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Barns rätt till delaktighet i hälso- och sjukvården i Sverige jämfört med Finland – och särskilt om frågans komplexitet i kontexten könsbekräftande vård

Perheentupa, Vilma LU (2021) JURM02 20212
Department of Law
Faculty of Law
Abstract (Swedish)
Antalet barn och unga som upplever könsdysfori har ökat drastiskt under det senaste årtiondet. Unga könsdysforiker har behandlats och behandlas idag med hormoner som kan bromsa pubertetsutvecklingen eller göra att kroppen utvecklas närmare till det könet som den unga identifierar sig som. Könsbe-kräftande hormonbehandlingar till barn har på senare tid väckt ett antal frågor, eftersom behandlingarnas långtidseffekter inte har fastställts. Inte minst aktua-liserar ämnet frågan om huruvida underåriga patienter kan förstå en sådan behandlings innebörd och effekter på ett sådant sätt att hen självständigt ska få samtycka till pubertetsbromsande eller könskonträra hormonbehandlingar.

Med denna uppsats avser jag att utreda barnets rätt till... (More)
Antalet barn och unga som upplever könsdysfori har ökat drastiskt under det senaste årtiondet. Unga könsdysforiker har behandlats och behandlas idag med hormoner som kan bromsa pubertetsutvecklingen eller göra att kroppen utvecklas närmare till det könet som den unga identifierar sig som. Könsbe-kräftande hormonbehandlingar till barn har på senare tid väckt ett antal frågor, eftersom behandlingarnas långtidseffekter inte har fastställts. Inte minst aktua-liserar ämnet frågan om huruvida underåriga patienter kan förstå en sådan behandlings innebörd och effekter på ett sådant sätt att hen självständigt ska få samtycka till pubertetsbromsande eller könskonträra hormonbehandlingar.

Med denna uppsats avser jag att utreda barnets rätt till delaktighet inom hälso- och sjukvården i svensk rätt jämfört med finsk, och att åskådliggöra kom-plexiteten i frågan om barns självbestämmanderätt i fallet könsbekräftande vård. För att uppfylla uppsatsens syfte eftersträvar jag att besvara dels
hur barns rätt till delaktighet regleras inom hälso- och sjukvården och vilken vikt barnets inställning ges i beslut om vård i svensk rätt jämfört med finsk rätt, dels i vilken mån och på vilka sätt frågan om barns rätt till självbestäm-mande är särskilt komplex när det gäller könsbekräftande vård och hur sam-tyckesfrågan har diskuterats i svenskt och finskt material avseende könsbe-kräftande vård till barn.

Enligt barnkonventionen har ett barn rätt att fritt uttrycka sina åsikter i frågor som rör barnet. Barnets åsikter ska enligt konventionen också tillmätas bety-delse i relation till dennes ålder och mognad. Eftersom barnkonventionen gäl-ler som lag i både Sverige och Finland är en komparativ studie om hur barns rätt till delaktighet har reglerats i de två länderna betydelsefull. Utifrån uppsat-sens syfte är det bra att jämföra svensk rätt med finsk rätt, eftersom en jämfö-relse kan ge mig mer kunskap om hur samma problem har lösts i liknande rättsordningar. I Finland har barnkonventionen införts som lag tidigare än i Sverige, varför frågan om barns rätt till delaktighet också har diskuterats i en större utsträckning där än i Sverige.

Jag konstaterar att den finska hanteringen av frågan om barns rätt till delaktig-het i huvudsak överensstämmer med den svenska. Hälso- och sjukvård till barn kräver i bägge jurisdiktionerna vårdnadshavarens samtycke, förutsatt att den underåriga själv inte har uppnått en sådan mognad att hen självständigt kan ta ställning till frågan. Barnets beslutsförmåga ska bedömas från fall till fall, med hänsyn till det enskilda barnets ålder och mognad, men också till den aktuella vårdåtgärdens angelägenhetsgrad. När barnet inte bedöms vara själv-bestämmande i relation till en vårdfråga, har barnet ändå rätt att uttrycka sina åsikter och få dem beaktade, och i vissa fall till medbestämmande.

Vad gäller könsbekräftande vård, konstaterar jag att frågan om barns rätt till delaktighet är särskilt komplex dels eftersom det är svårt att fastställa när ett barns könsdysfori är bestående och dels då det saknas forskning om könsbe-kräftandehormonbehandlingars långtidseffekter, vilket gör att det inte är säkert att en underårig patient kan ge sitt informerade samtycke till dessa behandling-ar. Av det material uppsatsen undersöker framgår att en annan typ av försik-tighet är befogad när könsbekräftande behandling ges till barn, jämfört med vuxna. Pubertetsbromsande hormonbehandlingar anses vara mer godtagbara, än könskonträra behandlingar som inte går att ångra. (Less)
Abstract
The number of children and adolescents who experience gender dysphoria has increased rapid-ly over the past decade. Gender dysphoria in adolescence may be treated with hormones that either delay the onset of puberty or govern the gender development closer towards the gender that the patient identifies with. Hormonal gender-affirming treatments in children have recently been brought up to discussion, due to the absence of long-term follow up studies and lack of knowledge on the long-term effects. Among other things, the topic raises the question on whether minor patients are able to understand the meaning and the effects of the treatment in a way that allows them to independently consent to puberty-suppressing or feminiz-ing/masculinizing... (More)
The number of children and adolescents who experience gender dysphoria has increased rapid-ly over the past decade. Gender dysphoria in adolescence may be treated with hormones that either delay the onset of puberty or govern the gender development closer towards the gender that the patient identifies with. Hormonal gender-affirming treatments in children have recently been brought up to discussion, due to the absence of long-term follow up studies and lack of knowledge on the long-term effects. Among other things, the topic raises the question on whether minor patients are able to understand the meaning and the effects of the treatment in a way that allows them to independently consent to puberty-suppressing or feminiz-ing/masculinizing hormone treatments.

The aim of this essay is to examine how child’s right to participation in healthcare decisions is regulated in Swedish law compared with Finnish law, and further to illustrate the complexity in the minors right to self-determination in the context of gender-affirming treatment. In order to meet the aim of the essay I will try to answer the following questions. How is child’s right to participation in healthcare regulated and what weight is a child’s opinion given in decisions on the child’s healthcare and medical treatment, in Swedish law compared with Finnish law? To what extent and in which ways is the question on a child’s right to self-determination particular-ly complex in the context of gender-affirming hormone treatment and how is the question of consent discussed in Swedish and Finnish material concerning gender-affirming treatment to children?

The United Nations Convention on the Rights of the Child regulates child’s rights to freely express views on matters that concern the child. The views of the child are to be given due weight in accordance with the child’s age and maturity. The Convention has status of national law in both Sweden and in Finland, which makes a comparative study on child’s right to partic-ipation between the two jurisdictions meaningful. With respect to the aim of the essay, doing a comparative study with Finnish law can give more knowledge about how the same issues have been solved in other jurisdictions. In Finland, the Convention on the Rights of the Child has been given status as national law earlier than in Sweden. Consequently, the question on child’s right to participation has been discussed further in Finland than in Sweden.

I conclude that children’s right to participation in healthcare decisions in Finnish law generally corresponds to that in Swedish law. In both jurisdictions, healthcare and medical treatment of children requires consent from the child’s legal guardian, given that the child has not reached a maturity that allows the child to self-determination in relation to the matter in question. The child’s decision-making capacity is to be assessed on a case-by-case basis and account has to be taken to the individual child’s age and maturity as well as to the importance and urgency of the matter in question. Even when the child lacks decision-making capacity, she or he has a right to express views, which have to be weighed in accordance with the child’s age and ma-turity.

As regards gender-affirming hormone treatments, I conclude that the question on the child’s right to participation and self-determination is particularly complex partly as it is difficult to determine whether the gender dysphoria a child experiences is permanent or passing, partly as more research is needed on the long-time effects of the treatments, which makes it hard to de-termine whether a minor can give their informed consent to these treatments. The material I have studied emphasize that a higher grade of caution is to be taken when gender-affirming treatment is considered for a child, compared to an adult. The material considers puberty-suppressing hormone treatment for children as more acceptable than the partly irreversible fem-inizing/masculinizing hormone treatments. (Less)
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author
Perheentupa, Vilma LU
supervisor
organization
alternative title
Child’s right to participation in healthcare decisions in Sweden compared to Finland – and particularly on the topic’s complexity in the context of gender affirming treatment
course
JURM02 20212
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
komparativ rätt, comparative law, medicinsk rätt, healthcare law, barnrätt, barnkonventionen, patient, rätten till delaktighet, självbestämmande
language
Swedish
id
9070314
date added to LUP
2022-01-25 11:33:26
date last changed
2022-01-29 14:22:21
@misc{9070314,
  abstract     = {{The number of children and adolescents who experience gender dysphoria has increased rapid-ly over the past decade. Gender dysphoria in adolescence may be treated with hormones that either delay the onset of puberty or govern the gender development closer towards the gender that the patient identifies with. Hormonal gender-affirming treatments in children have recently been brought up to discussion, due to the absence of long-term follow up studies and lack of knowledge on the long-term effects. Among other things, the topic raises the question on whether minor patients are able to understand the meaning and the effects of the treatment in a way that allows them to independently consent to puberty-suppressing or feminiz-ing/masculinizing hormone treatments.

The aim of this essay is to examine how child’s right to participation in healthcare decisions is regulated in Swedish law compared with Finnish law, and further to illustrate the complexity in the minors right to self-determination in the context of gender-affirming treatment. In order to meet the aim of the essay I will try to answer the following questions. How is child’s right to participation in healthcare regulated and what weight is a child’s opinion given in decisions on the child’s healthcare and medical treatment, in Swedish law compared with Finnish law? To what extent and in which ways is the question on a child’s right to self-determination particular-ly complex in the context of gender-affirming hormone treatment and how is the question of consent discussed in Swedish and Finnish material concerning gender-affirming treatment to children?

The United Nations Convention on the Rights of the Child regulates child’s rights to freely express views on matters that concern the child. The views of the child are to be given due weight in accordance with the child’s age and maturity. The Convention has status of national law in both Sweden and in Finland, which makes a comparative study on child’s right to partic-ipation between the two jurisdictions meaningful. With respect to the aim of the essay, doing a comparative study with Finnish law can give more knowledge about how the same issues have been solved in other jurisdictions. In Finland, the Convention on the Rights of the Child has been given status as national law earlier than in Sweden. Consequently, the question on child’s right to participation has been discussed further in Finland than in Sweden.

I conclude that children’s right to participation in healthcare decisions in Finnish law generally corresponds to that in Swedish law. In both jurisdictions, healthcare and medical treatment of children requires consent from the child’s legal guardian, given that the child has not reached a maturity that allows the child to self-determination in relation to the matter in question. The child’s decision-making capacity is to be assessed on a case-by-case basis and account has to be taken to the individual child’s age and maturity as well as to the importance and urgency of the matter in question. Even when the child lacks decision-making capacity, she or he has a right to express views, which have to be weighed in accordance with the child’s age and ma-turity.

As regards gender-affirming hormone treatments, I conclude that the question on the child’s right to participation and self-determination is particularly complex partly as it is difficult to determine whether the gender dysphoria a child experiences is permanent or passing, partly as more research is needed on the long-time effects of the treatments, which makes it hard to de-termine whether a minor can give their informed consent to these treatments. The material I have studied emphasize that a higher grade of caution is to be taken when gender-affirming treatment is considered for a child, compared to an adult. The material considers puberty-suppressing hormone treatment for children as more acceptable than the partly irreversible fem-inizing/masculinizing hormone treatments.}},
  author       = {{Perheentupa, Vilma}},
  language     = {{swe}},
  note         = {{Student Paper}},
  title        = {{Barns rätt till delaktighet i hälso- och sjukvården i Sverige jämfört med Finland – och särskilt om frågans komplexitet i kontexten könsbekräftande vård}},
  year         = {{2021}},
}