Ethical Issues in Gender Reassignment

Ethics involve society's accepted standards of right and wrong. In the practice of gender reassignment surgery, doctors must make ethical choices regarding which gender to assign babies with ambiguous or deformed genitals. Determining ethical practices in this arena has evolved since the first sexual reassignment surgery was performed in 1922. There is still not a consensus among doctors as to what makes a person male or female.

Genetics Versus Environment

• Doctors must decide if they believe gender is determined mostly by the chromosomes or by the way a child is raised. If they believe babies are psycho-sexually neutral at birth, they make the baby a male if making a fully functioning penis is possible. Otherwise, the baby is female by default, as making female genitals is a less complicated surgical procedure. If doctors believe that chromosomal makeup dictates gender, they assign a baby as male only if his chromosomal makeup is XY.

Questioning Gender Neutrality

• According to pediatric urologists Baskin and Duckett, up until 1950, doctors felt that babies were psycho-sexually neutral at birth. The watershed case of David Reimer in 1950 led doctors to question this belief. Reimer was born male but was reassigned surgically as female when his penis was severely deformed in an accident at the age of seven months. He was raised as a girl but resisted the psychological indoctrination and hormones. As an adult, Reimer assumed a male identity and married a female. In interviews, he stated that he never felt he was a female.

Using Chromosomal Makeup

• Controversy again arose regarding the belief that babies are genetically neutral. This happened when child and adolescent psychiatrist William G. Reiner studied 29 people with a male chromosomal makeup, who had been surgically reassigned and reared as females. Over half felt they were males by the time they were teenagers despite the surgical operations and social indoctrination. The David Reimer case and the Reiner study caused some doctors to believe that babies are born with a specific gender that cannot be altered surgically or socially. These doctors advocate assigning a baby as male if they have an XY chromosomal makeup in all cases.

Changing Adolescents' Gender

• According to Drs. J. Polsdorfer and Rebecca Frey, some doctors feel that it is unethical to perform gender reassignment surgery on adolescents, as they cannot give informed consent for the procedure given their emotional immaturity. "Any 46-chromosome, XY individual born with a normal nervous system, in keeping with the psycho-sexual bias thus prenatally imposed, should be raised up as a male," argued Drs. Milton Diamond and H. Keith Sigmundson. However, Polsdorfer and Frey cited a 2006 case that stirred controversy among doctors in Australia regarding a teenage girl who wished to undergo gender reassignment surgery, suggesting that not all surgeons agree with the chromosomal theory of gender reassignment.