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In, 'Forever young: the ethics of ongoing puberty suppression (OPS) for non-binary adults,' Notini et al discuss the risks, harms and benefits of treating non-binary patients via identity-affirming OPS. Notini et al's article makes a strong case for OPS's permissibility, and their conclusion will not be disputed here. Instead, I directly focus on issues that their article addressed only indirectly. This article will use a hypothetical case study to show that while Notini et al's ethical conclusion might be spot on, that perhaps the method they took to get there was superfluous. If the medical community is to take LGBT testimony seriously (as they should) then it is no longer the job of physicians to do their own weighing of the costs and benefits of transition-related care. Assuming the patient is informed and competent, then only the patient can make this assessment, because only the patient has access to the true weight of transition-related benefits. Moreover, taking LGBT patient testimony seriously also means that parents should lose veto power over most transition-related paediatric care.

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Both the diagnosis and medical treatment of gender dysphoria (GD)-particularly in children and adolescents-have been the subject of significant controversy in recent years. In this paper, we outline the means by which GD is diagnosed in children and adolescents, the currently available treatment options, and the bioethical issues these currently raise. In particular, we argue that the families and healthcare providers of children presenting with GD currently face two main ethical dilemmas in decision making regarding treatment: the pathway dilemma and the consent dilemma.

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Gender dysphoria (GD) is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it 'highly unlikely' that under-13s, and 'doubtful' that 14-15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to cross-sex hormone therapy and the 'life-changing consequences' of puberty blockers. In this article, I offer two concurrent arguments to dispute their reasoning. First, I argue that minors can be competent to consent to puberty blockers for GD, because the decision to undergo puberty blocker therapy is no more complex or far-reaching than other medical decisions that we accept a child should be able to make. Second, I argue that-irrespective of competence-such legal restriction for all children fundamentally contradicts the central ethical tenet of child healthcare: best interests. For these two reasons, the high court should not restrict access to puberty blockers for competent GD children.

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Gender-affirming healthcare (GAH) interventions are medical or surgical interventions that aim to allow trans and non-binary people to better affirm their gender identity. It has been argued that rights to GAH must be grounded in either a right to be cured of or mitigate an illness-gender dysphoria-or in harm prevention, given the high rates of depression and suicide among trans and non-binary people. However, these grounds of a right to GAH conflict with the prevalent view among theorists, institutions and activists that trans and non-binary people do not have a mental illness and that one can be trans and entitled to GAH without being depressed or suicidal. This paper challenges the orthodoxy that a right to GAH must be grounded in either of these ways and instead argues for a right to GAH grounded in a right to live and act with integrity. The standard view, which this paper explains, is that our rights to live and act with integrity ground a right to religious accommodation in many cases such as a right to not be denied social security due to one's refusal to work a job on a holy day. This paper argues that if our rights to live and act with integrity can ground prima facie rights to religious accommodation, our rights to live and act with integrity ground prima facie rights to GAH.

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In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female genital cutting, clitoridectomy and 'normalizing' surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it.

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Cisgender, heterosexual men's adherence to gender norms and prejudice against sexual minorities increases after observing sexuality-based gender norm violations of others (i.e., non-normative sexual attractions). No research to date has investigated whether similar effects occur after experiencing sexuality-based gender norm violations of the self. This study investigated the effects of one such norm violation-attraction to transgender women-on adherence to gender roles and attitudes toward gay men. Photographs of female models were shown to cisgender, heterosexual men (N = 135, M age ± S.D. = 28.12 ± 8.81) who rated their attractiveness. Half the participants were informed (accurately) that the models were transgender women (transgender condition). Other participants were not offered this information, leaving them to assume the models were cisgender. All participants then reported their support for traditional gender norms and attitudes toward gay men. As expected, participants in the transgender condition reported less positive attitudes toward gay men, an effect mediated by increased support for traditional gender norms, and only present when the participants had rated the women as highly attractive. These results suggest a strategy to compensate for gender norm violations to reestablish men's masculinity.

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The exponential rise in transgender self-identification invites consideration of what constitutes an ethical response to transgender individuals' claims about how best to promote their well-being. In this paper, we argue that 'accepting' a claim to medical transitioning in order to promote well-being would be in the person's best interests iff at the point of request the individual is correct in their self-diagnosis as transgender (i.e., the distress felt to reside in the body does not result from another psychological and/or societal problem) such that the medical interventions they are seeking will help them to realise their preferences. If we cannot assume this-and we suggest that we have reasonable grounds to question an unqualified acceptance in some cases-then 'acceptance' potentially works against best interests. We propose a distinction between 'acceptance' and respectful, in-depth exploration of an individual's claims about what promotes their well-being. We discuss the ethical relevance of the unconscious mind to considerations of autonomy and consent in working with transgender individuals. An inquisitive stance, we suggest, supports autonomous choice about how to realise an embodied form that sustains well-being by allowing the individual to consider both conscious and unconscious factors shaping wishes and values, hence choices.

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BACKGROUND: To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. METHODS: The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members. RESULTS: It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular (a staff member) described receiving intimate touch as a 'kind of care'-a particularly useful way of framing the conversation. CONCLUSION: While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach-one that focuses on caring for the whole person in order to improve overall well-being and quality of life.

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This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called 'blockers', analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: (1) the decision is too complex; (2) the decision-makers are too emotionally involved; (3) the decision-makers are on a 'conveyor belt'; (4) the possibility of detransitioning. We examine each of these reasons and we show that none of these stand up to scrutiny, and that some are based on a misunderstanding of the nature and purposes of this stage of treatment and of the circumstances in which it is usually prescribed. Moreover, accepting these claims at face value could have serious negative implications, not just for gender diverse youth, but for many other minors and families and in a much broader range of healthcare settings.

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O presente texto apresenta uma resenha do livro "Educação Física e sexualidade: desafios educacionais", organizado por Priscila Gomes Dornelles, Ileana Wenetz e Maria Simone Vione Schwengber, publicado pela Editora Unijuí em 2017. A obra é composta por seis capítulos, com pesquisas de renomados(as) pesquisadores(as) que se propuseram a investigar as possíveis relações entre as questões de gênero e sexualidade no âmbito da Educação Física, evidenciando as contribuições desse campo de conhecimento nos processos de fortalecimento de perspectivas de gênero e sexualidade determinadas a partir das características anatômicas e fisiológicas de cada sujeito. Em síntese, as pesquisas apresentadas servem como um indicativo de que a Educação Física escolar se caracteriza como uma disciplina que, seja a partir dos seus discursos, seja pelas práticas pedagógicas ou silenciamentos, potencializa a normalização de comportamentos fundamentados pela conexão e dependência entre as categorias sexo-gênero-sexualidade.

This text presents a review of the book "Physical Education and sexuality: educational challenges", organized by Priscila Gomes Dornelles, Ileana Wenetz and Maria Simone Vione Schwengber, published by Editora Unijuí in 2017. The work comprises six chapters, with research conducted by renowned researchers who proposed to investigate the possible relationships between issues of gender and sexuality in the context of Physical Education, highlighting the contributions of this field of knowledge in the processes of strengthening perspectives of gender and sexuality determined from the anatomical and physiological characteristics of each individual. In summary, the researches presented serve as an indication that school Physical Education is characterized as a subject that, whether based on its discourse, whether through its pedagogical practices or its silencing, potentializes the normalization of behaviors based on the connection and dependence between the sex-gender-sexuality categories.

Este texto presenta una reseña del libro "Educação Física e sexualidade: desafios educacionais", organizado por Priscila Gomes Dornelles, Ileana Wenetz y Maria Simone Vione Schwengber, publicado por la Editora Unijuí en 2017. El trabajo consta de seis capítulos, con investigaciones de reconocidos/as investigadores/as, quienes se propusieron indagar las posibles relaciones entre temas de género y sexualidad en el contexto de la Educación Física, destacando los aportes de este campo del conocimiento en los procesos de fortalecimiento de perspectivas de género y sexualidad determinadas a partir de las características anatómicas y fisiológicas de cada sujeto. En resumen, las investigaciones presentadas sirven como indicio de que la Educación Física escolar se caracteriza por ser una disciplina que, ya sea a partir de sus discursos, ya sea a través de prácticas pedagógicas o silenciamientos, potencia la normalización de conductas fundamentadas a partir de la conexión y dependencia entre las categorías sexo-género-sexualidad.

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The WHO, American Academy of Pediatrics and other Western medical bodies currently maintain that all medically unnecessary female genital cutting of minors is categorically a human rights violation, while either tolerating or actively endorsing medically unnecessary male genital cutting of minors, especially in the form of penile circumcision. Given that some forms of female genital cutting, such as ritual pricking or nicking of the clitoral hood, are less severe than penile circumcision, yet are often performed within the same families for similar (eg, religious) reasons, it may seem that there is an unjust double standard. Against this view, it is sometimes claimed that while female genital cutting has 'no health benefits', male genital cutting has at least some. Is that really the case? And if it is the case, can it justify the disparate treatment of children with different sex characteristics when it comes to protecting their genital integrity? I argue that, even if one accepts the health claims that are sometimes raised in this context, they cannot justify such disparate treatment. Rather, children of all sexes and genders have an equal right to (future) bodily autonomy. This includes the right to decide whether their own 'private' anatomy should be exposed to surgical risk, much less permanently altered, for reasons they themselves endorse when they are sufficiently mature.

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This paper spotlights ways in which sexual capacities relate to central human capabilities, such as the ability to generate a personally meaningful story of one's life; be physically, mentally and emotionally healthy; experience bodily integrity; affiliate and bond with others; feel and express a range of human emotions; and choose a plan of life. It sets forth a dignity-based argument for affording older people access to sex robots as part of reasonable efforts to support their central human capabilities at a floor level. The argument develops stepwise: (1) first, I dispel ageism and negative stereotypes about later-life sexuality, showing their deep historical roots in medicine and science; (2) second, I set forth a positive argument, grounded in capability accounts of justice, for deploying sex robots for older people with disabilities; (3) finally, after responding to objections, I conclude that sex robots are a reasonable way to support later-life sexuality for persons with disabilities. While often depicted as a product for younger, able-bodied people, this paper is a bid for reimagining sex robots as a product for older, disabled people.

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