Major Social and Ethical Issue of Ambiguous Sex in Modern Society

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Table of Contents

Introduction
The moral and ethical issues in focus
Conclusion
References
Notes

Introduction

Ambiguous sex has become a major social and ethical issue for entire societies and professional practices therein. The concept of ambiguous sex stems from the relation of sex and gender, whereby, it is argued that one’s sexuality is not a representation of his or her gender (Diamond & Beh, 2012).

In other words, a person with female genitals does not necessarily have to be female in gender; rather she can be socialized to be male in gender. To shed more light on the sex ambiguity, Diamond (2002) defines the term sex as the anatomical structure of the genitals, and gender as the adopted or imposed psychological and social condition. Such distinctions imply that use of sex and gender as synonyms is wrong.

Professionally, members of the medical profession are charged with the responsibility of offering psychological guidance to people with ambiguous sex, helping them have a sex change if they so desire, and helping them deal with their new found identities once the sex change has been done.

In some cases, professionals in the medical field have even had to contend with legal processes where they have been accused of giving the wrong kind of advice, and allegedly leading their patients into making the wrong decisions. Such was the case of Alan Flinch, who applied to have sex reassignment surgery when he was 21 years old.

His sex change had been conducted eight years earlier enabling him to live as a woman; he however claimed that he should not have been allowed to make such a transition and blamed the psychologists who had diagnosed him as a transsexual and who had advised him to undergo sex change for his predicament (Goodenough, 2008ⁱ). Flinch’s decision to reverse the sex change is an example of the draw backs that people with ambiguous sex and the medical professionals who attend them have to face. A similar scenario was reported in the United Kingdom (Bohon, 2012ⁱⁱ). Such scenarios underscore the importance of informed consent as a condition for making the sex change. It would be advisable for children to understand the effect of undergoing a sex change, both in the short term and in the long-term.

The drawbacks of sex change notwithstanding, people with ambiguous sex should be the ultimate decision makers on whether or not to have the sex altering surgery. Additionally, people who make the decision to change their sex should not be discriminated against based on such a decision. If anything, they should be treated as equal members of the society.

Even after sex change has been made, other ethical issues arise such as what was portrayed in the documentary titled The Southern Comfort.^ⁱⁱⁱ The ethical issue in the documentary arises because two dozen doctors refuse to treat Robert Eads who is suffering from ovarian cancer, and hence it becomes a certainty that he will die. Notably, the doctors are worried about the effect that treating Eads would have on their reputation and are seen to contravene the ‘do no harm’ principle of the medical profession.

Following the documentary, one gets the impression that the medics are more concerned about their reputations and have little regard to relieving pain in Eads, thus posing even more questions regarding the ethical nature of their conduct.

Arguably, patients (regardless of their sex or gender) do not just receive treatments because they demand for the same. Additionally, it is understandable that physicians or people in the medical profession do not have an obligation to deliver healthcare that is unlikely to benefit the subject patient (American Medical Association (AMA) (2012a^iv).

In Eads’ case however, it is seems that the doctors simply refused to offer him medical attention on account of his sex-change. Ethically, “a physician has a duty to do all that he or she can for the benefit of the individual patient” (AMA, 2012b^v). As indicated by Cancer Monthly (2012), each stage of ovarian cancer can be treated with even the most advanced cancer (stage IV) having a 1-5% 5-year survival.

The moral and ethical issues in focus

Making Eads’ the focus of this section, it is worth noting that he had the right to a sex exchange, because after all, he was not forced into it and he did what he thought suited him best. The moral and ethical issues in how the doctors denied him treatment are however questionable especially if one is to consider that they feared losing patients on treating him.

Under the current anti-discrimination laws in New England for example, “ no one deserves to be harassed or discriminated against based on someone else’s idea of “appropriate” male or female gender identity” (GLAD, 2011, p. 3). Yet, it appears that the doctors denied a patient medical attention based on the imposed self or societal beliefs that a woman should not and cannot change their sex.

Just as a transgender person may be denied employment or other social services based on his/her non-conformance to social expectations, it can be argued that Eads was denied medical attention for similar reasons.

Unfortunately, the denial of medical attention meant that Eads had to die and this is arguably tantamount to denying a person some life-saving service. Morally, medical professionals should do everything within their powers to preserve and/or enhance the quality of a patient’s life (American College of Physicians (ACP), 2012).

If the principles of medical ethics as illustrated in figure 1 below were to be considered, the two dozen doctors who refused to attend Eads would fare badly in all the four principles. In relation to beneficence, it could be argued that whatever the doctors did or said did not benefit the patient.

According to Simon (2008), the principle of beneficence states that the possible benefits of treating a patient must outweigh the associated risks. It is also evident that the doctors did not respect Eads autonomy, since they did not respect his wishes to have specific treatment.

By so doing, they were judging him on something he had done in his past and can therefore be said to having disrespected his rights to self-determination. Further, it appears that the doctors went against the principles of justice by discriminating Eads based on his sex change. According to Simon (2008), healthcare should be given to patients based on need, and any health care provision based on color, creed, class, wealth or even sex should be considered as an injustice committed against an individual.

*Figure 1: The principles of medical ethics. Source: Simon (2008).*

Conclusion

As noted in the introductory section of this essay, ambiguous sex poses both ethical and moral issues to professional, most especially in the medical profession. As argued in this essay however, a person who undergoes sex change does so, based on his/her right to self-determination and should not be discriminated against because of the sex change.

Additionally, professionals in the medical professional should always uphold the four ethical principles namely beneficence, non-maleficience, autonomy and justice when handling patients. The identified principles will no doubt act as the much needed guide whenever ethical issues arise.

In conclusion, it is worth reiterating that sex change is an individual decision, which should be respected by professionals and non-professionals alike. However, such decisions should only be made when one is fully informed and conscious of the implications it may have in future.

References

American College of Physicians (ACP) (2012). ACP ethics manual sixth edition. Web.

American Medical Association (AMA). (2012a). Opinion 2.03- allocation of limited medical resources. Web.

American Medical Association (AMA). (2012b). Opinion 2.035 – Futile care. Web.

Bohon, D. (2012). San Francisco to offer free “sex reassignment” surgeries to its uninsured. The New American. Web.

Cancer Monthly. (2012). Ovarian cancer. Web.

Diamond, M. (2002). Sex and gender are different: sexual identity and gender identity are different. Clinical Child Psychology & Psychiatry, (Special Issue in Press): 1-26.

Diamond, M., & Beh, H, G. (2012). The right to be wrong- sex and gender decisions. Web.

GLAD. (2012). Transgender legal issues- New England. Gay & Lesbian Advocates & Defenders, Boston, MA.

Goodenough, P. (2008). ‘Sex change’ clinic faces inquiry, lawsuit. Cnsnews. Web.

Simon, D. (2008). Ethical issues in palliative care. Oxford Journals –InnovAiT, 1(4): 274-279.

Notes

See Goodenough (2008) for more about the ‘sex-change’ clinic that Flinch attended and the controversies surrounding it.
See Bohon (2012), who reports that Charles Kane reversed his sex change stating that what would have helped him before the sex-change surgery was counseling and not the altercations made on his body.
The Southern Comfort is a documentary whose main character is 52-years old Robert Eads who made a woman to man sex change. He however develops ovarian cancer and comments that the disease (or the ovaries) is the last part of him that was female, and incidentally, it was the same part that was killing him.
See Opinion 2.035- futile care as published by the American Medical Association (AMA) (2012).
See Opinion 2.03- allocation of limited medical resources as published by AMA (2012, para. 1).

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