DOCSLIB.ORG

A Principled Ethical Approach to Intersex Paediatric Surgeries Kevin G

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Principled Ethical Approach to Intersex Paediatric Surgeries Kevin G Behrens BMC Med Ethics (2020) 21:108 https://doi.org/10.1186/s12910-020-00550-x DEBATE Open Access A principled ethical approach to intersex paediatric surgeries Kevin G. Behrens* Abstract Background: Surgery for intersex infants should be delayed until individuals are able to decide for themselves, except where it is a medical necessity. In an ideal world, this single principle would sufce and such surgeries could be totally prohibited. Unfortunately, the world is not perfect, and, in some places, intersex neonates are at risk of being abandoned, mutilated or even killed. As long as intersex persons are at such high risk in some places, any ethical guidelines for intersex surgeries will need to take these extreme risks of harm into account. Main text: I therefore argue for fve basic principles that ought to inform ethics guidelines for surgical interven- tions in intersex children, specifcally in contexts in which such children are at risk of signifcant harm. What I set out to come up with is a set of principles that do not completely prohibit surgery, but only allow it where a strong case can be made for its necessity, in the best interests of the child, and where there is some kind of oversight to prevent misuse. The frst principle is that interventions as drastic as these surgeries should only be performed when there is strong evidence that they are benefcial and not harmful. The second principle is that in surgeries should normally only be performed in cases of true medical necessity. Principle three is that surgeries should normally be delayed until such time as the intersex person is mature enough to assent to treatment or decide against it. Principle four is that the conventional ethical requirements regarding truth telling apply equally to intersex children as to anyone else. The fnal principle is that where physicians or parents think that surgery is in the best interests of the child, the burden of proof lies with them. Conclusion: It is hoped that these principles might help medical teams and parents make better decisions about intersex surgeries on children, and they would make such surgeries very rare indeed, if they happen at all. Keywords: Intersex, Intersex surgery, Intersex paediatric surgery, Intersex ethics Background was killed by family members when it was discovered On 24 January 2018, a South African newspaper, the that it had been born with ambiguous genitalia. Tey Mail and Guardian, posted an article online. It was enti- decided to lie to the mother and tell her that the child was tled ‘Intersex babies killed at birth because they are bad stillborn. Te author points out that this is an example of omens’. In it the author describes an incident in a rural many cases of intersex infanticide that occur because of a South African village in which a traditional healer, assist- belief that ‘intersex babies are bad omens. Tey are seen ing with the delivery of a baby, witnessed how the baby as a sign of witchcraft and a curse on the family and the community as a whole’ [1]. While we do not have reliable statistical data for how *Correspondence: [email protected] often intersex infanticide takes place in South Africa, Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Phillip V. Tobias there is sufcient evidence to know that it does occur. Health Sciences Building, 29 Princess of Wales Terrace, Parktown, In an informal study conducted by Tunchio Teriso in Johannesburg 2193, South Africa a rural area of South Africa, 88 out of the 90 traditional © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Behrens BMC Med Ethics (2020) 21:108 Page 2 of 9 midwives and birth attendees interviewed owned up to position. How would I feel if the total prohibition of child having killed babies born with ambiguous genitalia [1, surgeries did have the efect of a signifcant rise in infan- 2]. Furthermore, we know that, in a context in which an ticide or abandonment, or if worried parents resorted to intersex person is sometimes believed to be a bad omen, back street surgeries, with the predictable, harmful con- a curse, or a sign of punishment, witchcraft, or the dis- sequences? Changing beliefs and entrenched cultural pleasure of ancestors, intersex children are exceptionally practices takes time. We would be foolish to think that vulnerable to social stigma, rejection and even physical that it would not take decades for even well-conceived violence [1, 2]. It is against this contextual backdrop that I and funded education programmes to be successful in seek, in this paper, to develop a set of principles to guide efecting such change. So, my interlocuters had a point. medical teams and parents to make ethically justifed I would need to carefully consider the potentially very decisions about intersex paediatric surgeries. harmful unintended consequences of simple prohibi- While this article has arisen out of the situation in tion. It is for this reason that I here adopt a slightly less rural South Africa described above, it is of relevance in rigid approach that would make surgical procedures a other contexts, too. It is likely that if intersex babies are rare exception only to be used in cases where they might killed in South Africa, they are also killed in other coun- be necessary to protect an intersex person from serious tries on the continent, and indeed in other parts of the harm. world, where similar beliefs about intersex children pre- In this paper, my aim is not to argue for legal reform, vail. Intersex infanticide or attempted infanticide has but rather to address the problem of early intersex sur- been reported from Uganda [3], Kenya [4] and China [5]. geries1 by seeking to infuence the decisions and actions It is likely that the most vulnerable intersex infants are mainly of health care professionals. Partly this is because those born in rural communities, where births take place I am employed as a teacher of bioethics to such profes- in private homes and out of sight of authorities. Further- sionals. However, I am also mindful of the very signif- more, globally, intersex infants are at risk of being dis- cant role health professionals play in the decisions made carded, abandoned, neglected or mutilated [6]. Intersex by parents regarding the treatment of their intersex chil- individuals are also vulnerable to violence and even mur- dren. Parents frequently rely on their counsel as medical der after infancy and right through into adulthood. What experts, and their opinions are very infuential. While it all of this suggests is that there is a need for an approach is parents who must give consent for treatment and sur- to early infant intersex surgeries that is cognisant of the gery, it is often the physicians’ views that swing the out- very real threat to life and limb of intersex individuals. come [7, 8], even if (in some cases) it is only in conceding Te frst talk I gave on this subject was to staf and stu- to parental choices where these are not in the best inter- dents of the Philosophy department at a neighbouring ests of the child. Tus, I have chosen to essentially target university in Johannesburg. I took a hard line, arguing for health professionals and, through them, the parents of law reform to completely prohibit medically unnecessary intersex children. intersex surgeries before an age where intersex persons I have also chosen to focus on health profession- can give consent or at least express their wishes. During als because it is the case that resorting to early surger- question time, I was challenged on this by one of the aca- ies remains a common response to intersex births in my demics in the audience. He asked me whether I had con- home country, South Africa, as well as in many other sidered the possibility that in the South African context, countries. With what is already a comparatively high inci- prohibiting surgeries completely might have the unin- dence of intersex births [1], South Africa has no ofcial tended consequence of leading to even more intersex professional ethical guidelines for medical specialists on infanticide or abandonment. Perhaps, he said, the option such surgeries and is not party to the Chicago Consensus of surgery could potentially save lives, and removing the [9], the one multinational set of professional guidelines option could have disastrous consequences. Another person asked whether—in communities in which intersex persons are so feared—surgery might not sometimes be necessary to prevent a child from experi- 1 I deliberately use the term ‘intersex’ throughout this article, as this is appears to be the term preferred by intersex activist groups.
Load more

Recommended publications
  • Grade Five and Six Sexuality: Questions and Concerns
    GRADE FIVE AND SIX SEXUALITY: QUESTIONS AND CONCERNS DAVID CARNEGY B.Ed., University of Lethbridge, 1987 A One-Credit Project Submitted to the Faculty of Education of the University of Lethbridge in Partial Fulfilment of the Requirements for the Degree MASTER OF EDUCATION LETHBRIDGE, ALBERTA April, 1997 Sexuality is an integral part of the personality of everyone: man, woman, and child. It is a basic need and an aspect of being human that cannot be separated from other aspects of human life .. .It is in the energy that motivates us to find love, contact, feel warmth, and intimacy; it is expressed in the way we feel, move, touch and are touched; it is about being sensual as well as sexual. Sexuality influences thoughts, feelings, actions and interactions, and thereby our mental and physical health. Since health is a fundamental human right, so must sexual health also be a basic human right... [including] freedom from fear, shame, guilt, and false beliefs and other psychological factors. (The World Health Organization 1986) "We believe that the facts of one's life are not as important as one's perceptions of those facts." (Christensen and Thomas 1983 pg. 10) Part One Research INTRODUCTION My name is David Carnegy, I am an elementary school teacher and counsellor for Medicine Hat School District #76. One of my assignments every year is to teach the grade five and six "Human Sexuality" program. The Alberta Health Curriculum mandates what teachers should teach to grade five and six students who are 10 to 13 years old. I personally feel that the "Human Sexuality" curriculum is suitable for this age group of children and that it will hopefully help them to better understand their sexuality.
    [Show full text]
  • Unit 1 Structure and Functions of Male Reproductive Organs
    UNIT 1 STRUCTURE AND FUNCTIONS OF MALE REPRODUCTIVE ORGANS Structure 1.0 Objectives 1.1 Introduction 1.2 Meaning and Concept of Male Reproductive System 1.2.1 External Reproductive Organs 1.2.2 Internal Reproductive Organs 1.3 Maturation of Male Sex Organs 1.4 Functions of Male Reproductive Organs 1.5 Role of Teachers and Parents 1.6 Let Us Sum Up 1.7 Keywords 1.8 Answer to Check Your Progress 1.9 References 1.0 OBJECTIVES After going through this unit you will be able to: list and describe the organs of the male reproductive system; explain the functions of various male reproductive organs; describe the secondary sexual characteristics in boys; and emphasize that nocturnal emission is a normal phenomenon. 1.1 INTRODUCTION Adolescents are usually shy about asking questions related to their reproductive organs and rely on their peers and other sources which provide incomplete and unreliable information. It is therefore essential, as a responsible adult to open channels of communication and give them correct and complete information. The most important change which occurs during adolescence is related to changes in the reproductive organs. In this unit you will learn about the structure and functions of the male reproductive organs and related changes. This topic is of great concern to adolescents as they have curiosity about the changes in their bodies . This has long term impact on their self-esteem and personality development. In addition, you will undertake several activities, to reflect and understand the structure and functions of reproductive organs of male. 5 Reproductive and Sexual Changes 1.2 MEANING AND CONCEPT OF MALE REPRODUCTIVE SYSTEM One of the most important characteristics that differentiate a living organism from a non – living organism is their ability to reproduce.
    [Show full text]
  • Male Reproductive System
    MALE REPRODUCTIVE SYSTEM DR RAJARSHI ASH M.B.B.S.(CAL); D.O.(EYE) ; M.D.-PGT(2ND YEAR) DEPARTMENT OF PHYSIOLOGY CALCUTTA NATIONAL MEDICAL COLLEGE PARTS OF MALE REPRODUCTIVE SYSTEM A. Gonads – Two ovoid testes present in scrotal sac, out side the abdominal cavity B. Accessory sex organs - epididymis, vas deferens, seminal vesicles, ejaculatory ducts, prostate gland and bulbo-urethral glands C. External genitalia – penis and scrotum ANATOMY OF MALE INTERNAL GENITALIA AND ACCESSORY SEX ORGANS SEMINIFEROUS TUBULE Two principal cell types in seminiferous tubule Sertoli cell Germ cell INTERACTION BETWEEN SERTOLI CELLS AND SPERM BLOOD- TESTIS BARRIER • Blood – testis barrier protects germ cells in seminiferous tubules from harmful elements in blood. • The blood- testis barrier prevents entry of antigenic substances from the developing germ cells into circulation. • High local concentration of androgen, inositol, glutamic acid, aspartic acid can be maintained in the lumen of seminiferous tubule without difficulty. • Blood- testis barrier maintains higher osmolality of luminal content of seminiferous tubules. FUNCTIONS OF SERTOLI CELLS 1.Germ cell development 2.Phagocytosis 3.Nourishment and growth of spermatids 4.Formation of tubular fluid 5.Support spermiation 6.FSH and testosterone sensitivity 7.Endocrine functions of sertoli cells i)Inhibin ii)Activin iii)Follistatin iv)MIS v)Estrogen 8.Sertoli cell secretes ‘Androgen binding protein’(ABP) and H-Y antigen. 9.Sertoli cell contributes formation of blood testis barrier. LEYDIG CELL • Leydig cells are present near the capillaries in the interstitial space between seminiferous tubules. • They are rich in mitochondria & endoplasmic reticulum. • Leydig cells secrete testosterone,DHEA & Androstenedione. • The activity of leydig cell is different in different phases of life.
    [Show full text]
  • LECTURE V: Puberty in Males and Females
    LECTURE V: Puberty in Males and Females EDITING FILE IMPORTANT MALE SLIDES EXTRA FEMALE SLIDES LECTURER’S NOTES 1 PUBERTY IN MALES AND FEMALES Lecture Five OBJECTIVES ● Define puberty. ● Recognize the physiology of puberty related to changes in hypothalamic-pituitary-gonadal axis. ● Describe the physical changes that occur at puberty in boys and girls. ● Recognize the influencing factors leading to puberty. ● Describe the pathophysiological conditions associated with puberty. Puberty Puberty (AKA: adolescence) is a physiological transition from childhood (juvenility) to adulthood, Accelerated somatic growth. Characteristics of puberty: ● HPG axis matures. ● The primary sexual organs mature (gonads). ● The secondary sexual characteristics develop. ● The adolescent experiences the adolescent growth spurt. ● The adolescent achieves the ability to procreate. Terms & Events GnRH Receptors Sensitivity ● Thelarche: development of breast. ● Pubarche: development of pubic and axillary hair. ● Menarche: the first menstrual period1 . ● Adrenarche: the onset of an increase in the secretion of androgens; responsible for the development of pubic/axillary hair, body odour and acne.2 ● Gonadarche: maturation of gonadal function. Figure 5-1 Increased sensitivity of the GnRH receptors to very low gonadotropins before puberty. Hormonal Changes 3 4 1 Pulsatile secretion of GnRH from the hypothalamus → Increased sensitivity of the GnRH receptors in anterior pituitary. Pulsatile secretion of LH and FSH → Appearance of large nocturnal pulses of LH, during REM sleep5. 2 3 Maturation of primary sexual characteristics (gonads) → Secretion of gonadal steroid hormones (testosterone & estradiol) Appearance of the secondary sex characteristics at puberty (pubic and axillary hair, female breast development, male 4 voice changes)6 FOOTNOTES 1. For unclear reasons, the initial menstrual periods (during the first one-to-two years of puberty) are anovulatory, however this does suggest that the ovary is being made ready for reproduction during the first one-to-two years of puberty.
    [Show full text]
  • The Male Body
    Fact Sheet The Male Body What is the male What is the epididymis? reproductive system? The epididymis is a thin highly coiled tube (duct) A man’s fertility and sexual characteristics depend that lies at the back of each testis and connects on the normal functioning of the male reproductive the seminiferous tubules in the testis to another system. A number of individual organs act single tube called the vas deferens. together to make up the male reproductive 1 system; some are visible, such as the penis and the 6 scrotum, whereas some are hidden within the body. The brain also has an important role in controlling 7 12 reproductive function. 2 8 1 11 What are the testes? 3 6 The testes (testis: singular) are a pair of egg 9 7 12 shaped glands that sit in the scrotum next to the 2 8 base of the penis on the outside of the body. In 4 10 11 adult men, each testis is normally between 15 and 3 35 mL in volume. The testes are needed for the 5 male reproductive system to function normally. 9 The testes have two related but separate roles: 4 10 • to make sperm 5 1 Bladder • to make testosterone. 2 Vas deferens The testes develop inside the abdomen in the 3 Urethra male fetus and then move down (descend) into the scrotum before or just after birth. The descent 4 Penis of the testes is important for fertility as a cooler 5 Scrotum temperature is needed to make sperm and for 16 BladderSeminal vesicle normal testicular function.
    [Show full text]
  • Reproductive System Physiology of Male Reproductive System
    Reproductive System Function: producing offspring propagation of the species in terms of evolution – the only reason all the other systems exist only major system that doesn’t work continuously only activated at puberty unlike most other organisms on planet mammals only reproduce sexually humans are dieocious separate sexed (many animals are monoecious or hermaphrodites) in 7th week of embryonic development genes are activated that trigger differentiation of gonads Physiology of Male Reproductive System Testes primary reproductive organ of male consists of seminiferous tubules interstitial cells has dual function a. hormone secretion: interstitial cells testosterone 1. development and maintenance of secondary sexual characteristics 2. stimulates protein synthesis 3. promotes growth of skeletal muscles b. spermatogenesis: seminiferous tubules formation and maturation of sperm cells Male Accessory Organs three accessory glands secrete fluids that mix with the sperm = semen seminal vesicles (paired) secrete viscous liquid rich in fructose fructose serves as energy source for sperm prostate gland (single) Human Anatomy & Physiology: Reproduction; Ziser, 2004 1 surrounds ejaculatory duct at junction with urethra secretes an alkaline liquid that constitutes major portion of semen akalinity protects sperm for acidity of male urethra and female vagina bulbourethral glands (paired) small pea shaped glands below prostate also secrete alkaline fluid male hormone (=androgens) are secreted mainly by interstital cells of testes additional testosterone is secreted by Adrenal Cortex at puberty Ant Pituitary secretes FSH & large amounts of LH (ICSH) FSH & LH cause testes to increase in size and begin sperm production LH also triggers testes to produce testosterone There are two male hormones: testosterone androstenedione main male hormone is Testosterone testosterone functions: 1.
    [Show full text]
  • Health and Wellbeing of People with Intersex Variations Information and Resource Paper
    Health and wellbeing of people with intersex variations Information and resource paper The Victorian Government acknowledges Victorian Aboriginal people as the First Peoples and Traditional Owners and Custodians of the land and water on which we rely. We acknowledge and respect that Aboriginal communities are steeped in traditions and customs built on a disciplined social and cultural order that has sustained 60,000 years of existence. We acknowledge the significant disruptions to social and cultural order and the ongoing hurt caused by colonisation. We acknowledge the ongoing leadership role of Aboriginal communities in addressing and preventing family violence and will continue to work in collaboration with First Peoples to eliminate family violence from all communities. Family Violence Support If you have experienced violence or sexual assault and require immediate or ongoing assistance, contact 1800 RESPECT (1800 737 732) to talk to a counsellor from the National Sexual Assault and Domestic Violence hotline. For confidential support and information, contact Safe Steps’ 24/7 family violence response line on 1800 015 188. If you are concerned for your safety or that of someone else, please contact the police in your state or territory, or call 000 for emergency assistance. To receive this publication in an accessible format, email the Diversity unit <[email protected]> Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, March 2019 Victorian Department of Health and Human Services (2018) Health and wellbeing of people with intersex variations: information and resource paper. Initially prepared by T.
    [Show full text]
  • Intersex in 2018: Evaluating the Limitations of Informed Consent in Medical Malpractice Claims As a Vehicle for Gender Justice
    Intersex in 2018: Evaluating the Limitations of Informed Consent in Medical Malpractice Claims as a Vehicle for Gender Justice CAROLINE LOWRY* Each year, hundreds of individuals are born intersex, meaning they have genitalia that do not meet the criteria for being exclusively male or female. For decades, doctors have performed corrective genital surgeries on intersex infants in an attempt to make it easier for them to grow up as “normal” boys and girls. In recent years, however, there is a growing consensus that cosmetic genital correctional surgeries are both unnecessary and often harmful to the long-term wellbeing of intersex individuals. Given increasing recognition of negative outcomes over the past decade, critics and activists have called for a moratorium on corrective genital surgeries performed on infants. In 2017, an intersex youth named M. Crawford obtained the first legal settlement ever in the United States challenging infant correctional surgeries under the doctrine of informed consent. This Note explores the implications of this the landmark legal settlement on efforts to combat nonconsensual genital correction surgery performed on intersex children. In particular, this Note explores the strengths and weaknesses of pursuing litigation based on the informed consent claims raised in M.C.’s lawsuit. This Note also offers alternative methods to combat the practice of performing intersex correctional surgeries. * Note Editor, Colum. J.L. & Soc. Probs., 2018–2019. J.D. Candidate 2019, Columbia Law School. The author would like to thank Sylvan Fraser at InterACT Advocates for Intersex Youth and the intersex individuals and advocates that have made this Note possible. In additional, the author would like to thank Professor Elizabeth Emens for her guidance and insight and the staff of Columbia Journal of Law and Social Problems for all their insight and hard work.
    [Show full text]
  • Clinical Assessment of Sexual Maturation in Adolescents
    0021-7557/01/77-Supl.2/S135 Jornal de Pediatria - Vol. 77, Supl.2 , 2001 S135 Jornal de Pediatria Copyright © 2001 by Sociedade Brasileira de Pediatria REVIEW ARTICLE Clinical assessment of sexual maturation in adolescents Eugenio Chipkevitch* Abstract Objective: to present the methods for clinical evaluation of sexual maturation in adolescents. Methods: bibliographic review concerning the practice of pubertal staging. Results: the assessment of sexual maturation is an essential step in the comprehensive health care of adolescents, allowing for the evaluation of their developmental stage. In addition, this assessment allows establishing a correlation between different pubertal events, following up diseases, and interpreting laboratory tests appropriately. Pubertal stage is assessed by the examination of breasts and pubic hair in females, and genitals and pubic hair in males. A new photographic standard for pubertal staging and a new method for clinical measurement of testicular volume are presented. Conclusions: the assessment of sexual maturation is an important feature in the health care of adolescent patients and must be included in the clinical practice of pediatricians involved in adolescent medicine. J Pediatr (Rio J) 2001; 77 (Supl. 2): S135-S142: adolescence, puberty, sex maturation. Introduction Puberty is a period of biological maturation marked by In adolescence, chronological age is not a reliable the appearance of secondary sexual characteristics, growth parameter for biological, psychological, and social spurt, and changes in body composition. With the exception characterization of individuals. Adolescents with the same of the fetal period, there is no other stage in human age are frequently in different stages of puberty considering development in which height growth and changes in body that its onset and progression are highly variable.
    [Show full text]
  • Sexual Selection in Humans: an Evolutionary and Anthropological
    old mate, since, as Dawldns suggests, "longevity is not prima facie evidence of virility" (1989: 157). These ideas have established a common place in the study of animals in nature, but have often been misunderstood in the examination of human reproductive strategies. Evolutionary narratives about the adaptive significance of human sexuality have traditionally assumed that human female sexual traits evolved because females had to compete for mates, reinforce the pair bond, and reduce competition among males. Conversely, traditional biological theory predicts that males are more likely to compete for females (Hamilton, 1984). Traits such as nearly continuous receptivity to mate and breast prominence have typically been assigned to human females as sexual traits which reinforce the pair bond. Hamilton suggests that prominent female breasts may be the pleiotropic effect of selection for increased fat deposition, which would allow "flexibility in coping with the caloric expense of maintaining normal activities during lactation or food shortages" (1984:655). Fisher (1958) has argued that if any trait is correlated with selective advantage, selection will favour individuals of the opposite sex who most clearly discriminate the difference and most decidedly prefer the advantageous type (In Burd, 1986). While competition among the sexes in humans is clearly a feature of modern social life, an understanding of the influences which have shaped female and male sexual and reproductive traits is of particular interest. In order to create a comprehensive understanding of sexual selection in humans, an understanding of the evolution of human reproduction is essential, as well as a realization of the cultural influences which mould individual behaviour.
    [Show full text]
  • Ensuring the Rights of Children with Variations of Sex Characteristics in Denmark and Germany
    FIRST, DO NO HARM ENSURING THE RIGHTS OF CHILDREN WITH VARIATIONS OF SEX CHARACTERISTICS IN DENMARK AND GERMANY Amnesty International is a global movement of more than 7 million people who campaign for a world where human rights are enjoyed by all. Our vision is for every person to enjoy all the rights enshrined in the Universal Declaration of Human Rights and other international human rights standards. We are independent of any government, political ideology, economic interest or religion and are funded mainly by our membership and public donations. © Amnesty International 2017 Except where otherwise noted, content in this document is licensed under a Creative Commons Cover illustration: INTER*SHADES by Alex Jürgen*. Alex is an intersex artist living and working in (attribution, non-commercial, no derivatives, international 4.0) licence. Austria. Alex spells their name with a * to signify that intersex is not a recognized sex, and is currently https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode involved in a court case to change their name and passport. For more information please visit the permissions page on our website: www.amnesty.org © Alex Jürgen Where material is attributed to a copyright owner other than Amnesty International this material is not subject to the Creative Commons licence. First published in 2017 by Amnesty International Ltd Peter Benenson House, 1 Easton Street London WC1X 0DW, UK Index: EUR 01/6086/2017 Original language: English amnesty.org CONTENTS 1. EXECUTIVE SUMMARY 7 1.1 METHODOLOGY 7 1.2 MEDICAL PRACTICES 7 1.3 THE IMPACT ON INDIVIDUALS 9 1.4 HUMAN RIGHTS AND GENDER STEREOTYPING 10 1.5 FURTHER HUMAN RIGHTS VIOLATIONS 10 1.6 PRINCIPAL RECOMMENDATIONS 11 2.
    [Show full text]
  • Reproduction and Development 975 DO NOT EDIT--Changes Must Be Made Through “File Info” Correctionkey=A
    DO NOT EDIT--Changes must be made through “File info” CorrectionKey=A Reproduction CHAPTER 34 and Development BIg IdEa Human reproduction depends on hormone cycles, and fetal development progresses in stages. 34.1 Reproductive anatomy 34.2 Reproductive Processes 6g, 10A 34.3 Fetal development data analysis INtERPREtINg gRaPhs 2g 34.4 Birth and development Online BiOlOgy HMDScience.com ONLINE Labs ■■ QuickLab Human Sex Cells ■■ Hormones in the Human Menstrual Cycle ■■ Development of an Embryo ■■ Effects of Chemicals on Reproductive Organs ■■ Stages of Human Development ■■ Video Lab Sonography (t) ©Nestle/Petit Format/Photo Inc. Researchers, 974 Unit 9: Human Biology DO NOT EDIT--Changes must be made through “File info” CorrectionKey=A Q What protects this developing fetus? This developing fetus, only about four months old, floats in a liquid world, receiv- ing all its oxygen and nutrients from its mother’s body. The journey from a single cell to a fully developed human being is guided by genetic instructions, environ- mental influences, and the complex actions of hormones in both mother and baby. RE a d IN g T ool b O x this reading tool can help you learn the material in the following pages. UsINg LaNgUAGE YOUR tURN Recognizing Main Ideas A main idea is a sentence Find the main idea in the paragraph below. that states the main point of a paragraph. The main idea is Disease-causing pathogens are transmitted in many ways. often, but not always, one of the first few sentences of a Some pathogens can be passed by drinking contaminated paragraph. All the other sentences of the paragraph give water.
    [Show full text]