Re: Sex Change

Sarah Marr (
Fri, 18 Jul 1997 10:39:48 +0100

I thought I'd wait a little while until the expected replies to my post had
drop on to the list before replying to them all at once.

Daniel Lee Crocker:

>If a person is mentally competent to engage in ordinary contracts, can
>hold a job, make decisions such concerning sexual relations, other
>medical procedures, and other important aspects of life, then any law
>or professional "standard" that interferes with that individual's
>decision is repugnant to individual sovereignty.

Your conditional clause mimics closely two caveats of my own, in my post:
"given ...the fact that many people asking for it [surgery] have other
psychological problems" and "many such people are not in a suitable mental
state to take such a decision". The medical role here is not to decide
whether or not an individual can take the decision to have surgery, but to
decide whether or not that individual is competent to take such a decision
in an informed, rational and considered way. So your argument in the above
paragraph does not differ from mine, except in one respect. Whilst you
simply introduce an introductory condition clause relating to the abilities
of the individual, I introduce the members of the medical profession as the
people best equipped to decide the applicability of that clause to an
individual. Would you allow the individual to decide mental competency? In
which case (a) you'd probably not get very many people deciding they were
not competent and (b) would you expect any doctor/surgeon simply to ask the
question, "Are you mentally OK?" and believe any answer they received
irrespective of any contraindications?

>Medicine is just a product
>like any other, and the doctor provides that product at my request and
>for my payment.

Except of course when your are in ER, comatose and bleeding to death, when
the product (service) is not at your explicit request. Or in a system such
as the UK has (although one could argue the same to a degree with an
insurance scheme) where it isn't your payment. That is, "Medicine is a
product like any other, except that I might not say I want it and other
people might pay for it."

>Well if I want
>green tile in my kitchen, I'm not going to listen to some builder
>telling me I'm not capable of that decision. Why should I tolerate
>the same arrogance from a doctor or lawyer?

That argument ad absurdum is not a very apposite analogy. Suppose you
wanted to knock a door through a wall. You talk to a builder, who knows
about such things in far more depth than do you, and she tells you that it
would be wise to take the time to do a full survey of the house to find out
if the door would cause it to collapse or not; she herself, being able to
analyse the survey in ways you cannot, would interpret the results of the
survey to let you know the answer. But no! you can take this decision
yourself; you don't need her to take it for you; so you tell her to get on
with it, and your house falls down.

Besides, even mine is not a good analogy. Because in the subject about
which we are talking you are in effect asking people to assess their own
mental state. Is that viable? Or would you argue that, viable or not,
people should be allowed to take their own decisions; an argument which
effectively removes the conditional clause from your first paragraph.

Another thing worth noting is part of my orginal posting which you elided:
"Perhaps this [the role of the medical profession] [is] a moral issue which
will have to be faced in an individual basis for each possible modification
as the technology we so-often discuss becomes available..."

Nanotech would probably make all of this reversible, and one would then be
in a position where an individual could try out the physical change and
then reverse it if depression, suicidal-tendencies, psychosis, or whatever
started to make themselves apparent. (Still, one could ask, could the
individual spot those things in himself, or would he require monitoring
over a 'test' period?)

Kathryn Aegis:

>My one small addition is that the temporary or permanent nature of a
>biological change should not be read as an indication of the seriousness
>of that decision for the person involved.

My orginal post, of course, used the phrase "severity and irreversibility"
in recognition of this.

Although, the temporary or permanent nature of the change is a factor in
the seriousness of the decision. An obvious example is the difference
between, "Want to know what it is like to be dead?", and "Want to know what
it is like to be dead for a minute and then revived using this new, tried
and tested technology?" I can imagine the answers being different for some
people. There must be many more, everyday examples of the irreversability
of a decision changing its seriousness. One that springs to mind is, "I'm
don't think I'm happy in this relationship but if I leave her to find out
whether or not I'm then happier I know I'll never get her back." The
irreversability of the decision to leave effects its seriousness.

But, whatever, "severity and irreversability" was my original phrase.

>The very notion of choice,
>of making an active decision about one's own biology or sex role,
>challenges the base power structures of human society.

Indeed. As well as challenging its base morality, ethics, socio-economic

>Taking on those
>encoded norms by refusing to stay in one gender, however it is done--
>through semipermanent hormones, permanent surgery, or temporary
>cosmetic alteration--carries the same societal consequences for the

But not the same psychological consequences; nor, for each individuals,
will those societal or psychological consequences be the same. In fact, on
reflection, the three types of modification you mention do not even carry
the same societal consequences, since within societal interaction one has
to include intimate contact.

Further, you don't say what those societal consequences might be:
ostracization, loss of employment, public ridicule, etc. And these things
can have deep psychological effects: depression, suicidal tendencies, etc.
At the end of the day a major function of gender expression must be
internal happiness: if that is outweighed by the unhappiness caused by
society it seems reasonable that some people will choose to limit their
times and modes of non-'standard' gender expression to reach their optimal
state of happiness. Fine: unless the first time they realize their
depression, realize they are now more unhappy and wish to modify their
gender expression, is after they've had an instant, irreversible operation.

>The medical profession carries a vested interest in
>preserving the binary sex system and, therefore, in its role as
>gatekeeper will try to weed out those who would practice some

Well, in the case of the female to male change, doctors are quite prepared
to condone bi-lateral mastectomies and hormonal changes, without requiring
phalloplasty. Equally, breast implants are available to individuals who do
not intend to have vaginoplasty, etc.

Do you have a specific example in mind?

There seems to be the view that the medical profession are 'the enemy' in
this case. Why so? Doctors don't seem to be the enemy when it comes to
things like removing tumours, clearing up infections, setting broken limbs.
Yet, in all these cases there is an element of observation on the part of
the doctor: the biopsy, the swab and culture, the x-ray. Is it not possible
that the psychiatrists, psychologists, doctors and surgeons involved in the
sex change process are there to help; to clarify intentions, point out
potential problems, act as shoulder to cry on, ensure hormones aren't
causing endocrinological damage, etc.


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