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Intersex(es) and Informed Consent: How Physicians' Rhetoric Constrains Choice

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Abstract

When a child is born with ambiguousgenitalia it is declared a psychosocialemergency, and the policy first proposed byJohn Money (Johns Hopkins University) andadapted by the American Academy of Pediatrics(and more broadly accepted in Canada, the U.K.,and Europe) requires determination ofunderlying condition(s), selection of gender,surgical intervention, and a commitment by allparties to accept the ``real sex'' of thepatient, all no later than 18–24 months,preferably earlier. Ethicists have recentlyquestioned this protocol on several grounds:lack of medical necessity, violation ofinformed consent, uncertainty of standards ofsuccess, among others. This suggests that thefaults in the protocol can be addressed andimproved. Through a rhetorical approachinformed by Perelman/Olbrechts-Tyteca, thedisciplinary pathologization and reconstructionof the body are explored as incidents ofconstraining rhetoric that enact theirpersuasion upon the body of intersexedchildren. This essay shows that thepresumptions, judgments, values, andpresuppositions brought by the physician to theidentification, diagnosis, and curativeprocedures create a network of constraints thatexclude alternative possibilities. The resultis a situation wherein parents, physicians, andintersexed patients have ``no choice'' but toaccept the medical treatment guidelines.

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Hester, J.D. Intersex(es) and Informed Consent: How Physicians' Rhetoric Constrains Choice. Theor Med Bioeth 25, 21–49 (2004). https://doi.org/10.1023/B:META.0000025069.46031.0e

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