The HHS Report on Pediatric Gender Dysphoria - a summary (Part 4 of 4)
The concluding sections, including the extremely important discussion on medical ethics.
The HHS Report on Pediatric Gender Dysphoria: A Summary – Part 4: Ethical Considerations, Psychotherapy, and Appendices
The other parts are here: Part 1, Part 2, Part 3
Welcome back to this ongoing exploration of the nearly 600-page HHS report, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” In a world where the Cass Review ignited conversations all around the globe, this HHS document has, rather curiously, remained largely in the shadows. My goal with this series is to bring its comprehensive findings into the light, offering a summary for those who may not have the time to delve into the full text.
In Part 1 (Chapters 1-4), we covered the Foreword, Executive Summary, and the initial background. Part 2 delved into the core of the evidence review (Chapters 5-8), revealing the shaky foundations upon which current pediatric gender medicine stands. Part 3 looked at the “Clinical Realities” (Chapters 9-12)—the institutional structures and processes that have allowed these medical practices void of evidence to become so entrenched in the United States.
Now, in this fourth and final content installment, I cover the report’s vital discussion on Ethical Considerations (Chapter 13) and the often-misrepresented role of Psychotherapy (Chapter 14). There is even a section in the report on its overall limitations, strengths, and conclusions. I will then briefly touch upon the Appendices, which provide further context and methodological detail. And I will conclude this four-part summary with some of my own observations about the report.
As always, it’s important to state that this summary is my own interpretation and is not sanctioned by the HHS. The full report is publicly available on the HHS website, and I encourage readers to consult it directly to assess the faithfulness of this summary and to form their own conclusions.
Let’s dive in.
PART IV: ETHICS REVIEW
Chapter 13: Ethical Considerations
This chapter analyzes pediatric medical transition (PMT) through the established principles of medical ethics, raising fundamental questions about the justification for hormonal and surgical interventions in physically healthy youth who are experiencing gender-related distress.
Introduction: The chapter begins by noting that PMT interventions—puberty blockers (PBs), cross-sex hormones (CSH), and surgeries—are typically used to treat conditions like Gender Dysphoria (DSM) or Gender Incongruence (ICD). It observes a shift in stated outcome measures for these interventions, moving from primarily addressing psychiatric morbidity (like depression or anxiety) towards achieving “embodiment goals” or “gender euphoria.” This shift, the report suggests, moves the ethical debate beyond traditional notions of clinical improvement towards a focus on patient preference, prompting the question of whether PMT, under this new rationale, aligns with core medical ethics.
Consent (13.1): The report acknowledges the ongoing debates about the capacity of adolescents to provide truly informed medical decision-making competence (MDC) for PMT. Proponents often cite research suggesting that adolescents can have this capacity and draw parallels with consenting to other invasive medical treatments, such as chemotherapy. However, critics argue that youth, especially young teens or pre-teens eligible for puberty blockers, may lack the cognitive and emotional maturity to fully grasp the profound long-term consequences of these interventions, such as potential infertility or sexual dysfunction. Furthermore, critics point out that providers often fail to provide genuinely informed consent due to inadequate disclosure of risks, the use of pressure tactics (e.g., invoking suicide risk if treatment is not pursued), and the use of misleading or euphemistic language. Crucially, the report argues that before even considering the issue of consent, a prior ethical question must be addressed: is the intervention itself medically permissible, meaning does it have a favorable risk/benefit profile?
From Paternalism to Shared Decision-Making (13.2): The chapter traces the historical shift in medical practice from a “doctor knows best” paternalistic model to one that respects patient autonomy through the process of informed consent, which importantly gives patients the right to refuse care.
Respect for Autonomy vs. Caveat Emptor (13.2.1): This section highlights a critical distinction. While respecting patient autonomy is paramount, it does not obligate clinicians to provide interventions that are non-beneficial or potentially harmful, even if a patient requests them. The report cites Finnish authorities and the Institute of Medicine, stating that autonomy means the right to choose among medically justified options, not an unrestricted right to any preferred treatment. To provide non-beneficial care simply upon request is equated to an unethical form of medical consumerism ("caveat emptor" or "buyer beware"), which violates professional integrity.
Nonmaleficence, Beneficence, and Autonomy in Pediatrics (13.2.2): The ethical duties of nonmaleficence (do no harm), beneficence (act in the patient's best interest), and respect for autonomy are even stricter in pediatrics due to the inherent vulnerability and limited decision-making capacity of youth. The report cites the AAP’s stance that a provider’s primary duty is to the child's needs, which may not always align with parental desires, and that parental authority is itself constrained by the child’s best interests.
Risk/Benefit Assessment in PMT (13.2.3): Clinicians have an ethical obligation to ensure that any intervention offered has a favorable risk/benefit profile when compared to alternatives, including the option of “doing nothing” or watchful waiting. The report refers back to Chapter 5, which found very low certainty evidence for the benefits of PMT in improving mental health outcomes. This uncertainty regarding benefits is contrasted with the increasing recognition of significant risks and harms (detailed in Chapter 7), supported by clinical research and basic biological understanding. These harms include potential infertility, sexual dysfunction, and negative impacts on bone density, cardiovascular health, and cognitive development. The report argues that imposing these substantial harms and risks on physically healthy youth, without a clear expectation of proportionate medical benefit, is ethically unjustified. Psychotherapy is presented as a less risky alternative, with no evidence of causing harm in this context (as discussed further in Chapter 14). The chapter addresses a common counter-argument: that if uncertainty exists about both benefits and harms, then patients should be allowed to decide. It counters this by arguing that many harms (like infertility from early puberty blockade followed by cross-sex hormones, or the risks of complex surgeries after puberty suppression) are actually more certain, based on physiological knowledge, indirect evidence, and the likelihood of publication bias downplaying negative outcomes. In situations of high uncertainty, especially when potential harms are serious and irreversible, a precautionary approach is ethically warranted, particularly given the lack of robust evidence for proportionate benefit. The report contends that PMT often fails to meet the risk/benefit threshold required even for justifiable off-label prescribing. Just because off-label use of medications is sometimes appropriate does not mean doctors can prescribe any drug for any reason. Off-label prescribing is only ethically sound when there’s a reasonable expectation of benefit, no better options exist, and the potential risks are clearly outweighed by the likely improvement in the patient’s health outcome.
Justice (13.2.4): The principle of justice dictates that withholding effective care would be unjust. However, providing harmful or non-beneficial care to vulnerable youth, many of whom present with complex co-occurring mental health conditions, is also unjust. The report raises concerns about “diagnostic overshadowing,” where all of a youth's distress is attributed solely to gender dysphoria, leading to other underlying needs being ignored and potentially resulting in inadequate overall care. It also highlights the overrepresentation of same-sex attracted youth in PMT cohorts (citing Dutch data) and touches upon the historical pathologization of homosexuality, raising justice concerns about interventions that may impair fertility and sexual function in this particular group.
Alternative Clinical Rationales (13.3): The chapter discusses the significant shift away from conceptualizing gender dysphoria primarily as a mental disorder requiring distress and functional impairment for diagnosis. Instead, the newer ICD-11 “Gender Incongruence” diagnosis, which does not strictly require distress, has gained traction. This shift was partly aimed at reducing stigma while maintaining a diagnostic category necessary for insurance reimbursement. However, the report critiques the ICD-11 criteria as potentially circular, allowing for a diagnosis based solely on a youth's expressed desire for other-sex characteristics or treatments. It cites Florence Ashley, who argues that the effectiveness of PMT, under this new rationale, is simply defined by achieving these desired physical changes, including “gender euphoria” and “creative transfiguration.” The report argues that this justification, which moves beyond demonstrable clinical improvement in overall well-being, makes PMT ethically reckless, especially given the frequent lack of thorough exploration into why a youth might desire profound body modification (which could stem from trauma, internalized homophobia, social pressures, or other underlying issues).
Regret (13.4): The report argues that rates of regret or satisfaction with PMT—which are currently unknown and poorly researched—are not valid primary indicators of whether these interventions are medically justified. Patients may regret entirely justified treatments (due to unlikely complications or changes in personal values over time), or conversely, they may express satisfaction with treatments that were not medically justified (perhaps by finding meaning in adversity or due to other psychological factors). The central ethical question, the report concludes, is not about regret rates, but whether PMT provides tangible health benefits that are proportionate to its known and potential harms. Current evidence, it suggests, indicates it does not.
Research Ethics (13.4.1): Given the weak evidence base, there are frequent calls for more research into PMT. However, the chapter questions the feasibility and ethics of conducting certain types of research, particularly randomized controlled trials (RCTs). Proponents of PMT might argue that RCTs would violate equipoise because they already believe PMT is beneficial. Conversely, critics argue that equipoise now leans against PMT, given the accumulating evidence of potential harms and uncertain benefits. The report raises concerns that the UK's planned puberty blocker trial might potentially violate established ethical norms for human subjects research. These norms include the Nuremberg Code (requiring prior animal data and knowledge of natural history), the Declaration of Helsinki (requiring confidence that risks are adequately assessed and managed), and the Belmont Report (requiring a favorable risk/benefit assessment based on systematic analysis). The report argues that PMT research may currently conflict with these standards due to the profound uncertainty about benefits and the largely unmanaged or unassessed risks of serious, irreversible impairment. It suggests that safer research avenues—such as studies on psychotherapy, longitudinal data collection on existing patient cohorts, and animal studies on hormonal effects—should be prioritized.
PART V: PSYCHOTHERAPY
Chapter 14: Psychotherapy
This final content chapter of the HHS report advocates for psychotherapy as a primary, non-invasive approach for youth experiencing gender dysphoria (GD). It contextualizes this recommendation within broader trends in youth mental health and addresses significant barriers that have hindered the use of psychotherapeutic approaches.
Youth Mental Health Crisis (14.1): The chapter sets the stage by acknowledging adolescence as a period of significant biological and psychosocial change, intense identity formation, emotional instability, and increased risk-taking behavior. It references the declared “National State of Emergency in Children’s Mental Health” (by the AAP, AACAP, and CHA in 2021) and Surgeon General advisories that highlight sharply rising rates (since approximately 2010) of youth depression, anxiety, self-harm, suicidality, and loneliness. These trends are potentially linked to a variety of factors, including shifts in parenting styles (e.g., overprotective parenting), reduced opportunities for unstructured free play, and the pervasive influence of social media (14.1.1).
Diagnostic and Social Labels (14.2): The report discusses the potential for overdiagnosis resulting from increased mental health awareness. While diagnostic labels can impact self-perception and guide treatment, they also risk oversimplifying complex individual experiences. There are concerns about the broadening of diagnostic definitions without commensurate evidence of benefit from such expansion. The chapter traces the evolution of diagnostic terms in the DSM: from “Transsexualism” (DSM-III) to “Gender Identity Disorder” (DSM-IV), and finally to “Gender Dysphoria” (DSM-5). This evolution aimed to reduce stigma by focusing on the distress associated with gender incongruence, rather than pathologizing the identity itself. This is contrasted with the recent proliferation of social labels (such as “nonbinary,” “transgender,” etc.), which are not formal medical terms but may increase the likelihood of individuals seeking clinical input, where medicalization might then be offered as a solution.
Controversies Regarding Assessment & the Role of the Psychotherapist (14.3): A key contrast is drawn between the original Dutch Protocol—which mandated intensive assessment and ongoing mental health care—and the contemporary approach often seen in the United States. There is ambiguity regarding the role and responsibility of psychotherapists within multidisciplinary teams (MDTs), potentially leading to a “diffusion of responsibility.” The report cites the Cass Review’s recommendation that endocrinologists (who prescribe hormones) should ultimately be responsible for the comprehensive assessment, rather than simply relying on approval letters from therapists. It highlights that some US PMT leaders argue against rigorous assessment, viewing it as “gatekeeping.” Instead, they favor focusing on patient goals (a view attributed to Dr. Turban) or seeing gender identity as self-evident and not requiring external validation (Dr. Garofalo). Some (like Dr. Olson-Kennedy) have even compared initiating hormones for gender dysphoria to starting insulin for diabetes, implying that no specific therapeutic assessment or support is necessary.
Psychotherapy for GD: Re-emergence in Europe (14.4): The report notes a significant shift in several European countries. Sweden, Finland, and England, following systematic reviews that found poor evidence for the benefits of PMT and identified potential harms, have restricted medical interventions for minors. These countries now recommend psychotherapy and psychosocial support as the first-line treatment approach. This aligns with conservative medical management principles, where less invasive options are tried before resorting to more invasive ones. The report quotes policies from all three countries that explicitly emphasize this shift towards prioritizing psychotherapeutic interventions.
Psychotherapy and Its Application to GD (14.5): The chapter argues that while direct evidence for the effectiveness of psychotherapy specifically for resolving gender dysphoria itself is currently of very low certainty (as established in Chapter 5), its effectiveness for common co-occurring conditions (such as depression, anxiety, trauma, etc.) is well-established. This suggests a strong potential benefit for GD youth, many of whom suffer from these comorbidities.
Psychotherapy for Co-occurring Conditions (14.5.1): The report reviews the evidence for various psychotherapeutic modalities in treating conditions frequently seen alongside GD:
Cognitive Behavioral Therapy (CBT) is effective for depression and anxiety.
Psychodynamic Therapy (PDT) is effective for depression and potentially for anxiety.
Family-Based Treatment (FBT) shows effectiveness for adolescent depression and eating disorders.
Dialectical Behavior Therapy (DBT) is effective for managing suicidality and self-harm.
CBT combined with SSRIs can be effective for Body Dysmorphic Disorder.
The report quotes the Cass Review, which strongly emphasizes the need for youth with gender dysphoria to have access to these evidence-based treatments for their co-occurring mental health conditions.
Psychotherapy for Gender Dysphoria Itself (14.5.2): While acknowledging the dearth of research specifically on psychotherapy for GD, the report cites systematic reviews which found no evidence of harm resulting from psychotherapy in this context.
The Charge of "Conversion Therapy" (14.5.2.1): A significant barrier to the use of exploratory psychotherapy has been the claim by some PMT advocates that any therapy not immediately affirming a youth's transgender identity and facilitating medical transition is tantamount to “conversion therapy.” This term historically refers to discredited and harmful practices aimed at changing an individual's sexual orientation. The report counters this by noting that some critics argue PMT itself could be seen as a form of conversion therapy (i.e., altering a person's body due to societal non-acceptance of their gender expression or same-sex attraction). The HHS report argues that labeling exploratory therapy—which aims to understand the youth's distress, explore underlying factors, and help them accept their bodies—as “conversion therapy” is a harmful rhetorical device. This mischaracterization creates anxiety among therapists and hinders access to potentially beneficial, non-invasive care. It is noted that exploratory therapy was an integral part of the original Dutch Protocol and is inherent to good psychotherapeutic practice, which should be neutral and facilitate unbiased exploration. The report cites PMT proponents like Dr. Laura Edwards-Leeper, who also condemn the conflation of exploratory therapy with conversion therapy.
Psychotherapeutic Approaches (14.5.2.2): The report argues that psychotherapy is well-suited for youth experiencing gender dysphoria, as it can help them develop self-understanding and manage distress. It warns against the reflexive assumption that all distress experienced by these youth is solely “minority stress,” as this risks overlooking other contributing factors such as trauma, primary mental health issues, or internalized homophobia, and could lead to prematurely recommending medicalization. It quotes Dr. Stephen Levine on the importance of a holistic assessment that explores multiple influences on a youth's gender-related distress. It also quotes Dr. Roberto D'Angelo on how psychotherapy can examine the impact of gender stereotypes, promote autonomy, and clarify whether gender dysphoria might be entangled with other psychological issues. The report advocates for the utilization of transdiagnostic approaches to address underlying patterns of emotional and behavioral difficulties. Table 14.1 in the original report (summarized here) outlines potential applications of Manualized Therapies (like CBT/DBT), Psychodynamic Therapy, and Family Therapy approaches for GD youth. These approaches focus on skill-building (e.g., emotional regulation, distress tolerance), exploring underlying dynamics and conflicts, and improving family functioning and communication. The chapter concludes that psychotherapy is a non-invasive intervention that promotes mental health, carries little to no risk of harm in this context, and its significant potential has been unfortunately overshadowed by the intense focus on puberty blockers and other medical interventions.
Limitations, Strengths, and Conclusion of the HHS Report
Limitations: The HHS report itself acknowledges certain limitations. It clarifies that it is not a Clinical Practice Guideline (CPG) and therefore does not make specific treatment recommendations. Its focus is solely on minors, and it does not offer specific policy advice, for example, regarding youth who are already on a path of medical transition.
Strengths: Despite these limitations, the report has significant strengths, especially within the US context, where such a comprehensive review has been lacking. It highlights the very low-quality evidence supporting the benefits of PMT. It details significant and plausible harms associated with these interventions. It provides an ethical assessment concluding that routine PMT, as currently practiced, is inconsistent with core principles of medical ethics. Furthermore, it examines psychotherapy as a viable alternative with a much more favorable risk/benefit profile. The report shows that high-quality international guidelines (from countries like Finland and Sweden) favor psychotherapy as a first-line approach, while lower-quality guidelines, which are nonetheless highly influential in the US, tend to recommend routine PMT. A crucial contribution is its description of the enforced insularity and hostility to debate within the PGM field, cautioning against uncritical acceptance of claims about a supposed US medical consensus.
Overall Conclusion of the HHS Report: The report argues that many US medical professionals and associations have fallen short of their duty by rapidly implementing PMT without sufficient scientific or ethical justification. They have often failed to reconsider their positions despite contrary evidence emerging internationally and have frequently mischaracterized the state of the evidence while marginalizing dissenting voices. The report concludes that, despite undoubtedly good intentions on the part of many, this collective failure has ultimately harmed vulnerable patients. It implicitly refers to the social contract in which medical self-regulation is granted in exchange for prioritizing patient and societal health needs. A central theme emerging from the review is that, in the case of pediatric gender medicine, many US medical professionals and associations have not adequately fulfilled this duty to prioritize the health interests of young patients.
Appendices
The HHS report includes several appendices that provide additional detail and context:
Appendix 1: Abbreviations: Self-explanatory. This appendix provides a list of abbreviations used throughout the HHS report and their corresponding full terms, serving as a helpful reference for readers navigating the technical language.
Appendix 2: Diagnostic Criteria: This section details the specific diagnostic criteria for various gender-related conditions. It traces how these conditions (such as Gender Identity Disorder, Transsexualism, Gender Dysphoria, and Gender Incongruence) have been defined and redefined in different versions of major diagnostic manuals, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-IV, DSM-5) and the International Classification of Diseases (ICD-11). This historical perspective is crucial for understanding the evolving conceptualization of these conditions.
Appendix 3: Systematic Reviews and Evidence-Based Medicine (EBM): This appendix offers a valuable primer on the principles of Evidence-Based Medicine (EBM), contrasting it with older, “eminence-based” approaches where expert opinion held more sway. It meticulously details the methodology of systematic reviews (SRs), which are considered the highest tier of evidence in EBM. This includes defining clear research questions (often using the PICO framework: Patient/Problem, Intervention, Comparison, Outcome), systematically searching literature, selecting relevant studies, extracting data, assessing the risk of bias in included studies, synthesizing the results, and formally assessing the overall quality of evidence using frameworks like GRADE (Grading of Recommendations Assessment, Development and Evaluation). The appendix clarifies the different levels of evidence quality (High, Moderate, Low, and Very Low) and explains how systematic reviews and GRADE assessments are intended to inform the development of trustworthy clinical guidelines and recommendations. It also defines “overviews of reviews” (or umbrella reviews, like the one conducted for this HHS report) and distinguishes systematic reviews from other types of literature reviews, such as narrative or scoping reviews.
Appendix 4: Overview of Systematic Reviews: Methodology, Evidence Synthesis, Tables: This appendix, which was published as a separate document alongside the main report, contains the comprehensive methodological details, the synthesized evidence findings, and all accompanying data tables for the “umbrella review” (an overview of existing systematic reviews) that was specifically conducted for this HHS review. This extensive appendix forms the core evidentiary basis for the critical assessment of interventions presented in Chapter 5 of the main report.
Observations: The Reckoning Ahead
This concludes the summary of the HHS report. As we step back, it's impossible not to be struck by its profound implications, especially within the American context. While the Cass Review deservedly garnered global attention, its focus was inherently on the UK’s NHS. It could not have addressed the issues peculiar to the American pediatric gender industry—especially when, as the HHS report made clear—the criticisms lobbed at it came largely from US-based advocates that contained many factual errors.1
The HHS report, however, speaks directly to the unique and often chaotic landscape of US healthcare. It meticulously builds upon Cass, but its greatest strength lies in its unflinching examination of why and how pediatric gender medicine evolved as it did here in the United States.
A particularly damning indictment is the report’s revelation that major US medical and mental health associations—organizations entrusted with setting standards and safeguarding patients—have largely failed to conduct their own rigorous systematic reviews. Instead, as the report documents, there has been an over-reliance on deeply flawed and ideologically driven guidelines like WPATH SOC-8, a document shown to have prioritized legal and insurance goals over scientific rigor and patient safety—of a young and vulnerable population.
The HHS report exposes a troubling inversion: practices were widely adopted before evidence was established, and institutional inertia now prevents a course correction. It details the systemic decay: the dismantling of safeguards, the suppression of dissent, the rise of “rubber stamp” clinics where comprehensive assessments are abandoned, and the institutional dynamics that allowed this “ideological takeover,” as I see it, to occur on an unprecedented scale.
This isn’t just a failure of science; it is a profound ethical failure. Perhaps the report’s greatest contribution is its stark reminder of core medical ethics. The idea that clinicians have an unwavering obligation to ensure any intervention has a favorable risk/benefit profile compared to all other alternatives—including the often-ignored alternative of doing nothing—seems lost on many within the American medical establishment.
The HHS report forces us to confront whether we are truly adhering to “First, do no harm” when we offer irreversible interventions with uncertain benefits and known, serious risks to physically healthy children. Just because we have a hammer does not mean we must swing it every time someone shouts “Nail!” And just because we possess chemical and surgical tools capable of altering secondary sex characteristics does not mean we are ethically justified in wielding them whenever a distressed child expresses a wish to be different.
What, then, is the path forward? The HHS report implicitly calls for an institutional reckoning—one rooted in humility and a courageous recommitment to Evidence-Based Medicine. US medical associations must move beyond defensiveness. There is no longer any need to stall and declare that “we need to do our own reviews” (that, by the way, was in 2023). That time is long gone. Their credibility to do one transparently has long been shredded. And most importantly, the HHS report has obviated the need for yet another systematic review when it conducted its umbrella review of all the existing systematic reviews, including ones that were published in 2025. Whatever knowledge that exists out there, whichever clinical studies have been conducted, these systematic reviews have pored over them—over and over and over.
The time has come for the major US medical and mental health associations to foster an environment of open debate, where concerns can be raised without fear of career-ending accusations. Crucially, they must re-establish rigorous, holistic assessment processes that prioritize a child's overall well-being, acknowledging the high rates of co-occurring mental health conditions and exploring all underlying factors.
This means re-centering psychotherapy, not as the bogeyman of “conversion therapy,” but as the vital, non-invasive, and ethically sound first-line approach it represents—an approach focused on understanding distress and building resilience (and as practiced in several other countries with healthcare systems that are ranked higher than ours). Ultimately, the HHS report serves as a critical, urgent call to put the child and their long-term health first. This demands a move away from ideologically driven models and a return to care that is cautious, evidence-based, ethically sound, and truly dedicated to the complex, developing human being at its heart. The health and future of a vulnerable generation depend on it.
Perhaps no critique was as influential as a non-peer-reviewed, online publication that was published on the Yale Law School website. This, and three other publications, were exhaustively fact-checked in a peer-reviewed journal publication called “Critiques of the Cass Review: Fact-Checking the Peer-Reviewed and Grey Literature,” which was published in February 2025. It found that the misstatements of the critics spanned five key areas. Essentially, these critics had lied about (1) the Cass Review’s own contents and processes, (2) the evidence base for pediatric transgender healthcare, (3) the existing clinical guidelines and the claims of consensus among them, (4) the principles of evidence-based medicine, and (5) the validity of the Review’s conclusions. They also often misrepresented research, e.g., claiming statistically significant improvements in depression/suicidality in Tordoff et al. (2022) (there was none) and Chen et al. (2023) (they reported some post-facto associations in the data, and even then, there was none at all among the male participants in the study) and conveniently omitted numerous systematic reviews from across the world that support the Cass Review’s essential findings.
Another analysis published in the Archives of Disease in Childhood in October 2024, titled “Gender medicine and the Cass Review: why medicine and the law make poor bedfellows,” further deconstructed the criticisms of the Yale Law School web report. Cheung et al. argued that the Yale report was written for a “primarily litigious, rather than academic, purpose” (it is Yale Law School, after all!), with versions of its arguments submitted in several US court cases, including Skrmetti. A central observation by Cheung et al. was that critics, and especially the Yale report, fundamentally misunderstood the Cass Review’s role, wrongly treating the independent UK government-commissioned inquiry as if it were a clinical practice guideline (in fact, exactly the same point is applicable to the HHS report). Because of this basic misunderstanding, the Yale report failed to understand that a key requirement of the Cass Review was its independence. As they pointed out, “the independence of the Review chair from the specific medical field is a key safeguarding measure to prevent bias inherent to working within the field, and to protect patients and the public from the undue influence of these vested interests in the process.”
Thank you for your time & efforts in summarizing & sharing this.
This has been an extremely helpful and informative series, and I understand your enthusiasm for the ethics section in particular. We need to get more eyes on it!