Powerpoint

Ethical issues of intersex and transgender persons

SECRECY IN THE CHILD’S BEST INTEREST

Most families cannot accept a child with ambiguous genitalia or mixed reproductive organs. In elementary school, bathrooms do not exist for males, females, and others. For normal development, a child must have a gender identity. Therefore, it is best for the child to have a clear gender assigned, one way or the other, than to have a mixed one or none at all.

Consider normal social expectations: everyone who knows a pregnant woman wants to know the gender of her baby at birth. Many people learn the gender of the fetus before birth, setting up a definite expectation. Families express disgust at going home with, not a boy or girl, but an “it.”

Intersex children are often bullied or battered when they try to use the “wrong” bathroom in public places.17 Androgyny, having the appearance and affect of neither gender, is not a good option. If the person's sexual orientation is heterosexual, others will mistakenly interpret the lack of a clear gender as evidence of homosexual orientation.

Furthermore, most children do not need to know about their problems at birth with ambiguous genitalia. If such problems can be corrected, or given a better appearance, then the adult can live and function normally. In fact, some people may not even know they were “sexed” at birth and still live happy lives.

Finally, surgeons and parents at birth do the best they can. They believed that lack of gender at birth was a social emergency and that decision had to be made. It is wrong to second-guess them years later.

ENDING THE SHAME AND SECRECY

In his 20s, David Reimer met Cheryl Chase, who soon became the leading advocate for intersex people and who argued that everyone should know his or her true origins and make their own decisions about their gender and sexuality.

At birth, Cheryl had ambiguous genitalia and was first sexed as a boy, but after 18 months and an unusual appearance, doctors decided to make her a girl. Cheryl's life refuted Money's claim that professionals can assign gender with happy results. Like some other intersex teenagers and adults, Cheryl never felt completely male or female and lived between genders.

Cheryl argues that, “What most harms the intersex child is the attitude that the child suffers from something shameful that must be concealed and never publicly acknowledged.”18 She argues that such children would be better off being told the truth and being allowed to choose, in early adolescence, which gender they want to be. Ideally, the parents would embrace the child as he/she is and not be ashamed.

In the late 1990s, Cheryl Chase and other intersex people challenged the view of Hopkins/Money that early surgery and hormones were good for intersex children. They picketed a meeting in 1996 of the American Academy of Pediatrics. With David Reimer's public testimony falsifying Money's claims that biology doesn't matter to gender, other intersex people emerged and claimed they were wrongly assigned a gender at birth and irreversibly harmed by it. Some who were absent had committed suicide.

Page 275During the same period, a more sophisticated view was emerging in endocrinology, genetics, and medicine about normal sexual development and intersex. Behaviorism was fading and biology was ascending.

This situation of intersex children parallels that of conjoined twins. As bioethicist and historian Alice Dreger argues, most parents consider such births an emergency at birth and ask surgeons to normalize conjoined twins into singletons, even at the cost of killing both children.19

Alice Dreger and Cheryl Chase argued that (1) physicians and families should wait until the child/adolescent can decide for itself what gender it wants to be; (2) physicians should help families understand that a child with intersex can be happy with an ambiguous gender; (3) if physicians and families guess wrong about gender, intersex children can be irreversibly harmed; and (4) such crises at birth about gender were socially constructed and mediated by ignorance and fear.

The American Academy of Pediatrics disagreed. In its 2000 guidelines on how to deal with intersex children, it wrote, “The birth of a child with ambiguous genitalia constitutes a social emergency.”20 By sexing a child immediately at birth, it hoped to prevent later harms, such as uterine infections, cancer, and infertility. It also hoped to provide the child with working genitalia for later sexual satisfaction and a stable gender identity. It wanted to foster parental bonding with a gender-defined child and help the child to avoid being different.

TRANSGENDER/INTERSEX AND CIVIL RIGHTS

In the last 20 years, a remarkable change has occurred in North American culture. Not only have gay men and lesbians been increasingly accepted as normal, but transgendered people have also been accepted. Popular television shows such as Glee and DeGrassi: The Next Generation portray “trans” people. People magazine has done feature stories on Chaz Bono's female-to-male (F.T.M.) transition21 and of supportive parents who allow the same transition to start by giving puberty blockers to a group of 30 transgendered children as young as 10 years old in the Los Angeles area.22 A child of Warren Beatty and Annett Benning, born Kathlyn, transitioned to Stephen, making a video of himself in the popular series, “WeHappyTrans.”

Various singers present as sexually ambiguous: Lady Gaga, Freddy Mercury, David Bowie, Elton John, George Michael, Melisa Etheridge, the Indigo Girls, K. D. Lang, and many others. Children's books such as Parrotfish, Luna, and I am J help intersex kids understand who they are at an early age.23

In The New Yorker, Margaret Talbot portrays the female-to-gay-male transition of Skylar, a precocious child living around Yale University whose parents supported his transition at a young age. She writes:

Transgenderism has replaced homosexuality as the newest civil-rights frontier and trans activists have become vocal and organized. Alice Dreger, a bioethicist and historian of science at Northwestern University, says, “The availability of intervention and the outspokenness of the transgender community are causing a lot more people to see themselves as transgender, and at younger ages.”24