Ethics and Children with Differences in Sex Development and Gender Nonconformity

Society once considered children born with atypical genital anatomy to be freaks of nature. Until recently, doctors labeled these children “hermaphrodites” and urged early appearance-altering surgery. While times have changed, somewhat, medical interventions continue despite mounting evidence of long-term harms associated with both medical and surgical “treatment.” In the last few years, family, public, and medical attention has increasingly focused on children who feel trapped in the body of the “opposite” sex and wish to live as the other gender. Controversy continues about how often these feelings persist into adulthood and when to use medical interventions, such as hormone blocking to prevent full pubertal development, to support the gender nonconformity. When should society constrain clinicians from intervening in these contentious arenas?
Joel E. Frader, MD, MA, is a Professor of Pediatrics and Professor of Bioethics and Medical Humanities at Northwestern University, and Medical Director of Bridges Pediatric Palliative Care Program at Lurie Children’s Hospital of Chicago.
Recorded September 28, 2016