跨身份和去精神病化:伦理问题。全国受训精神科医生调查

IF 0.5 4区 医学 Q4 PSYCHIATRY Annales medico-psychologiques Pub Date : 2024-04-01 DOI:10.1016/j.amp.2023.11.009
Eloïse Maakaron , Bérengère Saliba-Serre , Nicole Cano , Pierre Le Coz , Thierry Merrot
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引用次数: 0

摘要

本文重点探讨了与变性人(即性别与其出生时所分配的性别不符的人)的性别确认护理相关的伦理问题,尤其是在精神评估过程中尊重变性人自主权的问题。首先,我们对文献进行了回顾,以探讨性别的历史性、其定义和变化,以及性别认同的概念。为了确定性别认同与精神病学的关系,我们回顾了性别焦虑症在精神病学分类和指南中的演变过程,以及精神病学家在性别认同治疗过程中的作用。此外,还对变性人医疗护理的伦理问题进行了反思,包括选择的自主性、接受荷尔蒙-手术过渡的受益性和非渎职性,以及性别考虑演变过程中涉及的社会问题。我们通过网络调查进行了一项研究,并向在法国完成学业的精神科住院医师发出了一份调查问卷。共有 70 名受访者参与了调查。调查问卷要求住院医师就变性人在精神评估和心理投入过程中的自主权(以及如何尊重他们)发表意见。结果住院医师的回答表明,他们主要支持维护变性人的自主权,重点是他们的能力和自决权。相反,15% 的受访者认为变性人身份是一种精神障碍,更赞成以医学模式来治疗性别障碍。受访者仍然认为,在接受性别确认护理之前,有必要进行精神病学评估,以消除鉴别诊断,并评估知情同意的能力,然而,这可能会被认为是对变性人的过度病理化。另一方面,如果由心理学家进行咨询,这种病态化的感觉就会减弱。这些答案表明,有必要与相关个人的感受进行比较,以便对变性进行更合乎道德的管理。我们有理由提出这样的问题:我们是否可以在变性人自由选择的幌子下,让他们在没有经过医疗评估的情况下做出决定;个人的自主权是否必须优先于潜在的不可逆转的负面结果。通过这项研究,被抽样调查的精神科住院医师似乎感觉到,那些寻求变性治疗的人有一种病态化的感觉,而这种病态化的感觉是在开始性别确认治疗之前向精神科医生咨询所引起的。另一方面,如果咨询是由心理学家进行的,这种病态化的感觉就不那么重要了。这一假设显然应得到相关人员的确认。
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Transidentité et dépsychiatrisation : enjeux éthiques. Enquête nationale auprès des psychiatres en formation

Objectives

This article focuses on the ethical issues surrounding gender-affirming care for transgender people (i.e. A person whose gender does not correspond to their sex assigned at birth), particularly the respect of the rights of transgender patients to autonomy during psychiatric evaluations. This topic gives leave to a deeper investigation into the principles of non-maleficence when diagnosing gender dysphoria and into the principles of justice when providing essential medical care for transgender people in France.

Materials and methods

Firstly, a review of the literature was carried out in order to explore the historicity of sex, its definition and variations, and the concept of gender identity. To establish the latter's relationship to psychiatry, the evolution of gender dysphoria through psychiatric classifications and guidelines was reviewed, as well as the role of the psychiatrist in the process of gender-affirming treatment. A reflection was also carried out concerning the ethical issues of the medical care of trans people, through the autonomy of choice, beneficence and non-maleficence of access to the hormonal-surgical transition, and the societal issues involved in the evolution of the consideration of gender. A study was conducted via a websurvey and a questionnaire was sent to psychiatric residents completing their studies in France. A total of 70 respondents were included. The questionnaire asked residents to give their opinion on transgender people's right to autonomy (and how to respect them) during psychiatric assessments and psychological inputs.

Results

The answers from the residents indicate that they are mainly in favor of upholding transgender people's right to autonomy, with an emphasis on their capacity and their right to self-determination. Conversely, 15% of the respondents viewed transgender identities as a mental disorder and were more in favor of a medicalized model of treating gender dysphoria. A psychiatric assessment prior to receiving gender-affirming care was still perceived as necessary in order to eliminate differential diagnoses and to evaluate the capacity for informed consent, however, this may be perceived as excessive pathologization for transgender people. On the other hand, this feeling of pathologization is perceived as diminished if this consultation is performed by a psychologist. These answers suggest the necessity of carrying out a comparison with the feelings of the concerned individuals, for a more ethical management of transidentity.

Conclusion

The issue of meeting the demands of the transgender population is still being debated. It is legitimate to ask whether we can, under cover of their freedom of choice, let the persons concerned make the decision without having first undergone a medical evaluation, and whether the individual's autonomy must take precedence over potential irreversible negative outcomes. Through this study, it appears that the sampled psychiatry residents sense that those individuals seeking transgender care have the feeling of pathologization that is induced by a consultation with a psychiatrist before starting gender-affirming care. On the other hand, if the consultation is conducted by a psychologist this feeling of pathologization is less a factor. This assumption should obviously be affirmed with the concerned persons.

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来源期刊
Annales medico-psychologiques
Annales medico-psychologiques 医学-精神病学
CiteScore
1.30
自引率
33.30%
发文量
196
审稿时长
4-8 weeks
期刊介绍: The Annales Médico-Psychologiques is a peer-reviewed medical journal covering the field of psychiatry. Articles are published in French or in English. The journal was established in 1843 and is published by Elsevier on behalf of the Société Médico-Psychologique. The journal publishes 10 times a year original articles covering biological, genetic, psychological, forensic and cultural issues relevant to the diagnosis and treatment of mental illness, as well as peer reviewed articles that have been presented and discussed during meetings of the Société Médico-Psychologique.To report on the major currents of thought of contemporary psychiatry, and to publish clinical and biological research of international standard, these are the aims of the Annales Médico-Psychologiques.
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