Eliminating the “Abnormal”

  • Nikoletta Pikramenou


“Normality” or “normalcy” is a broad concept and its definition varies among disciplines, scientific communities, individuals, eras, societies and circumstances. “Normality” is treated as a statistical perception according to which philosophers and society consider it as the state of being “normal” which is linked to the “most usual”. Several psychoanalysts use “normal” to indicate the perfect and ideal and physicians frequently use “normal” with a technical significance which implies what ought to be. Attributing characteristics to an individual such as “normal” or “deviant” and “unusual” lead to “labeling”. “Labeling” is based on the thesis that human identity is created through the process of interaction between an individual and the others in society. Then, society based on “labeling”, responds by forming prejudices and stigmatising the targeted individuals. Individuals who are victims of stigmatisation often create a negative image for themselves and face marginalisation, discrimination and human rights violations.


  1. Akchurin W, Kartzke R (2007) The ethics of gender selection. In: McIntosh D, Drabic R, Huber K, Vinogradov I, Bassick M (eds) The ethical imperative in the context of evolving technologies. University of Colorado Leeds School of Business, pp 21–33Google Scholar
  2. Dreger AD (1999) A history of intersexuality. In: Dreger AD (ed) Intersex in the age of ethics. University Publishing Group, HagerstownGoogle Scholar
  3. Fausto-Sterling A (2000a) Sexing the body. Basic BooksGoogle Scholar
  4. Feder KE (2014) Making sense of intersex: changing ethical perspectives in biomedicine. Indiana University PressGoogle Scholar
  5. Foucault M (1980) Herculine Barbin: being the recently discovered memoirs of a nineteenth century French hermaphrodite (trans: McDougall R). Pantheon Books, New YorkGoogle Scholar
  6. Foucault M (1996) The social extension of the norm in foucault live: collected interviews, 1961–1984. In: Lotringer S (ed) (trans: Honchroth L, Johnston J), 2nd edn. Semiotext (e), New YorkGoogle Scholar
  7. Fountedaki K (2004) Civil medical liability (in Greek). SakkoulasGoogle Scholar
  8. Garland J (2016) On science, law, and medicine: the case of gender- “normalizing” interventions on children who are diagnosed as different in sex development. Uppsala UniversityGoogle Scholar
  9. Ghattas C (2013) Human Rights between sexes: a preliminary study on the life situations of inter∗ individuals. Heinrich Böll FoundationGoogle Scholar
  10. Karkazis K (2008) Fixing sex: intersex, medical authority, and lived experience. Duke University PressGoogle Scholar
  11. Korff D (2006) The right to life: a guide to the implementation of Article 2 of the European Convention on Human Rights. In: Human rights handbooks No. 8, Council of Europe, pp 6–8Google Scholar
  12. Kuhnle S, Sander A (2010) The emergence of the welfare state. In: Castles FC, Leibfried S, Lewis J, Obinger H, Pierson C (eds) The Oxford handbook of the welfare state. Oxford University Press, OxfordGoogle Scholar
  13. Lind AS (2011) The Right to Health from a Constitutional Perspective – the Example of the Nordic Countries, in Nordic Health Law in a European Context Welfare State Perspectives on Patients’ Rights and Biomedicine. International Law E-books online, pp 67–76Google Scholar
  14. Morland I (2006) Postmodern intersex in ethics and intersex. Springer, NetherlandsGoogle Scholar
  15. Ní Mhuirthile T (2015) Building bodies: a legal history of intersex in ireland in sexual politics in modern Ireland. Irish Academic PressGoogle Scholar
  16. Preves ES (2008) Intersex and identity: the contested self. Rutgers University PressGoogle Scholar
  17. Scherpe MJ, Dutta A, Helms T (eds) (2018) The legal status of intersex persons. IntersentiaGoogle Scholar
  18. Van Kersbergen K, Vis B (2014) Comparative welfare state politics. development, opportunities, and reform. Cambridge University Press, CambridgeGoogle Scholar
  19. Alderson P (2007) Competent children? Minors consent to health care treatment and research. Soc Sci Med 65:2272–2283CrossRefGoogle Scholar
  20. Arora P (2017) Right to access reproductive technologies – a right or a wrong? J For Med Leg Aff 2(1):114Google Scholar
  21. Baratz BA (2016) Re: “Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how?”. J Pediatr Urol 12(6):442–443CrossRefGoogle Scholar
  22. Bayefsky JM (2016) Comparative preimplantation genetic diagnosis policy in Europe and the USA and its implications for reproductive tourism. Reprod Biomed Soc Online 3:41–47CrossRefGoogle Scholar
  23. Behrmann J, Ravitsky V (2013) Queer liberation, not elimination: why selecting against intersex is not “straight” forward. Am J Bioethics 13(10):39–59CrossRefGoogle Scholar
  24. Campbell M (2015) CEDAW and women’s intersecting identities: a pioneering new approach to intersectional discrimination. Revista Direito GV, São Paulo 11(2):479–504CrossRefGoogle Scholar
  25. Carpenter M (2016) The human rights of intersex people: addressing harmful practices and rhetoric of change. Reprod Health Matters 46(47):74–84CrossRefGoogle Scholar
  26. Chase C (1998) Hermaphrodites with attitude: mapping the emergence of intersex political activism. GLQ A J Lesbian Gay Stud 4(2):189–211CrossRefGoogle Scholar
  27. Chase C (2002) “Cultural practice” or “reconstructive surgery”? U.S. genital cutting, the intersex movement, and medical double standards. In: Stanlie MJ, Robertson CC (eds) Genital cutting and transnational sisterhood: disputing US polemics. University of Illinois Press, Urbana, pp 126–152Google Scholar
  28. Creighton MS, Michala L, Mushtaq I, Yaron M (2014) Childhood surgery for ambiguous genitalia: glimpses of practice changes or more of the same. Psychol Sex 5(1):34–43Google Scholar
  29. Creighton S (2001) Surgery for intersex. J Royal Soc Med 94(5):218–220CrossRefGoogle Scholar
  30. Creighton S, Minto C (2001) Managing intersex: most vaginal surgery in childhood should be deferred. BMJ 323(7324):1264–1265CrossRefGoogle Scholar
  31. Crissman HP, Warner L, Gardner M, Carr M, Schast A, Quittner AL, Kogan B, Sandberg DE (2011) Children with disorders of sex development: a qualitative study of early parental experience. Int J Pediart Endocrinol 1(10). Scholar
  32. Daaboul J, Frader J (2001) Ethics and the management of the patient with intersex: a middle way. J Pediatr Endocrinol Metab 14(9):1575–1583CrossRefGoogle Scholar
  33. Damiano L (2011) When parents can choose to have the “Perfect” child: why fertility clinics should be required to report preimplantation genetic diagnosis data. Family Court Rev 49(4):846–859CrossRefGoogle Scholar
  34. Davis G (2013) The social costs of preempting intersex traits. Am J Bioethics 13(10):51–53CrossRefGoogle Scholar
  35. Dayner EJ, Lee AP, Hook PC (2004) Medical treatment of intersex: parental perspectives. J Urol 172(4):1762–1765CrossRefGoogle Scholar
  36. DeLaet LD (2012) Genital autonomy, children’s rights, and competing rights claims in international human rights law. Int J Children’s Rights 20:554–583CrossRefGoogle Scholar
  37. Devine WJ (2018) Gender, steroids, and fairness in sport. Ethics Philos 13(2):161–169. Scholar
  38. Diamond M, Garland J (2014) Evidence regarding cosmetic and medically unnecessary surgery on infants. J Pediatr Urol 10(1):2–6CrossRefGoogle Scholar
  39. Ehrenreich N, Mark B (2005) Intersex surgery, female genital cutting, and the selective condemnation of “cultural practices”. Harv Civil Rights Civil Liber Law Rev 40:72–140Google Scholar
  40. Fausto-Sterling A (2000b) The five sexes, revisited. Sciences 40(4). Accessed 10 Dec 2018
  41. Feder EK, Dreger A (2016) Still ignoring human rights in intersex care. J Pediatr Urol 12(6):436–437CrossRefGoogle Scholar
  42. Fujimura M (2000) The welfare state, the middle class, and the welfare society. Rev Popul Soc Policy 9:1–23Google Scholar
  43. Ford K (2001) “First, do no harm”: the fiction of legal parental consent to genital-normalizing surgery on intersexed infants. Yale Law Policy Rev 19(2):469–488Google Scholar
  44. Gough B, Weyman N, Alderson J, Butler G, Stoner M (2008) They did not have a word’: the parental quest to locate a ‘true sex’ for their intersex children. Psychol Health 23(4):493–507CrossRefGoogle Scholar
  45. Henkin L (1989) The universality of the concept of human rights. The annals of the American Academy of political and social science. Sage Publications, Inc. in association with the American Academy of political and social science. Human Rights Around World 506(1):10–16Google Scholar
  46. Hermer L (2002) Paradigms revised: intersex children, bioethics & the law. Ann Health Law 11(1):195Google Scholar
  47. Hester JD (2004a) Intersex (es) and informed consent: how physicians’ rhetoric constraints choice. Theoretical Medicine, Kluwer Academic Publishers 25:21–49Google Scholar
  48. Hester JD (2004b) Intersexes and the end of gender: corporeal ethics and postgender bodies. J Gender Stud 13(3):215–225CrossRefGoogle Scholar
  49. Ireland-Piper D, Weinert K (2014) Is there a “Right” to Sport?. Bond University. Sports Law e-journal, Accessed 10 Feb 2018
  50. Ittelson A, Tamar-Mattis A (2016) Avoiding liability in the treatment of intersex patients. J Pediatr Urol 16(6):439–440CrossRefGoogle Scholar
  51. Jones L (2009) The third sex: gender identity development of intersex persons. Grad J Couns Psychol 1(2):10–16Google Scholar
  52. Kahn JA (2002) Explaining the Welfare State. The University of Chicago Press. Soc Serv Rev 76(75th Anniversary):189–195Google Scholar
  53. Kessler JS (1990) The medical construction of gender: case management of intersex infants. Signs J Women Cult Soc 16(1):3–21CrossRefGoogle Scholar
  54. Lane J-E, Mæland R (1998) Welfare states or welfare societies? Statsvetenskaplig Tidskrift 2:1–20Google Scholar
  55. Lee AP, Nordenström A, Houk PC, Ahmed SF, Auchus R, Baratz A, Baratz DK, Liao L-M, Lin-Su K, Looijenga 3rd LH, Mazur T, Meyer-Bahlburg HF, Mouriquand P, Quigley AC, Sandberg ED, Vilain E, Witchel S and the Global DSD Update Consortium (2016) Global disorders of sex development update since 2006: perceptions, approach and care. Hormone Res Pediatr 85:158–180Google Scholar
  56. Macioce F (2011) Individual liberty and self-determination. Libertarian Pap 3(3):1–18Google Scholar
  57. Magritte E (2012) Working together in placing the long term interests of the child at the heart of the DSD evaluation. J Pediatr Urol 8(6):571–575CrossRefGoogle Scholar
  58. Mouriquand PDE, Brindusa GD, Gay C-L, Meyer-Bahlburg HFL, Baker L, Baskin LS, Bouvattier C, Braga LH, Caldamone AC, Duranteau L, Ghoneimim AEL, Hensle TW, Hoebeke P, Kaefer M, Kalfa N, Kolon TF, Manzoni G, Mure P-Y, Lee P (2016) Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how? J Pedriatr Urol 12(93):139–149CrossRefGoogle Scholar
  59. Newbould MJ (2016) What do we do about women athletes with testes? Med Ethics 42:256–259CrossRefGoogle Scholar
  60. Nisker J (2013) Informed choice and PGD to prevent “intersex conditions”. Am J Bioeth 13(10):47–49CrossRefGoogle Scholar
  61. Pitsiladis Y, Harper J, Betancurt OJ, Matrinez-Patino M-J, Parisi A, Wang G, Pigozzi F (2016) Beyond fairness: the biology of inclusion for transgender and intersex athletes. Curr Sports Med Rep 15(6):386–388CrossRefGoogle Scholar
  62. Reis E, Kessler S (2010) Why history matters: fetal sex and intersex. Am J Bioeth 10(9):58–59CrossRefGoogle Scholar
  63. Robertson AJ (2003) Procreative liberty in the era of genomics. Am J Law Med 29:439–487Google Scholar
  64. Salako SE (2011) Informed consent under the European Convention on biomedicine and the UNESCO declaration on bioethics. Med Law 30(1):101–113Google Scholar
  65. Shelby Deeney M (2013) Bioethical considerations of preimplantation genetic diagnosis for sex selection. Wash Univ Jurisp Rev 5(2):333–360Google Scholar
  66. Skillen A (1985) Welfare State versus welfare society? J Appl Philos 2(1):3–17CrossRefGoogle Scholar
  67. Skopalová J (2010) Social deviations, labelling and normality. Human Aff 20:327–337Google Scholar
  68. Sonksen P, Ferguson-Smith AM, Bavington LD, Holt IGR, Cowan AD, Catlin HD, Kidd B, Davis G, Davis P, Edwards L, Tamar-Mattis A (2015) Medical and ethical concerns regarding women with hyperandrogenism and elite sport. J Clin Endocrinol Metab 100(3):825–827CrossRefGoogle Scholar
  69. Sparrow R (2013) Gender eugenics? The ethics of PGD for intersex conditions. Am J Bioeth 13(10):29–38CrossRefGoogle Scholar
  70. Stanley AE (2014) Gender Self-Determination. University of Melbourne, pp 89–91. Accessed 5 Mar 2019CrossRefGoogle Scholar
  71. Steuli CJ, Vayena E, Cavicchia-Balmer Y Huber J (2013) Shaping parents: impact of contrasting professional counseling on parents’ decision making for children with disorders of sex development. J Sex Med 10:1953–1960Google Scholar
  72. Teetzel S (2006) On transgendered athletes, fairness and doping: an international challenge. Sport Soc 9(2):227–251CrossRefGoogle Scholar
  73. Thorn DE (2014) Drop the Knife! Instituting policies of nonsurgical intervention for intersex infants. Family Court Rev 52(3):610–621CrossRefGoogle Scholar
  74. Valleala A (2014) Legal recognition of same-sex family life in the jurisprudence of the European Court of Human Rights Master’s thesis published by the University of HelsinkiGoogle Scholar
  75. Wellman M (1958) The concept of normal in medicine. Can Med Assoc J 79:43–45Google Scholar
  76. Yamin EA (2005) The right to health under international law and its relevance to the United States. Am J Public Health 95(7):1156–1161CrossRefGoogle Scholar
  77. Zhou C, Zhou X, Lei Wang X, Hesketh T (2011) Son preference and sex-selective abortion in China: informing policy options. Int J Public Health 57(3):459–465CrossRefGoogle Scholar
  78. Center for Reproductive Rights (2012) “Whose Right to Life? Women’s Rights and Prenatal Protections under Human Rights and Comparative Law”, available on
  79. European Court of Human Rights (2016) Research Report “Bioethics and the case-law of the Court”,
  80. European Court of Human Rights (2015) Thematic Report “Health-related issues in the case-law of the European Court of Human Rights”,
  81. Human Rights Watch and Interact (July 2017) “I Want to Be Like Nature Made Me” Medically Unnecessary Surgeries on Intersex Children in the US, available on
  82. Human Genetics Alert (December 2002) “The case against sex selection”, Human Genetics Alert Campaign BriefingGoogle Scholar
  83. Kilkelly U, Donnelly M (2006) “The Child’s Right to be heard in the Healthcare Setting: Perspectives of children, parents and health professionals”,
  84. Koffemena NR (June 2010) “(The right to) personal autonomy in the case law of the European Court of Human Rights”. Thesis, University of Leiden,;jsessionid=CCE1BCA991B6F07C20983D3CBCA63C81?sequence=3
  85. Lee AP, Houk PC, Ahmed F, Hughes A (2006) Ieuan in collaboration with the participants in the International Consensus Conference on Intersex organized by the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology, “Consensus Statement on Management of Intersex Disorders”, available on
  86. OHCHR (2002) Factsheet: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment”, available on
  87. OII Europe, Malta Declaration (1 December 2013) available on
  88. Pinde R, Malhotra A (2006) “Son Preference and Daughter Neglect in India, What happens to Living Girls?”, International Center for Research on Women,
  89. Tamar-Mattis A (2012) “Medical Treatment of People with Intersex Conditions as Torture and Cruel, Inhuman or Degrading Treatment or Punishment”, Report to the UN Special Rapporteur on Torture, available on
  90. United Nations Free & Equal (2016) “Factsheet Intersex”, available on
  91. United Nations Human Rights Office of the High Commissioner (2017) “Tackling Discrimination against Lesbian, Gay, Bi, Trans, & Intersex People, Standards of Conduct for Business”, available on
  92. WHO (June 2015) “Sexual health, human rights and the law”, available on
  93. Zillén K, Garland J, Slokenberga S (11 January 2017) “The Rights of Children in Biomedicine: Challenges posed by scientific advances and uncertainties”, Commissioned by the Committee on Bioethics for the Council of EuropeGoogle Scholar
  94. Lear J (2007) “Unnecessary surgery on intersex infants: Problems of theory become problems in practice”, Master’s Thesis in Applied Ethics Centre for Applied Ethics Linköpings universitet, presented May 2007Google Scholar

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Authors and Affiliations

  • Nikoletta Pikramenou
    • 1
  1. 1.AthensGreece

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