Personally, I've never understood the obsession some people have with others' genitalia.
I know that it can be difficult for some to understand anything outside of what they perceive as being "normal", but science and psychology are coming to understand and teach that most characteristics exist along a spectrum. Forcing others to exist within your idea of "normal", because you see them as somehow less of a person or have a different set of experiences, is not only dehumanizing, it is also unethical and immoral. Society has historically tried to normalize people through surgery, drugs, institutionalization, or by labeling them as unwanted or "other", leading to social banishment/exclusion (Pence 315).
About a month ago in my neuroendocrinology course ("Hormones and Behavior") we were discussing the biological sex differences in animals and humans, and as part of our discussion/lecture for the week we viewed a documentary on intersex persons, Intersexion. The documentary focuses on real people and their stories. This was the first time I had watched a full documentary on the topic and only had somewhat limited knowledge going into the assignment. It's a powerful documentary, and definitely worth watching. Over this past summer I also watched a film that was part of the Edinburgh International Film Festival about a transgender teen, Just Charlie. It is a well-made film that clearly and effectively portrays the main character's experience with gender dysphoria, coming out, and many other aspects of their experience. I've included a link at the end of this post to the full documentary on YouTube as well as the trailer of the film (currently available on Hulu and Amazon Prime). As a member of the LGBTQIA+ community, I know how important representation is, and would strongly recommend that everyone take a moment to listen to personal stories before forming opinions about a community or identity that they don't belong to or fully understand. Another resource worth watching is a TEDxUSU talk given by John Dehlin a handful of years ago on the power and importance of allyship. A little effort, education, and understanding go a long way.
Before jumping into the ethics and some of the cases discussed, I want to start with some basics. These definitions come from the Human Rights Campaign website, hrc.org.
Sexual orientation: An inherent or immutable enduring emotional, romantic, or sexual attraction to other people.
Biological sex: Determined by chromosomes, hormones, and internal or external genitalia.
Gender identity: One's innermost concept of self as male, female, a blend of both or neither--how individuals perceive themselves. One's gender identity can be the same or different from the sex assigned at birth.
Gender expression: External appearance of one's gender identity, usually expressed through behavior, clothing, haircut or voice; and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.
Transgender: An umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation.
Gender dysphoria: Clinically significant distress caused when a person's assigned birth gender is not the same as the one with which they identify.
This chapter is long and contains a lot of topics, and I honestly don't have the time or energy to write about them all here. I'm hopeful that the class discussion on this chapter will be productive, but I also know from past discussions that a majority of the class is fairly conservative and may not have a strong background or understanding of these topics. I'm definitely open to discussion though! For anyone reading this that has questions or wants to discuss anything related to this post and/or the chapter, please leave a comment and I'm happy to chat with you.
Chapter 13 in Medical Ethics is about the ethical issues in the treatment of intersex and transgender persons. The first case discussed is a famous one; I've heard about it in psychology classes, a genetics course I was in last year, my neuroendocrinology class, and now this one! It follows the case of David Reimer, a man who was born biologically male (as Bruce Reimer), lost his penis in a botched circumcision, and was raised as a girl (as Brenda Reimer). John Money, a psychologist at Johns Hopkins at the time (1967), was involved throughout the process and believed that early childhood experiences constructed a person's later gender identity. There are many controversial aspects to this case, including fraud and multiple attempts to cover up the truth about what was actually happening in David's life. By the time "Brenda" was 11, they were experiencing gender dysphoria and confusion about their identity. At the age of almost 15, David learned the truth and almost immediately decided to live as a man. After a complex life, including the loss of his twin, his wife, and his money, he successfully took his own life in 2004.
On intersex people, the author of Medical Ethics concludes that as high as every 1/5,000 births are intersex people and that most intersex babies are born with ambiguous genitalia because of fetal development, and are therefore not anomalies (Pence 316). On sexual orientation, the author concludes that sexuality results from a complex mixture of genetics, biological interactions, and environmental factors (Pence 317). On gender, the conclusion is that it is more ambiguous than a strict binary, is complex and layered, and is a mistake to define sex as if there are only two straight-forward choices (Pence 320).
I would argue that the most relevant ethical question in this chapter is one that the author poses, "What is normal and who defines it?" (Pence 321). Unfortunately, the society that we live in is one that often demands every individual fit into a binary. Whether that is for sports, gender on an ID card, or using a public restroom, it seems that many people have an opinion on others' gender identities and often care more than they should. It is vital that we work toward ending the shame and secrecy associated with being born an intersex person, transitioning to a gender other than the biological sex assigned at birth, any sexual orientation that is not heterosexual, as well as any and all other "issues" associated with anything outside what society deems as "normal". Shame and secrecy, as well as a myriad of other negative emotions, often compound and lead to various other psychological and/or psychiatric disorders. Forcing an individual to fit inside of a box or classification that you can understand is not ethical.
In conclusion, I agree with the author's assertion that it doesn't make sense for physicians to attempt to normalize every child born intersex, guessing which way is "correct" (Pence 326). Ultimately, it's unethical and morally wrong to force any individual into an identity or life with which they don't agree or identify with. No person, intersex or otherwise, should ever be required to put up a façade or live their lives in a way that doesn't feel authentic to themselves. Sometimes it makes things easier to understand when you can categorize, that's why stereotypes exist. But when categorization becomes harmful to another person, it's no longer beneficial to anyone.
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