Bioethical breaches of the Andalusian LGTBI Law

The bioethical violations in the Andalusian LGTBI Law have been blatant. Political correctness takes precedence over the best interests of the child.

INTRODUCTION

In this post I will try to present some aspects of the new Andalusian Anti-LGTBIphobia Law which, in my opinion, violates several principles of bioethics, especially the  the principles of beneficence, non-maleficence, justice, and totality. The articles of the Law that refer to comprehensive approach to transsexuality They disregard WHO recommendations, fail to consider advances in neuroscience, and disregard the most relevant clinical guidelines. This carries a heavy responsibility because it will be applied to a population that is inherently highly vulnerable: children and adolescents.

See: New Andalusian LGTBI law and its impact on children and families

Our analysis does not adhere to any particular bioethical doctrine, since the approaches of any ethics of maximalism I could not give an objective answer to the reflections on transsexuality here, as is clearly seen in the following section.

• Ethics of the highest ideals of the Catholic Church (A. Cortina)

The bioethical position that is officially held by Catholic Church It takes as a reference the encyclical Humane Vitae (HV) of Paul VI. According to HV, only the following are morally admissible: heterosexual relationships and within marriage (male/female); denies any contraceptive method that does not rely on natural methods, since every sexual act is necessarily oriented towards procreation. It speaks of the inseparability of unitive aspect y procreative of human sexuality. It uses the principle of totality to justify their doctrinal position

As one might obviously deduce, any non-heterosexual sexual relationship that does not occur within marriage and does not have a procreative purpose is morally reprehensible. It must be acknowledged that, while this is the official position of the Catholic Church and is reflected in the Catechism, not all opinions coincide.

I think that  Law to guarantee the rights of people who identify as LGBTI and to eradicate LGBTIphobia in Andalusia, It presents some ideological excesses that They do not respect the biopsychosocial reality of the person, nor the new advances in medical knowledge.

1. The different sexual orientations

We have known since 1989 Richard Troiden What are the stages a person goes through in building their own identity? homosexual identity and/or orientationThese stages are wonderfully described because they faithfully correspond to the reality experienced in the clinic. They are: 1. Awareness which is usually immediately before puberty, or even earlier. 2. Confusion Regarding orientation. It is normal that in a hegemonic heterosexual society, this stage occurs in which the adolescent is confronted with their biological sex and their sexual orientation. 3. Assumption of identity and 4. Commitment. It's a personal process that isn't always easy and often requires psychological help. Not to change one's identity or sexual orientation, which will fail in most cases, but to guide the person in deciding on their life path with the least possible psychological cost.

In short: it talks about treatment of homosexuality, There are even professionals who report having achieved “Therapeutic” successes. In this sense, when the sexual orientation is clearly homosexual, absolutely nothing can be achieved. homosexuality It is a gradient which ranges from strict homosexuality to bisexuality, including heterosexuality. Therefore, it is likely that the “therapeutic successes” occur in those cases possibly bisexual  where the individual represses one of the orientations (homo or heterosexual).

Therefore, sexual orientations would be: heterosexuality, the homosexuality and bisexuality. I feel that intersexuality and transsexuality They deserve a separate analysis taking into account, as I have been insisting, the current scientific data. 

2. Transsexuality or Gender Dysphoria

Transsexuality is included in the DSM 5 (APA, 2014) , the Gender dysphoria: In children (302.6, F64.2) and in adolescents and adults (302.85, F64.1). It forms part of the section on Sexual Dysfunctions.  Defines it as “a marked incongruity between the sex one feels or expresses and the one assigned, lasting a minimum of six months.”

In children: The individual must meet at least six of the eight proposed behavioral criteria, as well as criterion B, which refers to clinically significant distress or impairment in social, academic, or other important areas of functioning. It must be specified whether or not this is accompanied by a disorder of sexual development.

In adolescents and adults: They must meet at least two out of six criteria.

Why has DSM-5 removed the homosexuality and bisexuality of the classification system? Although some think it was done solely due to pressure from LGBT lobby, This is not entirely true. The fundamental reason is that, while there is no scientific data to support classifying homosexuality and bisexuality as mental disorders, in the case of gender dysphoriaScientific data, especially neuroscientific data, is becoming increasingly precise and supports the opposite.

Due to the objective of this post and the length it should have, I will only briefly present the current knowledge on the subject.

• Genetic findings

Negative investigations: Lombardi et al (2013); Fernández R et al (2015): No association between transsexualism and the ERβ, AR, and CYP19A1 genes related to hormone production.

Positive research: Fernández R et al (2014): Association between the ERβ gene and F/M transsexualism; Fernández R et al (2015): Association with a CYP17 MspA1 polymorphism greater in M/F than in F/M.

Therefore, although some positive findings are emerging, they are not yet conclusive in the sense that we can either definitively affirm or deny. the genetic implication in the etiopathogenesis of transsexuality.

• Functional brain alterations

It has been shown that transsexuals present some abnormalities in the functioning of the brain connectome and some changes have been observed in the microstructure of the cortex cerebral.

Brain information is regulated by neural networks who meet in nodes. and these on portals. The network that processes body image and its representation, giving rise to our subjectivity regarding our identity and awareness of it, is known. The functional importance of these networks is defined as Degree of CentralityThe greater the centrality, the more relevant it is in the function it performs.

In this way, both Functional Magnetic Resonance Imaging (fMRI)as per Diffusion MRICertain anomalies in the processing of corporeality and emotions have been highlighted in cases, especially M/F, of transsexuals: Zuo et al. (2012); Longo et al. (2010); Moratalla et al. (2016). Figure 1

Similarly, particularities have been found in voice processing depending on sex, Junger et al. (2014). These researchers found the involvement of structures such as the medial prefrontal gyrus, the island y the precuneus gyrus.

3. The Andalusian Anti-LGBT Law, transsexuality and bioethics

• Without going into too much detail, I believe that the confidentiality requirement, While enforceable and protected by law, the right to confidentiality has limits. The main one concerns when maintaining confidentiality will have negative consequences for the autonomy and right to information of others. Therefore, in situations where the constitutional rights of a third party are at stake, confidentiality should not be upheld. This is especially clear in cases where one wishes to maintain an intimate relationship with another person. Both parties should know each other's sexual orientation. Concealing it is deception and manipulation, and cannot be invoked under the right to confidentiality, as it infringes upon the other person's fundamental right to freedom of choice with full knowledge of the circumstances that condition their actions. (autonomy).

• But the most worrying aspect of the Law is everything related to the treatment of transsexuality.

Says the Fourth Additional Provision, at their point three y Regarding the modification of article Article 9 of Law 2/2014 of July 8: “Comprehensive care for transgender and intersex people, including minors, will be the same as that provided for all other users of the health system, without any possibility of conditioning endocrinological and/or surgical services "These people must first undergo a psychological or psychiatric examination.".

This provision is an attack on the Patients' rights and it is unconstitutional for denying, without any scientific basis and solely due to ideological prejudice, treatment, evaluation, and psychological support to people who need it. Furthermore, it is against the majority of the International Clinical Guidelines. ¹

– Gender dysphoria has very different causes than homosexuality and cannot be culturally compared to it at all.

– All the research points in the direction of confirming that we are facing a dysfunction in the processing of the body, therefore, with a neurobiological basis.

– Today it is included in all universally used classification systems for mental disorders.

– We are aware of the great suffering (dysphoria) and high suicide rates related to transsexualism.

– We are aware of the high psychiatric comorbidity that is often present in gender dysphoria.

• Therefore, we are in breach of the principle of non-maleficencesince we are fostering psychological complications and increased psychosocial risk by prohibiting assessment/intervention.
• We are failing to comply with the Principle of justiceBecause we are taking away the right of children and their families to receive care if they need it, and because we are depriving them of an interprofessional evaluation in a decision so crucial to their future,
• which contributes to violating another bioethical principle, the Principle of Totality, since we have abandoned the biopsychosocial view of the human being for another of culturalist ideology and clearly denying scientific knowledge.

We must also ask ourselves where the evaluation of Degree of Autonomy of the minor (Minor Maduro). It is unknown, or hidden, that any Guide on this subject must clearly address this; if we want the child to be autonomous (Principle of Autonomy) The individual must have the capacity for understanding; that is, their level of autonomy at the time of the decision must be assessed. This assessment is conducted by mental health professionals (clinical psychologist and/or child psychiatrist).

I acknowledge that many children and adolescents are benefiting from puberty blocking, although I know that many others are suffering serious psychiatric consequences for having opted for blocking interventions without having previously assessed the contraindications of the procedure.

1. For example, the "Dutch Protocol". Lease Steensma et al. Treatment of Adolescents With Gender Dysphoria in the Netherlands, 2011. Child and Adolescent Psychiatric Clinics of North America, 20 (2011): 689 – 700. A prior study, both psychological and psychiatric, is recommended to rule out comorbidities.