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The Role of Mental Health Professionals in Gender Reassignment Surgeries: Unjust Discrimination or Responsible Care?

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Abstract

Objective

Recent literature has raised an important ethical concern relating to the way in which surgeons approach people with gender dysphoria (GD): it has been suggested that referring transsexual patients to mental assessment can constitute a form of unjust discrimination. The aim of this paper is to examine some of the ethical issues concerning the role of the mental health professional in gender reassignment surgeries (GRS).

Method

The role of the mental health professional in GRS is analyzed by presenting the Standards of Care by the World Professional Association of Transgender Health, and discussing the principles of autonomy and non-discrimination.

Results

Purposes of psychotherapy are exploring gender identity; addressing the negative impact of GD on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; promoting resilience; and assisting the surgeons with the preparation prior to the surgery and the patient’s follow-up. Offering or requesting psychological assistance is in no way a form of negative discrimination or an attack to the patient’s autonomy. Contrarily, it might improve transsexual patients’ care, and thus at the most may represent a form of positive discrimination. To treat people as equal does not mean that they should be treated in the same way, but with the same concern and respect, so that their unique needs and goals can be achieved.

Conclusions

Offering or requesting psychological assistance to individuals with GD is a form of responsible care, and not unjust discrimination.

Level of Evidence V

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Notes

  1. There are various other ways of referring to similar procedures: “gender reaffirming” surgery, “gender confirming” surgery, “sex reassignment surgery,” and “gender realignment” surgery are the most common. Some terms, such as “confirming” or “realignment,” seem to suggest that perceived gender is innate, and surgery is meant to re-align the body to the “real” gender of the person. We will not examine in great detail the terminological issues; partly, people’s preference for one term rather than the other depends on views relating to how gender identity develops. For theories on gender identity development, see Giordano S, Children with Gender Identity Disorder, Routledge, 2012, Chapter 2. For ease, in this paper, we opt for “gender reassignment surgery.” We opt for “gender” rather than “sex,” because the latter refers to the genital area only.

  2. Wherever possible, we shall privilege the terms “medical interventions” and “medical procedures” over the terms “medical treatments” or “therapies”, in that they might imply a difference between these and “cosmetic” procedures. The terms “procedures” or “interventions,” in fact, would apply to all areas of medical care. We shall also refer particularly to surgery, but what is said is also relevant to other areas of healthcare for people with GD.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gröna Stråket 8, 41345, Gothenburg, Sweden

    Gennaro Selvaggi

  2. Reader in Bioethics, CSEP/iSEI, The School of Law, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK

    Simona Giordano

Authors
  1. Gennaro Selvaggi
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  2. Simona Giordano
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Correspondence to Gennaro Selvaggi.

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Selvaggi, G., Giordano, S. The Role of Mental Health Professionals in Gender Reassignment Surgeries: Unjust Discrimination or Responsible Care?. Aesth Plast Surg 38, 1177–1183 (2014). https://doi.org/10.1007/s00266-014-0409-0

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