This article presents the Islamic bioethical deliberation on the issue of sex assignment surgery for infants with disorders of sex development or intersexed as a case study. The main objective of this study is to present a different approach in assessing a biomedical issue within the medium of the Maqasid al-Shari’ah. Within the framework of the maqasidic scheme of benefits and harms, any practice where benefits are substantial is considered permissible, while those promoting harms are prohibited. The concept (...) of Maqasid al-Shari’ah which is the mechanistic interpretation of Qur’an and Hadith presents the holistic attention of Islam on many life activities, including healthcare. Indeed, this concept encompasses many aspects of worldly life, both for the human individual and collectively for the whole society. In healthcare, the practice of SAS on DSD newborns has presented an assortment of implications on the future livelihood of the affected individual. The process of decision-making seems to be very multifaceted since every element such as the determination of the ‘correct’ sex and the urgency of early surgery must consider the benefits and harms, as well as the child’s rights and best interest. The application of the concept of Maqasid al-Shari’ah, would convey a pragmatic approach that is often disregarded in Western medicine. This approach considers the right of the individual to live life optimally, individually and socially and practice his faith, precisely, in accordance with the assigned gender. (shrink)

In this critical, feminist account of the management of intersex conditions under 2006's controversial “Disorders of Sex Development” (DSD) treatment model, I argue that like the “Optimal Gender of Rearing” (OGR) treatment model it replaced, DSD aims at securing a cisgendered future for the intersex patient, referring to a normalized trajectory of development across the lifespan in which multiple sexed, gendered, and sexual characteristics remain in “coherent” alignment. I argue this by critically analyzing two ways that intersex (...) management has changed between OGR and DSD: 1) regarding sex‐assignment recommendations for three patient populations and, 2) with the prenatal treatment of pregnant individuals at risk of conceiving a fetus with congenital adrenal hyperplasia with the steroid hormone dexamethasone. I conclude that like OGR before it, DSD also unjustifiably presumes that typical genitalia are necessary for cisgendered development. However, unlike OGR, it appeals to the empirically inadequate, theoretically suspect, and biologically determinist model of gender development known as brain‐organization theory. Given this, I conclude that the treatment of intersex people under DSD continues to be driven by problematically heterosexist and transphobic assumptions regarding the value and normalcy of cisgendered life, while practically and discursively constituting it as such. (shrink)

In this paper, I apply Michel Foucault’s analysis of normalization to the 2006 announcement by the US and European Endocrinological Societies that variations on the term “hermaphrodite” and “intersex” would be replaced by the term, “Disorders of Sex Development” or DSD. I argue that the change should be understood as normalizing in a positive sense; rather than fighting for the demedicalization of conditions that have significant consequences for individuals’ health, this change can promote the transformation of the conceptualization (...) of intersex conditions from “disorders like no other” to “disorders like many others.” Understood in these terms, I conclude, medical attention to those with atypical anatomies should be recast from a preoccupation with “normal appearance” to the concern with human flourishing that is the proper object of medical attention. (shrink)

Fertility preservation has become more common for various populations, including oncology patients, transgender individuals, and women who are concerned about age-related infertility. Little attention has been paid to fertility preservation for patients with differences/disorders of sex development (DSD). Our goal in this article is to address specific ethical considerations that are unique to this patient population. To this end, we present a hypothetical DSD case. We then explore ethical considerations related to patient’s age, risk of cancer, concern about (...) genetic transmission of a DSD condition to children, co-occurring gender dysphoria, and access to experimental fertility preservation procedures. Given the limitations of current technologies, we recommend offering fertility preservation to individuals living with DSD using an informed decision-making approach that instills realistic expectations and minimizes the potential for false hope. Finally, we conclude with practical recommendations for this case based on the ethical considerations. (shrink)

Wir diskutieren ethische Probleme der medizinischen Behandlung intersexueller Kinder. Gefragt wird nach dem Stellenwert von Elternwünschen nach eindeutiger Geschlechtszuweisung sowie nach den Konfliktfeldern, die zum einen zwischen konkurrierenden Wunschvorstellungen der Eltern und der behandelnden Ärzte, zum andern zwischen Kindeswohl und Kinderrechten entstehen können. Gegenwärtig wird Neugeborenen mit anatomisch uneindeutigem Genital trotz unsicherer Prognose über die Behandlungsergebnisse oft noch ein Geschlecht zugewiesen und operativ erstellt. Dieses Vorgehen ist von verschiedenen Seiten ethisch heftig kritisiert worden. Kipnis u. Diamond forderten 1998 im „Journal (...) of Clinical Ethics“ ein Moratorium für alle nicht vital indizierten geschlechtskorrigierenden Eingriffe. Diese Forderung orientiert sich am Interesse des zukünftigen Erwachsenen, betont dessen prospektive Autonomie und klammert den Elternwunsch aus. Dieses „Modell des antizipierten Konsenses“ kann jedoch mit Bezug auf Neugeborene und Kleinkinder bedeutsame Aspekte des Eltern-Kind-Verhältnisses nicht angemessen erfassen. Im Aufsatz werden Argumente angeführt, die es aus Sicht einer Ethik der Elternschaft rechtfertigen, ethische Entscheidungen auf der Basis eines beziehungsorientierten Modells zu treffen. In unserem Modell fallen Elternwünsche ethisch ins Gewicht. (shrink)

Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual (...) class='Hi'>development, and early gender-defining surgeries have potentially lifelong consequences. We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult. (shrink)

In mid-2019, the controversy regarding South African runner Caster Semenya’s eligibility to participate in competitions against other female runners culminated in a Court of Arbitration for Sport judgement. Semenya possessed high endogenous testosterone levels (arguably a performance advantage), secondary to a disorder of sexual development. In this commentary, Aristotelean teleology is used to defend the existence of ‘male’ and ‘female’ as discrete categories. It is argued that once the athlete’s sex is established, they should be allowed to compete in (...) the category of their sex without obligatory medical treatment. Indeed, other athletes who possess advantageous genetic or phenotypic traits that fall outside of the human norm have been allowed to compete as humans without restraint. In both cases, if an athlete possesses the essential attributes of being a human or being male or female they should be permitted to compete in those respective categories; athletes’ eligibilities should not be based upon accidental attributes. (shrink)

Disorders of sexual differentiation lead to what is often referred to as an intersex state. This state has medical, as well as some legal, recognition. Nevertheless, the question remains whether intersex persons occupy a state in between maleness and femaleness or whether they are truly men or women. To answer this question, another important conundrum needs to be first solved: what defines sex? The answer seems rather simple to most people, yet when morphology does not coincide with haplotypes, and (...) genetics might not correlate with physiology the issue becomes more complex. This paper tackles both issues by establishing where the essence of sex is located and by superimposing that framework onto the issue of the intersex. This is achieved through giving due consideration to the biology of sexual development, as well as through the use of a teleological framework of the meaning of sex. Using a range of examples, the paper establishes that sex cannot be pinpointed to one biological variable but is rather d... (shrink)

Many decades after the publication of Genesis and development of a scientific fact, Fleck’s collective Denkstil remains a very important notion for analyzing the history of the biological and medical sciences. Following Fleck’s perspective this paper argues that the history of the sex hormones was critically shaped by our representation of the sexes, and our perceptions of the division of reproductive labor. Emerging at the boundary between physiological laboratories and consultation room, a molecular/endocrine style of thought stabilized during the (...) early decades of the twentieth century around the manipulation of sex hormones. This not only proved important in normalizing the sexual body, but also in defining sterility, menstrual disorders or menopause as pathological events to be treated ‘causally’.Analyzing the role played by industrial companies like the German firm Schering which produced these drugs, the paper suggests that the idea of a work style may be a convenient way to complement Fleck’s style of thought. First, the idea of work style is a reminder that science involves material action, which has strong links with industrial production. Second, it draws our attention to a deeply entrenched goal of the modern biosciences, the search for means to control the variability of the living, and standardize its uses. (shrink)

Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices (...) and biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles. (shrink)

This essay investigates the tensions produced by the categorization of different forms of excessive desire under the singular model of addiction, and it challenges the increasing acceptance of addiction as an all-purpose explanation for unruly desires through a comparison of the different forms of disordered desire in sex addiction and alcoholism. Moreover, it argues for a broad understanding of addictive processes to undermine the normative and moralizing assumptions of addiction discourses. Refiguring addiction as a kind of intimacy is one way (...) of making sense of the intense relationships people can develop with substances and with activities. (shrink)

The author was consulted by two Catholic schools in separate cases of a student and a teacher preparing to undergo sex reassignment. Such cases give rise to special ethical and pastoral concerns. This article discusses the disorders that may lead to sex reassignment, distinguishing between con­genital disorders of sex development (intersex conditions) and gender identity disorder (gender dysphoria). It also notes the ethical differences between the correction of congenital anomalies and interventions to relieve dysphoria: in the former, (...) treatment is meant to restore as much normal function as possible; in the latter, mutilating intervention destroys what were otherwise healthy bodily functions. In Catholic schools, concern for the well-being of an affected student or teacher is required, as is a clear understanding of the condition being treated, the ethical implications of treatment, the privacy issues, the effects on other students and staff, and the effects on a teacher’s ability to give faithful witness to Catholic teaching. National Catholic Bioethics Quarterly 12.1 (Spring 2012): 85–97. (shrink)

Attention-deficit hyperactivity disorder is one of the most common neurodevelopmental disorders in children and adolescents. People who have this disorder are characterized by presenting difficulties in the processes of sustained attention, being very active, and having poor control of their impulses. Despite the high prevalence of this disorder and the existence of various tests used for its diagnosis, few data are available regarding the usefulness and diagnostic validity of these tools. Given the difficulties that these subjects present in executive (...) functions, the aim of this study was to evaluate whether the Neuropsychological Assessment of Executive Functions battery for Children allows to establish specific profiles of executive performance for people with attention-deficit hyperactivity disorder. The sample was made up of 197 participants of both sexes, aged between 6 and 12 years age. A nonexperimental design was followed, using a comparative descriptive study method. The results indicated that the scales of phonological fluency, color path, rings, and interference are the most associated with the diagnosis of ADHD, providing data on inhibition, mental flexibility, sustained and selective attention, planning, verbal fluency, and working memory, among others. The practical implication of these results is in line with providing support in the clinical diagnosis that is carried out in children’s mental health units. In addition, the ENFEN tool can be valued as a suitable psychometric instrument in the psychoeducational field, helping professionals in a school environment to be more aware of the areas of cognitive development in which a student diagnosed with ADHD will have more difficulties and, in doing so, providing more adjusted and effective psychopedagogical measures when it comes to supporting students in their adaptation to the school environment. (shrink)

Background: Losing one’s only child may lead to post-traumatic stress disorder, of which re-experiencing is the core symptom. However, neuroimaging studies of sex differences in re-experiencing in the context of the trauma of losing one’s only child and PTSD are scarce; comparisons of the functional networks from the hippocampal subfields to the thalamus might clarify the neural basis.Methods: Thirty couples without any psychiatric disorder who lost their only child, 55 patients with PTSD, and 50 normal controls underwent resting-state functional magnetic (...) resonance imaging. The functional connectivity from the hippocampal subregions to the thalamus and the correlations of FC with re-experiencing symptoms were analyzed within and between the sexes.Results: Compared with husbands without PTSD, wives without PTSD had higher re-experiencing symptoms and weaker FC between the right hippocampal cornu ammonis 3 and the right thalamus. Moreover, only the correlation between the RCA3-RT FC and re-experiencing in wives without PTSD was significant. Among the three groups, only the RCA3-RT FC in female subjects was markedly different. Additionally, the RCA3-RT FC in wives without PTSD was remarkably lower relative to female patients with PTSD.Conclusion: Wives without PTSD who lost their only child had worse re-experiencing symptoms relative to their husbands, which was associated with the FC alteration between the hippocampal subregions and the thalamus. Importantly, the low level of the RCA3-RT FC may play a potentially protective role against the development of PTSD in wives who have lost their only child. (shrink)

Once described as hermaphrodites and later as intersex people, individuals born with intersex variations are routinely subject to so-called “normalizing” medical interventions, often in childhood. Opposition to such practices has been met by attempts to discredit critics and reasserted clinical authority over the bodies of women and men with “disorders of sex development.” However, claims of clinical consensus have been selectively constructed and applied and lack evidence. Limited transparency and lack of access to justice have helped to perpetuate (...) forced interventions. At the same time, associated with the diffusion of distinct concepts of sex and gender, intersex has been constructed as a third legal sex classification, accompanied by pious hopes and unwarranted expectations of consequences. The existence of intersex has also been instrumentalized for the benefit of other, intersecting, populations. The creation of gender categories associated with intersex bodies has created profound risks: a paradoxically narrowed and normative gender binary, maintenance of medical authority over the bodies of “disordered” females and males, and claims that transgressions of social roles ascribed to a third gender are deceptive. Claims that medicalization saves intersex people from “othering,” or that legal othering saves intersex people from medicalization, are contradictory and empty rhetoric. In practice, intersex bodies remain “normalized” or eliminated by medicine, while society and the law “others” intersex identities. That is, medicine constructs intersex bodies as either female or male, while law and society construct intersex identities as neither female nor male. Australian attempts at reforms to recognize the rights of intersex people have either failed to adequately comprehend the population affected or lacked implementation. An emerging human rights consensus demands an end to social prejudice, stigma, and forced medical interventions, focusing on the right to bodily integrity and principles of self-determination. (shrink)

This article discusses the ethics of the use of preimplantation genetic diagnosis to prevent the birth of children with intersex conditions/disorders of sex development , such as congenital adrenal hyperplasia and androgen insensitivity syndrome . While pediatric surgeries performed on children with ambiguous genitalia have been the topic of intense bioethical controversy, there has been almost no discussion to date of the ethics of the use of PGD to reduce the prevalence of these conditions. I suggest that PGD (...) for those conditions that involve serious medical risks for those born with them is morally permissible and that PGD for other “cosmetic” variations in sexual anatomy is more defensible than might first appear. However, importantly, the arguments that establish the latter claim have radical and disturbing implications for our attitude toward diversity more generally. (shrink)

Wir diskutieren ethische Probleme der medizinischen Behandlung intersexueller Kinder. Gefragt wird nach dem Stellenwert von Elternwünschen nach eindeutiger Geschlechtszuweisung sowie nach den Konfliktfeldern, die zum einen zwischen konkurrierenden Wunschvorstellungen der Eltern und der behandelnden Ärzte, zum andern zwischen Kindeswohl und Kinderrechten entstehen können. Gegenwärtig wird Neugeborenen mit anatomisch uneindeutigem Genital trotz unsicherer Prognose über die Behandlungsergebnisse oft noch ein Geschlecht zugewiesen und operativ erstellt. Dieses Vorgehen ist von verschiedenen Seiten ethisch heftig kritisiert worden. Kipnis u. Diamond forderten 1998 im „Journal (...) of Clinical Ethics“ ein Moratorium für alle nicht vital indizierten geschlechtskorrigierenden Eingriffe. Diese Forderung orientiert sich am Interesse des zukünftigen Erwachsenen, betont dessen prospektive Autonomie und klammert den Elternwunsch aus. Dieses „Modell des antizipierten Konsenses“ kann jedoch mit Bezug auf Neugeborene und Kleinkinder bedeutsame Aspekte des Eltern-Kind-Verhältnisses nicht angemessen erfassen. Im Aufsatz werden Argumente angeführt, die es aus Sicht einer Ethik der Elternschaft rechtfertigen, ethische Entscheidungen auf der Basis eines beziehungsorientierten Modells zu treffen. In unserem Modell fallen Elternwünsche ethisch ins Gewicht. (shrink)

Surgeries inevitably raise questions of bodily integrity: how the post-surgical body reframes (or does not reframe) its experiences of functionality to incorporate new features. Nevertheless, when we try to define or delimit the concept of bodily integrity, it becomes increasingly important to think about how the physical and social unease caused by some forms of surgeries sits alongside the more transformative potential of surgical bodily modification. This article focuses on aesthetic genital surgeries on infants with disorders of sex (...) class='Hi'>development (DSD, previously termed ‘intersex’ conditions). Using the work of Pierre Bourdieu and Elizabeth Freeman on time, bodies and ‘chrononormativity’, this article excavates not only the temporalities that produce what I would term ‘chrono-abnormalities’ of sex development, but also the temporalized medical responses, including surgeries, which retrieve ‘abnormal’ bodies into more normative time-lines. My conclusion is that when DSD-affected individuals experience aesthetic genital surgeries as painful and full of social unease this is not necessarily because the pre-surgical body was the ‘natural’, ‘whole’ or ‘intact’ body prior to surgery. Instead, it is because these surgeries interrupt what Bourdieu would term a sense of corporeal ‘immersion into the forthcoming’; an immersion which, in his theory of time as social action, is intimately linked with social power and possibilities. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in (...) analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

With recent controversies surrounding the eligibility of athletes with disorders of sex development and hyperandrogenism, as well as continued discussion of the conditions transgender athletes must meet to compete in high-performance sport, a wide array of scholars representing a diverse range of disciplines have weighed in on both the appropriateness of classifying athletes into the female and male categories and the best practices of doing so. In response to cases of high-profile athletes’ sex being called into question, the (...) International Olympic Committee, the International Association of Athletics Federations, and the National Collegiate Athletics Association, among others, published or updated policies addressing who is eligible to compete in the women’s sport category and under what conditions. This paper addresses the areas in which philosophical reasoning and ethical analysis can contribute to reopened debates about the surveillance of the women’s category in sport. Emphasis is placed on determining where the onus of responsibility should fall for ensuring the new policies are followed. (shrink)

Opioid use disorder rarely presents as a unitary psychiatric condition, and the comorbid symptoms likely depend upon the diverse risk factors and mechanisms by which OUD can arise. These factors are heterogeneous and include genetic predisposition, exposure to prescription opioids, and environmental risks. Crucially, one key environmental risk factor for OUD is early life adversity. OUD and other substance use disorders are widely considered to derive in part from abnormal reward circuit function, which is likely also implicated in comorbid (...) mental illnesses such as depression, bipolar disorder, and schizophrenia. ELA may disrupt reward circuit development and function in a manner predisposing to these disorders. Here, we describe new findings addressing the effects of ELA on reward circuitry that lead to OUD and comorbid disorders, potentially via shared neural mechanisms. We discuss some of these OUD-related problems in both humans and animals. We also highlight the increasingly apparent, crucial contribution of biological sex in mediating the range of ELA-induced disruptions of reward circuitry which may confer risk for the development of OUD and comorbid neuropsychiatric disorders. (shrink)

As medical professionals, we outline the science underlying disorders or differences of sexual development (DSD), discuss the nuances of sex and gender and how terminology can differ based on medical vs. non-medical context, briefly review the evidence of the ergogenic effects of hyperandrogenism, and discuss the medical complications with the hormonal contraceptive use currently dictated by World Athletics to allow DSD athletes to compete in the female category.

A 35-year-old woman presents to the hospital after a fall at home. A routine medical history and physical examination reveal that the patient identifies as intersex, and an X-ray of the left hip demonstrates profound osteopenia. The patient is admitted to the hospitalist service for further evaluation. What does it mean to identify as intersex? In the medical world, “intersex” is usually referred to as DSD, or “disorders of sex development.” Until the 1990s, physicians referred to this condition (...) as hermaphroditism, but this label is no longer used because it evokes mythical creatures rather than real human beings. Even the DSD label is controversial, and the patient in our case study does not think... (shrink)

Is intersexuality a mere difference or disorder? Since the 2006 Chicago consensus statement's disorder of sexual development (DSD) nomenclature, intersex scholars have criticized and repudiated the use of “disorder” by arguing that it is medically inaccurate, yields unwarranted surgical implications, unnecessarily pathologizes intersex individuals, and that, most importantly, intersex individuals do not prefer it. They argue for linguistic alternatives such as “difference” and other similar alternatives, for example, “variation,” “divergence,” and so forth. These criticisms of “disorder” have had significant (...) uptake by scholars writing on intersexuality. While the motivation(s) for using “mere difference” is doubtless rooted in beneficence for intersex persons, medically inaccurate intersex terminology compromises optimal clinical care and should consequently be either abandoned or revised. This focus paper argues (moderately) for the thesis that some cases of intersex are disorders, and some mere differences. The upshot of my proposal is not only that it conceptually disambiguates disorder and mere difference, but by failing to generalize unique intersex individuals their care is prioritized. (shrink)

BackgroundThe aim of this study is to compare depression and loneliness among adult siblings of people on the autism spectrum, adult siblings of normotypic individuals, and adults raised alone. In recent years, an increasing interest in the perspective of siblings of children diagnosed with autism has been observed, with studies among this population particularly concerned with the developmental trajectories of children and adolescents at “high risk” for ASD, rarely focusing on their mental well-being.MethodsThe respondents filled out: the survey on sociodemographic (...) data designed by the authors, Beck Depression Inventory II, and De Jong Gierveld Loneliness Scale.ResultsA rise in BDI and an increase in the DJGLS score were predicted by having a sibling diagnosed with ASD. Those effects were independent of subjects’ sex, educational status, place of residence, or a number of siblings.ConclusionThe results underline a fundamental need for the development of mental hygiene programs for families where children with autism spectrum are accompanied by healthy siblings. (shrink)

The aim of this article is to analyze the effects of comunication, conflicts, and body language on sexual dysfunctions. As explained in the work of Merleau Ponty, the everyday experience goes through the body and communicates its being in the world through external stimuli, generating emotions and developing affectivity. In this perspective, the sexuality is something more than a set of biological mechanism. Simultaneous, experiencing of conflicting feelings and emotions, such as anger, may affect the body sexual response, such as (...) vaginism and dyspareunia. One of the most important purpose of Sex Therapy is the integration of all the contributing professional and academic disciplines both from the points of view of research and clinical practice. This perspective requires a change in the attitude of the disciplines in recognising the importance of the integrated study of sexuality for the future happines of human beings and the implications for society. (shrink)

We propose that virtue ethics can be used to address ethical issues central to discussions about sex robots. In particular, we argue virtue ethics is well equipped to focus on the implications of sex robots for human moral character. Our evaluation develops in four steps. First, we present virtue ethics as a suitable framework for the evaluation of human–robot relationships. Second, we show the advantages of our virtue ethical account of sex robots by comparing it to current instrumentalist approaches, showing (...) how the former better captures the reciprocal interaction between robots and their users. Third, we examine how a virtue ethical analysis of intimate human–robot relationships could inspire the design of robots that support the cultivation of virtues. We suggest that a sex robot which is equipped with a consent-module could support the cultivation of compassion when used in supervised, therapeutic scenarios. Fourth, we discuss the ethical implications of our analysis for user autonomy and responsibility. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in (...) analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

This study explored spatial navigation alongside several other cognitive abilities that are thought to share common underlying neurocognitive mechanisms (e.g., the capacity for self-projection, scene construction, or mental simulation), and which we hypothesised may be impaired in autism spectrum disorder (ASD). Twenty intellectually high-functioning children with ASD (with a mean age of ~8 years) were compared to 20 sex, age, IQ, and language ability matched typically developing children on a series of tasks to assess spatial navigation, episodic memory, episodic future (...) thinking (also known as episodic foresight or prospection), theory of mind, relational memory, and central coherence. This is the first study to explore these abilities concurrently within the same sample. Spatial navigation was assessed using the “memory island” task, which involves finding objects within a realistic, computer simulated, three-dimensional environment. Episodic memory and episodic future thinking were assessed using a past and future event description task. Theory of mind was assessed using the “animations” task, in which children were asked to describe the interactions between two animated triangles. Relational memory was assessed using a recognition task involving memory for items (line drawings), patterned backgrounds, or combinations of items and backgrounds. Central coherence was assessed by exploring differences in performance across segmented and unsegmented versions of block design. Children with ASD were found to show impairments in spatial navigation, episodic memory, episodic future thinking, and central coherence, but not theory of mind or relational memory. Among children with ASD, spatial navigation was found to be significantly negatively related to number of repetitive behaviours. In other words, children who showed more repetitive behaviours showed poorer spatial navigation. The theoretical and practical implications of the results are discussed. (shrink)

Intersex pediatric surgery is a family of surgical practices performed by pediatric urologists which aim to clarify the sex of an individual with differences/disorders of sexual development, specifically those with ‘intersex’ conditions. It aims to functionally and aesthetically disambiguate an individuals’ binary sex that is obscured by intersex conditions. I ethically reassess intersex pediatric surgery in light of contemporary biotechnology, formal specialization in pediatric urology and long-term data on the efficacy of intersex pediatric surgery, finding that there are (...) only select contexts in which intersex pediatric surgery is morally justifiable. I develop novel, operationalizable and testimonially-informed moral criteria to regulate intersex pediatric surgery, working out the details for how medical professionals in pediatric healthcare facilities are best able to facilitate and augment the decision-making of parents as they decide whether intersex pediatric surgery is in the best interests of their child with intersex conditions. (shrink)

This article explores the relationship between gender, technology, language, and how infants and children born with disorders of sexual development are shaped into intelligible members of the community. The contemporary medical model maintains that children ought to be both socially and surgically assigned and reared as one particular gender. Gender scholar Suzanne Kessler rejects this position and argues for the acceptance of greater genital variability through the use of language. Using a Heideggerian lens, the main question I seek (...) to answer in this article is: does Kessler’s approach succeed in its aim to better treat individuals born with disorders of sexual development? I argue that Kessler is successful in offering practical solutions for persons with intersexed conditions to exist and flourish as intelligible members of the community, but that her project ultimately relies on power to “challenge forth” greater acceptance of genital variance. Building on the work of Kessler and Heidegger, I argue that a better approach to making intelligible the existence of an infant born with a disorder of sexual development is not to rely on the manipulation of language, but to instead reinvigorate a sense of the sacred in response to having an intersex condition. (shrink)

According to the DSM IV, a person with GID is a male or female that feels a strong identification with the opposite sex and experiences considerable stress because of their actual sex (Task Force on DSM-IV and American Psychiatric Association, 2000). The way GID is characterized by health professionals, patients, and lay people belies certain assumptions about gender that are strongly held, yet nevertheless questionable. The phenomena of transsexuality and sex-reassignment surgery puts into stark relief the following question: “What does (...) it mean to be male or female?” But while the answer to that question may be informed by contemplation of GID, we should also be aware that the answer to the question “what does it mean to have GID?” is shaped by our concepts of male and female. First, I consider the concept of transsexuality, and explain how it forces us to clarify our concepts of sex and gender, and leads to the development of what I will call the “standard view.” I then explain GID from a mental-health standpoint, question the concept of gender identity, and try to uncover some fundamental assumptions of the standard view. I argue that these assumptions are at odds with the plausible view that gender supervenes on physical, psychological, and/or social properties. I go on to argue, contra the standard view, that gender has no essence. I suggest an anti-essentialist account of gender according to which “man” and “woman” are cluster concepts. This undermines the dualistic conception of gender that grounds the standard view. An anti-essentialist view of gender cannot make sense of the concept of “gender identity” and hence sees so-called “GID” as primarily conflict between the individual and her society, and only derivatively a conflict between the individual and her body. (shrink)

In 2006, based on the advice of 50 international experts, the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology issued a consensus statement on the nomenclature and management of children who have a phenotype that is neither typical male nor female (Lee et al. 2006). Responding to a decade of criticism over the terminology that had been in place, including such terms as intersex, hermaphrodite, or pseudohermaphrodite, they proposed to call those conditions in which the patient (...) does not have the typical male or female gonads, chromosomes, or anatomy "disorders of sexual development."While this proposed change in nomenclature is helpful, in order to truly effect a .. (shrink)

An autobiographical reflection on the experience of being diagnosed as intersex, this essay considers the waiting room an apt metaphor for lives shaped by medical understandings of queer corporealities. Drawing upon the work of Gayle Salamon, Malatino develops the concept of sexual synecdoche as a useful analytic tool for considering the operations of medical pathologization in the realm of non-normative gender. She concludes with a discussion of queer becoming as an alternative ontology of gendered being that offers a resistant, coalitional (...) way beyond contemporary, problematic institutionalized understandings of intersex subjectivities. (shrink)

This article argues for a ban on the performance of medically unnecessary genital normalizing surgeries as part of assigning a binary sex/gender to infants with intersex conditions on the basis of autonomy, regardless of etiology. It does this via a dis/analogy with the classic case in bioethics of Jehovah Witness (JW) parents' inability to refuse life-saving blood transfusions for their minor children. Both cases address ethical medical practice in situations where parents are making irreversible medical decisions on the basis of (...) values strongly held, identity, and relationship-shaping values—such as religious beliefs or beliefs regarding the inherent value of binary sex/gender—amidst ethical pluralism. Furthermore, it takes seriously—as we must in the intersex case—that the restriction of parents' right to choose will likely result in serious harms to potentially large percentage of patients, their families, and their larger communities. I address the objection that parents' capacity to choose is restricted in the JW case on the basis of the harm principle or a duty to nonmaleficence, given that the result of parent choice would be death. I provide evidence that this is mistaken from how we treat epistemic uncertainty in the JW case and from cases in which clinicians are ethically obligated to restrict the autonomy of nonminor patients. I conclude that we restrict the parents' right to choose in the JW case—and should in the case of pediatric intersex surgery—to secure patient's future autonomy. (shrink)

There exist a variety of biological variations known as intersex conditions or disorders of sex development, which cause a per­son’s sex as male or female to be uncertain at birth. In the past several decades, cosmetic surgery aimed at “normalizing” the infant’s body has become an increasingly controversial treatment for an infant with an IC or DSD. While ICs and DSDs are not addressed directly by Catholic moral teaching, the Catholic Tradition has a number of tools that can (...) undergird a Catholic response to the suffering of people with ICs and DSDs and support improved medical, pastoral, and spiritual care for them and their families. (shrink)

Males are selectively afflicted with the neurodevelopmental and psychiatric disorders of childhood, a broad and virtually ubiquitous phenomenon that has not received proper attention in the biological study of sex differences. The previous literature has alluded to psychosocial differences, genetic factors and elements pertaining to male “complexity” and relative immaturity, but these are not deemed an adequate explanation for selective male affliction. The structure of sex differences in neurodevelopmental disorders is hypothesized to contain these elements: Males are more (...) frequently afflicted, females more severely; disorders arising in females are largely mediated by the genotype; in males, by a genotype by environment interaction; complications of pregnancy and delivery occur more frequently with male births; such complications are decisive and influence subsequent development. We hypothesize that there is something about the male fetus that evokes an inhospitable uterine environment. This “evocative principle” is hypothesized to relate to the relative antigenicity of the male fetus, which may induce a state of maternal immunoreactivity, leading either directly or indirectly to fetal damage. The immunoreactive theory thus constructed is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders. Although the theory is necessarily speculative, it is heuristic and hypotheses derived from it are proposed; some are confirmed in the existing literature and by the authors' research. (shrink)

As Archer argues, recent developmental data on human physical aggression support the sexual selection hypothesis. However, sex differences are largely due to males on a chronic trajectory of aggression. Maternal characteristics of these males suggest that, in societies with low levels of physical violence, females with a history of behavior problems largely contribute to maintenance of physical aggression sex differences.

Youth is a critical period in the development of maladaptive eating behaviors. Previous systematic reviews suggest the etiological significance of parent-child relationships for the onset of disordered eating in youth, but less is known about the role of parenting styles. This rapid scoping review aimed to identify whether research supports the role of parenting styles in the development of disordered eating symptoms among youths. Sixteen studies, retrieved from three databases, met the inclusion criteria: original studies, published in English, (...) examined the effect of parenting styles on cognitive and behavioral disordered eating outcomes, among young people up to 18 years of age. Studies supported an association between various youth disordered eating symptoms such as unhealthy weight control behaviors, and experiences of adverse parenting styles characterized by high levels of control and low levels of responsiveness. Associations between adverse parenting styles and youth disordered eating were frequently indirect and differed depending on the sex of the parent and offspring. Synthesis of findings was limited due to variation in the operationalization and measurement of parenting styles, family context and disordered eating across studies. Longitudinal and standardized research is required to better understand the dynamic associations between parenting styles and youth disordered eating. Implications for family-based care in clinical practice are discussed. (shrink)

Drawing on the writings of Michel Foucault, this paper argues that the establishment of a new nomenclature and treatment model for intersexed individuals expands both the number of disciplines and the number of physical elements recognized as involved in (im)proper sex development and further, that the temporalization of these elements works to establish sex development as a discipline . Sex development thus emerges as a field of power/knowledge that allows for the distribution of not just individuals with (...) intersex conditions, but of all individuals, in relation to a norm. Further, while many see this model of treatment as finally acknowledging the calls of intersex activists for patient involvement in decision making, for the delaying of unnecessary surgical and hormonal treatment, and for urging honesty among physicians, patients and parents, this article argues that for some these may be hollow victories, requiring that both the patient and his or her family be disciplined into the right attitudes, behaviours and responses to treatment—and that they themselves discipline others accordingly—in order to enjoy these gains. (shrink)

Argues that affirming the irreducible differences between men and women can lead to more transformative politics than the struggle for abstract equality between the sexes. In The Symbolic Order of the Mother Luisa Muraro identifies the bond between mother and child as ontologically fundamental to the development of culture and politics, and therefore as key to achieving truly emancipatory political change. Both corporeal development and language acquisition, which are the sources of all thinking, begin in this relationship. However, (...) Western civilization has been defined by men, and Muraro recalls the admiration and envy she felt for the great philosophers as she strove to become one herself, as well as the desire for independence that opposed her to her mother. This conflict between philosophy and culture on the one hand and the relationship with the mother on the other constitutes the root of patriarchy’s symbolic disorder, which blocks women’s (and men’s) access to genuine freedom. Muraro appeals to the feminist practice of gratitude to the mother and the recognition of her authority as a model of unconditional nurture and support that must be restored. This, she argues, is the symbolic order of the mother that must overcome the disorder of patriarchy. The mediating power of the mother tongue constitutes a symbolic order that comes before all others, for both women and men. Luisa Muraro is Professor Emeritus of Philosophy at the University of Verona, Italy. Francesca Novello is an instructor at the University of Oklahoma. Timothy S. Murphy is Houston-Truax-Wentz Professor and Regents Professor of English at Oklahoma State University. (shrink)

The current view that behaviour which is manifest in non-human primates forms a baseline for human behaviours is examined with special reference to the development of gender determination. A review of 21 non-human primate societies suggests that the behaviour of the sexes relates to assumption and occupation of societal roles defined by the local group. The significance of these findings for the human condition is discussed.