Gender Reassignment Surgery

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Gender Reassignment Surgery

• Carol Bayley, PhD
• April 8, 2009
• Ethics Champions

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Overview

• Background
• Distinctions
• Two ways to view gender dysphoria
• Ethical issues
• Further thinking

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Background Assumptions

• Sex has three meanings
• Genetic (XY, XX, XXY, etc.)
• Phenopytic (what you look like physically)
• Social (how you are raised, how you present)
• Gender has one (main) meaning the social or
  behavior aspects of sexual identity.
• There is no 11 relationship between sex and
  gender

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Background Assumptions

• Sexual dimorphism is part of the mental landscape
  in our culture.
• First question when baby is born
• treatment of intersex babies
• As species go, we are not too dimorphic
  variations within the sexes are greater than the
  variations between them.

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Background Assumptions

• There is a lot we dont know about sexual and
  gender development
• How genotype is translated into phenotype
• What hormone surges (in utero and at puberty) do
  what can go wrong
• How people feel like women or men apart from
  social conditioning

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Distinctions

• Heterosexual
• Homosexual
• Bisexual
• Transvestite
• Transsexual
• Transgender

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Distinctions

• Heterosexual, homosexual, and bisexual describe
  sexual attraction, grounded in biology but
  affected by culture.
• Medically speaking, these are not disorders.
• Attraction is fluid and changing most people
  think attraction is established before birth.
• DSM-III (1974)
• Transvestite describes people who wear clothes of
  the other gender. Motives differ.

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(Catholic Teaching

• Sexual function has two purposes
• Fun (aka union)
• Babies (aka procreation)
• Double effect
• Good or morally neutral act
• One effect intended, one foreseen
• Bad effect is not a means to the good)

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Transsexual/Transgender

• terms refer to the same thing
• gender dysphoria (DSM-IV)
• Transgendered persons can self-identify as gay or
  straight.
• Some transgendered persons get married some
  engage in homosexual relationships with members
  of their new sex.

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Gender Dysphoria one view

• Objectively disordered
• Psychiatric in nature
• You dont do surgery for psychiatric symptoms
  (unless you do see Elliot)
• Gender reassignment surgery mutilates and results
  in sterilization, therefore it is wrong.

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Gender Dysphoria other view

• Biological in nature hormone surge in utero
  contributes to sexualization of fetus. Disruption
  can cause GD.
• Male and female brains differ in some respects,
  m-gtf brains look like female brains and f-gtm
  brains look like male brains.

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GD other view

• If GD is biological, then surgical correction is
  appropriate.
• Other surgical corrections
• Strabismus
• Cochlear implant
• Aortic repair
• Lasix surgery septoplasty
• Mutilation and sterilization are side effects.
  (see Double Effect)

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Surgery is last step in transition

• Transition includes
• Psychological counseling
• Living as the other
• Hormone treatments to affect secondary sex
  characteristics (hair growth, breast size, voice)
• Plastic surgery to fashion new genital and
  urethral equipment mastectomy for f-gtm breast
  augmentation for m-gtf.
• cause of action in Seton lawsuit

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Some transitions are finished without surgery

• Expense
• Mutilation
• Irreversibility

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Ethical Issues

• Should surgeons be allowed to perform gender
  reassignment surgery?
• How do we take care of patients after surgery?
• How do we take care of transgendered persons in
  the hospital for other reasons?

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Allowing surgery for GRS

• Patient must be part of program
• Program must be rigorous
• Surgeon must have experience double boarded in
  some cases (e.g., urology and plastic surgery)
• Treat these patients fairly

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Ethical Issues

• Respect for transgendered persons means
• Using the form of address and pronoun he or she
  chooses. How the person presents is the persons
  social identity and should be honored.
• Protecting privacy, especially with regard to
  roommate if there is one.
• Private rooms are nice but not always possible.
• No one taking care of the patient should be
  surprised confidence must be held carefully.

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Stoke your imagination

• Stories of Native Americans
• Middlesex by Jeffrey Eugenides
• Oscar-nominated film Transamerica
• Carl Elliot, A New Way to Be Mad. Atlantic
  Monthly, Dec 2000.
• Call Me Malcolm (UCC Office of LGBT Concerns in
  Cleveland has copies)