It’s been 60 years since the notion of situational ethics came into vogue. The 1966 release of Joseph Fletcher’s book Situation Ethics: The New Morality was well suited to the anti-establishmentarianism of the era, positing what Merriam-Webster defines as “a system of ethics by which acts are judged within their contexts instead of by categorical principles.”
Situational ethics is a pretty squishy concept. According to an analysis by the BBC, “It may approve of 'evil' acts. Situation ethics teaches that particular types of action don't have an inherent moral value - whether they are good or bad depends on the eventual result.” The goodness or badness of any result is variable, depending on how one defines good and evil.
Today, we’re witnessing a parallel within the medical profession, resulting in what may be considered situational science. It began on February 3, when the American Society of Plastic Surgeons (ASPS) altered its guidance for gender surgery on minors, citing “insufficient evidence” on whether irreversible procedures on children are appropriate.
In the wake of the ASPS announcement, NBC News reported the organization “did not conduct an independent evidence assessment or take other steps that would be involved in setting new care guidelines.” It would appear that the context of transgender surgery has changed: New situation, new policy. We’ve all seen this before. COVID-19 and global warming come to mind.
One day after the ASPS changed its position, the American Medical Association (AMA) followed suit. “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood,” said the nation’s largest organization for physicians. The New York Times noted, “In its previous public statements, the AMA opposed efforts to restrict gender-related care for young people.” Again, we see a change in context, and a policy shift reflecting a new situation.
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Within 24 hours, two of the nation’s largest medical associations announced significant changes to their recommendations on transgender interventions for children who, along with their parents, believe chemicals or surgical mutilation is a good idea. What situational context might account for this sea change?
The unspoken but fairly obvious predicate for these changes is the January 30 New York State jury award of $2 million to Fox Varian. The 22-year-old woman sued her former psychologist and surgeon for malpractice after her healthy breasts were removed when she was 16. ASPS and the AMA can characterize their decisions however they want, but the absence of any new medical research on the issue suggests that situational science is at play.
The thing that makes the revised ASPS and AMA recommendations more interesting is that the Varian case was not about chemical or surgical interventions in cases involving minors alone. “All patients, regardless of the nature of their treatment, are entitled to medical care that meets established and accepted standards of practice,” wrote the woman’s lawyer Adam Deutsch.
What exactly are the “established and accepted standards of practice,” for medical interventions on people with clinical transgenderism or those deceived by transgender ideology? This week, they’re one thing. A week ago, they were something different. What will they be next month? We don’t know; situational science may change the standards of medical care yet again. There was no new research to account for the recent shifts by the ASPA and the AMA, so perhaps it was some other situation - like a successful lawsuit.
Like transgender ideology itself, it appears treating it can also be fluid. The shifting standards of care leave doctors in the unenviable position of navigating unclear and changeable guidance. Perhaps more vexing, as argued in the Varian case, is that proper treatment isn’t limited to children. How many adults were provided similarly inadequate counsel and treatment prior to irreversible medical intervention? Conventional wisdom suggests the floodgates are open for future lawsuits by families whose children were subject to transgender treatments like those revised by the ASPS and the AMA. But it may be that the universe of potential plaintiffs is much larger than anticipated.
These capricious changes to standards of care may have inadvertently exposed more medical professionals to liability for past actions; good tort lawyers have a knack for seeking and finding chinks in the armor of defendants. Situational science may just have provided another avenue for seeking damages against those who wrongly subjected adults to irreversible, life altering damage.
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