The “affirming” healthcare model for gender-distressed youth is endorsed by the medical establishment in the United States, but many European nations have retreated from it. This controversy would be expected to attract the interest of philosophers and bioethicists, with a diverse range of opinions appearing in academic articles. However, when philosophers and bioethicists have ventured into print, they have almost invariably endorsed the affirmative approach, which involves life-changing medical interventions on children with psychological problems. This is a sign that the (...) process of academic research and writing is not functioning as it should. -/- We recount the failure of philosophy and bioethics to address the issues raised by gender-affirming healthcare. We also offer an explanation of this failure, and in the final section make some recommendations for improving academic integrity. (shrink)

This commentary responds to the article “What Is the Aim of Pediatric ‘Gender‐Affirming’ Care?,” by Moti Gorin, in the same issue of the journal. Gender‐affirming care is often treated as exceptional and subject to heightened scrutiny. This exceptionalization results in its being held to stricter evidentiary standards than other forms of medical interventions are. But values and value judgments are inextricable from the practice of evidence‐based medicine. For gender‐affirming care, values shape what counts as “strong” evidence, whether the legitimacy of (...) transgender identity is assumed versus treated as something to be investigated, how to characterize the testimonial accounts of trans and gender‐nonconforming patients, and more. We argue that these kinds of questions are part of the practice of medicine, not exceptional to transgender people and gender‐affirming care. However, litigation of evidence for gender‐affirming care in state and national policy underscores the moral urgency of thinking carefully about what values ought to guide evidence. (shrink)