Pregnancy, Gender Identity, Autonomy, and Trust

Abstract

I ask what is required for pregnant trans and gender diverse (TGD) people to receive trustworthy reproductive healthcare which supports their autonomy. My focus is on wanted pregnancies. I understand interpersonal trust as a positive attitude towards the competence and motivation or commitment of a person trusted in a particular role, such as a healthcare professional, and autonomy as self-governance shaped by what one cares about. I conceive of autonomy as relational and potentially enhanced or damaged by social interactions. I argue that mainstream bioethical conceptions of autonomy can accommodate my claims about how the autonomy of pregnant TGD persons can be diminished or supported, especially in relation to trust. I argue that support for the autonomy of pregnant TGD persons requires acknowledgement and understanding of their gender identity even when it is not relevant to their healthcare. My discussion has implications for whether morality requires us to affirm trans identities and what this means in healthcare. I conclude with remarks about what else we can learn by centering the experiences of pregnant TGD persons.