Australian Doctor News
(No source. Passed on to me by doctor via email marked FYI.)
Should doctors be banned from surgically ‘correcting’ intersex traits in children?
The ACT could be the first jurisdiction to enforce legal controls.
By Sarah Simpkins
Clitorectomies, phalloplasty and gonadectomies on intersex children will be illegal without an urgent clinical justification, under draft ACT laws.
Chief Minister Andrew Barr says doctors have performed inappropriate interventions, and the legislation — the first in Australia — is necessary to protect children from harm.
It would ban significant deferrable surgeries affecting a child’s sex characteristics until the intersex child had capacity to consent, with potential penalties of up to $22,000 in fines or two years’ imprisonment.
Medical ethics expert Dr Wendy Bonython (PhD) says that “historically”, babies born with intersex characteristics have been treated “almost immediately”.
“The response from doctors would be: ‘We need to give them some form of gender identifiable physical characteristics.’
“Labiaplasties and a whole lot of cosmetic procedures were performed, not so much to address function, but just to give the child recognisable and gender-identifiable external genitalia.
“But many of these children later reported they felt they were ‘in the wrong body’ or were assigned the wrong gender, or really wished they had the opportunity to participate in that decision-making process.”
The definition of intersex varies, complicating the issue.
Fundamentally, intersex include children born with genitals, gonads or chromosome patterns that do not completely fit male or female phenotypes.
But prevalence estimates depend on the definition — whether it is children with any ‘noticeably atypical’ genitalia (around 2%), or only those where a specialist doctor is required for sex differentiation (around 0.02%).
Dr Bonython, an Associate Professor of Law at Bond University on the Gold Coast, stresses that doctors have not intervened due to “malevolence” or “wanting to harm children”.
“It was basically a case of: ‘How can we make this child’s life easier?’
“Back in the ’50s and ’60s, this was done without even consulting the parents.
“The assumption was it was too distressing for the parents, and doctors would go for either the easiest surgical option or the one they thought was most likely to be ‘correct’.”
The first draft of the ACT law will permit surgery in health emergencies, or if the procedure is easily reversible or does not affect the child’s sex characteristics.
Other procedures will require approval of the treatment plan from an assessment board, which will include members trained in medicine and ethics, and at least one intersex person.
Significantly, a risk of psychological harm from stigma or discrimination will not be counted as a legitimate medical reason to intervene, under the draft bill.
“For example, surgery on a child with chronic UTIs that had a structural basis, which need correcting, would not be banned,” Dr Bonython says.
“The bill wouldn’t leave the child to suffer from the chronic condition until they reached 18.
“It essentially says: ‘Anything that’s not medically necessary in the short term should absolutely be delayed until the child is old enough to actively participate in the decision-making.
“But the review committee will be required to discount considerations about discrimination and stigma.
“That said, if these are not legitimate reasons for providing that type of treatment, what are the other things the government is doing to offset the risk of stigma and discrimination against these kids?”
Mr Barr has said his government will invest $2.6 million over four years to support services for intersex people, including extra training for health professionals.
The ACT bill remains before Parliament, although with no Senate to negotiate, the government bill is expected to become law later this year.
And Dr Bonython expects that, if it becomes law, other jurisdictions will follow.
What about circumcision?
Circumcision will not be affected by the ACT bill. As the government explains:
“Circumcision of the penis is excluded for several reasons.
“This bill applies only to people who have a variation in sex characteristics.
“If circumcision of the penis were not exempted, this would mean people without a variation in sex characteristics could be circumcised, while those with a variation could not, despite there not necessarily being an underlying difference in the health circumstances between those two groups.
“[Also] there is a religious element to why some people seek to circumcise their children.
“Prohibiting circumcision would involve a different consideration of freedom of religious practices.”
WONDER WHAT THIS MEANS FOR TOP AND BOTTOM SURGERY.