Misogynistic Attitudes underlying the Surgical Reassignment of Intersex Infants - The UK Intersex Association (UKIA)
The West is now becoming more aware of the widespread genital modification done abroad, with attention especially centring on the highly controversial practice of "female circumcision," which involves mutilation of the labia majora and/or labia minora and clitoris. Far less publicity however is given to the practice in Western medicine of surgically reassigning an intersex infant to be an anatomical match with (what is regarded as standard) male or female, irrespective of the child’s true sex or gender identity. One part of this process involves reconstructive surgery of the genitalia of male infants which also involves the removal of the gonads and consequent fertility. Inherent in his procedure is the attitude that an infertile, surgically constructed ‘female’ is preferable to a fertile, underdeveloped male. This speaks loudly to assert that “female” is the best option for a “failed” male.
Recommendations to clinicians involved in the treatment of intersex infants:
- Perform no major surgery for cosmetic reasons alone; only for conditions related to physical/medical health.
- Explain to parents that appearances during childhood, while not typical of other children, may be of less importance than functionality and post pubertal erotic sensitivity of the genitalia. Surgery can potentially impair sexual/erotic function.
- Such surgery, which includes all clitoral surgery and any sex reassignment, should typically wait until puberty or after when the patient is able to give truly informed consent. [See: Kipnis, K. and Diamond, M. Pediatric Ethics and the Surgical Assignment of Sex The Journal of Clinical Ethics, 1998. 9 (December (Winter)): (p. 398-410)]
Doctrine of Informed Consent
The informed consent doctrine preserves a patient’s right to make medical decisions on his or her own behalf. It protects “‘the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law.’” Two key interests are at stake: bodily integrity and self-determination.“The law of informed consent is predicated on notions of patient sovereignty and serves to safeguard the patient’s right of choice.”
Generally, informed consent includes an obligation to provide relevant information concerning alternatives to the proposed treatment, including “material risks incident to abstention from treatment.”Although some courts continue to follow an older physician-oriented standard and measure the adequacy of disclosure with reference to the custom and standard within the medical community, the decisional trend over the past two decades has been toward a patient-oriented standard, with reference to “what a reasonable person objectively needs to hear from his or her physician to allow the patient to make an informed and intelligent decision regarding proposed medical treatment”.
While children and incompetents possess bodily integrity and self-determination rights in theory, finding a practical framework that allows others to make decisions and yet assures the correctness of those decisions for that patient presents a legal and ethical challenge. The primary obligation for making medical decisions on behalf of children resides with the child’s parents and the obligation to disclose information about treatment runs to them.
Therefore, it is proposed:
1. That there be a general moratorium on such surgery when it is done without the consent of the patient.
2. That this moratorium not be lifted unless and until the medical profession completes comprehensive look-back studies and finds that the outcomes of past interventions have been positive.
3. That efforts be made to undo the effects of past deception by physicians.
[Ref: “Pediatric Ethics and the Surgical Assignment of Sex”]
Authors: Kenneth Kipnis and Milton Diamond
