Along with the ethical issues regarding cosmetic surgery, the ones, concerning sex reassignment, remain of high controversy for medical science, psychology, philosophy and religion. While sometimes gender reassignment can be viewed as a caprice of a person, in vast majority of cases the willingness to undergo gender reassignment surgery is a consequence of gender identity disorder.
According to M.Hume (2011), gender identity disorder can be considered both as a physical and psychiatric disorder. For those specialists, who consider gender identity disorder purely mental health issue, question whether surgery can be viewed as morally appropriate solution to the incongruity between a body and mind of a person (p.3). The people, who believe that transsexualism is a physical issue, view the gender reassignment surgery as medically appropriate treatment. They think that it can both solve physiological issues one experiences and provide a source of inner peace for people, who feel that their biological gender is not compatible with their inner gender. Different points of view regarding moral permissibility of gender reassignment surgery exist in society. Let us examine the arguments of the adherents of moral permissibility of gender reassignment surgery and the possible answer of their opponents.
The first idea that allows justifying the gender reassignment surgery is concerned with the principle of patient’s autonomy that lies in the fact that each rational person is free and is capable of making proactive decisions regarding him/her and his/her own health. According to this idea, competent adults, who feel themselves being transsexual, need to have the right to self-determination. Competence is a keyword that determines, whether a person can get an access to the procedure of gender reassignment.
Secondly, there are cases, in which a person requires surgical gender reassignment, if initially doctors faced issues, when assigning gender to an individual and made a mistake. Modern ethics of gender assignment to children with intersex conditions is based on the assumption that sex assignment is never emergent and urgent, and the children are supposed to know their gender identity (Intersex Society of North America 1). As opposed to a present situation, in the past issues appeared, when doctors failed to assign a proper sex to person, and in the adolescence the person he/she started to experience the conflict between his/her body and gender identity.
The peculiarity of sex reassignment surgery lies in the fact that surgeons create new genitalia for their patients that do not provide patients with the opportunity to conceive a baby. Taking into account this peculiarity, many opponents of gender reassignment surgery claim that it is no need to undergo surgery in such case. However, as patients get the image of their body that matches their inner gender identity, as well as the chance to have sex with the person of the opposite gender and even experience sexual sensation, it may be stated that gender reassignment surgery can have an important meaning for a person’s wellbeing.
Last, but not least to mention is that sex reassignment surgery can help patients combat with many negative consequences of gender identity disorder. Among them one scholars most often mention negative body image, high rates of mental health issues prevalence, as well as drug addiction ( Fitzgibbons, Sutton, O’Leary, 2009, p.117). Furthermore, transgender people often experience domestic violence that can be manifested in the form of using offensive pronouns, ridiculing the body of a transgender partner, as well as denying access to medical treatment and hormones (National Coalition against Domestic Violence, n.d., p.2).
The opponents of surgical gender reassignment tend to substantiate their point with several arguments. Firstly, they claim that this is morally unacceptable for a physician to remove healthy functioning parts of a person’s body under any circumstances. This argument can be supported by the the one of the central principles of doctors’ ethics, formulated by Hippocrates -“First, do not harm”.
Secondly, opponents of sex reassignment surgery often view surgery as the type of intervention that is aimed at dealing with physical states. As transsexuality is most often viewed as a psychiatric disorder, it is claimed that patients do not need surgery to improve their condition. However, this argument does not seem to be well-substantiated in the light of world-known definition of health as a notion that encompasses not only physical, but mental and social elements.
Finally, one may claim that it is not professional for a physician to base a decision regarding surgery on patient’s own opinion regarding the means that can help him/her feel better. For instance, from the point of view of physical health, one can look like a man with no intersex conditions, capable of having normal sexual relationships and children. However, he may seek undergoing gender reassignment procedure, claiming that he feels like a woman and would like to have a female body. Is it possible for a physician to let a person undergo serious surgical intervention, basing solely on the words of a patient? Everything depends on a doctor’s approach to building doctor-patient relationships and the degree to which the doctor is capable of respecting the autonomy of the patient.
As many specialists look forward to separating mental health and overall wellbeing of a person from his/her health, it has been already been scientifically proven that there is an inseparable link between the mind and the body of a person. Only a combination of a healthy body and healthy mind combines a healthy person. So, medicine (including surgery) and psychiatry need to cooperate in order to help adult patients, who suffer from the disharmony of their body and mind, using the means, available to both physicians and psychiatrists. However, the decision regarding the conduct of the surgery needs to be made with an account to several conditions. Firstly, it is necessary to get aware about the existence of disequilibrium between the person’s body and gender identity. Secondly, a physician needs to be convinced of the fact that the choice to undergo surgery is fully autonomous. Finally, the decision of the patient needs to be based on his/her informed consent. Under these circumstances, it is possible to support the decision of a person to undergo the operation. For both physicians and psychiatrists, who work with patients, suffering from gender identity disorder, it is important to get the insight into the patient’s understanding of his/her issue. On this basis the specialist can decide whether there are means that can help the patient, so that he/she refuses from the idea of gender reassignment. However, undergoing a gender reassignment is a free choice of a patient, and a patient is expected to have an inner feeling of his real gender identity.
Works cited
Fitzgibbons, R.P., Sutton, P.M., O’Leary, D. The psychopathology of “sex reassignment” surgery. The National Catholic Bioethics Quarterly (Spring 2009): 97-127.Web.
Hume. M.A. sex, lies and surgery: the ethics of gender reassignment surgery. Res Cogitans, 2(1). (2011): 37-48. Web.
In the article the author claims that for competent adult patients, who suffer from long-term gender identity disorder gender reassignment surgery is a morally permissible solution. The article is useful for research as it provides answers to most common arguments against gender reassignment surgery
Intersex Society of North America. Ethics of gender assignment, 2014. Web.5 March 2014
The information, provided by the Society, concerns the way physicians assign gender to the people with cross-gender conditions. As sex reassignment follows its assignment, it is important to understand the whole process.
National Coalition Against Domestic Violence. Domestic violence and lesbian, gay, bisexual and transgender relationships, 2014. Web. 5 March 2014
The source provides the insight into the peculiarities of domestic violence issue in lesbian, gay, bisexual and transgender relationships. It helps to get aware about the possible impact of domestic violence experience on a person’s decision to undergo gender reassignment surgery.
