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We are recruiting an open rank, tenure track/tenured faculty member with expertise in clinical ethics consultation to begin as early as September 2024. This position is within The Department and Institute of Bioethics and Health Humanities (IBHH), housed in the School of Public and Population Health at the University of Texas Medical Branch at Galveston.


In April of 1970, both The University of Texas Graduate School of Biomedical Science at Houston and The University of Texas Medical Branch at Galveston sponsored the symposium "Humanism in Medicine" that would help shape and give impetus to the new institute that would emerge at UTMB in 1973. This new institute would be dedicated to medicine and the humanities.

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Cover of Clinical Practice in Pediatric Psychology

Dr. Lisa Campo-Engelstein and IBHH graduate student Grayson Jackson publish in Clinical Practice in Pediatric Psychology

Mar 13, 2024, 08:02 AM by IBHH

Objective: This article aims to explore ethical tensions in pediatric gender-affirming care and illustrate how these tensions arise in the clinical setting. Method: This article utilizes two de-identified cases of transgender youth—Emma and Jayden—as a framework for discussing ethical principles in pediatric gender-affirming care. Case summaries detail the medical history of these two patients, their familial context, and their encounters with healthcare providers. Subsequently, the ethics of both cases are synthesized. As represented in this work, these cases do not constitute Institutional Review Board-regulated human subjects research. Results: Emma’s parents want to forgo pubertal suppression and pursue hormone therapy, effectively skipping a step in the gender-affirming care standard for youth presenting in early puberty. Jayden’s parents, on the other hand, are skeptical of their son’s identity and resistant to pursuing treatment. Both cases reflect disparate health goals between youth and parents and offer insight into the ethical tensions of gender-affirming care for pediatric patients. Conclusions: Key ethical discussions center on the standard of care, treatment reversibility, and pediatric decision-making. Jayden’s parents resist the standard of care for pediatric transgender patients. In contrast, Emma’s parents seek an acceleration of the staged progression recommended in the standard-of-care guidelines. The degree of reversibility of the treatment option in question influences the deliberation of these cases because it is the provider’s ethical obligation to preserve the future rights and autonomy of pediatric patients. Finally, while capacity in children is not presumed, providers should actively involve pediatric patients in treatment decisions that are increasingly subjective.

Implications for Impact Statement:
The standard of care, treatment reversibility, and pediatric decision-making are three important considerations in the ethical provision of gender-affirming care for pediatric patients. Clinicians and decision-makers, including parents, ought to weigh the impact of each consideration on patient autonomy. Although the autonomy of pediatric patients is necessarily limited, steps should be taken to safeguard these patients’ future decision-making capacity and align with their healthcare goals and values to the fullest extent possible.

Citation (APA):
Jackson, G. R., Chen, D., Coyne, C., Donahue, K., & Campo-Engelstein, L. (2024). Ethics of pediatric gender-affirming care: A case study comparison. Clinical Practice in Pediatric Psychology, 12(1), 104–113.