Informed consent is both an ethical and a legal requirement for medical treatment. It can largely be traced back to the Nuremberg Code — a set of post-World War II principles concerning human experimentation that appear to be lost on a growing class of American health care professionals.

While the legal particulars vary from state to state, informed consent universally requires that health care providers educate their patients with relevant and accurate information about all risks, burdens, expected benefits, and alternatives pertaining to a given procedure or intervention.

This ethical guideline is especially true of elective medical interventions that pose significant risks, have life-changing impacts, and are irreversible, such as those that fall under the umbrella of so-called "gender-affirming care."

When it comes to sex-change procedures, supportive health care professionals and government-commissioned investigators alike have indicated that informed consent may be hard to secure, if not impossible — not only for adolescent patients and their parents but for many adult patients as well.

For insights into the problem of informed consent in the controversial field of gender medicine as well as into related issues, Blaze News recently spoke to Dr. Melanie Crites-Bachert, a urologist and osteopathic surgeon with expertise in pelvic reconstruction, as well as to Dr. Miriam Grossman, the board-certified child and adolescent psychiatrist who authored the 2023 book "Lost in Trans Nation: A Child Psychiatrist’s Guide Out of the Madness," for which Dr. Jordan Peterson penned the foreword.

While Blaze News also contacted a host of academics in medical ethics and various medical associations, such as the American Urological Association, they were not similarly forthcoming on the issue of informed consent as it pertains to "gender-affirming care."

'There is not a reliable evidence base upon which to make clinical decisions.'

Whereas medical establishments in other Western nations are waking up to the reality that the sex-change industry relies upon pseudoscience and false value propositions, mainline medical institutions and health care providers in the United States appear to be leaning harder into this exceptionally lucrative business of which the fallout, too, will likely pay dividends.

Drs. Grossman and Crites-Bachert both indicated there might ultimately be a legislative and litigable reckoning — far beyond what has already come to pass — but that in the meantime, many more victims incapable of providing informed consent will be created and fashioned into lifelong patients.

Faulty information cannot inform consent

Dr. Hilary Cass, an esteemed British medical doctor who previously served as president of the Royal College of Pediatrics and Child Health, was commissioned by NHS England to lead a penetrating investigation into the U.K.’s sex-change regime and its youth-facing services. Her final report came out earlier this year, painting a damning picture of "gender-affirming care."

Among the Cass Review's many conclusions was that where so-called gender science is concerned, "there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices."

The Cass Review commissioned the University of York to undertake a series of systematic reviews to "provide the best available collation of published evidence relevant to epidemiology, clinical management, models of care and outcomes."

While the field of so-called gender science is crowded with "research," the systematic reviews determined that most of it is of "poor quality," demonstrating "poor study design, inadequate follow-up periods and a lack of objectivity in reporting of results."

In the case of puberty blockers and cross-sex hormones, the review made clear that the uses "are unproven and benefits/harms are unknown."

"In addition to this making it difficult for clinicians to know whether these are appropriate treatments to offer, it is also challenging to provide children, young people and families with sufficient information on which to make an informed choice," said the review. "The duty of information disclosure is complicated by many 'unknown unknowns' about the long-term impacts of puberty blocker and/or masculinizing/feminizing hormone during a dynamic developmental period when gender identity may not be settled."

While some health care providers might accept activists' suggestion that a failure to transition minors might mean they will alternatively kill themselves, the review — as well as other studies — indicated there was no evidence to suggest that "gender-affirmative treatments reduce this."

Too young, too desperate, too complicated

The problem of informed choices and consent also came up in leaked internal communications from the World Professional Association for Transgender Health — the self-identified medical organization that wrote the go-to standards of care for "the health of transsexual, transgender, and gender nonconforming people" cited in policy statements and guidance by numerous mainstream medical associations and organizations in the United States, including the American Academy of Pediatrics.

Journalist Mia Hughes highlighted in her 242-page report, published in March by Michael Shellenberger's think tank, Environmental Progress, that WPATH-affiliated health care professionals "admit[ted] to the impossibility of getting proper informed consent for hormonal interventions from their young patients."

The WPATH criteria for surgery, which largely overlaps with its criteria for hormone treatment, indicates an adult patient must: demonstrate capacity to consent to the specific surgical intervention; understand the effect of the intervention on reproduction and have explored reproductive options; undergo an assessment for mental health and physical conditions "that could negatively impact the outcome of gender-affirming surgical intervention"; and be stable on his or her "hormonal treatment regime."

Adults and adolescents alike need only one letter of assessment recommending a sex-change medical intervention.

In the case of adults, that single letter must come from a "health care professional who has competencies in the assessment of transgender and gender diverse people." In the case of children, the letter, if required, "needs to reflect the assessment and opinion from the team that involves both medical and mental health professionals."

It appears that, in practice, these criteria may be just smoke and mirrors and that informed consent is a bridge too far.

Canadian endocrinologist Daniel Metzger is quoted in the report as indicating during a May 6, 2022, internal WPATH panel that gender doctors are "often explaining [medical treatments] to people who haven’t even had biology in high school yet" and that even adult patients are often unable to comprehend the effects of sex-change interventions.

'We're fighting against the community's desire to have less gatekeeping.'

Another WPATH member, Dianne Berg, a co-author of the child chapter of the organization's child Standards of Care 8, indicated that while adolescents are not mature enough to understand "the extent to which some of these medical interventions are impacting them," some parents also lack the requisite health literacy to understand the treatments.

"What really disturbs me is when the parents can't tell me what they need to know about a medical intervention that apparently they signed off for," said Berg.

Berg cast doubt on whether the status quo in the sex-change industry was "what we need to be doing ethically."

Jamison Green, a former WPATH president and transvestite rights activist, is quoted in the leaked communications as admitting some patients "look at an informed consent form that says, 'Your hormones are going to do this, this, and this.' They don’t take any of that in yet because they're so scared that they're not going to get what they need. They, they just go, 'Show me where to sign.'"

Green stated, "We're fighting against the community's desire to have less gatekeeping, less professional intrusion, less spending time in doctors' offices. And how do we manage that and make sure that everybody's got the right level of education to make good decisions for themselves? So this is a problem that we're facing."

A surgeon's insights

Dr. Melanie Crites-Bachert is board-certified by the American Osteopathic Board of Surgery and is a fellow of both the American College of Osteopathic Surgeons and the American College of Surgeons. She recently told Blaze News, "Informed consent is severely lacking here. You're not giving patients all of the information that they need to make these types of decisions, especially minors."

Having worked as one of the top pelvic reconstruction surgeons in Portland, Oregon, and having previously bought in to a surgery center as a partner, Crites-Bachert knows what is involved in making sure that patients know their options, the risks involved, and what to expect in the wake of a major medical procedure such as an orchiectomy, urinary diversion, vaginoplasty, and other transformative procedures — surgeries she has performed on those who need them, contra those who simply want them.

'To amputate a penis is $804.'

Crites-Bachert also knows that sex-change surgeries — which she has refused to have any part in — are big moneymakers.

"A lot of these surgeries can be done in a surgery center. They are very lucrative with reimbursement," Crites-Bachert told Blaze News. "If somebody were going to have an orchiectomy or castration — my former biller pulled up this information — the Medicare reimbursement is $324. To amputate a penis is $804. Now, keep in mind, therapeutically, you sometimes do need to amputate a penis if there's penile cancer or things like that, but purely amputating a penis is $804. A hysterectomy, an abdominal hysterectomy, is a little over $1,000. A vaginoplasty, which is basically reconstructing the vagina for things like trauma, is $1,161."

The surgeon noted that these figures represent Medicare reimbursements for therapeutic procedures. Crites-Bachert indicated that a surgery center can expect 150%-200% reimbursement above that from commercial insurance if a patient has commercial insurance paying these procedures.

"So you can see how lucrative this would be doing this for transgender purposes because insurance is now covering this," said Crites-Bachert.

When pressed on whether the financial incentive has helped grease the way for patients into operating rooms, Crites-Bachert said, "I think our profession has been perverted by greed — that this is all monetarily motivated as well as an attack on our most vulnerable, meaning our children."

"I still think that adults are not given the proper informed consent," continued the surgeon. "But when you're talking about children, this is the most vulnerable of our population. They are vulnerable at that time in their life where hormones are everywhere. … They are being promised a magic injection or a magic pill: 'Oh yes, all of your problems will be solved.'"

'They do not understand the significant ramifications of this.'

Potential sex-change patients might be more reluctant to provide their consent if afforded the information Crites-Bachert shared with Blaze News:

This is taking normal, healthy, functioning tissue and, in the instance of a man, taking a normal functioning penis and completely deconstructing it; pushing it inside to make a vagina that a lot of times is shallow. You have to graft and harvest from other places if the penis is not robust enough to have enough tissue to push it inside. To invert it to have a functional vagina, you have to take a skin graft from the thigh or other areas around the groin, so you're creating scar tissue. So you're creating damaged tissue by doing this. And it's not like once you deconstruct a penis, you can just reconstruct it and it will function normally. That's not the way this works. If somebody has regret and needs to have this reversed, or if they have complications, they're looking at multiple, multiple surgeries, which, again, in and of themselves, are lucrative. So this whole process is creating patients for life.

When it comes to informed consent in "gender-affirming care," Crites-Bachert indicated that in some cases, patients "get a packet and they get literature that goes through some of the potential complications, but it's glossed over. I mean, it's a small little paragraph about, for instance, fistula formation. That's a big complication that deserves more than a paragraph — and how many of those people actually read that?"

The surgeon noted that when giving patients literature about something as relatively minor as a kidney stone surgery, she would still have some individuals "come back and say, 'Well, I didn't get that,' or 'I didn't see that.' One would like to think that patients are reading over this information, but the general population — they do not understand the significant ramifications of this, that it is not gender-affirming care but the deconstruction and destruction of normal, healthy tissue for tissue that may or may not be functional."

Crites-Bachert suggested it starts with social pressure when pressed about what is needed to prompt change and reform in American medical circles. Legislation will follow, and then litigation, which eats away at the regime's financial incentives and security.

A psychiatrist's insights

Dr. Miriam Grossman has long hammered away at the false narratives sex-change surgeons feed their patients in exchange for consent.

Several months before the release of the Cass Review, Grossman testified to the House Energy and Commerce Subcommittee on Health, saying there was “no evidence that puberty blockers, cross-sex hormones, and gender surgeries are lifesaving or medically necessary.”

Although numerous studies have indicated as much, thereby demolishing gender ideologues' narrative around sex changes, Grossman told Blaze News that patients and their families are still being barraged with the same talking points and emotional blackmail.

"Many parents of trans-identified children are warned that if they do not sign on the dotted line and agree to medical interventions, the risk of their children ending their lives will increase dramatically," said Grossman. "That is a myth. There is no evidence of that whatsoever. It's an emotional manipulation of the parents, and it's like blackmail."

"What parent wouldn't agree to even the most extreme treatment in order to save the life of their child? Nearly every parent would do anything, especially when the professionals are strongly recommending it, and when those professionals are failing to get informed consent," said Grossman.

The psychiatrist cast doubt on whether medical professionals are explaining to patients and parents "that these procedures are highly experimental and controversial."

According to the American Medical Association's code of ethics, a physician educating a patient about a proposed or desired sex-change medical intervention must present "relevant information accurately and sensitively" and include information about the nature and purpose of the recommended interventions as well as "the burdens, risks, and expected benefits of all options, including forgoing treatment."

Today, that would mean acknowledging or at the very least referring to the findings of the Cass Review, which prompted the U.K. to effectively ban medical interventions outside research settings, as well as recent bombshell studies indicating that so-called gender-affirming care does not remedy suicidality or improve mental health in the long term.

Providing the patient with accurate and up-to-date information would likely also involve a note about the strong possibility that gender dysphoria will dissipate with time, as it apparently does with most confused minors.

Instead, Grossman suggested, "they are presenting these puberty blockers, cross-sex hormones, and sometimes surgeries as reflecting a medical consensus; that this is how we help these children and these teenagers; that this is the model of care that is internationally accepted as the standard of care."

Grossman referred to the Cass Review, noting that almost every page includes terms such as "'alarming,' 'unsafe,' 'remarkably weak evidence,' 'major gaps in our knowledge' — this group of young people deserve much better."

"Are parents in this country and in Canada being told that someone of the stature of Hilary Cass and her team — a prominent veteran pediatrician in the United Kingdom, and her team from York University — came out with this report? I think not," said Grossman. "Unless the patient and her or his parents fully understand the risks and alternatives to the proposed treatment, their consent is not 'informed' and therefore not valid."

Grossman used the example of a gallbladder surgery:

So if you are having problems with your gallbladder and the surgeon is sitting down with you and saying, "You need to sign here indicating consent to have your gallbladder removed," that surgeon is supposed to have presented alternatives to you. One alternative is do nothing. Another alternative is change your diet. Another alternative is take this medication. You have to spell that out; that's a part of getting informed consent.

While admitting she has not examined all of the informed consent forms pertaining to sex-change procedures and drugs, Grossman suggested they likely fail to underscore just how controversial the medical interventions are.

LGBT activists appear keen to intervene in those instances when informed consent forms adequately account for the risks and nature of sex-change procedures.

For instance, when Florida Gov. Ron DeSantis (R) ratified legislation last year requiring that patients and their guardians in the Sunshine State sign consent forms detailing some of the actual risks sex-change interventions entail, which health care providers might prefer to gloss over, activists backed by the Human Rights Campaign Foundation and GLBTQ Legal Advocates and Defenders sued.

According to the Florida Phoenix, the consent forms that angered the activists simply stated what the Cass Review would indicate months later:

Medical treatment of people with gender dysphoria is based on very limited, poor-quality research with only subtle improvements seen in some patients' psychological functioning in some, but not all, research studies. This practice is purely speculative, and the possible psychological benefits may not outweigh the substantial risks of medical treatments and, in many cases, the need for lifelong medical treatments.

While activists fight to erase unfortunate truths from consent forms, professional associations ignore data that disrupts gender ideologues’ preferred narrative.

The American Academy of Pediatrics was among the medical associations immune to the findings in the Cass Review. In May, Dr. Cass told the New York Times that she respected the AAP but respectfully disagreed with the group on holding on to a position that is now demonstrated to be out of date by multiple systematic reviews.

Cass suggested that it "wouldn't be too much of a problem if people were saying, 'This is clinical consensus, and we're not sure.' But what some organizations are doing is doubling down on saying the evidence is good."

When asked about Cass' remarks, Grossman noted that she very much agrees that "the American public is being misled and that the damage and destruction that comes as a result of being misled — it can’t be measured. My practice consists of seeing these kids, and their parents, and their families, their siblings, and sometimes their grandparents, and this destroys families."

'It's just a juggernaut of lies and falsehoods.'

Informed consent relies upon the provision of accurate, timely, and relevant information, which some health care professionals might ignore or gloss over for ideological or financial reasons. However, informed consent also relies upon the patient's competence.

Blaze News raised the question of whether an individual who asks for healthy sexual organs to be cut off, turned inside out, or refashioned into useless scar tissue can be characterized as competent, mentally or otherwise, and whether informed consent is possible in such circumstances.

"In my opinion, anybody that wants a healthy body part to be surgically removed has an emotional illness, in my opinion," said Grossman. "Now, getting informed consent is actually a legal process. It's not a medical process."

Grossman noted that she spent years working in a prison that housed severely mentally ill patients who had committed various crimes. During this time, she gained considerable experience evaluating people on whether they could give informed consent for various dental and medical procedures.

While someone with a "sufficiently accurate understanding" of what the medical procedure entails, along with its risks, may qualify as competent, a person who is psychotic or delusional around the issue of the procedure could be ruled incompetent.

"So if a person comes and says, 'I'm really not a woman. I'm a man. I want my breasts removed because I am a man.' Well, I think an argument could be made that those people have a delusion. I acknowledge I'm in the minority of medical professionals who would say that," said Grossman.

Until this apparent minority of vocal dissenters puts the sex-change regime in check, a great many patients for whom informed consent is impossible might be rubber-stamped for irreversible procedures.

Grossman anticipates seeing "a flood of young people who severely regret what they've done."

"This also ties in to the revenue and the billions of dollars that are going to be made from reproductive technologies because we're producing a generation of sterilized people who are going to need egg and sperm donations. They're going to need IVF. They're going to need surrogates in order to have children," said Grossman.

"People have to wake up," continued the psychiatrist. "People have to understand what this is really about. It's not about kindness. It's not about respect. It's about a social political crusade to transform our society, to eliminate male and female. Nothing could make that more clear than the Olympics — the opening performance and the theft of medals from women by men. That's what this is about."

When asked what might arrest this trend, Grossman said, "We need action on many fronts. First and foremost, people must educate themselves about the history of the trans crusade, the intimidation of doctors, the takeover of medical associations, and what parents can do to inoculate their families."

The psychiatrist indicated lawsuits will help to, at the very least, make practitioners "think twice before they pick up a scalpel and remove the healthy breasts of a 13-year-old girl."

"It could be the malpractice carriers will stop covering — if they have to pay out huge amounts, they may think twice about covering the malpractice of these surgeons," continued Grossman, indicating that legislation is also essential, especially since the prominent medical associations presently appear resistant to reform or common sense.

"It's just a juggernaut of lies and falsehoods. You can try and deny reality, but you're going to pay a price."

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