Assignment task:
Topic & Background Knowledge:
I chose the topic of gender affirming care. For the purpose of this discussion, I will use the term gender affirming care to mean the medical, social, and psychological support that trans people receive when their gender identification deviates from the sex they were assigned at birth. This is an issue that is widely discussed due to the court case U.S. v. Skrmetti, which is actually set to be heard tomorrow, December 4, 2024, by the Supreme Court. (Burga, 2024) Senate Bill 1 (SB1) became law in Tennessee in 2023, and it forbids physicians from recommending medication and surgery to transgender children who are considering gender transformation. In particular, the American Medical Association defines care as counseling regarding changes in a child's social expression (such as a change in name or hairdo), hormone therapy, puberty blockers, or surgery. (American Psychological Association, 2024) This is important because, according to the Williams Institute at UCLA School of Law, there are over 3,000 transgender teenagers in Tennessee and around 300,000 transgender youths between the ages of 13 and 17 in the United States. (UCLA School of Law, 2023) The result of this court case can influence on legislation that limits adult care as well.
Legal & Ethical Points (Negligence/Malpractice)
According to a recent Trevor Project study that was published in the journal Nature Human Behavior, anti-transgender legislation have led to an increase in suicide attempts among transgender and nonbinary kids. (Lee et al., 2024) Clinically and morally, caring for suicidal patients is difficult. It is legally required of practitioners to actively prevent a patient from taking their own life. Therefore, it is essential that they understand the ethical and legal obligations associated with their position. Three major categories of ethical issues were found in a 2021 journal article on the moral dilemmas of suicide care: (1) ethical problems resulting from acute care settings and discrete decisions, (2) ethical problems resulting from therapeutic relationships and chronic care, and (3) organizational factors and their impact on care [7]. Potential common problems were found in all three groups, such as involuntary hospitalization, therapeutic connections between health care professionals and suicidal patients, and problems with healthcare providers' training and readiness to treat suicidal patients.
(Montreuil et al., 2021)
The treatment of suicidal patients can be both a legal and ethical concern. However, another legal concern comes to mind in regard to this law. Gender dysphoria is a diagnosis that an individual who identifies as transgender may have. The PMHNP may encounter a patient in their care with whom they are asked to work on an interdisciplinary team. The PMHNP then could be called to court for any action or inaction that they participate in while treating the patient. According to the Tennessee bill, providers who violate SB1 will be disciplined under Title 63 of the Tennessee code, which governs health professions (class B misdemeanor). Also outlined is the attorney general's direct enforcement authority, regardless of consent. The right to file a wrongful death lawsuit, particularly in cases when a youngster dies as a result of emotional or physical abuse without the parents' knowledge or permission is given. (SB0001, Tennessee, 2023) If the PMHNP is named in a suit it could affect so many other areas such as insurance, licensure, job prospects just to name a few.
Care of Children vs Adults (Informed Consent)
When caring for children, parental consent must be considered. A multifaceted strategy is necessary for children and adolescents, taking into account their stage of development, neurocognitive function, and language skills. Mental health assistance should be provided, and the advantages and disadvantages of social transition should be discussed. Adults are capable of giving their informed permission, but it is important to consider their physical and mental health. (Poteat et al., 2023). Need Online Tutoring?