Intersex children: Who are we really treating?

Abstract

Surgery to align an infant child's genitals to a medically assigned sex is controversial because it is irreversible and therefore may potentially be detrimental to the child as they develop into a gender identity. I argue that the significant issue for genital-normalizing surgery is decision-making and that English law does not promote or protect the best interests of the intersex child or the inherent human rights that are protected by both domestic and international law. Using a doctrinal and socio-legal methodology along with a close analysis of bioethical arguments, I argue that the interpretation of the best interests of infant intersex children is manipulated to support the lack of social, legal and medical acceptance of intersex as an 'abnormality' that must be corrected, in order to conform to the accepted normality of binary male and female sex. In acknowledgment of this legal and professional standards deficit, I will propose a shared-decision-making approach to support the welfare of the child, which, at its core, places the child as the primary decision maker.

Intersex: cultural and social perspectives

“…Recent writing of this kind includes papers by Ghattas (2013), Carpenter (2016), Bauer, Crocetti and Truffer (2020, Monro et al 2017 andCrocetti et al (2020). Critical legal approaches to sex variance, which also address the human rights issues, include work by Fox and Thomson (2017), Horowicz (2017), Garland and Slokenberga (2019), Garland and Travis (2018) and Travis (2015). Recent psychosocial healthcare research is reviewed in Roen (2019).…”

Preserving the reproductive potential of transgender and intersex people

“…In the past, the expectation was that infants should be assigned a binary gender (female or male) -and would adhere to this [25]. Also, there is pressure for ambiguous genitalia to be refashioned so as to appear 'normal' and for medical decisions about allocation to be made in infancy.…”

“…Protection of children from ill-considered early surgery can be brought about by safeguarding policies and laws [25]. Gender dysphoria can occur when an individual develops a gender identity discordant with the sex assigned as an infant.…”

Parental Responsibilities and Rights during the “Gender reassignment” Decision-making Process of Intersex Infants

“…As a result, the birth of a child with ambiguous sexual characteristics may present practical, medical, legal and ethical issues (Ahmed, Morrison and Hughes, 2004). Every year, approximately two million infants displaying intersex1 characteristics, are born (Horowicz, 2017). It is estimated that approximately 1.7 per cent of live births, 'do not conform to a Platonic ideal of absolute sex chromosome, gonadal, genital, and hormonal dimorphism' (Blackless et al, 2000: 161).2 Children born with intersex characteristics are likely to be subjected to medical intervention during the early years of infancy (Haas, 2004).3 The rationale for medical intervention is often socially driven as it is considered "necessary" to allocate a conclusive sex to an intersex child (Kennedy, 2016).…”

“…During the Middle Ages, "hermaphrodites" were even considered monstrosities and were ostracised from the society in which they lived (Kennedy, 2016). In the 16th century, English society would not allow an intersex child to be baptised until they were categorised according to a heteronormative sex (Horowicz, 2017). In the 17th century, practitioners were consumed with the idea of protecting sexual "purity" and preventing against sexual deviance and dishonesty, which was associated with intersexed bodies (Carpenter, 2018).…”