Changes

In the search for an ethical approach to treating intersex individuals, I first needed to find out exactly what the traditional treatment for intersex infants is. I then went on to find a more current and evidence based plan of ethical treatment. The traditional method of treatment operates on the assumption that gender identity is solely the result of nurture, whereas more modern methods are based on the idea that it’s more affected by nature though nurture can have a significant effect as well. The way that doctors treat intersex infants vary greatly, but typically fall somewhere between the two plan of actions I will be discussing. 

Optimum Gender of Rearing System and the Concealment-Centered Model

Developed by a medical group at Johns Hopkins University in the 1950s, the optimum gender of rearing system is a treatment plan for intersex infants that focuses on selecting a gender as soon to birth as possible and using surgery and hormones to carry out treatment. It was thought that the sooner a child was raised to be a certain gender, the less psychological damage they would endure. Another important aspect of this method was keeping the disorder secret from the patient until they were an ‘emotionally intelligent’ enough age to understand. From the optimum gender of rearing system, the concealment-centered model was created. The concealment-centered model is basically a more in depth step-by-step model of the optimum gender of rearing system. This model focused greatly on the alleged emergency being intersex was for an infant. It was thought that an intersex child that did not receive this treatment would be subject to ridicule and rejection by society and family, face what they referred to as “gender confusion”, increase the chances of them being homosexual, and increase the chances of them suffering from severe mental illness. It should be noted that there have been many recent studies finding much of this to be false. 

Ethical Principles and Recommendations for the Medical Management of Differences of Sex Development (DSD)/Intersex in Children and Adolescents 

This updated recommended model of treatment, Ethical Principles and Recommendation for the Medical Management of Differences of Sex Development (DSD)/Intersex in Children and Adolescents, was created by a group of “members of patient support groups (persons with DSD/intersex and/or parents); bioethicists; specialists in pediatrics and adolescent medicine, surgery, urology, obstetrics and gynecology, endocrinology; a psychologist and psychotherapist; a specialist in medical law; and a medical sociologist”. This draft drew from medical models from professionals all around the world. There are nine recommendations for the team treating an intersex infant:

1.       Because intersex does not typically cause an immediate physical emergency, non-life threatening affected children should not be treated until all options are considered fully by the medical team and the parents without a time restraint.

2.       The parents of the child have the last and final say in any possible treatment, because of this, they should always be well informed and involved in the decision-making process.

3.        Psychological support of the child is of more importance than “the creation of biological normalcy”. The first step is to accept the child, change in biology is the second. There is always a possibility of the child changing their gender identity and any surgical procedures should be done after evaluating the possible cost for the permanency of these decisions.

4.       Parents should always be given proper information about self-help groups and any other support systems so they can create the most open, loving, and accepting environment for their child.

5.       As many experts as possible should be involved in discussion possible treatment. This team should “always consist of competent representatives from the fields of medicine, nursing, psychology, and psychotherapy as well as social workers” to create the most educated plan possible.

6.       Any surgeries that would permanently affect the patient’s body, specifically ones that would have a negative impact on sexuality and reproduction, should ideally be made by the patient themselves. These decisions should only be made when there is solid evidence showing that this treatment plan is best for the patient.

7.       The patient should always be given information about their disorder in an age appropriate manner. The older they become, the more of a say they should get in their treatment and they should be made aware of information about their disorder as soon as possible.

8.       Documentation and record keeping should always be a priority and the patient should always have access to this in the future as an adult whenever they desire. The privacy of this documentation should always be of top importance.

9.       These recommendations should be reviewed regularly and altered based on scientific evidence.

I found reading both of these sources extremely interesting. I am now interested in learning more about the psychological effects of treatment versus no treatment and social consequences. I am also very curious to get a better understanding of what cultural shifts have occurred to create a more open mindset to those who are intersex.