This review assesses a rare and insightful philosophical examination of the ethics of the medical management of sex-atypical children. In Making Sense of Intersex, Ellen K. Feder crafts an ethics that would shift several common foci of the contemporary debate on her topic: from questions of gender to the ethics of normalization; from individual or parental autonomy to a general corporeal vulnerability; and from parental medical proxy rights to the interdependency of parent-child relations. The review identifies some seemingly unavoidable conundrums (...) that would remain unsolved after such shifts: the continuing role of gender in normalizing medical aims, the utility of an undifferentiated concept of vulnerability in medical decision making, and the place of cosmetic medicine in general. (shrink)

In this critical, feminist account of the management of intersex conditions under 2006's controversial “Disorders of Sex Development” (DSD) treatment model, I argue that like the “Optimal Gender of Rearing” (OGR) treatment model it replaced, DSD aims at securing a cisgendered future for the intersex patient, referring to a normalized trajectory of development across the lifespan in which multiple sexed, gendered, and sexual characteristics remain in “coherent” alignment. I argue this by critically analyzing two ways that intersex management has changed (...) between OGR and DSD: 1) regarding sex‐assignment recommendations for three patient populations and, 2) with the prenatal treatment of pregnant individuals at risk of conceiving a fetus with congenital adrenal hyperplasia with the steroid hormone dexamethasone. I conclude that like OGR before it, DSD also unjustifiably presumes that typical genitalia are necessary for cisgendered development. However, unlike OGR, it appeals to the empirically inadequate, theoretically suspect, and biologically determinist model of gender development known as brain‐organization theory. Given this, I conclude that the treatment of intersex people under DSD continues to be driven by problematically heterosexist and transphobic assumptions regarding the value and normalcy of cisgendered life, while practically and discursively constituting it as such. (shrink)

One of two commentaries on “Normalizing Atypical Genitalia: How a Heated Debate Went Astray,” by Josephine Johnston, from the November‐December 2012 issue.

Bioethics influences public policy, scientific research, and clinical practice. Thinkers in Continental traditions have increasingly contributed scholarship to this field, and their approaches allow new insights and alternative normative guidance. In this essay, examples of the following Continental approaches in bioethics are presented and considered: phenomenology and existentialism; deconstruction; Foucauldian methodologies; and biopolitical analyses. Also highlighted are Continental feminisms and the philosophy of disability. Continental approaches are importantly diverse, but those I focus upon here reveal embedded models of individualized autonomy (...) in medical discourses and encourage awareness of medicine's normalizing edges, thereby drawing attention to lacunae in traditional bioethical frameworks. (shrink)

In a series of essays and letters published in 2010, commentators in bioethics debated the ethics of two interventions that aim to prevent or treat a symptom of a genetic condition called congenital adrenal hyperplasia, which can cause “virilization” in affected baby girls—the development of atypical, sometimes masculine‐appearing, genitals. Surgeries are often performed to try to “normalize” both the appearance and the function of affected girls’ genitals, and a drug thought to prevent virilization is sometimes prescribed to pregnant women who (...) are likeliest to be carrying an affected fetus. The CAH debates suggest that there is profound disagreement in the field about whether preventing or treating virilization is an appropriate goal of medicine—or, indeed, parenting. Of course, that disagreement has its roots in ongoing debates about how to understand and react to a range of anatomical and behavioral differences, from short stature to deafness to hyperactivity, as well as ongoing debates about the limits of autonomy—in this case, parental autonomy, which is all the more complex. These issues are at the heart of bioethics. Yet it can be very difficult for us to talk and write respectfully and clearly about them. Here, I recount the debates, show how they lost focus, and attempt to explain why the question about how parents and physicians should respond to atypical genitalia in children is so important and difficult. I argue that it is not a question that should be answered based on a single principle or philosophical commitment. No one principle can do all of the work. For each individual or family that faces it, the question is shaped by details about particular interventions aimed at altering a particular difference and offered in a particular social and family context. Scholars in bioethics who hold an especially strong commitment to any one principle should advocate for their views, but they must also make room for and respect the kind of pragmatic, particularized decision‐making that parents sometimes engage in. (shrink)