On becoming autonomous and “coercive cultural acts”: a reply to Max Buckler

Child genital cutting and surgery across cultures, sex, and gender. Part 2: assessing consent and medical necessity in “endosex” modifications

“…Applied to the examples in Box 1, it might then be thought that the second woman in each pair, but not the first, is (more) capable of freely choosing the GGM in question (that is, without being unduly influenced by unjust gender norms or other potentially coercive societal pressures), thus making her consent (more) morally valid. However, such a simple dichotomy has been forcefully challenged by many scholars, including contributors to the current collection [47,48]. They argue that women from communities that customarily practice both female and male GGMs are not necessarily as compromised in terms of "meaningfully voluntary" decision-making as they are commonly made out to be.…”

“…In contrast to legal minors, adult women who request a GGM such as labiaplasty-among other "cosmetic" procedures-are more likely to be assumed capable of consenting to the surgical modification of their sexual anatomy. However, as contributors to this collection note, in reality, things are not so simple [47,48]. Instead, in many Western countries, when it comes certain GGMs, at least, appraisals of consent-capacity do not seem to turn on objective facts about each woman's actual decision-making ability (or on the specific risks or potential benefits associated with the requested procedure).…”

Child genital cutting and surgery across cultures, sex, and gender. Part 1: female, male, intersex—and trans? The difficulty of drawing distinctions

“…What if the child is too young to meaningfully participate in the decision? Alternatively, should there be categorical restrictions on genital modifications that are not necessary for the child's physical health until they are mature enough to give their own consent [12][13][14][15]?…”

“…The collection will be published over two consecutive issues of the journal. This editorial is an introduction to the first part, which begins by examining tensions and contradictions surrounding current ethicolegal treatment of diverse forms of genital cutting or surgery [4,9,13,14,51]. In particular, authors question why different standards of protection are applied to equally non-consenting children based, in practice, on their sextyped anatomy.…”

“…Going forward, we expect that debates in this area will center on questions about the kind or degree of maturity, selfknowledge, understanding, and so on, required for a minor's active agreement or assent to genital modification to count as an ethically valid basis for proceeding, assuming that there is (also) parent or guardian permission. Some might be tempted to give a categorical answer in the negative (i.e., no minor can validly assent to a permanent modification of their sexual or reproductive anatomy that is not necessary to save their life or avoid long-term physical impairment) [14], whereas others are likely to argue that the decision must be made on a case-by-case basis, taking into account the physical and mental healthcare needs of each individual as well as specific information and evidence regarding the procedure being proposed [51].…”