IHRA welcomes publication of these statements. Crucially for us, the Position Statement quotes Principle 32 of the Yogyakarta Principles plus 10, on the right to bodily and medical integrity and calls on medical practitioners to affirm it:
Doctors have an ethical and professional duty to provide evidence-based care impartially and without discrimination, including on the basis of gender identity and expression, sexual orientation, and sex characteristics; […]
Calls on medical practitioners to […] Affirm Yogyakarta Principle 32 that “no-one should be subjected to invasive or irreversible medical procedures that modify sex characteristics without their free, prior and informed consent, unless necessary to avoid serious, urgent and irreparable harm to the concerned person”
It follows a statement approved in September 2021 by the Public Health Association of Australia, calling for an end to human rights abuses affecting people of diverse sex characteristics in medical settings.
The Yogyakarta Principles plus 10 were also cited in a recent Australian Human Rights Commission report on an inquiry on protecting the human rights of people born with variations of sex characteristics in the context of medical interventions.
Unfortunately, a minority of doctors are AMA members, and the Commission’s report makes it clear that adherence to guidelines and any other non-mandatory standards is unlikely. The Commission also found that clinicians in areas other than psychiatry and psychology justified surgical decisions using psychosocial and mental health rationales that are rejected by institutions of psychiatrists and psychologists (page 81). The Commission states (page 131):
there is a real risk that medical interventions, other than on grounds of medical necessity, may be undertaken in the future. This position is informed by the views of a range of clinicians that psychosocial factors are justifiable considerations for medical interventions, with such justifications given weight in leading international guidance documents. Therefore, overall cultural change would be unlikely in the absence of binding directions […]
more formal regulation is necessary to prevent medical interventions that infringe human rights. […]
These medical interventions do cause some people devastating and lifelong harm – and are in conflict with the principle of bodily integrity.
Morgan Carpenter, executive director of Intersex Human Rights Australia, is a signatory of the Yogyakarta Principles plus 10 and was a member of the drafting committee. He is also a member of the Public Health Association of Australia and was an expert reference group member for the Australian Human Rights Commission’s inquiry. He comments:
We warmly welcome this Position Statement by the AMA, as one of Australia’s leading institutions of medical practitioners, as we also do the recent statement by the Public Health Association of Australia. It is so important that clinical organisations take steps to recognise concerns about the treatment of people with innate variations of sex characteristics and affirm everyone’s rights to autonomy and bodily integrity.
Despite these important statements, there is sadly no universal acceptance of fundamental human rights norms in medicine. Many clinicians, including those in key areas of medicine involved in the treatment of people with innate variations of sex characteristics, still adhere to practices that violate human rights.
The Australian Human Rights Commission report identifies key problems with historical and current clinical practice, including lack of evidence, a reliance on psychosocial rationales that are better addressed by peer support and other forms of support, and a lack of attention to concerns raised by psychological and psychiatric professionals. The Commission recognises that criminal penalties and oversight are necessary to protect the human rights of children with variations of sex characteristics in medical settings, and it calls for more action on redress and resourcing. The ACT and Victoria have made public commitments to legislative reform. We call on clinical organisations to support new laws that recognise our right to decide what happens to our own bodies.
Australian Medical Association. 2021. ‘Position Statement on LGBTQIA+ Health – 2021’. https://www.ama.com.au/articles/lgbtqia-health-2021.
Public Health Association of Australia. 2021. ‘The Health of People with Diverse Genders, Sexualities, and Sex Characteristics Policy Position Statement’. https://www.phaa.net.au/documents/item/5352.
Australian Human Rights Commission. 2021. Ensuring Health and Bodily Integrity: Towards a Human Rights Approach for People Born with Variations in Sex Characteristics. Sydney, Australia: Australian Human Rights Commission. https://humanrights.gov.au/intersex-report-2021.
Yogyakarta Principles. 2017. The Yogyakarta Principles Plus 10: Additional Principles and State Obligations on the Application of International Human Rights Law in Relation to Sexual Orientation, Gender Identity, Gender Expression and Sex Characteristics, to Complement the Yogyakarta Principles. http://www.yogyakartaprinciples.org/principles-en/yp10/.