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Are acts of self-amputation for survival morally justifiable in the Catholic tradition? I propose that a proper understanding of the principle of totality that involves a benefit/risk assessment of the impact of a surgical intervention on the well-being of the embodied person justifies such acts: A bodily part may be sacrificed to save the life of an individual person because all bodily parts are ordered towards the flourishing of that person. As such they can be sacrificed for the good of the whole, because this would be in accord with their natural end. [ABSTRACT FROM AUTHOR]

In an important article, John Finley suggests a correction to Aquinas's understanding of gender distinction. Disagreeing with Aquinas, Finley proposes that gender distinction (male and female) stems from the soul rather than from the body. In this essay, I will show that this is not a tenable position because it does not fit with either what we know about the physical development of sex differences or the unity of man and woman as a single human species. I will defend Aquinas's fundamental insights into the root of gender distinction without defending his biological understanding of the process itself. I will argue that there is a single generic generative power in the soul that is determined by the matter to which the soul is united, to be expressed as either male or female. This paradigm, I believe, copes better than the one offered by Finley with phenomena such as intersexed persons and sex reassignment surgery. While I do not accept the idea of a feminine or masculine soul, the paradigm offered here does lead to the notion of the soul being feminized or masculinized on account of the matter that it informs. [ABSTRACT FROM AUTHOR]

Individuals who experience a gender identity that is discordant with biological sex are increasingly presenting to physicians for assistance in alleviating associated psychological distress. In contrast to prior efforts to identify and primarily address underlying psychiatric contributors to gender dysphoria, interventions that include uncritical social affirmation, use of gonadotropin-releasing hormone agonists to suppress normally timed puberty, and administration of cross-sex steroid hormones to induce desired secondary sex characteristics are now advocated by an emerging cohort of transgender medicine specialists. For patients with persistent gender dysphoria, surgery is offered to alter the appearance of breasts and genital organs. Efforts to address ethical concerns regarding this contentious treatment paradigm are dependent upon reliable evidence on immediate and long-term risks and benefits. Although strong recommendations have been made for invasive and potentially irreversible interventions, high-quality scientific data on the effects of this approach are generally lacking. Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on "expert" opinion. Existing data reveal significant intervention-associated morbidity and raise serious concern that the primary goal of suicide prevention is not achieved. In addition to substantial moral questions, adherence to established principles of evidence-based medicine necessitates a high degree of caution in accepting gender-affirming medical interventions as a preferred treatment approach. Continued consideration and rigorous investigation of alternate approaches to alleviating suffering in people with gender dysphoria are warranted. Summary: This paper provides an overview of what is currently known about people who experience a gender identity that differs from their biological sex and the associated desire to engage the medical profession in alleviating associated discomfort and distress. The scientific evidence used to support current recommendations for affirming one's preferred gender, halting normally timed puberty, administering cross-sex hormones, and surgically altering primary and secondary sexual traits are summarized and critically evaluated. Serious deficits in understanding the cause of this condition, the reasons for the marked increase in people presenting for medical care, together with immediate and long-term risks relative to benefit of medical intervention are exposed. [ABSTRACT FROM AUTHOR]