Bioethics Blogs

What Would Aristotle Say About the Ethics of Publicly Subsidized Puberty-Blockers?


By Melani Shahin

In October 2014, Oregon became one of the few states to cover hormone suppressant therapy for transgender minors under Medicaid. The purpose of this treatment is to temporarily suppress puberty in transgender young people via hormone suppressant drugs, such as Lupron. While Oregon’s coverage of puberty blockers for minors under the state Medicaid plan increases the accessibility of this treatment, an interesting ethical question emerges for taxpayers, healthcare providers, and families: can minors truly give informed consent to this kind of medical treatment?

The treatment can be useful for several reasons: first, it is beneficial for minors who eventually want to medically transition because they will not develop the secondary sex characteristics of their assigned gender (such as breasts), which would later need to be altered or removed. Second, because the treatment is non-permanent and its effects are reversible, a minor can decide to end treatment and go through the puberty of their assigned sex, or to continue treatment until they begin to transition using cross-sex hormone therapy.

Though the use of puberty-blockers has been endorsed as a best practice for trans healthcare by the American Academy of Pediatrics, the treatment remains inaccessible to many families and young people because of its high cost. Indeed, Lupron injections can cost $7,500 for three months’ worth of treatment, which would add up to about $30,000 annually.

In order to investigate this modern question of the ethics of minors’ informed consent, it helps to reference an ancient source – the philosophy of Aristotle.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.