The silence of the bioethicists: Ethical and political aspects of managing gender dysphoria

GLQ

Volumn 4, Issue 2, 1998, Pages 213-230

  Nelson, James L ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

HORMONE;

ARTICLE; ATTITUDE; BIOETHICS; BIOETHICS AND PROFESSIONAL ETHICS; DECISION MAKING; ETHICIST; ETHICS; FREEDOM; GENERAL ASPECTS OF DISEASE; HEALTH; HEALTH CARE ORGANIZATION; HERMAPHRODITISM; HUMAN; INFORMED CONSENT; MEDICINE; MENTAL DISEASE; PATIENT; PATIENT CARE; PATIENT SELECTION; PERSONAL AUTONOMY; PHYSICIAN; PRACTICE GUIDELINE; PROFESSIONAL PATIENT RELATIONSHIP; SOCIAL DOMINANCE; SOCIAL PSYCHOLOGY; STANDARD; SURGERY; TRANSSEXUALISM;

BIOETHICS AND PROFESSIONAL ETHICS; PROFESSIONAL PATIENT RELATIONSHIP;

ATTITUDE; BIOETHICAL ISSUES; BIOETHICS; DECISION MAKING; DISEASE; ETHICISTS; ETHICS; FREEDOM; GUIDELINES; HEALTH; HEALTH CARE RATIONING; HERMAPHRODITISM; HORMONES; HUMANS; INFORMED CONSENT; MEDICINE; MENTAL DISORDERS; PATIENT CARE; PATIENT SELECTION; PATIENTS; PERSONAL AUTONOMY; PHYSICIANS; REFERENCE STANDARDS; SOCIAL DOMINANCE; SOCIAL VALUES; SURGERY; TRANSSEXUALISM;

EID: 0032228140     PISSN: 10642684     EISSN: None     Source Type: Journal    
DOI: 10.1215/10642684-4-2-213     Document Type: Article

References (40)

1. Sandra Harding, "Why Has the Sex/Gender System Become Visible Only Now?" in Discovering Reality: Feminist Perspectives on Epistemology, Metaphysics, Methodology and the Philosophy of Science, ed. Sandra Harding and Merrill B. Hintikka (Dordrecht: Reidel, 1983), 311-24, quotation on 316.
2. Julia Epstein and Kristina Straub, "Introduction: The Guarded Body," in Body Guards: The Cultural Politics of Gender Ambiguity, ed. Julia Epstein and Kristina Straub (New York: Routledge, 1991), 1-28, quotation on 2.
3. See Gayle Rubin, "The Traffic in Women: Notes on the 'Political Economy' of Sex," in Toward an Anthropology of Women, ed. Rayna R. Reiter (New York: Monthly Review, 1975), 157-210.
4. Some of the more prominent journals include the Hastings Center Report, the Journal of Medicine and Philosophy, the Journal of Medical Ethics, Bioethics, Theoretical Medicine, the Kennedy Institute of Ethics Journal, the Journal of Clinical Ethics, the Cambridge Quarterly of Health Care Ethics, and Medical Humanities Review, all of which have been founded since 1971.
5. In social policy, the work of bioethicists can be seen most prominently in the many influential volumes produced in the brief history of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1980-1983) and perhaps also in the 1991 passage of the Federal Patient Self-Determination Act.
6. The few pieces in the core bioethical literature include Michael Lavin's "Mutilation, Deception and Sex Changes," Journal of Medical Ethics 13 (1987): 86-91
7. the symposium "Marriage, Morality, and Sex-Change Surgery" (Baruch A. Brody, Richard A. McCormick, David H. Smith, and Stephen Toulmin, "Marriage, Morality, and Sex-Change Surgery: Four Traditions in Case Ethics," Hastings Center Report 11, no. 4 [1981]: 8-13).
8. On intersexuality, see Alice Dreger, "Ethical Issues in the Treatment of Intersexuality and 'Ambiguous Sex,'" Hastings Center Report, forthcoming.
9. Professionals involved in treating gender dysphoria have more often ruminated on the ethics of their activity. See especially William A. Walters, "Is Gender Reassignment Morally Acceptable?" in Transsexualism and Sex Reassignment, ed. William A. Walters and Michael Ross (Oxford: Oxford University Press, 1986).
10. Other writers, neither therapists nor (generally regarded as) bioethicists, have also addressed the ethics of sex reassignment, notably Janice Raymond, The Transsexual Empire (Boston: Beacon, 1979);
11. Sandy Stone, "The Empire Strikes Back: A Posttranssexual Manifesto," in Epstein and Straub, Body Guards, 280-304;
12. and several of the contributors to Blending Genders, ed. Richard Elkins and Dave King (London: Routledge, 1996).
13. Bernice L. Hausman, Changing Sex: Transsexualism, Technology, and the Idea of Gender (Durham, N.C.: Duke University Press, 1995);
14. Anne Bolin, In Search of Eve (New York: Bergin and Garvey, 1988);
15. Anne Bolin, "Transcending and Transgendering: Male-to-Female Transsexuals, Dichotomy, and Diversity," in Third Sex, Third Gender: Beyond Sexual Dimorphism in Culture and History, ed. Gilbert Herdt (New York: Zone Books, 1994);
16. Alice Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge, Mass.: Harvard University Press, forthcoming);
17. Holly Devor, Gender Blending: Confronting the Limits of Duality (Bloomington: Indiana University Press, 1979);
18. Deborah Feinbloom, Transvestites and Transsexuals: Mixed Views (New York: Dell, 1979);
19. Suzanne Kessler and Wendy McKenna, Gender: An Ethnomethodological Approach (New York: John Wiley and Sons, 1978).
20. Dwight Billings and Thomas Urban, "The Sociomedical Construction of Transsexualism: An Interpretation and Critique," Social Problems 29 (1982): 266-82
21. (page numbers in my subsequent citations of this article refer to its reprinting in Elkins and King, Blending Genders).
22. Elkins and King, Blending Genders Ibid., 99, 115.
23. This line of reasoning runs from Mary Daly (Gyn/Ecology: The Metaethics of Radical Feminism [Boston: Beacon, 1978])
24. Janice Raymond (The Transsexual Empire: The Making of the She-Male [Boston: Beacon, 1979])
25. 1970s through Billings and Urban in the 1980s to Janice Irvine (Disorders of Desire: Sex and Gender in American Sexology [Philadelphia: Temple University Press, 1991])
26. Hausman (Changing Sex) in the 1990s.
27. Billings and Urban, "Sociomedical Construction," 99.
28. J. Meyer and J. Hoopes, "The Gender Dysphoria Syndromes: A Position Statement on So-Called Transsexualism," Plastic and Reconstructive Surgery 54 (1974): 444-51,
29. quoted in Billings and Urban, "Sociomedical Construction," 114.
30. Harry Benjamin International Gender Dysphoria Association, Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons (Palo Alto, Calif.: Harry Benjamin International Gender Dysphoria Association, 1990);
31. International Conference on Transgender Law and Employment Policy, Health Law Standards of Care for Transsexualism (1993).
32. For a discussion of the DSM-IV's treatment of "gender-identity disorders," see Katherine K. Wilson and Barbara E. Hammond, "Myth, Stereotype, and Cross-gender Identity in the DSM-IV," paper given at the Association of Women in Psychology twenty-first annual Feminist Psychology Conference, Portland, Oreg., 1996.
33. There are exceptions to this requirement, most prominently cosmetic surgery, the significance of which for sex reassignment procedures will be touched on below.
34. Claudine Griggs, Passage through Trinidad: Journal of a Surgical Sex Change (Jefferson, N.C.: McFarland, 1966).
35. A good deal of this discussion exists in the form of Internet postings, but see, for instance, Dallas Denny, "Some Notes on Access to Medical Treatment" (Decatur, Ga.: American Educational Gender Information Service, n.d.).
36. The point concerning how pathologization silences the voice of the person pathologized has been made powerfully by Susan Stryker: "Through the filter of this official pathologization, the sounds that come out of my mouth can be summarily dismissed as the confused rantings of a diseased mind"
37. ("My Words to Victor Frankenstein above the Village of Chamounix: Performing Transgender Rage," GLQ 1 [1994]: 237-54, quotation on 244).
38. Ruth Faden and Tom Beauchamp, A History and Theory of Informed Consent (Oxford: Oxford University Press, 1986).
39. J.-N. Zhou et al., "Sex Differences in the Human Brain," Nature 378 (1995): 68-70.
40. Hilde Lindemann Nelson and James Lindemann Nelson, "Justice in the Allocation of Health Care Resources: A Feminist Account," in Feminism and Bioethics: Beyond Reproduction, ed. Susan Wolf (New York: Oxford University Press, 1996), 351-70.