from her family to change her gender. Later, as a man, she has faced so many challenges in changing her friends and lifestyle and even bullying from those who knew her as a girl and now she is a man. We thought all will be well she had changed to whom she wanted but the unexpected happened.
Resources to Help Deal with Gender Reassignment
Resources for the families with transgender children are available so that they can use them at supporting their children. They should be provided by the hospitals to the family but that does not happen often. The resources I found helpful to the affected families are www.familyeducation.com, www.genderspectrum.org, and ww.transEquality.org since they have the best information for children, teens, parents, nurses and other healthcare providers. It also provides legal and mental health resources.
De Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, peds-2013.
Weston, M. J., Brewer, K. C., & Peterson, C. A. (2012). ANA principles: The framework for nurse staffing to positively impact outcomes. Nursing Economics, 30(5), 247.
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