Medically Transitioning Minors: Whose Burden of Proof Is It Anyway?

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Transfeminine jurist Florence Ashley sits comfortably at the front of the pack of the most radical intellectuals in the transgender-theory space. From her perch as a law professor and bioethicist at the University of Alberta, she has churned out a fusillade of academic articles that stretch the bounds of what is considered ethical, legal and possible where gender-transition interventions, in particular as they apply to minors, are concerned.

Her papers lend an academic veneer to some astonishingly radical ideas, which, given they are published in legitimate journals, have routinely been laundered through the wider corpus of respectable academic and medical literature about pediatric gender medicine. I can always tell when a paper makes a truly eyebrow-raising ethical claim that the footnote at the end of the sentence will refer to an Ashley paper. It is probable that her theories lay at least part of the foundation for—or otherwise they are very much in keeping with—Pulitzer Prize-winning literary critic Andrea Long Chu’s astonishing claim in a 2024 New York magazine cover article that minors should be able to medically transition at any age for any reason.

Much of Ashley’s writing concerns mental health care, or at least the philosophy, policies, practices and structures that undergird that discipline’s contribution to pediatric gender medicine. This despite the fact that Ashley is not herself any sort of mental health professional or trained in psychology. One wonders: If she had any training in developmental psychology, might she think twice about expressing some of her more astonishing claims about the rights of adolescents to make decisions about irreversible modifications to their bodies?

Ashley has insisted that the decisional authority with pediatric gender-transition interventions should lie with the minor and not with adult authority figures. To wit, it may astonish many Americans to know that in some provinces in Canada, there is no specific age of consent for medical interventions. Patients are considered capable of consenting by default. A doctor can otherwise determine that they are incapable.

This fact came up in my recent reporting about the Ontario pediatrician Dr. Natasha Johnson, who, one mother recalled to me, told the mom that her (highly mentally ill) child was “competent” simply because she was 14 years old. The child’s mental health steadily declined during her testosterone treatment and following her mastectomy at age 16. She nearly died of anorexia. Then she detransitioned at 17. Dr. Johnson then dropped her as a patient.

Ashley has railed against gatekeeping of gender-transition treatment for minors and insisted that demanding so-called exploratory therapy as a condition of approving youth for gender-transition drugs is de facto conversion therapy. She also has flipped the burden of proof for a gender dysphoric adolescent’s path into puberty, insisting that those who argue against a minor receiving blockers must prove their case, not the other way around.

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The video featured above includes a scantily clad Ashley giving a short speech about medical gatekeeping for trans care at the 2021 conference of the U.S. branch of the World Professional Association for Transgender Health, known as USPATH.