Ethical Justification for Gender Reassignment Surgery Without Parental Consent for Transgender Youth aged 16 years and older in South Africa

Abstract

This dissertation examines the ethical justification for permitting transgender youth aged 16 and older in South Africa (SA) to consent independently to gender-affirming surgery, provided they undergo a mental health assessment and receive ongoing support. The thesis contends that such youth may possess the competence to make informed decisions regarding their gender identity and, consequently, their healthcare choices. This argument is supported by three premises grounded in theoretical frameworks and empirical literature. First, it is argued that transgender youth aged 16 and older, when supplemented with mental health assessment, are capable of making informed decisions that align with their gender identity, underscoring respect for their autonomy. Second, gender-affirming surgery is viewed as crucial for facilitating social transitioning and enhancing well-being by alleviating gender dysphoria, a stance supported by utilitarianism. The ability to consent independently to surgery is posited to mitigate harm by addressing the psychosocial distress that delays in transition may cause. Third, the requirement of parental consent is identified as a barrier to healthcare access for transgender youth aged 16 - 18, especially when parents are unaccepting or lack understanding of gender identity issues, which can exacerbate gender dysphoria. Where parents are assistive or supportive, they should be involved, however, their involvement and consent should not be a requirement. This position is grounded on well-being theories. This study applies ethical principles and theories, specifically respect for autonomy and utilitarianism to argue that respecting the self- determined decisions of transgender youth aged 16 - 18 aligns with broader social imperatives to promote well-being and minimise harm. The justifications aim to contribute to the discourse on the autonomy of transgender youth aged 16 – 18 and gender-affirming surgery in SA.