In Western nations, there is growing agreement about ethical approaches to clinical intersex management. At the same time, as Western-trained physicians increasingly encounter intersex patients in other parts of the world, new ethical tensions arise. Which cultural values are fair parameters for gender-assignment decision-making, particularly in cultural milieus where there is social and economic inequality between the sexes? How can physicians uphold universal bioethical principles while remaining culturally sensitive? Physicians have a primary commit- ment to patient beneficence and universal human rights, requiring physicians to promote concordance between the child’s assigned gender and his or her likely future gender identity. Ultimately, the potential patient distress posed by gender dysphoria fundamentally outweighs the influence of local cultural factors such as economics, gender politics, and homophobia.

In the 1960s, Victor McKusick inaugurated the Amish medicalgenetic tourist research program in order to learn moreabout the relationship between genes and human disease.However, Amish mistrust of outsiders and frustration at beingexploited by tourism, as well as other cultural and historicalfactors, would ultimately result in the transformation of medicalgenetic research paradigms from genetic tourism to communityhealth centers. Over time, Amish community healthclinics, partially funded by the Amish themselves, were establishedin Pennsylvania and Ohio. These clinics, which are longtermcenters dedicated to primary care and advanced medicalgenetic research, give the Amish a sense of agency. Doctorsfrom these clinics have achieved numerous medical breakthroughsthat were possible only as a result of their long-termcare of patients. This transition to Amish community healthclinics illustrates the successes science and medicine canachieve when they are sensitive to unique population needs.