This is not the first time that we have treated in our Observatory the case of transsexual people who, after undergoing gender transition treatment, regret having done so. Unfortunately, there are more and more of them.

According to the Daily Mail, Lois Cardinal, a 35-year-old, underwent vaginoplasty in 2009. After doctors assured her that everything was going to be fine and that there would be no complications, the young woman began to feel constant pressure, discomfort and severe pain that has not stopped until now. For Cardinal, this situation is “taking this psychological burden on me”, since, in addition, he states that she is not able to access proper medical care, which is why she has requested euthanasia.

The Canadian health system has opposed his request, but the young woman, who will try again in a few months, has denounced the doctors’ refusal, considering it a violation of human rights.

Extension of the Euthanasia Law

Canada recently announced that it would apply euthanasia to mentally ill people starting in March next year, so it will have to reform the law that was approved in 2016, the year in which the Medical Assistance in Dying (MAID) was created in Canada. Its function is to accompany and advise adults with terminal illnesses. In 2021, it underwent a first change to be able to assist people with serious and chronic physical conditions, even if they did not pose a risk to their life.

This expansion has sparked controversy and raised concerns that it could be too easy for vulnerable people to die in Canada, while the Government assures that the law “protects the most vulnerable Canadians while respecting patient autonomy.”

Since the law was approved in 2016, the Ministry of Health recognizes more than 30,000 deaths due to euthanasia. In 2021, 10,064 euthanasia or assisted suicide practices were performed, which represents no less than 3.3% of all deaths in this country.

Bioethical assessment

This dramatic case joins others in which gender transition interventions, both hormonal and surgical, significantly worsen the quality of life of those involved, who experience frustration and anguish when they realize that the promises received at the time of accepting these treatments were not fulfilled. Instead, they experienced a worsening of their health, both psychological and physical, due to the accumulation of side effects associated with transgender interventions, of which we have published previous reports.

Frequently, the gender dysphoria of people who request transition develops complications, in many cases serious, over time: side effects associated with cross-hormonal treatments that must be maintained for the rest of their lives or complications of surgical interventions, which significantly worsen the quality of life of these patients. They cause the initial satisfaction of achieving the desired transition to gradually be eclipsed by the progressive disappointment associated with these complications and, also, by the possible existence of undiagnosed and untreated initial disorders that may worsen.

It should not be ignored that the bodies of people who undergo gender transition treatments are mostly healthy and it is these treatments that induce pathologies over time. And this is exactly the line that medical interventions should never follow: “primum non nocere”, first do no harm.

This and other cases have forced professionals and institutions that were initially interventionist with respect to transition processes to modify their positions. They now tend to prioritize psychological care over pharmacological and surgical care, and intensify prior diagnoses to avoid erroneously intervening in those who need other treatments for certain dysfunctions.

Likewise, many countries have suspended early transition interventions in minors, due to the insecurity that these treatments present and the lack of solid scientific evidence on their effectiveness, in addition to their irreversibility.

Finally, thinking that the solution for the case at hand could be euthanasia shows the most sinister face of a medicine that has turned its back on patients, mistreats them without paying attention to scientific evidence and proposes death as a solution to their sufferings. Healing, alleviating or caring must be remembered as the true purposes of the health professions.

Julio Tudela and Cristina Castillo

Bioethics Observatory – Institute of Life Sciences

Catholic University of Valencia


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