This podcast is an audio repository of Florence Ashley‘s scholarly writing on trans law, bioethics, and more!
Interrogating gender-exploratory therapy
Florence Ashley, “Interrogating Gender-Exploratory Therapy” (2022) Perspectives on Psychological Science
Abstract: Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around “gender exploratory therapy” as a proposed alternative. Whereas gender-affirmative approaches follow the client’s lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities or gender dysphoria. Few detailed descriptions of the approach’s parameters have been offered. In this article, I invite clinicians to reflect on gender-exploratory therapy through a series of questions. The questions are followed by an exploration of the strong conceptual and narrative similarities between gender-exploratory therapy and conversion practices. Finally, the ethical dimensions of gender-exploratory therapy are discussed from the lenses of therapeutic neutrality, patient-centered care, loving attention, and therapeutic alliance, suggesting that the approach may be unethical.
Adolescent medical transition is ethical: an analogy with reproductive health
Florence Ashley, “Adolescent Medical Transition is Ethical: An Analogy with Reproductive Health” (2022) 32:2 Kennedy Institute of Ethics Journal, 127–71
Abstract: In this article, I argue that adolescent medical transition is ethical by analogizing it to abortion and birth control. The interventions are similar insofar as they intervene on healthy physiological states by reason of the person's fundamental self-conception and desired life, and their effectiveness is defined by their ability to achieve patients' embodiment goals. Since the evidence of mental health benefits is comparable between adolescent medical transition, abortion, and birth control, disallowing transition-related interventions would betray an unacceptable double standard. While great enough risks can override autonomy over fundamental aspects of personal identity, I demonstrate that the available scientific evidence does not corroborate the view that adolescent medical transition is dangerous. Consequently, adolescent medical transition should be recognized as ethical and remain available.
‘Trans’ is my gender modality
Florence Ashley, “‘Trans’ Is My Gender Modality: A Modest Terminological Proposal” in Trans Bodies, Trans Selves, 2nd ed. (Oxford: Oxford University Press, 2022) at 22
Abstract: Currently, no word exists in our vocabulary for the broad category which includes being trans and being cis. To address this gap, I propose the adoption of a new term: gender modality. Gender modality refers to how a person’s gender identity stands in relation to their gender assigned at birth. It is an open-ended category which includes being trans and being cis and welcomes the elaboration of further terms which speak to the diverse experiences people may have of the relationship between their gender identity and gender assigned at birth.
(Link to article)
Youth should decide: the principle of subsidiarity in paediatric transgender healthcare
Florence Ashley, “Youth should decide: the principle of subsidiarity in paediatric transgender healthcare” (2022) Journal of Medical Ethics (online first)
Abstract: Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, such as parents or judges, if lower level decision-makers are incapable of satisfactorily addressing the issue even with support and the higher level decision-maker is better positioned to satisfactorily address the issue than all lower level decision-makers. Because gender uniquely pertains to personal identity and self-realisation, parents and judges are rarely better positioned to make complex medical decisions. Instead of taking away trans youth’s authority over their healthcare decisions, we should focus on supporting their ability to take the best possible decision for themselves.
(Link to article)
The constitutive in/visibility of the trans legal subject
Florence Ashley, “The Constitutive In/Visibility of the Trans Legal Subject: A Case Study” (2021) 28:1 UCLA Women’s Law Journal 423–57
Abstract: The language of law creates the transgender subject by fabricating a legal conception of sex or gender which, for a long time, excluded trans people. Using Québec law as a case study, the article analyzes the law’s narratives of gender to highlight two conceptual phases. Through these two models – the medical and minoritizing models – Québec law first chronicles the existence of trans people as a transitional and liminal moment between two binary states of being, while the minority model sees transitude as an exceptional reality that is defined by its opposition to the dominant social framework. The two abovementioned visions follow each other historically and reveal the evolution of trans legal subjecthood. Despite recent progress, more remains to be done in order to truly include trans people as usual subjects of law.
(Link to article)
The clinical irrelevance of ‘desistance’ research for transgender and gender creative youth
Florence Ashley. “The Clinical Irrelevance of ‘Desistance’ Research for Transgender and Gender Creative Youth” (2021) Psychology of Sexual Orientation and Gender Diversity
Abstract: In recent years, the suggestion that over 80% of trans and gender creative children will grow up cisgender has been strongly criticized in the academic literature. Although concerns over the methodology of these studies, known as desistance research, has shed considerable doubt regarding the validity of the reported number, less attention has been paid to the relevance of desistance research to the choice of clinical model of care. This article analyzes desistance research and concludes that the body of research is not relevant when deciding between models of care. Three arguments undermining the relevance of desistance research are presented. Drawing on a variety of concerns, the article highlights that “desistance” does not provide reasons against prepubertal social transition or peripubertal medical transition, that transition for “desisters” is not comparably harmful to delays for trans youth, and that the wait-and-see and corrective models of care are harmful to youth who will grow up cis. The assumed relevance of desistance research to trans youth care is therefore misconceived. Thinking critically about the relationship between research observations and clinical models of care is essential to progress in trans health care.