New papers by Morgan Carpenter on health and human rights

We are pleased to share current and recent peer-reviewed journal articles by co-executive director Morgan Carpenter, on intersex health and human rights, and an associated book chapter.

The ‘normalization’ of intersex bodies and ‘othering’ of intersex identities

In an open access peer-reviewed journal article and a book chapter, Morgan describes contradictions where medicine construct intersex bodies as either female or male while law and society increasingly construct intersex identities as neither female nor male. The papers also present some historical material, and recent developments within the human rights system:

Once described as hermaphrodites and later as intersex people, individuals born with intersex variations are routinely subject to so-called “normalizing” medical interventions, often in childhood. Opposition to such practices has been met by attempts to discredit critics and reasserted clinical authority over the bodies of women and men with “disorders of sex development.” However, claims of clinical consensus have been selectively constructed and applied and lack evidence. Limited transparency and lack of access to justice have helped to perpetuate forced interventions. At the same time, associated with the diffusion of distinct concepts of sex and gender, intersex has been constructed as a third legal sex classification, accompanied by pious hopes and unwarranted expectations of consequences. The existence of intersex has also been instrumentalized for the benefit of other, intersecting, populations. The creation of gender categories associated with intersex bodies has created profound risks: a paradoxically narrowed and normative gender binary, maintenance of medical authority over the bodies of “disordered” females and males, and claims that transgressions of social roles ascribed to a third gender are deceptive. Claims that medicalization saves intersex people from “othering,” or that legal othering saves intersex people from medicalization, are contradictory and empty rhetoric. In practice, intersex bodies remain “normalized” or eliminated by medicine, while society and the law “other” intersex identities. That is, medicine constructs intersex bodies as either female or male, while law and society construct intersex identities as neither female nor male. Australian attempts at reforms to recognize the rights of intersex people have either failed to adequately comprehend the population affected or lacked implementation. An emerging human rights consensus demands an end to social prejudice, stigma, and forced medical interventions, focusing on the right to bodily integrity and principles of self-determination.

The Legal Status of Intersex Persons - cover

Morgan Carpenter. 2018 The ‘normalization’ of intersex bodies and ‘othering’ of intersex identities in Australia. Journal of Bioethical Inquiry, 15(4). Open access.

Morgan Carpenter. 2018. ‘The ‘normalisation’ of intersex bodies and ‘othering’ of intersex identities’. In Jens Sherpe, Anatol Dutta, and Tobias Helms (editors). The legal status of intersex persons. Cambridge, UK: Intersentia.

The book chapter presents additional detail, including some statistical information on clinical practices based on data from the Department of Health and the Australian Institute of Health and Welfare.

Morgan says about the book:

The book “The Legal Status of Intersex Persons” launches today, edited by Jens Scherpe and others. My chapter is on “The ‘normalisation’ of intersex bodies and ‘othering’ of intersex identities”. It’s a version of my Master of Bioethics thesis. I’m very grateful to the editors and publisher for printing it.

Based on the chapters I’ve read, the collection is very mixed: authors present a variety of clinical, legal, theological and human rights analyses. Many authors are from countries that don’t have different words for sex and gender, but those differences are less important to me than, say, a difference between sex characteristics and sex classifications. Many authors focus on legal status as a matter of legal gender recognition, ahead of recognition of a right to bodily integrity or freedom from discrimination – and it’s impossible to consider the legal gender recognition of intersex people in isolation without, at the same time, considering both our diversity and the rights of others. I’m glad that the editors have ensured the book contains a diverse range of perspectives.

The book is available online from the publisher, or via usual retail outlets.

Intersex variations, human rights, and the International Classification of Diseases

The above papers provide some analysis of recent cases before the Family Court of Australia. One recent Family Court case is analysed from a slightly different perspective in a new paper for Harvard’s Health and Human Rights Journal. This open access paper highlights how international clinical classifications facilitate or specify practices that violate the human rights of intersex people:

The ICD-11 introduces additional and pathologizing normative language to describe [intersex variations] as “disorders of sex development.” Current materials in the ICD-11 Foundation also specify, or are associated with, unnecessary medical procedures that fail to meet human rights norms documented by the WHO itself and Treaty Monitoring Bodies. This includes codes that require genitoplasties and gonadectomies associated with gender assignment, where either masculinizing or feminizing surgery is specified depending upon technical and heteronormative expectations for surgical outcomes. Such interventions lack evidence. Human rights defenders and institutions regard these interventions as harmful practices and violations of rights to bodily integrity, non-discrimination, equality before the law, privacy, and freedom from torture, ill-treatment, and experimentation. WHO should modify ICD-11 codes by introducing neutral terminology and by ensuring that all relevant codes do not specify practices that violate human rights.

Morgan Carpenter. 2018. Intersex variations, human rights, and the International Classification of Diseases. Health and Human Rights Journal, 20(2). Open access.

Each of these papers highlights concerns with evidence for claims of changes to clinical practices, and a lack of accountability and transparency.

‘Impossible “choices”: The inherent harms of regulating women’s testosterone in sport’

In a new joint paper in the Journal of Bioethical Inquiry, Katrina Karkazis and Morgan Carpenter detail the choices and harms involved in unnecessary regulations affecting the participation of some women with intersex variations in elite sport.

In April 2018, the International Association of Athletics Federations (IAAF) released new regulations placing a ceiling on women athletes’ natural testosterone levels to “ensure fair and meaningful competition.” The regulations revise previous ones with the same intent. They require women with higher natural levels of testosterone and androgen sensitivity who compete in a set of “restricted” events to lower their testosterone levels to below a designated threshold. If they do not lower their testosterone, women may compete in the male category, in an intersex category, at the national level, or in unrestricted events. Women may also challenge the regulation, whether or not they have lowered their testosterone, or quit sport. Irrespective of IAAF’s stated aims, the options forced by the new regulations are impossible choices. They violate dignity, threaten privacy, and mete out both suspicion and judgement on the sex and gender identity of the athletes regulated.

Katrina Karkazis and Morgan Carpenter. 2018. ‘Impossible “choices”: The inherent harms of regulating women’s testosterone in sport’. Journal of Bioethical Inquiry, 15(4).

The new IAAF regulations unwisely and inappropriately implicate all intersex people through their use of “DSD” terminology and reference to new sex classifications.

Acknowledgements

These publications were produced in connection with Morgan’s studies at Sydney Health Ethics, Faculty of Medicine and Health, University of Sydney, and his roles with IHRA and GATE.