HCR 210 ASU Ethics Treating Gid Application of Gender Reproductive Health Discussion
Description
For this you will once again be asked to dialogue with your peers. You will need to post an initial post answering the question below (if you have post a word, period, or something other than your initial post you will lose points for this discussion). And remember this is a discussion board and “discussion” is required. Dialogue with your peers, ask clarifying questions, move the discussion forward in a way that demonstrates your understanding of the material, application of theory and principles, etc.
You will need to demonstrate the application of ethical theory and principles prior to making any ethical decision. Work through the ethical decision making process:
1. identify the ethical dilemma/issue
2. Gather all the facts
3. Apply ethical theory and principles
4. Identify the moral agents and possible values
5. Identify possible solutions
You will be graded on participation, application of the ethical decision making process, and citation of sources.
Remember that these are difficulty topics. Be respectful, “listen” to others, be open to other thoughts and opinions, and ask constructive questions. Any disruptive, disrespective, or otherwise inappropriate comments will decreased point totals.
Below is a case study for this discussion.
Children represent a small number of individuals with gender dysphoria and in only 10-20% of the children, gender dysphoria will continue to manifest in adolescence [5]. However, psychological therapy and support are highly recommended; while such services are now far more widely available, they are still insufficient to provide for complete wellbeing of these patients. Inadequate management of children with persistent gender dysphoria can lead to isolation, feeling of self-hatred, and suicidal ideas and attempts. Also, “passing through the wrong puberty” can have serious consequences for these individuals. Viable treatment options vary from fully reversible treatment, such as puberty-suppressing gonadotropin-releasing hormone analogues (GnRH) to partly reversible treatment, gonadal steroid treatment, as well as irreversible treatment, such as surgical removal of genitalia and reconstruction of new ones according to the desired gender. Surgery includes bilateral mastectomy with chest reconstruction, hysterectomy with oophorectomy followed by either metoidioplasty or phalloplasty for trans-male individuals, and bilateral orchiectomy with penectomy followed by vulvoplasty and vaginoplasty in trans-female individuals [6].
Pubertal suppression is implemented using GnRH analogues at Tanner 2 or 3 stage of puberty. Hypothalamus produces GnRH at low levels in prepubertal children. Levels become cyclical during puberty, leading to the production of luteinizing hormone (LH) and follicle stimulating hormone (FSH) by the anterior pituitary. LH and FSH stimulate ovaries and testicles to produce sex hormones, estrogen and testosterone, which are responsible for stimulating the growth of genitalia. Also, they lead to the development of breasts, voice deepening, menstrual cycle, and so forth, which transgender youth can find particularly tough to handle [7].
There are only a few reports related to the use of GnRH analogues in transgender youth. De Vries et al. were the first to introduce the concept and research on the use of puberty blockers for treatment of transgender youth. The main idea behind the suppression of endogenous puberty was to decrease distress by preventing the development of “noncongruent” secondary sexual characteristics. This would give young individuals more time to get accustomed to their situation and to better explore their gender. In the examined group, all of 70 eligible candidates showed improved mental health and general functioning. Authors concluded that the treatment was fully reversible, which was one of its main advantages [8]. Despite the positive outcomes in puberty suppression, many experts still have concerns and resist the implementation of this treatment in their regular practice. Viner et al. proposed that GnRH therapy can be physically damaging for teenagers and can lead to unfavorable psychological consequences [9]. Olson-Kennedy et al. also recognized these dilemmas, stating that available data on puberty suppression was limited and many questions remained unanswered [10]. One of the main reasons against this treatment is that going through puberty may help the individual to become congruent with their biological sex, meaning that their GD would not persist into adolescence. Results from Steensma et al. showed that majority of children developed homosexual orientation after completion of the GnRH treatment [11]. As for potential consequences, Hembree recently reported no long-term consequences in follow-up studies of GnRH treatment [12].
Finally, the decision about implementing GnRH treatment is very difficult and cannot be made without ethical dilemmas. Both opponents and advocates of pubertal suppression are guided by the same ethical principles, beneficence, nonmaleficence, and autonomy, but have different views on where these principles lead. A unique and clear overview is necessary, and, to this day, it has not yet been elaborated. Considering that GnRH treatment is relatively new and controversial, additional qualitative research and empirical studies are necessary for appropriate bioethical definitions.
HCR 210 ASU Ethics Treating Gid Application of Gender Reproductive Health Discussion
In-Text Citations: The Basics
Note: This page reflects the latest version of the APA Publication Manual (i.e., APA 7), which released in October 2019. The equivalent resource for the older APA 6 style can be found here.
Reference citations in text are covered on pages 261-268 of the Publication Manual. What follows are some general guidelines for referring to the works of others in your essay.
Note: On pages 117-118, the Publication Manual suggests that authors of research papers should use the past tense or present perfect tense for signal phrases that occur in the literature review and procedure descriptions (for example, Jones (1998) found or Jones (1998) has found…). Contexts other than traditionally-structured research writing may permit the simple present tense (for example, Jones (1998) finds).
APA Citation Basics
When using APA format, follow the author-date method of in-text citation. This means that the author’s last name and the year of publication for the source should appear in the text, like, for example, (Jones, 1998). One complete reference for each source should appear in the reference list at the end of the paper.
If you are referring to an idea from another work but NOT directly quoting the material, or making reference to an entire book, article or other work, you only have to make reference to the author and year of publication and not the page number in your in-text reference.
On the other hand, if you are directly quoting or borrowing from another work, you should include the page number at the end of the parenthetical citation. Use the abbreviation “p.” (for one page) or “pp.” (for multiple pages) before listing the page number(s). Use an en dash for page ranges. For example, you might write (Jones, 1998, p. 199) or (Jones, 1998, pp. 199–201). This information is reiterated below.
Regardless of how they are referenced, all sources that are cited in the text must appear in the reference list at the end of the paper.
In-text citation capitalization, quotes, and italics/underlining
* Always capitalize proper nouns, including author names and initials: D. Jones.
* If you refer to the title of a source within your paper, capitalize all words that are four letters long or greater within the title of a source: Permanence and Change. Exceptions apply to short words that are verbs, nouns, pronouns, adjectives, and adverbs: Writing New Media, There Is Nothing Left to Lose.
(Note: in your References list, only the first word of a title will be capitalized: Writing new media.)
* When capitalizing titles, capitalize both words in a hyphenated compound word: Natural-Born Cyborgs.
* Capitalize the first word after a dash or colon: “Defining Film Rhetoric: The Case of Hitchcock’s Vertigo.”
* If the title of the work is italicized in your reference list, italicize it and use title case capitalization in the text: The Closing of the American Mind; The Wizard of Oz; Friends.
* If the title of the work is not italicized in your reference list, use double quotation marks and title case capitalization (even though the reference list uses sentence case): “Multimedia Narration: Constructing Possible Worlds;” “The One Where Chandler Can’t Cry.”
SHORT QUOTATIONS
If you are directly quoting from a work, you will need to include the author, year of publication, and page number for the reference (preceded by “p.” for a single page and “pp.” for a span of multiple pages, with the page numbers separated by an en dash).
You can introduce the quotation with a signal phrase that includes the author’s last name followed by the date of publication in parentheses.
According to Jones (1998), “students often had difficulty using APA style, especially when it was their first time” (p. 199).
Jones (1998) found “students often had difficulty using APA style” (p. 199); what implications does this have for teachers?
If you do not include the author’s name in the text of the sentence, place the author’s last name, the year of publication, and the page number in parentheses after the quotation.
She stated, “Students often had difficulty using APA style” (Jones, 1998, p. 199), but she did not offer an explanation as to why.
LONG QUOTATIONS
Place direct quotations that are 40 words or longer in a free-standing block of typewritten lines and omit quotation marks. Start the quotation on a new line, indented 1/2 inch from the left margin, i.e., in the same place you would begin a new paragraph. Type the entire quotation on the new margin, and indent the first line of any subsequent paragraph within the quotation 1/2 inch from the new margin. Maintain double-spacing throughout, but do not add an extra blank line before or after it. The parenthetical citation should come after the closing punctuation mark.
Because block quotation formatting is difficult for us to replicate in the OWL’s content management system, we have simply provided a screenshot of a generic example below.
Formatting example for block quotations in APA 7 style.
QUOTATIONS FROM SOURCES WITHOUT PAGES
Direct quotations from sources that do not contain pages should not reference a page number. Instead, you may reference another logical identifying element: a paragraph, a chapter number, a section number, a table number, or something else. Older works (like religious texts) can also incorporate special location identifiers like verse numbers. In short: pick a substitute for page numbers that makes sense for your source.
Jones (1998) found a variety of causes for student dissatisfaction with prevailing citation practices (paras. 4–5).
A meta-analysis of available literature (Jones, 1998) revealed inconsistency across large-scale studies of student learning (Table 3).
SUMMARY OR PARAPHRASE
If you are paraphrasing an idea from another work, you only have to make reference to the author and year of publication in your in-text reference and may omit the page numbers. APA guidelines, however, do encourage including a page range for a summary or paraphrase when it will help the reader find the information in a longer work.
According to Jones (1998), APA style is a difficult citation format for first-time learners.
APA style is a difficult citation format for first-time learners (Jones, 1998, p. 199).
Description
For this you will once again be asked to dialogue with your peers. You will need to post an initial post answering the question below (if you have post a word, period, or something other than your initial post you will lose points for this discussion). And remember this is a discussion board and “discussion” is required. Dialogue with your peers, ask clarifying questions, move the discussion forward in a way that demonstrates your understanding of the material, application of theory and principles, etc.
You will need to demonstrate the application of ethical theory and principles prior to making any ethical decision. Work through the ethical decision making process:
1. identify the ethical dilemma/issue
2. Gather all the facts
3. Apply ethical theory and principles
4. Identify the moral agents and possible values
5. Identify possible solutions
You will be graded on participation, application of the ethical decision making process, and citation of sources.
Remember that these are difficulty topics. Be respectful, “listen” to others, be open to other thoughts and opinions, and ask constructive questions. Any disruptive, disrespective, or otherwise inappropriate comments will decreased point totals.
Below is a case study for this discussion.
Children represent a small number of individuals with gender dysphoria and in only 10-20% of the children, gender dysphoria will continue to manifest in adolescence [5]. However, psychological therapy and support are highly recommended; while such services are now far more widely available, they are still insufficient to provide for complete wellbeing of these patients. Inadequate management of children with persistent gender dysphoria can lead to isolation, feeling of self-hatred, and suicidal ideas and attempts. Also, “passing through the wrong puberty” can have serious consequences for these individuals. Viable treatment options vary from fully reversible treatment, such as puberty-suppressing gonadotropin-releasing hormone analogues (GnRH) to partly reversible treatment, gonadal steroid treatment, as well as irreversible treatment, such as surgical removal of genitalia and reconstruction of new ones according to the desired gender. Surgery includes bilateral mastectomy with chest reconstruction, hysterectomy with oophorectomy followed by either metoidioplasty or phalloplasty for trans-male individuals, and bilateral orchiectomy with penectomy followed by vulvoplasty and vaginoplasty in trans-female individuals [6].
Pubertal suppression is implemented using GnRH analogues at Tanner 2 or 3 stage of puberty. Hypothalamus produces GnRH at low levels in prepubertal children. Levels become cyclical during puberty, leading to the production of luteinizing hormone (LH) and follicle stimulating hormone (FSH) by the anterior pituitary. LH and FSH stimulate ovaries and testicles to produce sex hormones, estrogen and testosterone, which are responsible for stimulating the growth of genitalia. Also, they lead to the development of breasts, voice deepening, menstrual cycle, and so forth, which transgender youth can find particularly tough to handle [7].
There are only a few reports related to the use of GnRH analogues in transgender youth. De Vries et al. were the first to introduce the concept and research on the use of puberty blockers for treatment of transgender youth. The main idea behind the suppression of endogenous puberty was to decrease distress by preventing the development of “noncongruent” secondary sexual characteristics. This would give young individuals more time to get accustomed to their situation and to better explore their gender. In the examined group, all of 70 eligible candidates showed improved mental health and general functioning. Authors concluded that the treatment was fully reversible, which was one of its main advantages [8]. Despite the positive outcomes in puberty suppression, many experts still have concerns and resist the implementation of this treatment in their regular practice. Viner et al. proposed that GnRH therapy can be physically damaging for teenagers and can lead to unfavorable psychological consequences [9]. Olson-Kennedy et al. also recognized these dilemmas, stating that available data on puberty suppression was limited and many questions remained unanswered [10]. One of the main reasons against this treatment is that going through puberty may help the individual to become congruent with their biological sex, meaning that their GD would not persist into adolescence. Results from Steensma et al. showed that majority of children developed homosexual orientation after completion of the GnRH treatment [11]. As for potential consequences, Hembree recently reported no long-term consequences in follow-up studies of GnRH treatment [12].
Finally, the decision about implementing GnRH treatment is very difficult and cannot be made without ethical dilemmas. Both opponents and advocates of pubertal suppression are guided by the same ethical principles, beneficence, nonmaleficence, and autonomy, but have different views on where these principles lead. A unique and clear overview is necessary, and, to this day, it has not yet been elaborated. Considering that GnRH treatment is relatively new and controversial, additional qualitative research and empirical studies are necessary for appropriate bioethical definitions.
