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Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?

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Abstract
The commonly used Standards of Care for people with gender dysphoria, including those of the World Professional Association for Transgender Health and The Royal College of Psychiatrists in the United Kingdom, as well as those standards used in many other countries, usually require that two signatures of approval from qualified mental health professionals be provided before genital reconstructive surgery (GRS) - sometimes called sexual reassignment surgery or gender confirmation surgery - is undertaken. This is different from surgeries which are similarly irreversible and remove reproductive capacity carried out on cisgender people. This paper explores the trans-specific issues from a standpoint of medical ethics and argues that, provided sufficient safeguards are in place, including assessment within a multidisciplinary team, a nuanced approach utilising a single signature may instead be appropriate.
Keywords
OUTCOMES, MALE-TO-FEMALE, SEX REASSIGNMENT SURGERY, GENDER IDENTITY DISORDER, medical ethics, transgender, trans-sexualism, Standards of Care, genital reconstructive surgery, gender dysphoria, DIAGNOSES, PSYCHIATRIC COMORBIDITY, TRANSSEXUAL PERSONS, UNITED-KINGDOM, DYSPHORIA, HEALTH

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MLA
Bouman, WP, C Richards, RM Addinall, et al. “Yes and Yes Again: Are Standards of Care Which Require Two Referrals for Genital Reconstructive Surgery Ethical?” SEXUAL AND RELATIONSHIP THERAPY 29.4 (2014): 377–389. Print.
APA
Bouman, WP, Richards, C., Addinall, R., de Montis, I., Arcelus, J., Duisin, D., Esteva, I., et al. (2014). Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical? SEXUAL AND RELATIONSHIP THERAPY, 29(4), 377–389.
Chicago author-date
Bouman, WP, C Richards, RM Addinall, IA de Montis, J Arcelus, D Duisin, I Esteva, et al. 2014. “Yes and Yes Again: Are Standards of Care Which Require Two Referrals for Genital Reconstructive Surgery Ethical?” Sexual and Relationship Therapy 29 (4): 377–389.
Chicago author-date (all authors)
Bouman, WP, C Richards, RM Addinall, IA de Montis, J Arcelus, D Duisin, I Esteva, A Fisher, F Harte, B Khoury, Z Lu, A Marais, A Mattila, DN Reddy, TO Nieder, RR Garcia, OM Rodrigues Jr, AR Guerra, D Tereshkevich, Guy T’Sjoen, and D Wilson. 2014. “Yes and Yes Again: Are Standards of Care Which Require Two Referrals for Genital Reconstructive Surgery Ethical?” Sexual and Relationship Therapy 29 (4): 377–389.
Vancouver
1.
Bouman W, Richards C, Addinall R, de Montis I, Arcelus J, Duisin D, et al. Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical? SEXUAL AND RELATIONSHIP THERAPY. 2014;29(4):377–89.
IEEE
[1]
W. Bouman et al., “Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?,” SEXUAL AND RELATIONSHIP THERAPY, vol. 29, no. 4, pp. 377–389, 2014.
@article{5775878,
  abstract     = {The commonly used Standards of Care for people with gender dysphoria, including those of the World Professional Association for Transgender Health and The Royal College of Psychiatrists in the United Kingdom, as well as those standards used in many other countries, usually require that two signatures of approval from qualified mental health professionals be provided before genital reconstructive surgery (GRS) - sometimes called sexual reassignment surgery or gender confirmation surgery - is undertaken. This is different from surgeries which are similarly irreversible and remove reproductive capacity carried out on cisgender people. This paper explores the trans-specific issues from a standpoint of medical ethics and argues that, provided sufficient safeguards are in place, including assessment within a multidisciplinary team, a nuanced approach utilising a single signature may instead be appropriate.},
  author       = {Bouman, WP and Richards, C and Addinall, RM and de Montis, IA and Arcelus, J and Duisin, D and Esteva, I and Fisher, A and Harte, F and Khoury, B and Lu, Z and Marais, A and Mattila, A and Reddy, DN and Nieder, TO and Garcia, RR and Rodrigues, OM, Jr and Guerra, AR and Tereshkevich, D and T'Sjoen, Guy and Wilson, D},
  issn         = {1468-1994},
  journal      = {SEXUAL AND RELATIONSHIP THERAPY},
  keywords     = {OUTCOMES,MALE-TO-FEMALE,SEX REASSIGNMENT SURGERY,GENDER IDENTITY DISORDER,medical ethics,transgender,trans-sexualism,Standards of Care,genital reconstructive surgery,gender dysphoria,DIAGNOSES,PSYCHIATRIC COMORBIDITY,TRANSSEXUAL PERSONS,UNITED-KINGDOM,DYSPHORIA,HEALTH},
  language     = {eng},
  number       = {4},
  pages        = {377--389},
  title        = {Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?},
  url          = {http://dx.doi.org/10.1080/14681994.2014.954993},
  volume       = {29},
  year         = {2014},
}

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