One cannot justify conversion therapy on grounds of “self-determination” or “informed consent”

Conversion therapy practitioners attempt to justify its use by including the perverse use of positive values in therapy such as “self-determination” or “informed consent.” These claims must be examined critically since it is clear that pursuit of conversion therapy is driven by societal and internalized stigma.

While any competent, ethical therapist respects a client’s right to self-determination, therapists cannot offer a “consumer choice” model of treatments because therapists are bound by medical and ethical guidelines to consider the efficacy of treatment and potential for harm. Ethically, therapists cannot apply treatments that pose a significant risk of harm even if requested. Similarly, psychologists are bound to respect and protect civil and human rights, and ensure that their treatments provide benefit, as well as avoid the risk of harm.

Informed consent does not assist the case of conversion therapy practitioners. Informed consent requires that the client be provided accurate information on the condition and potential benefits and harms of intervention. Yet, conversion therapy providers convey false, unscientific and discredited information, such as that homosexuality is a disorder or a symptom of a disorder, that homosexuality does not exist, or that gay and transgender people’s lives are unhappy and unfulfilling.

Informed consent also requires a clear understanding of benefits and harms of any intervention. A treatment that poses a significant risk of harm without unique benefits fails to meet minimal standards of informed consent because a treatment can only be offered if it provides benefits. Ethically, even if a client asks, mental health and health practitioners must avoid the risk of potential harm and provide treatment that benefits the client. There are a variety of alternative treatment options for this population outlined in professional guidelines.

In addition, informed consent can only be provided when the therapy is voluntary and pursued without undue influence, such that the client should ultimately be able to refuse or accept treatment. Children and adolescents cannot legally consent to treatment due to their minority, and in any event, may be taken to therapy regardless of their wishes, and lack the opportunity to refuse such treatment.

Finally, informed consent requires the person to be competent to understand the short term and long-term consequences of the treatment. It is very unlikely that a child or adolescent can foresee the potential consequences or harms of these treatments. A minor’s ability to understand long-term consequences of denying or changing their sexual orientation can be limited when they may not have reached puberty, or experienced sexual arousal, let alone fallen in love, or experienced the type of emotional intensity found in relationships. Likewise, gender identity is an aspect of self that has profound social and personal elements across one’s lifespan; children and adolescents may not understand the emotional impact of change efforts.

Roland Behm