Skip to main content

Medical interventions for children born with variations in their sex characteristics: what’s the rights approach?

Abstract

There have been growing calls within Australia and beyond to defer medical interventions for children born with variations in their sex characteristics. These calls are increasingly grounded in the claim that such interventions when performed on infants and young children are a violation of their human rights. This paper examines the basis for this claim. It also examines the differences between the principles-based approach to medical ethics which has tended to dominant decisions regarding the treatment of children born with variations in their sex characteristics, relative to the adoption of a rights-based approach. It identifies the points of complementarity between these two discourses but suggests that a rights-based approach offers some unique and differing insights into several issues concerning children born with variations in their sex characteristics.

This is a preview of subscription content, access via your institution.

References

  1. ACT Government. 2020. Key issues in the prohibition of deferrable interventions on intersex people: discussion paper Chief Minister, Treasury and Economic Development Directorate.

  2. Amnesty International. 2017. First, do no harm’ the rights of children with variations of sex characteristics in Denmark and Germany. London: Amnesty International.

  3. Ammaturo, Francesca Romana. 2016. Intersexuality and the “right to bodily integrity”: critical reflections on female genital cutting, circumcision, and intersex “normalizing surgeries” in Europe. Social & Legal Studies 25 (5): 591–610.

    Article  Google Scholar 

  4. Archard, David. 2004. Children: rights and childhood. London: Routledge.

    Google Scholar 

  5. Aurenque, Diana, and Hans-Jörg. Ehni. 2013. For the sake of “normality”? Medical indication, social justification, and the welfare of children. American Journal of Bioethics 13 (10): 55–57.

    Article  Google Scholar 

  6. Australian Human Rights Commission. 2009. Surgery on intersex infants and human rights.

  7. Australian Human Rights Commission. 2018. Protecting the human rights of people born with variations in sex characteristics in the context of medical interventions Consultation Paper.

  8. Behrens, Kevin G. 2020. A principled ethical approach to intersex paediatric surgeries. BMC Medical Ethics 21 (1): 108.

    Article  Google Scholar 

  9. Besson, S., and E. Kleber. 2019. Article 2: the right to non-discrimination. In The UN convention on the rights of the child: a commentary, ed. John Tobin, 41–72. Oxford: Oxford University Press.

    Google Scholar 

  10. Council of Europe. 2013. Resolution 1952: children’s right to physical integrity.

  11. Council of Europe. 2017. Resolution 2191/recommendation 2116: promoting the human rights of and eliminating discrimination against intersex people.

  12. Daniels, N. 2008. Just health: meeting health needs fairly. Cambridge: Cambridge University Press.

    Google Scholar 

  13. Darlington Statement. 2017. Joint consensus statement from the intersex community retreat in Darlington.

  14. Department of Health. 2013. Decision making principles for the care of infants, children and adolescents with intersex conditions. Victorian Government.

  15. Douché, Jeanie, and Mani Mitchell. 2018. Aotearoa childhood genital (re)assignment surgery: a case for the right to bodily integrity. Nursing Praxis in New Zealand 34 (2): 17–26.

    Article  Google Scholar 

  16. Eekelaar, John. 1994. The interests of the child and the child’s welfare: the role of dynamic self determinism. International Journal of Law and the Family 8: 42.

    Article  Google Scholar 

  17. Eekelaar, John. 2006. Family law and private life. Oxford: Oxford University Press.

    Google Scholar 

  18. Eekelaar, John, and John Tobin. 2019. Article 3: the best interests of the child. In The UN convention on the rights of the child: a commentary, ed. John Tobin, 73. Oxford: Oxford University Press.

    Google Scholar 

  19. Equality Australia. 2021. Towards a prohibition on deferrable medical interventions on intersex people: briefing paper for legal workshop on how a prohibition could operate in the Australian Capital Territory.

  20. Garland, Fae, and Mitchell Travis. 2018. Legislating intersex equality: building the resilience of intersex people through law. Legal Studies 38 (4): 587–606.

    Article  Google Scholar 

  21. Garland, Jameson, and Santa Slokenberga. 2019. Protecting the rights of children with intersex conditions from nonconsensual gender-conforming medical interventions: the view from Europe. Medical Law Review 27 (3): 482–508.

    Article  Google Scholar 

  22. Gillam, Lynn, Jaqueline K. Hewitt, and Garry L. Warne. 2010. Ethical principles for the management of children with disorders of sex development. Hormone Research in Peadiatrics 74: 412.

    Article  Google Scholar 

  23. Gillam, Lynn, Jaqueline K. Hewitt, and Garry L. Warne. 2012. Ethical principles for the management of children with disorders of sex development: a systematic approach for individual cases. In Disorders of sex development: an integrated approach to management, ed. John M. Hutson, Garry L. Warne, and Sonia R. Grover, 149–153. Berlin: Springer.

    Google Scholar 

  24. Gilleri, Giovanna. 2019. Gendered human rights and medical sexing interventions upon intersex children: a preliminary enquiry. Asian Yearbook of Human Rights and Humanitarian Law 3: 79–116.

    Google Scholar 

  25. Griffin, James. 2009. On human rights. Oxford: Oxford University Press.

    Google Scholar 

  26. Horowicz, Edmund M. 2017. Intersex children: who are we really treating? Medical Law International 17 (3): 183–218.

    Article  Google Scholar 

  27. Hughes, I., et al. 2006. Consensus statement on management of intersex disorders. Journal of Pediatric Urology 2 (3): 148.

    Article  Google Scholar 

  28. Human Rights Watch. 2017. I want to be like human nature made me” medically unnecessary surgeries on intersex children in the US (Human Rights Watch).

  29. Hutson, J., S. Grover, M. O’Connell, A. Bouty, and C. Hanna. 2020. Disorders/differences of sex development: an integrated approach to management, 2nd ed. Singapore: Springer.

    Book  Google Scholar 

  30. Kelly, Fiona, and Malcolmk Smith. 2017. Should court authorisation be required for surgery on intersex children? A critique of the family court decision in re Carla. Australian Journal of Family Law 31 (2): 118–133.

    Google Scholar 

  31. Lee, P.A., et al. 2016. Global disorders of sex development update since 2006: perceptions, approach and care. Hormone Research in Paediatrics 85: 158.

    Article  Google Scholar 

  32. Luthra, Shefali. 2020. Boston children’s hospital will no longer perform two types of intersex surgery on children. USA Today. https://www.usatoday.com/story/news/health/2020/10/22/intersex-surgery-boston-childrens-hospitals-decision-watershed-moment-rights/3721096001/.

  33. Money, J. 1968. Sex Errors of the Body: Dilemmas, Education, Counselling. Baltimoire, MD: John Hopkins University Press.

  34. O’Dwyer, Skye. 2017. “Treatment” of intersex children as a special medical procedure. Journal of Law and Medicine 24 (4): 870–885.

    Google Scholar 

  35. Re Carla. 2016. 54 Fam LR 576.

  36. Ruger, J. 2010. Health and social justice. Oxford: Oxford University Press.

    Google Scholar 

  37. Sanberg, Kirsten. 2018. Intersex children and the UN convention on the rights of the child. In The legal status of intersex people, ed. Jens Scherpe, 515. Cambridge: Intersentia.

    Chapter  Google Scholar 

  38. Secretary, Department of Health and Community Services v JWB and SMB (‘Marion’s Case’). 1992. 175 CLR 218.

  39. Segall, S. 2010. Health, luck and justice. Princeton University Press: Princeton.

    Google Scholar 

  40. Tasmanian Law Reform Institute. 2020. Legal recognition of sex and gender final report no 31.

  41. The Senate, Community Affairs References Committee. 2013. Involuntary or Coerced Sterilisation of Intersex People in Australia. Commonwealth of Australia.

  42. Tobin, John. 2012. The right to health in international law. Oxford: Oxford University Press.

    Google Scholar 

  43. Tobin, John. 2013. Justifying children’s rights. International Journal of Children’s Rights 21: 395.

    Article  Google Scholar 

  44. Tobin, John in Diduck, A. et al. (2015). Law in society: reflections on children, family, culture and philosophy: essays in honour of Michael Freeman. Leiden: Brill Nijhoff, p. 127.

  45. Tobin, John, and Sheila Varadan. 2019. Article 5: the right to parental direction and guidance consistent with a child’s evolving capacities. In The UN convention on the rights of the child: a commentary, ed. John Tobin, 159. Oxford: Oxford University Press.

    Google Scholar 

  46. Tobin, John, and Harry Hobbs. 2019. Article 37: protection against torture, capital punishment and arbitrary deprivation of liberty. In The UN convention on the rights of the child: a commentary, ed. John Tobin, 1420. Oxford: Oxford University Press.

    Google Scholar 

  47. Tobin, John, and Sarah Field. 2019. Article 16: the right to protection of privacy, family, home, correspondence, honour and reputation. In The UN convention on the rights of the child: a commentary, ed. John Tobin, 551. Oxford: Oxford University Press.

    Google Scholar 

  48. Tobin, John, ed. 2019. The UN convention on the rights of the child: a commentary. Oxford: Oxford University Press.

    Google Scholar 

  49. Tobin, J., and Todres, J. 2019. The Right to Preservation of a Child's Identity. in The UN Convention on the Rights of the Child: A Commentary (OUP 2019), ed. Tobin, J. 281.

  50. UN Commission on Human Rights. 1984. The Siracusa principles on the limitation and derogation provisions in the international covenant on civil and political rights, E/CN.4/1985/4.

  51. United Nations Committee on the Rights of the Child. 2016. General comment no 20 (2016) on the implementation of the rights of the child during adolescence. CRC/C/GC/20.

  52. United Nations Committee on the Rights of the Child. 2019. Concluding observations on the combined fifth and sixth periodic reports of Australia, CRC/C/AUS/CO/5-6.

  53. United Nations Committee on the Rights of Persons with a Disability. 2019. Concluding observations: UN report on australia’s review of the convention on the rights of persons with disability (CRPD). Para 34(b).

  54. United Nations Office of the High Commissioner for Human Rights. 2016. Media Release Intersex Awareness Day—Wednesday 26 October (2016) “End violence and harmful medical practices on intersex children and adults. UN and regional experts urge” Geneva. Accessed June 2, 2021 http://ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20739&LangID=E.

  55. Victorian Government. 2013. Department of health, decision making principles for the care of infants, children and adolescents with intersex conditions.

  56. Victorian Government, Department of Health and Human Services. (2019). Health and wellbeing of people with intersex variations: information and resource paper.

  57. Warne, G., and A. Mann. 2011. Ethical and legal aspects of management for disorders of sex development. Journal of Paediatrics and Child Health 47: 661.

    Article  Google Scholar 

  58. World Health Organization and others. 2014. Eliminating forced, coercive and otherwise involuntary sterilization: an interagency statement.

  59. Yogyakarta Principles Plus 10. 2017. Additional principles and state obligations on the application of international human rights law in relation to sexual orientation, gender expression and sex characteristics to complement the yogyakarta principles. Geneva: International Commission of Jurists.

Download references

Acknowledgements

Special thanks to Hannah Holland and Michael Frommer for their helpful comments on earlier drafts of this article. All errors remain my own.

Author information

Affiliations

Authors

Corresponding author

Correspondence to John Tobin.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tobin, J. Medical interventions for children born with variations in their sex characteristics: what’s the rights approach?. Monash Bioeth. Rev. (2021). https://doi.org/10.1007/s40592-021-00137-1

Download citation

Keywords

  • Intersex children
  • Human rights
  • International law