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Understanding Trans Racialized Youth Autonomy in Health Care Decision Making in Ontario

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Understanding Trans Racialized Youth Autonomy in Health Care Decision Making in Ontario Osgoode Hall Law School of York University Osgoode Digital Commons LLM Theses Theses and Dissertations 7-2-2019 Understanding Trans Racialized Youth Autonomy in Health Care Decision Making in Ontario Gitanjali Natasha Lena Follow this and additional works at: https://digitalcommons.osgoode.yorku.ca/llm Part of the Law Commons Recommended Citation Lena, Gitanjali Natasha, "Understanding Trans Racialized Youth Autonomy in Health Care Decision Making in Ontario" (2019). LLM Theses. 42. https://digitalcommons.osgoode.yorku.ca/llm/42 This Thesis is brought to you for free and open access by the Theses and Dissertations at Osgoode Digital Commons. It has been accepted for inclusion in LLM Theses by an authorized administrator of Osgoode Digital Commons. Understanding Trans Racialized Youth Autonomy in Health Care Decision Making in Ontario Natasha Gitanjali Lena A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF LAWS GRADUATE PROGRAM IN LAW YORK UNIVERSITY TORONTO, ONTARIO APRIL 2019 © Natasha Gitanjali Lena 2019 Abstract This thesis re-evaluates the concept of autonomy and the possibilities for trans racialized youth to practice it in current health care decision making contexts. After discussing access to health care in Ontario for this demographic using diverse research, an analytical foundation is laid using legal pluralism, relational autonomy, transgender theory and disidentification theory. The study uses Photovoice with trans racialized youth to produce visual texts analysed using thematic network analysis. Secondly, the study considers how together, law and medicine discursively work to encourage law-makers and health care providers to undermine the autonomy of trans racialized youth. Authoritative diagnostic and clinical texts are examined alongside decisions from courts and tribunals where trans racialized youth are present. Despite the autonomy granted in Ontario’s Health Care Consent Act, structural vulnerability, judicial paternalism, failure to mandate youth awareness of health care rights and professional ignorance restrict the autonomy practice of trans racialized youth. ii Acknowledgements After completing this two-year project, it seems I am relying on clichés to express how much my various communities and families carried me towards the finish line, and for that support I am grateful and honoured. To the trans racialized youth who inspired me and took part in my focus groups I thank you for trusting me and sharing your photos and analyses with me. I was lucky to be surrounded by a creative and critical community of multidisciplinary scholars and community workers from around the world who pushed me to find ways to articulate and prove my arguments. I want to thank: Kusha Dadui, Jake Pyne, Dr. Sarah Switzer, Professor Trish Salah, Cherie Moody, Florence Paré, Kai River Blevins, Kai Cheng Thom, Professor Benita Bunjun, Professor Jin Haritaworn, Salina Abji, Professor Dina Georgis, and everyone at the Women and Gender Studies Institute at the University of Toronto, my brilliant cousin Claudia Ezraeelian, and Jordan Zaitzow, Dr. Miriam Kaufman, Kiley May, Sly Sarkisova and the LGBTTQ2S Service Providers Network. Early draft readers waded through my chapters and provided invaluable editorial comments. I thank Rees Nam, Professor Julie James, Professor Ed Lee, Shazia Islam, Kusha Dadui, Tanisha Sri Bhaggiyadatta and Kamini Murthy-Korteweg. Writing community and study buddies for those long sessions with food: Rahina Zarma, Sarah Alghamdi, Rees Nam, Kusha Dadui and my Slack online writing bootcamp group. Formatting wizard AJ Clarke and copy editors Shazia Islam and Ola Skudlarska supported me through the formal technical requirements of an LLM thesis. I recognize the guidance of the Osgoode Hall Faculty of Law in particular my supervisor Professor Mykitiuk and my committee member Professor Sonia Lawrence as well as my knowledgeable and dedicated law librarian Sharon Wang. In the broader York University community, Professor Sarah Flicker was very helpful in teaching me about Photovoice and qualitative research. The practical analysis and encouragement of lawyers Nicole Nussbaum, barb findlay and Joanna Radbord, were essential in learning litigation history and finding a path through quandaries of legal reasoning. And finally, to the people who kept my body and psyche nourished with meals, rides, memes, songs, walks, emotional support dogs and pep talks, a.k.a. Mum, Dad, Stacia, Suvendrini, Athi, Amuthan and Arju I will not forget your kindness and wisdom. iii Table of Contents Abstract ......................................................................................................................... ii Acknowledgements ...................................................................................................... iii Table of Contents ........................................................................................................ iv List of Photographs ................................................................................................... viii List of Figures ................................................................................................................................ ix Chapter 1: Searching for Trans Racialized Youth ................................................... 1 Introduction .................................................................................................................. 1 Defining “Youth” ............................................................................................................................. 4 A Research Portrait of Trans Racialized Youth in Ontario .............................................................. 16 The Medical Model of Transness ..................................................................................................... 26 Roadmap of Thesis ........................................................................................................................... 30 Chapter 2: Theory Frameworks and Analytical Tools .......................................... 32 Intersectionality ................................................................................................................................ 33 Structural Vulnerability .................................................................................................................... 35 Accounting for Autonomy ............................................................................................................... 38 The Relationship between Oppression and Autonomy in Health Care ....................................................... 42 From Autonomy to Justice .......................................................................................................................... 45 Disidentification Theory .................................................................................................................. 47 Transgender Theory ......................................................................................................................... 53 Conclusion ....................................................................................................................................... 57 Chapter 3: Methods & Methodology........................................................................ 59 Guiding Concepts ............................................................................................................................. 60 Critical Legal Pluralism .............................................................................................................................. 60 Laws as Tactics ........................................................................................................................................... 60 Part I Legal Sources and Methods ................................................................................................... 62 Internal and External Analytical Method .................................................................................................... 63 Sources of Legal Norms .............................................................................................................................. 64 Jurisprudence ................................................................................................................................................. 65 Authoritative Texts ........................................................................................................................................ 65 iv Part 2 Qualitative Research .............................................................................................................. 67 Methodology ............................................................................................................................................... 67 Paradigms and Feminist Participatory Research ....................................................................................... 67 Representation, Truth and the Desire for Stories ....................................................................................... 70 Reflexivity ....................................................................................................................................................... 74 Methods ....................................................................................................................................................... 78 Recruitment ...................................................................................................................................................
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