First Do No Harm: What the Experts in Ethics Actually Say
Seven doctors who specialise in medical ethics explain why banning trans healthcare is the unethical choice
First do no harm.
You hear this phrase a lot when people talk about transgender healthcare. Critics say that giving young trans people medical treatment breaks this basic rule of medicine. They call it unethical, experimental, harmful.
But what do the people who actually specialise in medical ethics think?
Seven of them have just spoken out1. These are doctors whose whole job is working out what is right and wrong in medicine. They include children’s doctors, critical care specialists, and cancer specialists who also work in ethics. They have looked at the evidence and the arguments, and their verdict is clear.
Banning this care is the unethical position. Not providing it.
Here is why their argument matters. When people say “first do no harm,” they usually only think about one type of harm: the risks of treatment. But that is only half the picture. You also have to think about what happens if you do not treat someone.
These ethics experts point out that refusing care causes real harm too. Young people who cannot access treatment experience higher rates of suicidal thoughts. They go through permanent physical changes that do not match who they are, things like voice deepening or breast development that cannot be undone. They experience serious distress that can derail their whole adolescence.
If you genuinely care about doing no harm, you have to weigh up both sides. And when you do that, the ethics experts say, banning care is the harmful choice.
What about the claim that there is no evidence this care helps? The experts call this out directly. They point to studies showing real benefits. They quote Gordon Guyatt, the doctor who actually invented the term “evidence-based medicine.” He says: “There is, I would say, quite good evidence from the accounts of the individuals who have undergone the therapy, that they were really benefited by the therapy.”
When the person who literally coined the phrase “evidence-based medicine” says the evidence supports this care, that should mean something.
The ethics experts also tackle the question of who should make these decisions. They explain that good care involves the young person, their parents, and their doctor all working together. It is not, as some people claim, pushed on children by doctors or demanded by confused teenagers acting alone. This kind of shared decision-making is how all good children’s medicine works.
Their conclusion?
“These types of decisions belong in the hands of those most intimately impacted: the patient, their family, and expert clinicians, not the government.”
And they end with a warning that is hard to ignore: “It is not an exaggeration that more transgender and non-binary minors will suffer and die if these recommendations are enacted.”
These are not activists. They are not politicians with an agenda. They are professionals whose entire career is spent thinking carefully about what is ethical in medicine. And they are telling us that banning this care will cause serious harm.
First do no harm means thinking about all the harm, not just the harm that fits your argument.
The US government is accepting public comments on this proposed ban until 17 February.
If you want to have your say, links are available in the original STAT News article.