There are four primary principles for ethical decision-making in health care; however, these four principles do not necessarily yield the most beneficial results for trans youth or bodies that exist in contradistinction to state controlled modes of life. In essence, these bodies are unruly (or unrule-able), but the state continues to control them within the biopolitical frame, where biopolitics refers to the state’s ability to control the way its subjects live. Susan Stryker expands on Foucauldian biopolitics, with a specific trans studies bent, to describe it as “the calculus of costs and benefits through which the biological capacities of a population are optimally managed for state or state-like ends.” The medical-industrial complex works within this frame to manage the modes of life for trans youth, relying on non-maleficence and a paternalistic notion of future expectations to continually withhold medical intervention. Through withholding medical intervention, the state continually retains the ability to name and define trans youth within the gender framework—which isn’t to mention the biopolitical control of scientific claims to a “biological sex” or the medical narratives required to achieve intervention even for adults.
The four primary principles of health care ethics, referenced previously, are (1) respect for autonomy, (2) justice, (3) beneficence, and (4) non-maleficence. The principle of respect for autonomy refers to an individual’s ability to make decisions about their own body without constraints and refers to the ability to act freely (Beauchamp, 2007). Within the biopolitical framework, there are clearly constraints placed on the individual by the state, limiting the various modes of life that should be available to the autonomous individual. Further, for any youth, autonomy is diminished because of parental control. Nonetheless, informed consent in the medical setting provides the illusion of autonomy, though informed consent also positions the question of adequate information. Within the doctor-patient power relation, doctors are able to establish what counts as truth and the state determines what counts as adequate information, allowing for continued constraints on various modes of living that are unruly. For example, misinformation provided before receiving an abortion.