Guest Column* by Janet Liljestrand, M.D., M.A.
Trust, once lost, is difficult to regain. In last month’s Tennessee CBC article Credibility and How to Lose it, Dr. D. Joy Riley questioned if the American Academy of Pediatrics (AAP) risks its credibility for recommending “gender affirming care” in the treatment of gender dysphoria. Such treatment involves radically and unnaturally changing the body and is not based on scientific data. The AAP is indeed an influential organization. It makes recommendations, but pediatric practitioners and Children’s Hospitals put those recommendations into practice for minors. Children’s Hospitals and pediatricians alike risk losing credibility and may cease to be trusted when they follow these AAP guidelines that have little scientific basis. The number of hospitals involved is not small. Stop the Harm has compiled a large database of facts on its website regarding the many US Children’s Hospitals that offer treatment of gender dysphoria with puberty blockers, cross-sex hormones, and surgeries.
Truth telling is an essential part of trust. Euphemisms in medicine are not truth telling and erode trust. “Gender affirming care” sounds compassionate, but one might question how hormonally or surgically altering the body’s natural processes is “affirming”. It would seem that the patient would be better affirmed with help becoming comfortable with the body in which he or she was born. “Top surgery” is another euphemism. A woman with a high risk of breast cancer may choose to remove healthy breast tissue to eliminate that risk. The procedure is a double mastectomy, considered a major surgery, and both the risks and benefits would be discussed. For a female teenager who chooses to remove healthy breast tissue to “transition” to male and, thus, appear more masculine, the procedure is simply called “top surgery.” Same procedure, but a different term. Why? In all likelihood “top surgery” is used to deny the seriousness of the surgery.
I spent 25 years in pediatric practice within one hour (in good traffic) of a highly rated, nationally recognized Children’s Hospital. I learned that parents who distrusted a health care facility in one subspecialty, tended to distrust it in all subspecialties. The distrust need not be justified; it was still distrust. One must logically assume that parents’ and patients’ trust is impacted when they believe the hospital (and its doctors) treat gender dysphoria with powerful hormones and life altering surgeries without solid scientific data. Trust is further diminished if they personally believe the procedure to be inappropriate. Ultimately will that erosion of trust impact how the parents and patients follow recommendations for other procedures, both minor and major, such as heart surgery?
Children’s hospitals risk their future reputations with hormones and surgeries for gender dysphoria. The Cass Report in the United Kingdom revealed inadequate evidence for the use of these treatments and acknowledged that they may be harmful. Lack of scientific evidence for the recommendations of the World Professional Association for Transgender Health (WPATH) has been exposed.
Given the lack of positive scientific evidence, what is the hospital’s motivation to use life altering treatments for gender dysphoria? Compassion? Ideology? Financial gain? What is the hospital’s defense if/when these treatments are later proven harmful?
Erosion of trust in Children’s Hospitals would be no small matter. Many health issues in pediatrics are best treated by subspecialists in Children’s Hospitals. Some families make hours long trips for highly specialized care. What happens to these children if parents lose trust in the expertise and care of the needed Children’s Hospital? Do they turn to physicians with less training in their child’s condition, or worse, seek no care at all? Perhaps these are questions each Children’s Hospital should ask before continuing these life altering treatments on vulnerable patients.
The Tennessee Center for Bioethics & Culture encourages respectful discussion and debate of bioethics issues, and strongly supports freedom of speech. To that end, we invite and welcome other voices to the discussion of bioethics issues. Invited authors’ views are their own, and do not necessarily represent those of The Tennessee Center for Bioethics & Culture. *An preliminary draft of this column appeared on 30 October 2024. Editors at The Tennessee Center for Bioethics & Culture regret the error.