Forensics + Gender + Sex

MAID new Bill C7 changes

Removed the requirement that a person’s natural death must be reasonably foreseeable in order to be eligible for MAiD.

• Instead, death being reasonably foreseeable is now used only to determine which set of safeguards applies.

Track A — Natural death reasonably foreseeable

• Some safeguards are eased:

  • Only one independent witness needed instead of two

  • 10-day reflection period eliminated

Track B — Natural death not reasonably foreseeable

• Stronger safeguards:

  • Minimum 90-day assessment period

  • One assessor must have expertise in the underlying condition

  • More detailed discussion of alternatives (counseling, palliative care) and informed consent clarifications

If a person’s natural death is reasonably foreseeable, they can

• make an advance written arrangement with their clinician

• waiving the need to give final consent at the time of MAiD

• This means MAiD can proceed even if they lose capacity before the procedure — as long as they do not indicate refusal by words/sounds/gestures at the time

Criteria for puberty blockers

Crtieria for surgery

• gender dysphoria sustained

• excluded other causes of incongruence (BDD and delusional)

• capacity to consent

• reproductive effects discussed

• psychiatric issues addressed

• stable on hormone therapy minimum 6 months for genital and 18 months for breast

Criteria for hormonal treatment

• Marked and sustained gender incongruence

  • Persistent experience of incongruence between experienced gender and assigned sex.

• Capacity to provide informed consent

  • Ability to understand risks, benefits, alternatives, and expected effects.

• Reasonably well-controlled mental health concerns (if present)

  • Mental health conditions do not automatically preclude treatment.

  • They should be assessed and managed so they don’t impair decision-making.

• Discussion of reproductive effects and fertility preservation options

  • Sperm/oocyte cryopreservation, etc., should be discussed before starting.

• Assessment by a competent clinician

  • Can be a primary care provider with appropriate training; a mandatory mental health “letter” is no longer required under SOC-8 (unless local policy differs).

No mandatory mental health letter required now - centered around consent.

Forced normalization

Forced normalization: after you CONTROL a seizure disorder (e.g. with antiepileptics) you get psychotic symptoms

Hierarchy of paraphilias

Order of interventions for paraphilias:

• Psychotherapy

• Sertraline

• Cyproterone

• Mexodryprogesterone

• Lupron

Crtieria for puberty blockers

Diagnosis of Gender Incongruence

• The adolescent meets criteria for gender incongruence.

• The experience is marked and sustained.

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2⃣ Onset of Puberty

• The adolescent has entered puberty (Tanner stage ≥ 2).

• Blockers are not used pre-puberty.

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3⃣ Emotional & Cognitive Maturity

• Demonstrates sufficient ability to:

  • Understand treatment effects

  • Understand risks (e.g., bone density impact)

  • Participate meaningfully in consent/assent

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4⃣ Informed Consent Process

• Involves the adolescent.

• Parent/guardian consent if required by local law.

• Includes discussion of:

  • Fertility implications

  • Bone health

  • Reversibility (generally considered reversible, though long-term data evolving)

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5⃣ Mental Health Considerations

• Coexisting psychological or medical conditions are assessed.

• They should be reasonably well managed if they interfere with decision-making.

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6⃣ Multidisciplinary Involvement (Recommended)

• Care ideally includes clinicians experienced in:

  • Adolescent development

  • Gender diversity

  • Endocrinology

What are the puberty blockers used?