The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals (...) to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices. (shrink)

There's no doubt that reproductive technologies can transform lives for the better. Infertile couples and single, lesbian, gay, intersex, and transgender people have the potential to form families in ways that would have been inconceivable years ago. Yet we are concerned about the widespread commercialization of certain egg‐freezing programs, the messages they propagate about motherhood, the way they blur the line between care and experimentation, and the manipulative and exaggerated marketing that stretches the truth and inspires false hope in women (...) of various ages. We argue that although reproductive technology, and egg freezing in particular, promise to improve women's care by offering more choices to achieve pregnancy and childbearing, they actually have the potential to be disempowering. First, commercial motives in the fertility industry distort women's medical deliberations, thereby restricting their autonomy; second, having the option to freeze their eggs can change the meaning of women's reproductive choices in a way that is limiting rather than liberating. (shrink)

Our comments about the current fetal dexamethasone (dex) controversy are historical, highlighting the long, painful history of physicians’ approaches to people with intersex conditions. The ways in...

A 28-year-old female-to-male transgender patient presents to the emergency room with one day of pleuritic chest pain and shortness of breath. The patient is found to have an acute pulmonary embolus and is admitted is to the academic hospitalist teaching service for further management.The transgender population is diverse in gender identity, expression, and sexual orientation. Although estimates vary, one study suggests that 0.3% of adults identify as transgender. The U.S. National Transgender Discrimination Survey revealed that 28% of transgender adults have (...) experienced harassment in medical settings, 19% reported being refused care, and 28% postponed care because of discrimination... (shrink)

The two provocative essays in this issue of the Hastings Center Report should stimulate debate not only about female genital cutting, fetal dexamethasone, and clitoral reduction surgery, but also about our fierce commitment to particular cultural norms about the body. Under what conditions may adults irreversibly modify a child's body because they think the change is in her best interest? Certainly, parents who opt for female genital cutting or for surgical reduction of an enlarged clitoris in a girl with congenital (...) adrenal hyperplasia want to make choices that will contribute to their child's potential happiness. If cutting in Africa—or mitigating CAH symptoms here—upholds a girl's gender identity, which will translate into a fulfilled life as an adult, some argue that a parent's refusal to abide by social prescriptions does the child a serious disservice. (shrink)

My father died recently after a sudden heart attack. I ought to have been prepared for the five days my mother, brother, and I spent with him in the cardiac intensive care unit because I am a member of the Ethics Committee and the Ethics Consult Team at the local hospital in Eugene, Oregon, and have discussed many difficult end-of-life cases. But much of what happened—and what didn’t happen—came as a surprise to me. That surprise led me to reconsider the (...) ways in which families and hospital physicians communicate about the process of dying. How should doctors balance their messages of hope and realism when the situation is grim?My father got excellent care: his medical needs were attended to around the clock, and.. (shrink)

A 35-year-old woman presents to the hospital after a fall at home. A routine medical history and physical examination reveal that the patient identifies as intersex, and an X-ray of the left hip demonstrates profound osteopenia. The patient is admitted to the hospitalist service for further evaluation. What does it mean to identify as intersex? In the medical world, “intersex” is usually referred to as DSD, or “disorders of sex development.” Until the 1990s, physicians referred to this condition as hermaphroditism, (...) but this label is no longer used because it evokes mythical creatures rather than real human beings. Even the DSD label is controversial, and the patient in our case study does not think... (shrink)