On the Turning Away – A Brief Exploration of Medical Ethics

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Philip Zimbardo is an American psychologist. He was detailed to investigate the abuses – long denied – committed on prisoners at the Abu Ghraib detention camp. In his report he describes the phenomena whereby apparently otherwise “good” people do very bad things, in this case, the crimes committed in Abu Ghraib.

“Good people do bad things when there’s a dehumanisation of others, de-individuation of self, diffusion of personal responsibility, blind obedience to authority, uncritical conformity to group norms and passive tolerance of evil, through inaction or indifference. All this usually occurs in a new or unfamiliar situation.”

What Zimbardo sought to describe was the phenomena of situations, or received wisdom/s corrupting individuals to the point where they find it easier to fall into line with the norms of the group they work alongside. That phenomena has been called group think, and it’s most well known proponent was a man called Irving Janis. He described group think in these terms:-

“The main principle of groupthink, which I offer in the spirit of Parkinson’s Law, is this: The more amiability and esprit de corps there is among the members of a policy-making ingroup, the greater the danger that independent critical thinking will be replaced by groupthink, which is likely to result in irrational and dehumanizing actions directed against outgroups”

To a clinician, outgroups would be intersex individuals, and support groups that question what is done to them.

As the UN Special Rapporteur on Torture documented in their 2013 investigation into the treatment of intersex,  trans and LGBT people in the medical environment, Zimbardo could just as easily been talking about what happens to people born intersex.

“There is an abundance of accounts and testimonies of persons being denied medical treatment, subjected to verbal abuse and public humiliation, psychiatric evaluation, a variety of forced procedures such as sterilization, State-sponsored forcible … hormone therapy and genital-normalizing surgeries under the guise of so called “reparative therapies”. These procedures are rarely medically necessary, can cause scarring, loss of sexual sensation, pain, incontinence and lifelong depression and have also been criticized as being unscientific, potentially harmful and contributing to stigma”

People born intersex suffer grave abuses of their human rights, enacted by clinicians in the stated belief that it is in our best interests. Many people suffer multiple interventions over a period of years. They have no say in their enactment. Many people exhibit symptoms of deep trauma as a consequence of these medically un-necessary interventions.

Intersex protocols do not talk about people. Instead individuals are referred to by a nomenclature specifically devised to disconnect – de-individuate – that person from society and situate their being entirely as a descriptor: Disorders of Sex Development. That umbrella title is then further subdivided into XX-DsD, and XyDsD, thus following the artificial binary description of humankind, even though doctors have long known that there are many more variations of the genetic code that describes men and women, such as XO and XXY.

To be intersex is to be known by a descriptor, thus completely dehumanising individuals, the easier to contemplate enacting the very processes on infants and young people despite overwhelming evidence of the harm it does to those who suffer their interventions.

The justifications for these interventions have changed over the years. No longer do clinicians openly state that surgeries and hormone interventions are intended to forge a person’s gender identity. They know now that isn’t valid. However, once an assignment is made, that person often endures surgery to align them with the expectations of embodiment of that sex. So infant girls will endure surgery to refashion their genitals to more nearly resemble the appearance expected of a female. Functionality still remains a distant, secondary intention. The scarring and admitted sub-optimal outcomes speak to the consequences to people who have no say in these continuing, non-consensual, medically un-necessary elective procedures.

This situation will only change by education, people learning to accept difference, and acknowledging that people born intersex have exactly the same rights of autonomy and bodily integrity as people who are not intersex.

Malta became the first country in the world to legislate to protect people born intersex, and prevent pre-emptive medical interventions on infants and young people.  Jersey is about to adopt anti-discrimination laws that protect intersex people in society, and thus becoming the first part of the UK to acknowledge the existence of intersex people, and give some measure of protection.

It is long overdue that intersex people in the UK and worldwide, were granted the rights and protections of personal autonomy, and bodily integrity over all the decisions made about them.