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Journal of Bioethical Inquiry

, Volume 15, Issue 4, pp 557–568 | Cite as

Intersexual Births: The Epistemology of Sex and Ethics of Sex Assignment

  • Matteo CrestiEmail author
  • Elena Nave
  • Roberto Lala
Original Research

Abstract

This article aims to analyse a possible manner of approaching the birth of intersexual children. We start out by summing up what intersexuality is and how it is faced in the dominant clinical practice (the “treatment paradigm”). We then argue against this paradigm, in favour of a postponement of genital surgery. In the second part of this paper, we take into consideration the general question of whether only two existing sexes are to be recognized, arguing in favour of an expansion of sex categories. In the third part, we illustrate the reasons supporting provisional sex attribution: the child’s best interest and respect for their developing moral autonomy. This position aims to increase the child’s well-being and self-determination, limiting parents’ freedom to take decisions on behalf of others, in particular, those decisions concerning basic aspects of their children’s personal identity.

Keywords

Intersexuality Genital surgery Sex assignment Epistemology of sex Proxy consent Autonomy 

References

  1. Ainsworth, C. 2015. Sex redefined. Nature 518(7539): 288–291.CrossRefGoogle Scholar
  2. American Academy of Pediatrics. 2000. Evaluation of the newborn with developmental anomalies of the external genitalia. Pediatrics 106(1): 138–142.CrossRefGoogle Scholar
  3. American Psychological Association. 2002. Answer to your question about transgender people, gender identity, and gender expression. http://www.apa.org/topics/lgbt/transgender.pdf. Accessed May 8, 2018.
  4. Callahan, G.D. 2009. Between XX and XY: Intersexuality and the myth of two sexes. Chicago: Chicago Review Press.Google Scholar
  5. Chase, C. 2003. What is the agenda of the intersex patient advocacy movement? Endocrinologist 13(3): 240–542.CrossRefGoogle Scholar
  6. Committee on the Rights of Persons with Disabilities. 2016. Concluding observations on the initial report of Italy. http://intersex.shadowreport.org/public/italy_IT_CRPD_concl-obs_CRPD_C_ITA_CO_1_25069_E.pdf. Accessed January 2, 2018
  7. Cornwall, S. 2009. Theologies of resistance: Intersex/DSD, disability and queering the real world.” In Critical intersex, edited by M Holmes, 215–243. Farnham: Ashgate.Google Scholar
  8. Corwin, A.I. 2009. Language and gender variance: Constructing gender beyond the male/female binary. Electronic Journal of Human Sexuality 12(4). http://www.ejhs.org/Volume12/Gender.htm. Accessed May 8, 2018.
  9. Daaboul, J., and J. Frader. 2001. Ethics and the management of the patient with intersex: A middle way. Journal of Pediatric Endocrinology and Metabolism 14(9): 1575–1583.CrossRefGoogle Scholar
  10. de Beauvoir, S. 2011. The second sex. New York: Vintage.Google Scholar
  11. Diamond, M., and H.G. Beh. 2006. The right to be wrong: Sex and gender decisions. In Ethics and intersex, edited by S.E. Sytsma, 103–114. Dordrecht: Springer.CrossRefGoogle Scholar
  12. Diamond, M., and J. Garland. 2014. Evidence regarding cosmetic and medically unnecessary surgery on infants. Journal of Pediatric Urology 10(1): 2–7.CrossRefGoogle Scholar
  13. Dow, S. 2010. Neither man nor woman. The Sydney Morning Herald, June 27. http://www.smh.com.au/nsw/neither-man-nor-woman-20100626-zaye.html. Accessed January 2, 2018.
  14. Dreger A.D. 1998. Hermaphrodites and the medical invention of sex. Cambridge (MA): Harvard University Press.Google Scholar
  15. Dreger A.D. 2006. Intersex and human rights: The long view. In Ethics and intersex edited by S.E. Sytsma, 73–86. Dordrecht: Springer.CrossRefGoogle Scholar
  16. Dreger, A.D., and Herdon A.M. 2009. Progress and politics in the intersex rights movement: Feminist theory in action. GLQ: A Journal of Lesbian and Gay Studies 15(2): 199–224.CrossRefGoogle Scholar
  17. Eugenides, G. 2002. Middlesex. New York: Farrar, Straus and Giroux.Google Scholar
  18. Faden, R., T.L. Beauchamp. 1986. A history and theory of informed consent. Oxford: Oxford University Press.Google Scholar
  19. Fausto-Sterling, A. 1993. The five sexes: Why male and female are not enough. The Sciences March/April: 20–24.Google Scholar
  20. ———. 2000a. Sexing the body: Gender, politics and the construction of sexuality. New York: Basic Books.Google Scholar
  21. ———. 2000b. Sex/gender: Biology in a social world. New York-London: Routledge.Google Scholar
  22. Feder E.K. 2006. “In their best interests”: Parents’ experience of atypical genitalia. Surgically shaping children. Technology, ethics, and the pursuit of normality, edited by Parens E., 189–210. Baltimore, ML: The Johns Hopkins University Press: Baltimore.Google Scholar
  23. ———. 2009. Imperative of normality: From “intersex” to disorders of sex development.” GLQ: A Journal of Lesbian and Gay Studies 15(2): 225–247.CrossRefGoogle Scholar
  24. ———. 2014. Making sense of intersex. Changing ethical perspectives in biomedicine. Bloomington: Indiana University Press.Google Scholar
  25. Frader, J., P. Alderson, A. Asch, et al. 2004. Health care professionals and intersex conditions. Archives of Pediatric and Adolescent Medicine 158(5): 426–428.CrossRefGoogle Scholar
  26. Grisso, T., and P.S. Appelbaum. 1998. Assessing competence to consent to treatment: A guide for physicians and other health professionals. Oxford: Oxford University Press.Google Scholar
  27. Herdt, G. 1996. Third sex third gender: Beyond sexual dimorphism in culture and history. New York: Zone Books.Google Scholar
  28. Hester, D.J. 2004. Intersex(es) and informed consent: How physicians’ rhetoric constrains choice. Theoretical Medicine and Bioethics 25(1): 21–49.CrossRefGoogle Scholar
  29. Holmes, M. 2002. Rethinking the meaning and management of intersexuality. Sexualities 5(2): 159–180.CrossRefGoogle Scholar
  30. Hudson, W.D. 1969. The is-ought question: A collection of paper in the central problem in moral philosophy. London: MacMillan.CrossRefGoogle Scholar
  31. Houk, C.P., and P.A. Lee. 2012. Update on disorders of sex development Current Opinion in Endocrinology Diabetes and Obesity 19(1): 28–32.CrossRefGoogle Scholar
  32. Howe, E.G. 2006. Advances in treating (or not treating) intersexed persons: Understanding resistance to change. In Ethics and intersex, edited by S.E. Sytsma, 115–138. Dordrecht: Springer.CrossRefGoogle Scholar
  33. Hughes, I.A. 2008. Disorders of sex development: A new definition and classification Best Practice & Research: Clinical Endocrinology & Metabolism 22(1): 119–34.CrossRefGoogle Scholar
  34. Hughes, I.A., C.P. Houck, F.S. Ahmed, and P.A. Lee. 2006. Consensus statement of management of intersex disorders. Archives of Disease in Childhood 91(7): 554–563.CrossRefGoogle Scholar
  35. Human Rights Watch. 2017. I want to be like nature made me. Medically unnecessary surgeries on intersex children in the US. https://www.hrw.org/sites/default/files/report_pdf/lgbtintersex0717_web_0.pdf Accessed 2 January, 2018.
  36. Karkazis, K. 2008. Fixing sex: Intersex, medical authority, and lived experience. Durham: Duke University Press.CrossRefGoogle Scholar
  37. ———. 2014. Sex reassignment. In: Encyclopedia of bioethics, 4th ed, edited by S.G. Post, 2909–2914. Farmington Hills (MI): The Gale Group.Google Scholar
  38. Kemp, S.F. 2006. The role of genes and hormones in sexual differentiation. In: Ethics and intersex edited by S.E. Sytsma, 1–16. Dordrecht: Springer.Google Scholar
  39. Kessler, S.J. 1998. Lessons from the intersexed . New Brunswick: Rutgers University Press.Google Scholar
  40. Lee, P.A., A. Nordenström, C.P. Houk, et al. 2016. Global disorders of sex development update since 2006: Perceptions, approach and care. Hormonal Research in Paediatrics 85(3): 158–180.CrossRefGoogle Scholar
  41. Lee, P.A., C.P. Houck, S.F. Hamed, and I.A. Hughes. 2006. Consensus statement on management of intersex disorders. International Consensus Conference on Intersex. Pediatrics 118(2): 488–500.Google Scholar
  42. Lee, P.A., and C.P. Houk. 2016. Changing and unchanging perspectives regarding intersex in the last half century: Topics presented in the Lawson Wilkins Lecture at the 2015 Pediatric Endocrine Society Meeting. Pediatric Endocrinology Reviews 13(3): 574–584.PubMedGoogle Scholar
  43. Maier-Bahlburg, H.F.L. 2005. Gender identity outcome in female-raised 46 XY persons with penile agenesis cloacal extrophy of the bladder or penile ablation. Archives of Sexual Behavior 34(4): 423–438.CrossRefGoogle Scholar
  44. Mason, P. 2013. Intersex genital autonomy: A rights-based framework for medical intervention with intersex infants. In Genital cutting: Protecting children from medical, cultural, and religious infringements edited by G.C. Denniston, F.M. Hodges and M.F. Milos. 149–184. Dordrecht: Springer.CrossRefGoogle Scholar
  45. Mayer, L.S., and R.R. McHugh. 2016. Sexuality and gender: findings from biological, psychological, and social sciences. The New Atlantis, 50: 10–143.Google Scholar
  46. McCullough, L.B. 2002. A framework for the ethically justified clinical management of Intersex. Pediatric Gender Assignment 511: 149–173.CrossRefGoogle Scholar
  47. Mieszczak, J., C.P. Houk, and P.A. Lee. 2009. Assignment of the sex of rearing in the neonate with a disorder of sex development. Current Opinion in Pediatrics 21(4): 541–547.CrossRefGoogle Scholar
  48. Money, J., J.G. Hampson, and J.L. Hampson. 1957. Imprinting and the establishment of gender role. Archives of Neurology and Psychiatry 77(3): 333–336.CrossRefGoogle Scholar
  49. Morland, I. 2009. What can queer theory do for intersex? GLQ: A Journal of Lesbian and Gay Studies 15(2): 285–312.CrossRefGoogle Scholar
  50. Ozar, D.T. 2006. Towards a more inclusive conception of gender-diversity for intersex advocacy and ethics. In Ethics and intersex edited by S.E. Sytsma, 17–46. Dordrecht: Springer.CrossRefGoogle Scholar
  51. Parens, E. 2006. Surgically shaping children. Technology, ethics, and the pursuit of normality. Baltimore, ML: The Johns Hopkins University Press.Google Scholar
  52. Parliamentary Assembly of the Council of Europe. 2013. Resolution 1952. Children’s right to physical integrity. http://assembly.coe.int/nw/xml/XRef/X2H-XrefViewPDF.asp?FileID=20174. Accessed January 2, 2018.
  53. Pascual, J. 2015. Le sexe “neutre” reconnu pour la primière fois en France [The “neutral” sex recognized for the first time in France]. Le Monde, October 14, http://www.lemonde.fr/societe/article/2015/10/14/le-sexe-neutre-reconnu-pour-la-premiere-fois-en-france_4789226_3224.html. Accessed January 2, 2018.7
  54. Reis, E. 2009. Bodies in doubt. An American history of intersex. Baltimore: The John Hopkins University Press.Google Scholar
  55. ———. 2013. Intersex surgeries, circumcision, and the making of normal.” In Genital cutting: Protecting children from medical, cultural, and religious infringements, edited by G.C. Denniston, F.M. Hodges, and M.F. Milos, 137–147. Dordrecht: Springer.CrossRefGoogle Scholar
  56. Roen, K. 2009. Clinical intervention and embodied subjectivity: Atypically sexed children and their parents. In Critical intersex, edited by M. Holmes, 14–40. Farnham: Ashgate.Google Scholar
  57. Rosario, V.A. 2009. Quantum sex: Intersex and molecular deconstruction of swex. GLQ: A Journal of Lesbian and Gay Studies 15(2): 267–284.CrossRefGoogle Scholar
  58. Roughgarden, J. 2004. Evolution’s rainbow: Diversity, gender and sexuality in nature and people. Berkeley: University of California Press.Google Scholar
  59. Schober, J., A. Nordenström, P. Hoebeke, et al. 2012. Disorders of sex development: Summaries of long-term outcome studies. Journal of Pediatric Urology 8(6): 616–623.CrossRefGoogle Scholar
  60. Smith, D. 2013. Genital autonomy: A new approach. In Genital cutting: Protecting children from medical, cultural, and religious infringements, edited by G.C. Denniston, F.M. Hodges, and M.F. Milos, 327–334. Dordrecht: Springer.CrossRefGoogle Scholar
  61. United Nations. 2013. Report of the special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf. Accessed January 2, 2018.
  62. ———. 2015. Ending violence and discrimination against lesbian, gay, bisexual transgender and intersex people. http://www.unicef.org/media/files/Joint_LGBTI_Statement_ENG.pdf. Accessed January 2, 2018.
  63. Wilfond, B.S., P.S. Miller, C. Korflatis, D.S. Diekema, D.M. Dudzinski, and S. Goering. 2010. Navigating growth attenuation in children with profound disabilities: Children’s interests, family decision-making, and community concerns. The Hasting Center Report 40(6): 27–40.CrossRefGoogle Scholar

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2018

Authors and Affiliations

  1. 1.Department of Philosophy and Education ScienceUniversity of TurinTurinItaly
  2. 2.Pediatric PneumologyRegina Margherita Children’s Hospital, Città della Salute e della ScienzaTurinItaly
  3. 3.Pediatric EndocrinologyRegina Margherita Children’s Hospital, Città della Salute e della ScienzaTurinItaly

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