Free Paper Sample: Ethical Issues in Intersex Surgery

When people hear the word hermaphrodite, their minds probably conjure up a mythical creature that embodies both male and female sex organs. The word hermaphrodite comes from Greek hermaphroditos, and the story of Hermes and Aphrodite, the gods of female and male sexuality who had a two-sexed child. However, considering the situation in the United States today, it is apparent that hermaphroditism is not just a fictional idea or poetic story of mankind. The dominant medical models postulate the hermaphroditic body as a real biological condition and not just something poetic. It doesn't seem unreasonable to think that in the twenty-first century, the medical field would be more adept at incorporating ethical principles within the professional healthcare system by respecting one's autonomy and encompassing nonmaleficence.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

Currently, in the year 2020, intersex surgery is still a legal and practiced approach in the United States; which forces infants and children into irreversible surgery that often causes physical pain and emotional distress later in their lives (Carpenter, 2019). Doctors are making life-altering decisions based on what they think the sex of the baby or child should be and convincing the parents it's the "right" thing to do. It could be argued that infants and children don't have autonomy because they do yet have the capacity to decide on a plan and cannot make choices for themselves. To counteract that argument that is when nonmaleficence takes a front seat. Nonmaleficence requires us to avoid causing harm, yet doctors continue to perform unnecessary surgery that most often causes harm. Think about it, doctors take a guess on what sex a tiny human might be, based on the archaic construction of what Biology teaches - that sex only exists in two forms female or male (Human Rights Watch, 2020). However, the truth is that sex is a spectrum and the majority of humans just seem to fall at either end.

There is about 1.7 percent of babies who are different than what is typically considered male or female (Nooreyezdan, 2020). Autonomy is not conditional, meaning the essence of autonomy is not only for certain people, but it also does not matter what age, or what beliefs you hold. The essence of autonomy is that every single person has the right to their body and if someone is too young to make those decisions it is our duty as parents and healthcare professionals to give voice to these young children and make sure they are protected

Since the surgeries conducted to normalize the appearance of children with differences of sex development (DSD) are often irreversible, there is no way they can be made legitimate except through the patients' informed consent. The importance of the concept of informed consent in modern medicine cannot be overemphasized. Carrying out an unnecessary medical intervention on a patient who is not able to make competent informed consent can be considered abuse. As Wiesemann et al. (2009) observed, most early intersex surgeries are not necessary because being intersex does not always pose an urgent health threat or medical problem for children.

Besides, early surgical interventions are wrong because parents have no surrogate rights to choose sex for their infants. Parental surrogacy should only be limited to those decisions that serve the impartial best interest of the child. Most surgical interventions do not serve the best interest of the patient because it is difficult to determine the sex that a child will prefer when they become adults. Considering that such operations permanently restrict the patient's sex options later in life, nobody except the patient should make these important decisions.

All surgical interventions determining the sex of a child should be postponed until such a time when they can knowledgeably express their preferences. Some critics of early intersex surgeries recommend that minor interventions of this nature should begin when the child is at least 6 years of age while major ones should wait until they turn 12 (Wiesemann et al., 2009). However, this argument is unsound despite its appealing simplicity as it assumes that the interest of a small child at the age of 6 will remain the same when they become adults. The reality is that what a child may find beneficial during infancy or adolescence may be different from what they will like as adults. Small children, for example, tend to prefer gender conformity to independence because they value the ability to harmoniously relate to their peers, and that requires a stable gender identity role. As they become young adults, they might desire independence, authenticity, and the ability to choose the kind of relationships they want.

The problem with the postponed informed consent maxim is that patients become capable of determining their best interests as children when they are adults and not children anymore. Once the child becomes an adult, its childhood interests will be in the past. Accordingly, doctors argue that it is necessary to begin suppressing the hormones associated with the undesired or less dominant sex to ensure they do not manifest at puberty or disturb the patient’s gender identity in the future. The danger of this argument is that it transfers the right to decide whether a child should be raised as a girl or boy from the individual to their parents and doctors.

Early intersex surgery is a popular standard of care globally, and it has thrived on the misconception that children with abnormal genitalia experience psychological pain when they become adults. There is no evidence showing that intersex children who grow up with abnormal sex organs face more psychological suffering than those who get correctional surgery (Human Rights Watch, 2020). In both cases, the children grow up with genitalia that is a bit different from those of normal males or females. Arguably, it is far more disturbing for an intersex person to realize, as an adult, that they had surgery at birth without their consent, just for purposes of keeping to the arbitrary standards of genital appearance. The consequences are even worse if one realizes that their parents and doctors had lied to them about their being intersex.

There is no denying that social stigma and bullying are real concerns for parents who have intersex children. However, surgeries do not guarantee that those negative outcomes will not occur. While the worries are valid, they are not enough justification for the lifelong harm that the surgeries cause intersex children. Besides, those fears do not always materialize. Research done on parents who refused to subject their intersex children to early surgery has shown that not all children suffered unusual amounts of harassment or bullying because the appearance of their genitalia was not normalized (Wiesemann et al., 2009). The parents reported that their intersex children accessed healthcare developed friendships, and went to school just like others.

Intersex children who undergo the procedure, instead, risk having dangerous health issues for the rest of their lives. The unnecessary surgeries done during infancy expose many children to health complications at an early age. Intersex people who have had their gonads removed risk suffering severe loss of libido and osteoporosis if they do not receive competent hormone therapy before puberty (Human Rights Watch, 2020). Since doctors not only lie to intersex people but also withhold medical records from them, the patients suffer psychological harm and lose trust in the medical systems. Hence, they stop seeking and receiving the necessary medical care. According to Greenhalgh (2018), a recent Australian study showed that intersex children who get cosmetic surgeries early report cases of post-traumatic stress disorder when they reach adulthood due to exposure to rounds of surgical operations in childhood. About 50% of the respondents who participated in the study reported having contemplated self-harm.

Therefore, doctors need to approach the issue of intersex gender differently. They should treat intersex children as well as their parents in an open, supportive, and stigma-free manner. They should let the parents know the truth about intersex: that it is a common condition and surgery does not bring any health benefits for a child born with it. Besides, doctors should give parents of intersex babies all the medical records of their children and the details about the phenomenon. Parents can avoid permanent damage from surgeries by assigning their intersex children a social gender identity as a girl or boy.

Leaving the child’s body the way they are born is necessary to preserve their dignity, autonomy, fertility options, sexual functions, and health (Human Rights Watch, 2020). Intersex health specialists have agreed that data from research in this area has controversies and gaps. Little research has been done to show either that having nonconforming genitals causes harm or that early surgeries benefit them. Therefore, doctors should advise parents and children against performing early surgeries under such circumstances. Carpenter (2019) observed that the treatment of intersex persons whose atypical genitalia do not pose any health risk should emphasize educational and psychosocial support for the child and their family and not surgery.

Conclusion

In conclusion, while the parents and doctors who choose early intersex surgeries might be meaningful well for the patients, their decision leaves the affected individuals with permanent health and psychological harm. Cosmetic genital surgery for infants is not justified except in cases where it is supposed to help a child get out of a health danger. It will help parents and professionals avoid grappling with this difficult question if they could pay attention to the growing calls for the practice to stop. There are rationales for the consensus to end early intersex surgeries. First, cosmetic genitoplasty infringes on the rights of infants to personal control over their sex. Cosmetic intersex surgery should be postponed until the infants become adults capable of expressing their opinions about it. Secondly, despite the insufficient evidence that getting surgery to normalize infants' genitals reduces the risk of facing psychological distress, there is enough evidence that these operations can lead to irreversible and severe emotional harm and physical suffering. Doctors take an oath to "do no harm" and should thus take heed that research opposes cosmetic genital mutilation. The last one is the lack of sufficient evidence from research to prove that having different genitalia makes a person suffer psychological distress later in life.

References

Carpenter, M. (2019, November 10). Clinical opposition to early intersex medical interventions grows. Intersex Human Rights Australia. https://ihra.org.au/31680/clinical-surgery-opponents-increase/

Greenhalgh, H. (2018, October 26). Intersex babies caught in surgery battle over medical risks, ethical rights. U.S. https://www.reuters.com/article/us-global-intersex/intersex-babies-caught-in-surgery-battle-over-medical-risks-ethical-rights-idUSKCN1N02BX

Human Rights Watch. (2020, July 9). “I want to be like nature made me”. https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us

Nooreyezdan, N. (2020, January 13). The ethical pitfalls of 'Corrective' surgery for intersex babies. The Swaddle. https://theswaddle.com/the-ethical-pitfalls-of-corrective-surgery-for-intersex-babies/