Currently, the belief that a patient may experience post-treatment regret is sometimes taken as a sufficiently strong reason to withhold it, even when the patient makes an explicit, informed request Brockwell Contrary to the above views, I argue that the possibility of post-treatment regret is not necessarily a good reason for withholding the treatment. Regret is a complex, multivalent concept Landman One can use the term as a somewhat empty, ritualised expression for having to perform an action that will cause someone sadness or suffering, e. One can also use the term to express sympathy, sorrow or grief, e.
Typically, this will be because the consequences of the decision were worse than they had expected them to be Gilovich and Medvec ; Zeelenberg et al. In what follows, it is this final form of regret that I discuss and to which I refer when using the word.
Regret is a negative emotion: it is unpleasant to experience regret and we often strive to avoid it Janis and Mann ; Zeelenberg and Pieters Typically, this involves subjecting important decisions to extensive reflection before acting to ensure the best option is taken and the optimal outcome is achieved. This includes decision-making about medical treatment Speck et al. Because the experience of regret is unpleasant, and because we tend to assume that it indicates a flawed decision, the belief that we will regret doing something is taken as a strong reason against that course of action.
This suggests that we can be justified in endeavouring to prevent both ourselves and others from experiencing regret. However, as I will argue below, sometimes we should take decisions that we might come to regret.
Furthermore, not all regrets can be avoided simply by making more better decisions. Thus, some regrets do not demonstrate a flaw in the decision-making process. This is because some regrets are unforeseeable and uncontrollable from the perspective of the agent at the time that she is deliberating about what to. These claims will be explained and defended once the current understanding of regret within medical practice and research has been examined. The issue of regret has received relatively little attention from philosophers.
However, its normative status in and implications for medical decision-making are rarely assessed. Owing to the limitations of space, I will discuss regret in relation to gender confirmation treatment GCT and voluntary sterilisation VS. In focusing on them, I do not mean to efface the many differences between them. For example, GCT is a complex, multi-stage and expensive process, whereas sterilisation is a quick, cheap, one-off procedure. Post-sterilisation regret will thus target a single, isolated decision, whereas post-GCT regret can target either the cumulative effect of a series of decisions or a part of that process.
What unites them, for the purposes of this paper, is that many clinicians and researchers have expressed concern that patients will regret undergoing GCT or being sterilised. It is often assumed that patient-regret a is a strong reason against offering these treatments; and b reveals a problem in the decision-making process through which the treatment was identified as appropriate. Before proceeding, a few clarificatory remarks about GCT may be helpful.
I will treat these terms as synonymous as they refer to the same group of medical treatments and procedures. For trans men, these include taking testosterone, bilateral mastectomy, hysterectomy, phalloplasty, scrotoplasty and penile implant.
For trans women, these include taking oestrogen, facial feminisation surgery, orchidectomy, vaginoplasty, vulvoplasty, clitoroplasty and breast implants. Many trans individuals undergo only some of these procedures, either through choice, medical limitations or financial constraints Davy There is thus variety in how people transition and what their desired gender identity is. Furthermore, trans individuals are demographically diverse. Although more cis men than cis women are recorded as trans, the difference in population size is not vast — although numbers vary from study to study and country to country — and is diminishing Meier and Labuski ; Reed et al.
Finally, trans individuals are situated across the economic spectrum, although they tend to be towards the poorer end of it Whittle et al. Despite this diversity, much of the medical research focuses exclusively on male-to-female transsexuals. Nevertheless, what is important about this research is that it treats the possibility of a person coming to regret their decision to transition as a major problem. These are strong claims: regret is comparable to suicide in terms of negative outcomes following GCT and every regret case must be considered a major clinical and ethical problem.
The possibility of post-treatment regret is sometimes treated as a strong reason, even a sufficient and overriding one, for withholding GCT cf. Batty ; Duke Jeffreys , draws on occurrences of post-transition regret to support her argument that GCT should be banned. There is a strong implication underpinning the content of the website that one will likely come to regret transitioning.
Similarly, Djordjevic et al. I think this line of thinking is problematic, as I will explain below. Worries that a patient will experience post-treatment regret are also voiced in relation to sterilisation requests, especially when the patient is a childfree woman under the age of 30 Lawrence et al. This leads to many requests for sterilisation made by young, childfree women being denied Campbell ; Gillespie I will examine whether the possibility that these women will regret choosing to be sterilised is a good reason to deny their requests for it.
However, my argument will apply also to postpartum women who request sterilisation, should concerns be raised that they too may regret their decision. The implicit assumption underlying this research is that patient-regret is undesirable and should be prevented, which can be achieved by improving the decision-making process. Because the latter is a more complex issue than the former, I shall deal with the former first. Given this assumption, it seems reasonable for clinicians to strive to reduce the likelihood of patient-regret.
Doing so, it might be argued, will improve patient well-being and indicate that the treatment was appropriate. It would thus be consistent with the principle of beneficence, which is a central component of medical ethics Beauchamp and Childress , ff. However, this must be considered in relation to another key principle of medical ethics: respect for patient autonomy ff.
Discussion of autonomy can be difficult, given the numerous ways it is understood Christman ; Mackenzie and Stoljar However, I will understand it in a deeper sense, as relating to how a person organises their life in respect to their central values, desires and projects.
This is central to patient-centred care Epstein and Street This applies not only to life-saving or life-preserving treatment, but also to life-enhancing treatment. For example, a patient may request an intrauterine device IUD as their preferred form of contraception, with the expectation that their doctor will agree to this request. Alternatively, a doctor may prescribe diazepam to a patient with severe aviophobia. Consider, then, the type of sterilisation request that many clinicians are reluctant to agree to.
She thinks that parenthood is incompatible with many of her central values, feelings and projects. She has an adverse reaction to the pill and cannot use an IUD owing to a copper allergy. However, even if she could use an IUD, she is adamant that sterilisation is her preferred method of contraception. She is aware that it is a permanent, irreversible procedure she sees this as a positive aspect of sterilisation. She is also aware that she might later change her mind and want to become pregnant, although she is adamant that she has no reason to think it will happen. This awareness does not undermine or erode her desire for sterilisation.
She insists that she is happy to live with the consequences of their decision, even if she does change her mind. She is happy to live with her regret. Respect for the patient autonomy entails that the doctor ought to agree to the request. This argument is, of course, intended to apply to other medical treatments, such as GCT, that give rise to worries about patient-regret. It remains possible that she may change as a person in a such way that she does want to have children.
We cannot guarantee that our identities will remain unchanged throughout our lives. Nevertheless, her request for sterilisation is an autonomous one: it is made following extensive reflection on her deeply-held values, feelings and projects. When confronted with such a request, clinicians should not shield us from future regret. We may still hold that clinicians should make patients aware of the possibility of post-treatment regret and factors that might induce or exacerbate it, such as the irreversibility or negative side-effects of the treatment.
This would help patients to make more informed decisions. However, the possibility of regret should not be taken as an overriding reason to withhold a treatment, so long as the request is made in an autonomous, sufficiently-informed manner. It is notable that this perspective on regret and autonomy seems to be adopted in other areas of medical decision-making. This suggests a questionable asymmetry between the role that regret plays in decision-making about sterilisation compared to, say, IVF Mertes For example, a young, childfree woman may request sterilisation but still express her desire to give birth to children later in their life and has planned her future accordingly perhaps because she does not realise it is irreversible.
Because the patient lacks good reasons for wanting the treatment, we are right to expect them to later regret their decision and to act to prevent this regret just as someone who goes against their better judgement and, in a moment of rashness, buys a car that is clearly in need of repair or unsuitable for their needs will likely come to regret doing so.
This is because it fails to respect her autonomy. This still treats prospective regret as relevant to the medical decision-making process: preventing regret plays a role, just not a decisive one, in determining whether a treatment should be offered to a patient. However, it can be argued that, for some treatments, regret should play no role in deciding whether a treatment is appropriate. Furthermore, what it is like to experience these changes first-personally — what it will be like for me to experience them — cannot be known beforehand and so one will only know how one feels about the changes when one has undergone them.
PTTs represent what Paul refers to as transformative experiences.
In practice, it may be difficult to decide whether a treatment will be personally transformative. Nonetheless, there seem to be some reasonably clear-cut cases. Taking antibiotics or having a tooth removed will not be personally transformative. One reason for thinking it does not is that the person undergoing GCT will almost certainly have been living as their preferred gender for some time.
What it will be like first-personally to experience these changes, and how one will feel about them, cannot be known prior to taking the hormones. I thought I knew what I was doing. I really had no idea until her gorgeous blue eyes — my blue eyes — were staring back at me full of expectation and adoration and dependency. Another had an autistic partner who was unaware of his condition, and one of their children had autism while the other had Attention Deficit Hyperactive Disorder ADHD.
I have done their raising practically alone. According to health and wellness website HealthGuidance. Jessica Valenti, author of 'Why Have Kids' believes there needs to be less taboo around the topic of not wanting children, particularly among women. There also needs to be some sort of acknowledgement that not everyone should parent -- when parenting is a given, it's not fully considered or thought out, and it gives way too easily to parental ambivalence and unhappiness. You can find our Community Guidelines in full here.
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Who knows, bro. For example, a young, childfree woman may request sterilisation but still express her desire to give birth to children later in their life and has planned her future accordingly perhaps because she does not realise it is irreversible. Accessed 14 Oct Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Cassell, London Google Scholar. You short-circuit this programming by exercising discipline wherever you get the opportunity. Take the example of Libya -- Germany abstained in the United Nations Security Council, while other nations like France and Britain have taken the lead on the invasion.
Gina Miller. Our view.
Sign the petition. Spread the word. US surveys show that support for the Libya invasion is low. Obama has now transferred command to NATO, but is the alliance even capable of handling it? Rumsfeld: Time will tell. NATO member states vary dramatically in their capability and in their political steadfastness.
Rumsfeld: That is not the case. The reality is that Obama has some 15 countries in the current Libya coalition. President Bush put together close to 50 countries for the Afghan coalition, some 40 countries for the Iraqi coalition, more than 90 countries for the Proliferation Security Initiative and over 90 countries in the Global War on Terror, and yet as your question suggested, he was called a "unilateralist. Rumsfeld: I do not regret that comment. Some people were sensitive about my comment because they thought it was a pejorative way of highlighting demographic realities. Apparently they felt it pointed a white light at a weakness in Europe -- an aging population.
Take the example of Libya -- Germany abstained in the United Nations Security Council, while other nations like France and Britain have taken the lead on the invasion. Rumsfeld: At 78 years old, I am not surprised at much anymore. Germany has taken divergent positions before, so has France, so has England, so has the US. Berlin can look for new partners all over the world.
Is this the end of the Westbindung a term referring to Germany's foreign policy of aligning itself deeply with Western Europe and the Western World that has been the bedrock of German foreign policy since World War II? Rumsfeld: I did not read the tea leaves that way. I listened to it, and I said, Well, that is not new. During his address to the American people on Libya at the end of March, Obama pointed to the Iraq war. He said that regime change there took eight years, cost thousands of American and Iraqi lives as well as nearly a trillion dollars, and that is something the US cannot afford to repeat.