Stabilizing or Changing Identity? The Ethical Problem of Sex Reassignment Surgery as a Conflict among the Individual, Community, and Society

Abstract

The world is getting smaller and smaller. In Europe, borders are disintegrating and a joint currency (EURO) is already upon us. Globetrotters encounter the same companies, the same hotel chains, and the same fast food nearly everywhere they go. Some say the world is fast becoming a ‘global village’. And yet this ‘village’ is not governed by unanimity. Taking any sociopolitical topic at random, it is impossible to make a non-controversial statement about it. For every opinion there is a counter-opinion; for every attempt to solve a problem, a counter-attempt. Our opinions are divided on all matters of import, although our differences regarding the moral evaluation of (new) medical options are particularly marked. We have not even been able to achieve unanimity in individual countries (the villages within the global village), as the never-ending arguments about the permissibility of abortion, embryo research, germline interventions and euthanasia (to name but a few) aptly show. The reasons for this dissent are the profound anthropological differences and varying worldviews of the individual citizens at stake. Moral pluralism, as it is often termed, stems from the wars of religions and the Enlightenment, through which secular and religious communities have become mixed in many European states. Today we have to acknowledge the fact that there is a difference between society and (religious) community. There is no longer a single valid social stance acceptable to all (religious) communities, even in fundamental matters of human coexistence, even in the most fundamental of them all: the question of what constitutes being a man or a woman. Using the example of sex-reassignment surgery, the following paper will show that profound differences of opinion exist between individuals, (religious) communities and society about our understanding of males/females, and that there is a deep rupture between traditional and post-traditional understandings of the sex of a human being and its reassignment. The sex-reassignment surgery option requires individuals and individual communities to take a stance, which may range from ‘progressive’ to ‘conservative-orthodox’. The problem facing the State is how to succeed in providing a framework inside which such differing positions may be adopted side-by-side. The problem facing individual citizens is how to find orientation when forming their own opinions in a world which is becoming increasingly complex in its globality. One fixed point of orientation for many is the differentiation male/female: a parameter they believe to be both ‘natural’ and beyond debatable.

I am in deep debt to many who gave generously support to this article. In particular, I am especially grateful to Dr. Georg Bier, Office of the Catholic Bishop, Limburg, Germany; Prof. Dr. med. Michael Sohn, Department of Urology, Markus-Hospital, Frankfurt/M., Germany; and Prof. H.T. Engelhardt, Jr., M.D., Ph.D., Rice University, Houston, Texas. Special thanks to Sarah L. Kirkby (B.A. Hons.) and Christiane Hearne for all their work with the translation.