Abstract
In this paper, we aim to criticise the dualistic approach of gender-specific medicine with regard to sex and gender. Firstly, we analyse the definition of intersexuality and reject the idea that it is a disease unto itself. Medicine classifies cases of intersexuality as disorders of sex development, because they do not conform to the dualist scheme that defines an individual’s sex as “either male or female”. However, we argue that there is no compelling reason to label intersexuality as a disease unto itself. In order to support this claim, we then consider some relevant naturalistic conceptions of health and disease. Secondly, we show that gender-specific medicine, and medicine in general, could be improved by abandoning rigid dualism concerning sex and gender. Taking sex and gender pluralism seriously would potentiate us to recognise that intersexual, transsexual, and transgender people have their own specific physiology, pathophysiology, and health concerns, which up to now have been mostly overlooked and unaddressed by gender-specific medicine. It would also encourage us to consider intersexual, transsexual, and transgender people, and to include them in clinical trials, medical research, and treatment. All this would be an ethical, epistemological, and medical improvement.
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Notes
- 1.
Even if there are important differences between notions such as disease, disorder, illness, injury, and malady, the conceptual issues raised by them in the present context are similar enough to let us put these distinctions aside.
- 2.
Even if, from a theoretical point of view, the difference between sex and gender is acknowledged by gender-specific medicine, there is still a tendency to misrepresent and confuse the concepts of sex and gender, which are sometimes even regarded as interchangeable. We discussed this problem arguing that a distinction between the notion of sex (which refers solely to biological, anatomical, physiological, and pathophysiological differentiations) and that of gender (which considers cultural, historical, psychological, and social influences and characteristics) may still be useful in medicine (Amoretti and Vassallo 2013b).
- 3.
- 4.
On November 1st, 2013 Germany became the first country in Europe to allow parents to register intersex babies not as male or female. Australians have had the option of selecting “X” as their sex on passport applications since 2011, New Zealanders since 2012. Similar recognitions of a “third” sex can also be found in Bangladesh, India, Nepal, and Pakistan.
- 5.
We do not survey transsexuality, but many of the following reflections apply to it too.
- 6.
Even if it has been questioned that sterility is a disease unto itself, for the sake of the argument we won’t consider this option.
- 7.
We do not consider normativist accounts because, as they explicitly refer to what is good/bad, flourishing/harmful for someone (subject, culture, etc.), we feel that it would be easier to accommodate them instead with the idea that intersexuality is not a disease unto itself. Also, we do not want to defend any of the naturalist accounts we consider in this study, as our purpose is merely to show that the claim that intersexuality is not a disease is compatible with (almost) all of them.
- 8.
Some scholars have criticised the idea that biological fitness is the common goal of all human life, as humans have multiple and different goals. As we have already seen, it has also been questioned that sterility is a disease unto itself. If these claims were correct, then it would be easier to maintain that intersexuality is not a disease. For the sake of the argument, however, we won’t take this possibility into account.
- 9.
This conclusion might be problematic for the BST, as some diseases generally associated with certain forms of intersexuality could become typical within the reference class selected. This puzzle, however, is not new, as other diseases are typical within a reference class.
- 10.
We wish to thank the anonymous reviewers for their helpful comments and objections.
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Amoretti, M.C., Vassallo, N. (2015). Against Sex and Gender Dualism in Gender-Specific Medicine. In: Mäki, U., Votsis, I., Ruphy, S., Schurz, G. (eds) Recent Developments in the Philosophy of Science: EPSA13 Helsinki. European Studies in Philosophy of Science, vol 1. Springer, Cham. https://doi.org/10.1007/978-3-319-23015-3_27
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