First, Do No Harm? Pediatric Transgender Procedures, Detransition & Medical Ethics

What does “do no harm” mean when medicine itself cannot agree on what constitutes harm?Texas Children’s has reached a settlement requiring it to end specified pediatric gender-transition procedures, provide detransition care, and permanently exclude five physicians from its system. Cleveland Clinic and Connecticut Children’s have also reached federal agreements. Meanwhile, CMS is ending federal Medicaid and CHIP funding for specified procedures for minors, while the AMA and American Academy of Pediatrics continue to support access to evidence-based gender-affirming care.Doc G and the Discussants look past the slogans and ask the harder questions: What does the evidence actually establish? Why were five Texas physicians singled out? How much can a child understand about potentially irreversible treatment? What do parents owe their children? And when institutions disagree, what does the physician owe the patient?Because “first, do no harm” is easy when everyone agrees about what harm is. The difficult cases begin when they don't.