Ambiguous Sex: The Ethics of Medical Practitioners

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Even without the socialization process, it is arguably possible for a female to be born in a male body and vice versa as indicated by Dreger (2009)

On a biological perspective however, a third angle into the sex and gender debate is introduced through the term biological sex. The Planned Parenthood Federation of America (PPFA) (2012) defines biological sex as the physical and psychological condition that “identifies a person as …female, male, or intersex”.ⁱ A person’s hormones, chromosomes, and sexual anatomy all contribute to one’s biological sex status.

The chromosomes have a large role to play in the entire biological sex scenario since XX chromosomes combination produce a biologically female offspring, while an XY chromosome combination produces a biologically male offspring. As PPFA (2012) notes however, sometimes the human offspring does not fit into the XX or XY chromosomes combination hence bringing forth an ambiguous sex scenario (i.e. the offspring is neither completely male nor completely female).

At birth, a child “who has a mixture of male and female reproductive structures, so that it is not clear …whether the individual is a male or a female” is called Intersex.ⁱⁱ In some cases however, an intersex person can have completely female or male reproductive organs, but their biological variables (i.e. chromosomal gender, hormones, and internal reproductive organs such as uterus, fallopian tubes, seminal vesicles and prostate) may be in conflict.

This paper will focus on the ethics of medical practitioners in their treatment approaches to people with ambiguous sex conditions. The paper uses the illustration of Eads, a female to male transgender, who though not indicated whether he was intersex at birth, is denied treatment because of his non-conformance to the cultural expectations of being a man – at least because he had ovaries that were the same reason he was seeking treatment.

While such medical practices may be ethically questionable, it is arguable that the doctor considered what was best for the child’s future wellbeing, and did not perform the reconstructive surgery based on what Dreger (2009) calls welcoming a child “to their team and to their paradigm”.ⁱⁱⁱ

The ethics question however arises owing to child’s inability to make decisions for itself at that age, and the doctor’s assumptions about what was best for the child. The main issue in such cases stem from the question about the ethical nature of performing a sex-change surgery for a child who cannot be depended upon to give informed consent.

As reflected in emergent activist organizations such as the Intersex Society of North America, not every child who is a recipient of sex- reconstruction treatment is happy or satisfied with their status in adulthood. Such situations thus raise the question: would it be more ethical for medical professionals to leave the decision on whether to treat ambiguous gender cases to the affected people? After all, they would be clearer on the acquired gender they want to take up in adulthood.

Notably, the protocol to ‘treat’ “pseudohermaphrodites” was adopted in the 1960s based on the persuasion that children below 18 months could be successfully treated of ambiguous sex-related conditions. However, the surgeries had to be followed up with other medical treatments such as hormonal therapy (Hyde & Delamater, 2006)^iv.

Beginning in the 1990s however, people who had undergone ‘treatment’ have surfaced to petition the decisions made on their behalf by doctors and parents when they were babies. As noted by Hyde and Delamater (2006), such intersex people argue that ambiguous sex is a case of “genital variability” and nor “genital abnormality”.^v As such, they question the appropriateness of not only the treatments done on them, but on the continued use of such treatments on children who cannot object the decisions made for their bodies by the adults.

Although Eads case was a scripted fictitious story, it is unfortunate that similar incidences happen in reality. For example, it is documented that “29% Trans people have been refused treatment by a doctor or nurse because they did not approve their gender reassignment”.^vi

References

Dreger, A. (2009). Gender identity disorder in childhood: inconclusive advice to parents. Hastings Center Report 39(1), 26-29.

Hyde, J., & Delamater, H. (2006). Understanding Human Sexuality. 9^th Ed., London: McGraw-Hill.

Planned Parenthood Federation of America (PPFA). (2012). Female, male & Intersex. Web.

Thom, B. (2010). Transgender guide for NHS Acute hospital trusts. London: Royal Free Hampstead.

Notes

i See Planned Parenthood Federation of America (2012). Female, Male & Intersex.

ii Ibid.

iii Dreger, Alice. “Gender Identity Disorder in Childhood: Inconclusive Advice to Parents.” Hastings Center Report 39.1 (2009) at 27.

iv See Hyde, J., & Delamater, H. (2006). Understanding Human sexuality. 9^th Ed. London: McGraw-Hill, p.106.

v Ibid.

vi Thom, B. (2010). Transgender guide for NHS Acute hospital trusts. London: Royal Free Hampstead. p. 12.

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Ambiguous Sex: The Ethics of Medical Practitioners

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