title: Intersex(es) and informed consent: how physicians' rhetoric constrains choice.
abstract: When a child is born with ambiguous genitalia it is declared a psychosocial emergency, and the policy first proposed by John Money (Johns Hopkins University) and adapted by the American Academy of Pediatrics (and more broadly accepted in Canada, the U.K., and Europe) requires determination of underlying condition(s), selection of gender, surgical intervention, and a commitment by all parties to accept the "real sex" of the patient, all no later than 18-24 months, preferably earlier. Ethicists have recently questioned this protocol on several grounds: lack of medical necessity, violation of informed consent, uncertainty of standards of success, among others. This suggests that the faults in the protocol can be addressed and improved. Through a rhetorical approach informed by Perelman/Olbrechts-Tyteca, the disciplinary pathologization and reconstruction of the body are explored as incidents of constraining rhetoric that enact their persuasion upon the body of intersexed children. This essay shows that the presumptions, judgments, values, and presuppositions brought by the physician to the identification, diagnosis, and curative procedures create a network of constraints that exclude alternative possibilities. The result is a situation wherein parents, physicians, and intersexed patients have "no choice" but to accept the medical treatment guidelines.
authors.affiliation: Interfakultäres Zentrum für Ethik in den Wissenschaften, Tübingen, Germany. David@ars.rhetorica.net
authors.forename: J David
authors.initials: JD
authors.lastname: Hester
mesh_terms: D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003142:Communication; D003657:Decision Making / Q000941:ethics; D012734:Disorders of Sex Development / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007258:Informed Consent / Q000941:ethics*; D010372:Pediatrics / Q000941:ethics* / Q000592:standards; D010565:Persuasive Communication; D010817:Physician-Patient Relations