Sex-Assignment Surgery on Intersex Infants: Unethical? Illegal?
Making history, a family from South Carolina sued the hospital and state guardians responsible for performing a sex-assignment surgery on their adopted child, M.C., when he was an infant under the state’s custody. In her article, Should Doctors Operate on Intersex Babies? Azeen Ghorayshi explores the details of this case in an interview with M.C’s mother, Pam Crawford.
M.C. was included on an adoption website for children with special needs, which is where Pam and her husband were first introduced to him. He was presented as a little girl in pigtails with no obvious health problems. Upon further inquiry, Pam discovered that M.C. was born with a 2-centimeter penis, a small vaginal opening, and both testicular and ovarian tissue, leading to an official diagnosis of “ovotesticular disorder of sexual development.” For the many babies born intersex, as M.C. was, the doctors and parents analyze genetic, hormonal, and anatomical factors before making a decision about the surgical path. Pam was devastated to learn that M.C. is among the children who have been affected by nonconsensual, irreversible surgery.
When M.C. was about 10 years old, his parents embarked on a journey to sue the people responsible for the unnecessary sex-assignment surgery. Ghorayshi write in her article that people in opposition to operating on intersex infants claim that the surgeries “often cause the very shame and stigma that [proponents] claim to prevent later on in life, all in the name of sticking to social expectations around sex and gender.” The thought that gender identity will follow with sex assignment is credited to John Money, who performed work around this topic at Johns Hopkins Hospital in the 1950–60s. His most influential case involved two twin healthy boys, one of whom had received a botched circumcision. Money advised that they cut the remaining penis off and raise the child as a girl. The experiment was deemed a success, that was, until it came to light that the child had chosen to start living as a boy at the age of 14, and as an adult had undergone sex-reversal surgery. At 38, he shot himself.
In M.C.’s case, the determining factor used to decide the direction of his sex-assignment surgery was his XX chromosomes. The doctors removed M.C.’s penis and testicular tissue. The act of sex-surgery was always a given, the debate was simply around which sex he should be assigned. Pam states that there as never “one moment” when they knew that M.C. was a boy, but that it came about as M.C. got older and was able to assert his own preferences. However, a pivotal moment was when M.C. was six and asked to have a haircut “like Dad”, stating that it was fine if people thought he was a boy. By first grade, he wanted to be acknowledged as a boy all the time. Pam claims that they would have sued regardless of M.C.’s gender identity, stating in her interview, “That’s the thing that seems to grab people — ‘They got it wrong!’ But that’s besides the point. Nobody had the right to make that decision.”
The vast majority of intersex children in the United States are receiving sex-assignment surgery, sometimes as a decision of only one or two doctors. Many doctors, such as Michael DiSandro, a pediatric urologist at UC San Francisco, are still in favor of surgery as the best option, although he advocates that it be reversible and minimally invasive. Ghorayshi write that there are still physicians who argue that growing up intersex could be more psychologically detrimental to these children. Barry Kogan, pediatric urologist at Albany Medical College says, growing up intersex “is an experiment that has never been done.” DiSandro agrees, stating, “Forcing children to be raised with ambiguous genitalia is really tough — almost unethical.”
I think this is an idiotic line of reasoning since it is a flat out lie. Our society has only had the ability to perform these surgeries for the past 60 or so years, and obviously intersex people have existed as long as people have existed. Instead of trying to find the most ethical way to help these individuals “fit” into society, we need to change society as to create space for intersex people to exist as they are.
Personal testimonies of intersex people arguing against performing sex-assignment surgeries on infants are often dismissed as rare anomalies, and if they are taken seriously, the individuals are regarded as activists rather than experts. Pam understands that filing a lawsuit is taking a drastic measure, but often, dramatic actions are required to create real change. The lawsuit was initially filed under both federal and state courts. The federal case claimed that the surgery violated the 14th Amendment, but was thrown out due to its nature as a subject in a “gray area.” The state case is based around the concept of “informed consent”. In her article, Ghorayshi reported that
“The complaint argues that the possible consequences of surgery — loss of sexual function, scarring, loss of male fertility, gender misassignment, and a potential lifetime of psychological distress — were minimized without considering the alternative of doing nothing at all”
Overall Ghorayshi reports that physicians are hesitant about the case since it could set precedent for how doctors are allowed to treat patients in the future, while intersex advocates are excited about the change that could be brought about by such a lawsuit. My question is, why are these two separate categories? If you have created a career out of pediatric medicine, shouldn’t you also be an advocate for the rights of intersex children? We shouldn’t be asking the question “Will being intersex or surgically assigned a sex at birth scar the child the least?” We should be asking, “Why is it unacceptable in our society for these children to live their lives with the natural body parts with which they were born?”
An article on IntactWiki stated that the case was expected to be tried by a jury sometime after November 15th of 2016. I could not find any other updates on the state case, and therefore assume that its is still under review.
