Each year in the European Union thousands of children are subjected to genital operations without their consent. Most of them will endure substantial psychological and physical damage as a result which will cause lifelong suffering.
These operations serve no medical purpose, but serve exclusively to irreversibly normalise their ambiguous sex characteristics as rapidly as possible. Nevertheless the physicians refuse postponing these interventions until the children are old enough to be involved in the decision process. For the first time in Europe a doctor has been sued for bodily injury.
Doctors are nervous
So far the medical profession has been firmly opposed to any reconsideration of this topic. However, as a result of self-help groups that have been organised by those affected to denounce these human rights abuses, they have increasingly been under pressure to legally justify these procedures.
The controversy is expressed in professional journals, for example in the following Swiss Physicians’ periodical 47/2006: Whereas the medical doctors who remain anonymous get lost in absurd attempts to justify this, ethicists, Kathrin Zehnder and Nikola Biller-Andorno, from Switzerland criticise the irrationality of current practice and procedures still in effect. Researchers at the Institute for Sex Research in Hamburg document the injury caused by this chosen method. As usual in such discussions, those actually affected are ignored. What follows are some views from their perspective:
The individual
In the following two cases which are described, two possible solutions are explained about surgical interventions and their consequences. One child is to have healthy ovaries and a functional uterus removed and another is to have a penis “reduced” to a clitoris. (Kathrin Zehnder, Switzerland)
Once again: A six-year old child is treated as a “subject” in a patronising way and is deprived of any right to make a decision themselves, and is not asked about their feelings or thoughts. Official reason:
The age of the patient which is a child requires that decisions must be made without their input, but by the parents and the doctors involved who must make decisions for their future well-being (Principle of Beneficience).
What seems evident to the sociologist Kathrin Zehnder is not even taken into consideration at all by the physicians: the child is deprived of any ability to understand or to make a decision from the beginning. Even though the operations can be delayed, everyone arrogantly goes over the child’s head and makes the decision, once and for all. According to Kathrin Zehnder:
There is no real emergency which requires these genital operations and they are therefore postponable, but they are not irreversible. On first glance there seems to be no explanation why there would be any thoughts about such interventions on a five year old.
Also, Dr. Nikola Biller-Andorno, Professor of Biomedical Ethics at the University of Zurich, pleads “in view of the relatively minor risk involved, to postpone these very serious medical interventions”:
The child could be moved more in the male role through hormone therapy later in life without creating irreversible deeds surgically (…) In particular the “boy” could decide later what his sex (gender) identity was to be. (Nikola Biller Adorno)
However such trivial concerns do not in the least bit impede the “treating physicians” who choose to remain anonymous: The child is immediately labeled as “sick”. The power of medical discourse to define…
And power is not relinquished voluntarily – especially not to children:
The boy (sic!) could not himself be fully informed about his illness. He knows that he suffers from the same hormone disorder as his sister and that (as has already occurred in her case) it is necessary on occasion to perform an operation (hypospadias repair along with a hysterectomy [?] (in the original) and ovariectomy accompanied by repair of the external genitalia). (Ethik editorial staff, Switzerland) As a result “he” will require the support of a child psychiatrist on a long-term basis. Now that is what you call job creation.
Society
A third sex is not a social option at this time as formulated in the guidelines of the German Society for Urology for DSD’s. (Disorders of Sex Development or Disorders of Sexual Differentiation) (1999). (Nikola Biller-Andorno)
The decision to allow the child to grow up as a boy which required the removal of the female internal reproductive organs and a lifelong hormone therapy with male hormones was based on the fact that “the child was the only boy in the family and has a special position as the male progeny which will remain the case even after the parents explain to him about his chromosomal and anatomical situation.” The “possibility that the child might transition to female and therefore carry on the family reproductive capability is definitely not “seriously taken into account”. Because of the Muslim belief that the boy “because of the importance of the male role in his society would still preserve his value even as an “incomplete man”.
Besides, the Muslim background of the parents is often synonymous with a passive approach and resignation during the decision-making process such that the decision is almost totally handed over to the treating physician. (Ethik editorial staff, Switzerland)
It is not the individual affected who makes the decision about their body. No, it is the culturally conditioned sex roles, the parents and religion. Or their self-appointed representative: the physician. In addition, ethicist Nikola Biller-Andorno states with a sense of resignation:
Nevertheless guidelines as well as medical literature do at least mention in passing the critical demand for delaying sex assignment until there is the ability to consent and to recognize intersex as a third sex even though there is usually no follow-up with further discussion concerning this position. (Nikola Biller-Andorno)
Theory and Practice
Theoretically the decision for the surgical correction could be postponed and the boy could become involved in the decision making process at around 15. (Editorial Staff, Ethik, Switzerland)
On a more practical level there will be a trial on December 12, 2007 in Cologne, Germany in which a physician is charged with bodily injury. By an intersex person whose CAH was not recognized until later and who was deprived of their internal female reproductive organs and who is still suffering from having been forced into a male assignment.
That is the difference between theory and practice. Between speculation and demands. Between paternalism and autonomy.
n e l l a
Intersexuelle Menschen E.V.
More information and contact:
