Tea at Trianon: Impossibility of Informed Consent

John Wilson Croker on Marie-Antoinette

"We have followed the history of Marie Antoinette with the greatest diligence and scrupulosity. We have lived in those times. We have talked with some of her friends and some of her enemies; we have read, certainly not all, but hundreds of the libels written against her; and we have, in short, examined her life with– if we may be allowed to say so of ourselves– something of the accuracy of contemporaries, the diligence of inquirers, and the impartiality of historians, all combined; and we feel it our duty to declare, in as a solemn a manner as literature admits of, our well-matured opinion that every reproach against the morals of the queen was a gross calumny– that she was, as we have said, one of the purest of human beings."

~from History of the Guillotine by John Wilson Croker, 1844

Edmund Burke on Marie-Antoinette

"It is now sixteen or seventeen years since I saw the queen of France, then dauphiness, at Versailles; and surely there never lighted on this orb, which she hardly seemed to touch, a more delightful vision. I saw her just above the horizon, decorating and cheering the elevated sphere she had just begun to move in, glittering like a morning star full of life and splendor and joy. Oh, what a revolution....Little did I dream that I should have lived to see such disasters fall upon her, in a nation of gallant men, in a nation of men of honor and of cavaliers! I thought ten thousand swords must have leaped from their scabbards, to avenge even a look which threatened her with insult. But the age of chivalry is gone; that of sophisters, economists, and calculators has succeeded...."

~Edmund Burke, October 1790

Sunday, August 14, 2022

Impossibility of Informed Consent

From The Public Discourse:

The ideology glorified by “Pride” month has overtaken much of the medical profession. Burgeoning numbers of trans-identifying individuals demand euphemistically labeled “gender affirming treatment,” or GAT (puberty-blocking drugs, cross-sex hormones, surgeries), and clinicians in the thriving trans industry are often happy to provide it.

At the very least in this experimental area of medicine, these professionals should be scrupulous about obtaining truly informed consent before proceeding. Informed consent is the process by which physicians educate patients about the risks and alternatives of a medical intervention, to ensure that patients can fully understand and consent to the path chosen.

But in too many cases, this critical process that protects the dignity and authority of the patient is not happening. The marginalization of informed consent is contributing to the worst ethical scandal in the medical profession since the lobotomy craze ended in the mid-twentieth century. One hopes that this latest scandal will lead to an end to this dark chapter in the profession.

Dr. Steven B. Levine, professor of psychiatry at Case Western Reserve University, focuses on treating trans-identifying children and adolescents and has written extensively (see here and here) about the nature of informed consent for such patients. (In 2020, I discussed this work for Public Discourse in a two–part essay.) Although Levine, unlike many physicians, does not rule out GAT in all circumstances, he recognizes that medical interventions for gender dysphoria or incongruence profoundly implicate many aspects of a patient’s life: physical and mental health, social adjustment, family relationships, and romantic relationships. Decisions made now will determine whether the young patient ultimately flourishes or flounders.

Building on his earlier work, a new study by Levine and his colleagues E. Abbruzzese and Julia W. Mason, published in March 2022, finds that the informed-consent process is too often more of a box-checking exercise than a serious discussion and deliberation. In “Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults,” the authors (to whom I will refer as “Levine” for short) lament that clinicians in the trans industry have gone beyond simple negligence or incompetence; instead, they are engaging in demonstrably unethical practices. (Read more.)