Intersex Infants and Medical Ethics: Beyond the Binary Chapters 5-8
When first reading about Suzanne Kessler's study and report, I was quite shocked and even slightly disturbed. To recap, Suzanne Kessler interviewed six New York area pediatric intersex specialists in 1990. In her report, she tells of clinicians performing sex reassignment surgeries on infant children, mainly because it was the "right thing" to do according to the culture at that time. Clinicians often performed these sex reassignment surgeries because they believed that it would save the child from much psychological confusion in the future. They believed that by performing the surgery at such a young age, they were helping the child by sending them into the world with more "normal" anatomical features. Essentially, the clinicians were deciding the sex of the intersex infant for them, often times based on their own personal bias.
Before reading about this report in Shannon Dea's Beyond the Binary, I had never actually heard of intersex patients nor sex reassignment surgery on infants. I honestly did not know that intersex people truly existed until now. However, I quickly became fascinated about learning more about intersex people that I decided to do some additional research and reading. Interestingly, I ended up coming across a NUMBER of papers and studies that actually discussed this idea of performing sex reassignment surgery on infants. Once I read and processed them, I believe that I was truly shocked. This is because the main consensus across all researchers was that it was actually MORE harmful to force these infants to be subjected to sex reassignment surgery so early in their lives. Why then, was it so common in 1990 to perform these procedures? And if in fact it is more harmful to the patients, then doesn't that break oath that all doctors take: "First, do no harm" ?
As a student that would like to go into medicine in the future, I truly believe that the idea of "Do no harm" is needed, especially in modern society. This is because it is so easy to get caught in the moment and want to perform a surgery right away. However, in order to "do not harm," one must consider the different risks of a surgery and learn more about the patient before performing the surgery. A physician must also try not to allow their own personal bias get in the way of informing the patient or the patient's guardian about all the benefits or risks of a procedure. In my opinion, I believe that many of the physicians performing the sex reassignment surgeries on infants let their own personal bias get in the way. By performing so many surgeries on infants, I truly believe that they blindly went into each surgery. This means that, in my opinion, they did not do their job of researching and learning about the procedure before performing it. Thus, I believe that they broke their oath in performing their first surgery. Therefore, I dare say that they should have been brought in front of a medical ethics board at that time and disciplined accordingly.
As I just stated my own perspective, I also want to acknowledge the physicians perspective before I concluded my thoughts. It is very possible that many physicians were genuinely taught that performing the surgery would save the children much psychological harm in the future. In fact, I believe that medicine, even today, is full of many myths that were merely passed down from generation to generation. It is very easy for myths to get passed down as medicine is quite hierarchical and the newer, younger generation often has no say. However, if our society continues this way, who know who may be hurt next? I believe that in order for our society to progress, we must be open to accepting new ideas and more active in researching topics that we may consider a myth. If we do so, I believe that we will be one step closer to living in the world we deserve.
Natalie, I agree with your take that no one is a single sexual orientation and that we should simply accept people for who they are. Indeed this would make things a lot more easier, and it’s not necessary to come up with several different categories for every sexual orientation, because whoever does this will surely become exhausted after a point. And that's where minorities start breeding from, just because someone got lazy and decided not to give enough background and recognition to a certain group of people because the population of that group is either too small or for whatever reason. In response to your question about what to consider someone who is a different gender in their mind versus what their body is on the outside physically, I say that they have to be considered whatever they are thinking on the inside. It’s not about the body, as they say “don’t judge a book by its cover” so similarly the importance here would be to ask them what they prefer to call and understand that it’s all what’s on the inside that is counting and matters. Because if they have the body of a man but the mind and feeling of a woman then they are a woman. And if vice versa (a woman who has feelings like a man) then they are a man.
ReplyDeleteHi Runa and Natalie,
DeleteRuna, I'm not quite seeing how sexual orientation is relevant here. If we are discussing decisions about whether surgical intervention is appropriate on an infant, then no one will have access to any direct information about the sexual orientation of the infant patient. I suppose one could argue that there is some indirect information available via the statistical prevalence of different sexual orientations in a given population--but I'm not sure why that would be relevant to the decision about whether to operate on an infant or not. Perhaps you can say a bit more about this to help me follow your reasoning here?
If I understand the latter part of your comment correctly, you are suggesting that whether surgery is appropriate for a particular intersex person will depend (in part?) on that person's gender identity--is that what you intended? Presumably that would imply that any decisions about surgeries on intersex patients (unless perhaps there were some other medical concern), should be postponed until those patients can reasonably be expected to communicate about their gender identities? I'm curious if either you or Natalie think that postponing decisions about such surgeries might actually influence way patients come to regard their own gender identities. If so, would this be harmful? Helpful?
Take care,
Dr. Nora