When is Surgery Right for Intersex Infants?

When a fetus is born the physician holds the infant up and announces whether it is a boy or girl. In about 1 in 1500 to 1 in 2000 births occur where the child is born with noticeably atypical genitalia (Intersex Society of North America, 2008). A group of conditions where there is a discrepancy between external and internal genitals is known as intersex (Kaneshiro, 2009). Intersex is also known as hermaphroditism. The term hermaphrodite came from the joining of the names of Greek god Hermes, god of male sexuality and Greek goddess Aphrodite, goddess of female sexuality (Kaneshiro, 2009). Standard medical treatment usually consists of looking at the genitals, determining the gender and then correcting it surgically. The questions is, what if the doctor’s get it wrong? The nonmedically necessary surgeries that are performed are irreversible and can have disastrous consequences.
Ethical Concerns The ethical concern is that some physicians perform unnecessary surgery and get the gender wrong. The physician anticipates they know how the child will feel as an adult, but there is no guarantee that the child will feel like the chromosomes to which they are assingned. Surgery is an easy process for physicians, but is an extremely difficulty process for the child. Childen who do not identify with the gender they were surgical given can have profound psychosexual devlopment delays and deficits, and delayed or absent normal encounters with the opposite sex (Switzer, 2005). There are many instances where the physician choses one gender, performs surgery and as the child grows up they feel differently than the gender chose for them. Most surgeries that are performed are irreversible. Some surgeries can damage a person’s sexual function due to loss of feeling, painful sex from scar tissue or lack or sexual response (Switzer, 2005). There are many advantages in having surgery as an infant, but any surgery that is not necessary should be postponed until the parents and child are able to give informed consent together. The principle of informed consent is the right of every competent individual to advance their welfare by either consenting or refusing recommeneded medical procedures (Key Ethical Principles, 2011). There are many times where a parent is making the decision for the child and are not fully informed of the consequences of the surgery. Postponing gender assignment surgery provides autonomy for the patient. Autonomy is the person’s right to make choices and make decisions and take action based on their values and belief systems and nonmaleficence is that one cannot do good without also causing harm (Key Ethical Principles, 2011). Some parents goal of immediate surgery is their own personal emotional comfort rather than the child’s well-being. Surgery should be delayed until the parents and child have a better idea on how the child will develop naturally and not forcing the child into one gender (Switzer, 2005). Waiting for surgery and allowing the child to chose the gender they identify with will cause a decrease in the amount of dissatisfaction with clinical decisions that are made. A key ethical principle is utilitarianism where the choice that yields the greates benefit to the most people is correct (Rainbow, 2002). The choice to allowing the child to chose their gender would allow the greatest benefit for the child and family involved.
Alternatives to Uninformed Surgery The first alternative to uninformed surgery is assigning a gender to the infant. Gender assignment is aimed at putting gender identity (the way a child feels) and gender role (how we live in society) collectively as the child grows (James, 2011) .This assignment can occur after hormonal, genetic, and radiologic testing. The child may decide while they are growing up that the were given the wrong gender assignment. Children that are intersex have a significantly higher rate of gender transition with or without treatment. Since the rate is higher that is why it is important that medically unnecessary surgeries are not performed without the parent’s consent. A child that is born with an intersex condition may decide later that they want genitals (either the ones they were born with or surgically constructed anatomy) different then what physicians chose and it is extremely difficult and sometimes impossible to undo. Children that are altered at birth are trapped with what they are given.(Intersex Society of North America, 2008). The second alternative would be informed consent of surgery. If a parent is insistent on surgery is important that they are aware of the possible complications that can occur. Most parents do not realize that the surgery is irrversible and have tragic consequences (James, 2011). They physician should make a decsion with a lot of reflection and not to rush into any procedure and make sure that they parents are consulted (James, 2011). It is important to provide access to trained psychologists, social workers, and peer counseling and support groups. It is extremely important for the child to be closely followed and find out how they are feeling as they are growing older. Paying close attention to what the child is saying because sometimes this may indiciate that a switch needs to be performed and evaluated by expertise (James, 2011). The final alternative to surgery as an infant would be for the parents to do nothing. Every day there are intersex infants born to parents who have never heard of such a thing. It is alarming and overwhelming for the parents of a child that is born intersex. Some parents cannot accept that their child is different and are unable to form a bond or attachement with the child and attempt to hide the situation from outside people (Switzer, 2005).
Conclusion

Parents are always making difficult decisions for their children. Parents want their children to grow up healthy and happy. When a decision needs to be made it is important to get the input on the person it will affect the most. According to Switzer: Everyone should be given the opportunity to chose how he or she should live, and should not be forced into a life of psychological turmoil because of some clinical decision that was made on his or her behalf when they were too young to speak for themselves (Switzer, 2005).

References:
(2008). Retrieved July 25, 2011, from Intersex Society of North America: http://www.isna.org/faq/frequency
James, S. (2011, March 11). Intersex Babies: Boy or Girl and Who Decides? Retrieved July 25, 2011 , from ABC News: http://abcnews.go.com/Health/intersex-children-pose- ethical-dilemma-doctors-parents-genital/story?id=13153068
Kaneshiro, N. (2009, August 2). Intersex. Retrieved July 25, 2011, from Medline Plus: http://www.nlm.nih.gov/medlineplus/ency/article/001669.htm
Key Ethical Principles. (2011). Retrieved July 25, 2011, from Ascension Health: http://www.ascensionhealth.org/index.php?option=com_content&view=article&id =47&Itemid=171
Rainbow, C. (2002). Descriptions of Ethical Theories and Principles. Retrieved July 25, 2011, from http://www.bio.davidson.edu/people/kabernd/indep/carainbow/Theories.htm
Switzer, L. (2005). Can Surgery For Intersex Babies Be Justified? The York Scholar , 2 (Spring), 67-74.