Skip to main content

Advertisement

Log in

Still Quiet After All These Years

Revisiting “The Silence of the Bioethicists”

Journal of Bioethical Inquiry Aims and scope Submit manuscript

Abstract

Some 14 years ago, I published an article in which I identified a prime site for bioethicists to ply their trade: medical responses to requests for hormonal and surgical interventions aimed at facilitating transgendered people’s transition to their desired genders. Deep issues about the impact of biotechnologies and health care practices on central aspects of our conceptual system, I argued, were raised by how doctors understood and responded to people seeking medical assistance in changing their gender, and there were obviously significant issues of regulation involved as well. Yet mainstream bioethics was conspicuous by its relative absence from the discussion. Here, I return to the matter and find that, while the conceptual issues are just as profound and their connection to health care practice and policy just as intimate, even as transgender issues have become much more socially visible, bioethical engagement with gender reassignment has increased only slightly. I set the little movement that has occurred against the backdrop of the situation as I saw it in 1998 and conclude, once again, by trying to make the bait for bioethicists inviting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Notes

  1. As was. Ms. Chase’s name for all purposes is now Bo Laurent.

  2. Bayle and Levy suggest that, insofar as the desire for amputation stems from a psychiatric condition they characterize as “body integrity identity disorder” (BIID), analogies with gender identity disorder might authorize surgical responses. Johnson and Elliott, who are more dubious about the propriety of surgical responses to psychiatric problems, suggest that medical validation of BIID as a central characteristic of some people might function as what Ian Hacking (1995) has called a “looping kind,” with the implication that people who would otherwise never have understood their identities as requiring amputation will come to see themselves in such terms; in support of this concern, they point to the growth in the number of people putting themselves forth for sex reassignment surgery since Christine Jorgenson’s story became well-known in 1953. Butler (2004) might well be seen as agreeing with the possibility that “transsexual” might name a looping kind, but to celebrate, rather than decry, that possibility.

  3. Butler does not mention just which of Kate Bornstein’s books she had in mind, but likely contenders would be those from 1995 or 1997.

  4. Draper and Evans cite the Harry Benjamin International Gender Dysphoria Association, WPATH’s predecessor body (Draper and Evans 2006, 109).

  5. Hale relies chiefly on Pfäfflin and Junge (1998), who report an incidence of post-operative regret of less than 1 percent for female-to-male procedures, and 1 percent to 1.5 percent for male-to-female procedures.

References

  • American Psychiatric Association DSM-5 Development. 2011. P 01 gender dysphoria in adolescents or adults, May 4. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=482#. Accessed November 10, 2011.

  • Bayne, T., and N. Levy. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy 22(1): 75–86.

    Article  PubMed  Google Scholar 

  • Beauchamp, T.L., and J.F. Childress. 2001. Principles of biomedical ethics, 5th edition. New York: Oxford University Press.

    Google Scholar 

  • Billings, D., and T. Urban. 1982. The socio-medical construction of transsexualism: An interpretation and critique. Social Problems 29(3): 266–282.

    Article  Google Scholar 

  • Bornstein, K. 1995. Gender outlaw: On men, women, and the rest of us. London: Routledge.

    Google Scholar 

  • Bornstein, K. 1997. My gender workbook: How to become a real man, a real woman, the real you, or something else entirely. London: Routledge.

    Google Scholar 

  • Butler, J. 2004. Undoing gender. London: Routledge.

    Google Scholar 

  • Chase, C. 1998. Hermaphrodites with attitude: Mapping the emergence of intersex political activism. GLQ: A Journal of Lesbian and Gay Studies 4(2): 189–211.

    Google Scholar 

  • Draper, H., and N. Evans. 2006. Transsexualism and gender reassignment surgery. In Cutting to the core: Exploring the ethics of contested surgeries, ed. D. Benatar, 97–110. Lanham: Rowman & Littlefield.

    Google Scholar 

  • Giordano, S. 2008. Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder? Journal of Medical Ethics 34(8): 580–584.

    Article  PubMed  CAS  Google Scholar 

  • Hacking, I. 1995. Rewriting the soul: Multiple personality and the science of memory. Princeton: Princeton University Press.

    Google Scholar 

  • Hale, C.J. 2007. Ethical problems with the mental health evaluation standards of care for adult gender variant prospective patients. Perspectives in Biology and Medicine 50(4): 491–505.

    Article  PubMed  Google Scholar 

  • Hume, M.C. 2011. Sex, lies, and surgery: The ethics of gender reassignment surgery. Res Cogitans 2(1): 37–48. http://commons.pacificu.edu/rescogitans/vol2/issl/5. Accessed November 10, 2011.

    Google Scholar 

  • Johnson, J., and C. Elliott. 2002. Healthy limb amputation: Ethical and legal aspects. Clinical Medicine 2(5): 431–435.

    Google Scholar 

  • Nelson, J.L. 1998. The silence of the bioethicists: Ethical and political aspects of managing gender dysphoria. GLQ: A Journal of Lesbian and Gay Studies 4(2): 213–230.

    Google Scholar 

  • Pfällin, F., and A. Junge. 1998. Sex reassignment: Thirty years of international follow-up studies after sex reassignment surgery, a comprehensive review, 1961–1991. Trans. R.B. Jacobson and A.B. Meier. Dusseldorf: Symposium Publishing.

  • Preves, S.E. 2003. Intersex and identity: The contested self. Piscataway: Rutgers University Press.

    Google Scholar 

  • Raymond, J. 1979. The transsexual empire: The making of the she-male. Boston: Beacon press.

  • Scheman, N. 1996. Queering the center by centering the queer: Reflections on transsexuals and secular Jews. In Feminists rethink the self, ed. D. Meyers, 124–142. Boulder: Westview.

    Google Scholar 

  • Spriggs, M.P. 2004. Ethics and the proposed treatment for a 13-year-old with atypical gender identity. The Medical Journal of Australia 181(6): 319–321.

    PubMed  Google Scholar 

  • Valentine, D. 2007. Imagining transgender: An ethnography of a category. Durham: Duke University Press.

    Google Scholar 

  • Van Meter, W. 2010. Bold crossings of the gender line. The New York Times, December 9, E1.

  • World Professional Association for Transgender Health (WPATH). 2011. Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th version. http://www.wpath.org/publications_standards.cfm. Accessed November 10, 2011.

Download references

Acknowledgements

Autumn Fiester and Lance Walhert kindly encouraged me to base this paper on my earlier contribution to the literature on bioethics and transgender. In that connection, I want to take this opportunity to thank again Susan Stryker for her enormously thoughtful editorial engagement with the 1998 paper, whose influence once more makes itself felt. I also had two anonymous reviewers who did exemplary work responding to the first submitted draft of this paper, giving me a great deal to think about in general as well as many useful suggestions. As is always the case, I am grateful to Hilde Lindemann for her close reading of this paper, but even more, for what I have learned from the many long conversations we have had on issues of gender and its role in our shared lives these many years

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James Lindemann Nelson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nelson, J.L. Still Quiet After All These Years. Bioethical Inquiry 9, 249–259 (2012). https://doi.org/10.1007/s11673-012-9377-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-012-9377-8

Keywords

Navigation