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There is no guarantee that the child will have a female gender identity as an adult. As discussed above, a significant fraction of children with her specific medical condition and history have a male gender identity as adults. If the child grows up to have a male gender identity, then the surgeries that the doctors seek to perform will have been a terrible mistake. Moreover, even if her adult gender identity is female, there is no guarantee that she will not regret any genital surgeries that were performed without her consent as a child especially given the uncertain outcome of current surgical techniques. Given the deeply personal and irreversible nature of genital surgeries, the child herself is the only person who has the right to weigh the risks and to decide what kind of genital alterations, if any, she would like to undergo.
Parents have considerable legal control over their children, but they do not have the right to disregard the child's intrinsic human rights to privacy, dignity, autonomy, and physical integrity by altering a child's genitals through irreversible surgeries based on an unproven and controversial psychosocial rationale. See, for example, the American Convention on Human Rights, Article 1 (stating that "every human being" is entitled to the rights and freedoms recognized in the Convention); Article 5 (recognizing the right to "physical, mental, and moral integrity"); Article 11 (recognizing the right to privacy); and Article 19 (stating that "every minor child has the right to the measures of protection required by his condition as a minor on the part of his family, society, and the state"). See, for example, United Nations Convention on the Rights of the Child (signed by Colombia 26 January 1990, ratified 28 January 1991), Article 19 (requiring all states "to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation . . . while in the care of parent(s), legal guardian(s) or any other person who has the care of the child"); and Article 37 (requiring all states to ensure that "no child shall be subjected to torture or other cruel, inhuman or degrading treatment").
Summary
Therefore, we urge the Court not to approve the surgery, as a violation of the child's human rights as previously ruled by this Court and as guaranteed by international law, and specifically not to indemnify physicians against liability for what they obviously regard as a questionable procedure with a significant likelihood of resulting in regret, anger, and motivation to seek legal redress as the patient grows up and is able to take legal action on her own behalf.
Yours Truly,
Cheryl Chase
Executive Director, ISNA
PS: You specifically asked for a copy of the article "The Five Sexes," by Dr. Anne Fausto-Sterling. I have enclosed that article, but I would like to emphasize that, though the article is titled "Five Sexes," neither Dr. Fausto-Sterling nor I nor ISNA is suggesting that there are actually five sexes. Dr. Fausto-Sterling and ISNA support the recommendations of (Diamond and Sigmundson 1997b). In the current case, those recommendations indicate that the child should continue to be raised as a girl, but that no genital surgery be done unless at her own initiative and with her informed consent.
Appendix A
Feminizing Genital Surgery is Medically Unnecessary
"Our needs and the needs of the parents to have a presentable child can be satisfied. We argue that surgery in an infant maximizes a child's social adjustment and acceptance by the family. But do we truly realize and promote the best interest of the adult patient in terms of psychosocial outcomes? This knowledge is still obscure and much remains to be discovered" (Schober 1998, p19).
"The only indication for performing this surgery [clitoral reduction] has been to improve the body image of these children so that they feel 'more normal'" (Edgerton 1993).
"Scientific dogma has held fast to the assumption that without medical care hermaphrodites are doomed to a life of misery. Yet there are few empirical studies to back up that assumption, and some of the same research gathered to build a case for medical treatment contradicts it" (Fausto-Sterling 1993).
"The major justification for early surgery is the belief that children will suffer terrible psychological damage if they and those around them are not crystal clear about which sex they belong to. Surgically altering ambiguous genitalia is seen as an important component of clarifying the situation initially for family and friends, and as the child becomes conscious of his or her surroundings, for the child as well" (Fausto-Sterling and Laurent 1994, p8).
Hopkins surgeons justify early genital surgery because it "relieves parental anxiety about the child with relatives and friends" (Oesterling, Gearhart, and Jeffs 1987, p1081).
"For a small infant, the initial objective is to feminize the baby to make it acceptable to the parents and family" (Hendren and Atala 1995, p94).
"Although gender assignment by genital surgery reassures adults, it does not necessarily require surgery, based on anecdotal reports of untreated patients" (Drescher 1997).
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