Protecting children affected by Atypical Gender Identity Organization: the comparative legal perspective

Some children at a very young age could feel, in the deepest realm of self-perception, to belong to the opposite sex, in spite of their absolute biological normality. According to medical literature this phenomenon is defined "Atypical Gender Identity Organization" (A.G.I.O). The DSM-5 provides different criteria for the diagnosis of gender dysphoria in children than in adults and adolescents. It was highlighted that the variance of gender identity can be defined as the state in which gender identity is organized atypically during the psychosexual development of a child. These are cases in which children and adolescents perceive their sexual identity as inappropriate to their body and then to their biological sex. They may feel unhappy regarding their physical and sexual features and express a desire to be recognized as belonging to the opposite sex. Such situations are accompanied by difficulties from an emotional perspective, with significant behavioral suffering associated with their conditions. Medical experience shows that about 1/3 of those children affected by A.G.I.O. will be oriented to surgical intervention to change their sex, while the other 2/3 will overcome their perceived identity conforming to the biological sex during their pubertal development. After becoming adults half of the latter will have a heterosexual orientation and the other half will evolve towards a homosexual orientation. In rare cases, only after thorough psychological assessment, the international literature admits the possibility to carry out puberty blocking therapy and, subsequently, to a cross sex state. These are the cases considered appropriate to make the choice about possible drug treatment according the guidelines of the Endocrine Society issued in 2009 and ratified by WPATH (World Professional Association for Transgender Health) in 2011. These therapies help to provide more time for both professionals and young people to better understand what to do without worries about the development of sexual characteristics of the biological sex. In this sense, the desired role allowing a smoother inclusion of affected teenager in his or her social environment.The condition of children suffering from atypical organization of gender identity directly involves the relationship between parenting choices and protection of the preeminent best interest of the child, first of all his or her mental well-being, as well as to the manifestation of consent to administration of drug therapies It must be considered that in psychiatry A.G.I.O. is still considered a mental disorder, while in theory there are those who states that it is a medical convention detrimental to the personalistic principle of self-determination. The purpose of this paper is to analyze the comparative legal sources and case law concerning the manifestation of informed consent to medical treatment and the legal consequences related to gender change.25-29 July 201