Monday, 4 May 2009

Quick hit: Masectomies for 17 year old Australian

Found on Stuff, originally from The Age:
An Australian court has allowed a 17-year-old girl to have her breasts removed so she can be more like a boy.

The teenager, code-named "Alex", was on court-ordered hormone medication from the age of 13 to prevent menstruation and breast development. She returned to the court in December 2007 asking for a double mastectomy to make it easier for her to pass as a boy.

The Chief Justice of the Family Court, Diana Bryant, decided it was in the teenager's best interests to have the surgery immediately rather than wait until turning 18.

The teenager had been diagnosed with "gender identity dysphoria", a psychological condition in which a person has the normal physical characteristics of one sex but longs to be the opposite sex.

Justice Bryant told The Age: "In the end, it wasn't a particularly difficult issue because the only real issue was, 'Would he (Alex) have it at 17 or once he's 18?' Then, he doesn't need permission.

"So the issue was, 'Was there any likelihood he would change his mind in the meantime, and was it in his best interests to have it at that time?'

"Overwhelmingly, the evidence was that it was in his interests. And I made that order. I wanted to make it quickly so that he could have the operation straightaway."

But ethicist Nick Tonti-Filippini said mainstream medicine did not recognise hormone treatments and surgery as treatment for gender dysphoria. He said it was a psychiatric disorder qualifying under American guidelines as a psychosis because "it's a belief out of accordance with reality".

"What you are trying to do is make a biological reality correspond to that false belief."

The Chief Justice said Alex had not had any urgent plans to proceed with further surgery when he turned 18. She did not make Alex wait for the mastectomies until of age because the teenager had been living as a boy since the age of 13.

"Everyone was absolutely adamant that he wasn't going to change his mind. He was very comfortable . . . that he was going to continue on this path."
Click through for the rest of the article.

I'm far from being an expert on issues around sex changes, transgender, etc, and I'll be very interested in comments from readers.

I did find it odd how the article changes Alex's gender back and forth frequently. The Chief Justice seemed to accept Alex was a he, but the article (and the headline) refer to Alex as a "girl". Hmmmm.


s-j said...

The article is wrong - 'Alex' is a boy and should be referred to by masculine pronouns. This is just another example of the ongoing transphobia that is present in the media/society.

anna c said...

*agrees with s-j*. And who the hell is this ethicist and what does his opinion have to do with anything?

Anonymous said...

Agreed Anna c, the court has made their ruling and this is final. We can't have self appointed experts running around questioning the validity of court rulings; the authority of the judge is paramount in this case.

Jack said...

The ethicist is an associate professor at the John Paul II Institute for Marriage and the Family. I find it interesting that the article didn't bother to mention this, as I think it's pretty relevant to understanding their opinion.

Anonymous said...

Presumably this ethicist is a christian (given he works at the John Paul II institute). Amusingly his description of a pyschosis as "a belief out of accordance with reality" fits his own delusions about the existence of a supreme being who created the world pretty well too.

Louise said...

I think there is a great need for education and awareness around trans (I use trans not transsexual or transgender to reflect the diversity of identities and lives) identities. I feel the dialogue is necessary as well as guidelines on how to respect the diversity of trans identities.
The above article is problematic for a number of reasons, as already noted the pronouns need to reflect self-identity, ie Alex id as a boy/man. However, this can only be done because the story of Alex is well known and discussed previously in the media. Also mastectomy is generally not used as a term to describe breast removal surgery for trans men. Also the ethicist is kind of wrong, hormones and surgery are well known to be beneficial for some trans people and as already mentioned there is an obvious bias from the ethicist. There is a lot of tension between trans identities, media, society and feminism that need a lot more attention and discussion. This article is just an illustration of the tensions between media, some sectors of society, and trans identities. I could go on for hours, this is my PhD research area…but I will stop now ☺

anna c said...

I'm not saying that everyone should always just accept a court ruling - I have something of a history of doing the opposite :D. But I think there should be a good reason for giving this "ethicist" a platform, particularly as he has no obvious connection to the case and groups with an alternative point of view aren't quoted.

Is the thing about "mainstream medicine" even correct? Hormone treatments and in a few cases surgery are available as part of the public health system in NZ, so I'd have thought it did recognise them - can anyone more knowledgeable fill me in?

Julie said...

Thanks already to those more knowledgeable than I for your helpful comments.

I would have thought that John Paul II made him not so much Christian (a broad church) but Catholic (not so broad in terms of actual teachings)...

Anna said...

I have no problem with ethicists commenting on things judicial - so long as the things they say withstand a bit of logical/ethical scrutiny.

What I particularly don't get is the idea that failure to conform to a particular set of assumptions around gender (which change depending on time and culture) = psychological problem.

The ethicist seems to presuppose that there are certain characteristics that are inherently male or female. I prefer wearing trousers and like arsing about with power tools. I can parallel park like a demon. I go to work and my (male) partner stays home. Do these masculine-ish traits mean I've got a disorder? The ethicist would likely say no - but if I'd done these things 50 years ago, when they were less common, I might have qualified as 'disordered'.

The JPII ethicist is likely a Catholic, and Benedict XVI has recently iterated the supposedly natural complementarity of gender roles. He should really be honest about his key assumptions about gender identity - they may not have much in common with the way many or most people in Western societies think about gender. I wouldn't be surprised, for example, if the guy had concerns about women who marry but don't want children. We can be pretty certain he doesn't approve of gay people. When this guy talks about 'biological reality', he's actually talking about all the social/theological beliefs he attaches to certain body parts.

If the ethicist thinks Alex is sick, I wonder what sort of godawful treatment he had in mind to 'cure' him?

Anna said...

...and I agree with you, s-j, that transphobia is rife, but I think it's also important to recognise that there are a lot of well-meaning people out there who just haven't been exposed to trans issues, and make boo-boos.

So try to be patient with those of us who want to express solidarity but don't necessarily know how!

Moz said...

The Age in Melbun has better coverage, including a longer piece on the youf-medical angle.

The Stuff'd summary is not as clear on Alex's background and some of the things that make it more likely that this is a trauma reaction to some extent. That doesn't make it less valid a response, but I suspect increases the possibility of problems later. The Age also hints that there are religious and cultural problems, quite probably in the "delusional godbag hates women" category.

But yeah, the persistent gender confusion on the part of the interviewees grated on me, although I did think it usefully made their agenda very clear. Googling the godbag quickly revealed that he's not using a reality-based framework and does not use terms like "ethics" in a way that most of us would recognise.

Anna said...

Moz, 'not using a reality-based framework' is the best polite insult I've heard in a long while - I plan to use it often!

Deborah said...
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Deborah said...
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Deborah said...

I've just had a grumble about this over at my own place, but I won't cross post it here, given that you've already written about it, Julie.

Why The Advertiser is so special.


And there's more on other blogs. Hoyden about Town and The Dawn Chorus also have posts about it.

M-H said...

This so-called 'ethicist' pops up quite frequently in the meedja here in Australia. I have no idea how he gets so much sir-time when he represents nothing more than the Catholic Church in a mask. I was fascinated (with revulsion) to read his views in this morning's papers, and I'd like to know why the views of trans-activists and/or advocates wasn't also sought.

s-j said...

Anna, I do apologise for sounding angry/attacking because it wasn't my intention - I was (and still am) really angry about the continued use of the wrong pronouns for trans people in the press (and generally).

Anna said...

s-j - I completely understand the frustration, and I didn't think you sounded angry. :-)

Psycho Milt said...

"'Alex' is a boy and should be referred to by masculine pronouns."

Almost right - Alex is a girl and should be referred to by masculine pronouns. Biology doesn't give a rat's ass how we'd have preferred to have been born, and stamping our feet doesn't change that. None of which alters our moral obligation to accept that if someone prefers us to treat them as a member of the opposite sex, we should do so.

Sam said...

Actually, Psycho Milt, s-j had it completely right. It's important to distinguish between sex and gender here. Sex being the biological make-up of a person (Alex has been born female), gender being the social and cultural construction of what it is to be man or woman (Alex id's as a boy/man) - therefore, "Alex is a boy and should be referred to by masculine pronouns" is correct.

Zoe Brain said...

The problem is that other 17 year old boys get surgery for gynecomastea all the time without having to go to the Family Court about it.

...Associate Professor Tonti-Filippini is the Institute Associate Dean (Teaching, Learning and Research)Which institute? The John Paul II Institute for Marriage and Family. From their website:

He is the subject co-ordinator for:

* JP502 – Philosophical Foundations of Bioethics
* JP540 – Foundations of Christian Moral Life
* JP543 – Theological Bioethics
* JP544 – Beginning of Life Ethics
* JP545 – End of Life Ethics
* JP546 – Current Controversies in Bioethics
* JP547 – Theology and Practice of Natural Family Planning
* JP564 – Educating in Sexuality, Marriage, Family and Life
Concealing his strong and fervent religious affiliation could reasonably be said to be "lying by omission".

While Dr Tonti-Fillipini no doubt knows a great deal about "the Unresponsive State and Comercialization of Human Tissue", there is no evidence that Dr Tonti-Fillipini has had any training, formal or informal, on gender dysphoria, effects of gonadotrophins, or has ever seen a single patient presenting with Gender Identity Disorder. Moreover, he is compelled by his Faith to follow the official Vatican line, regardless of the Science.

Except that as the Official Vatican Line was sent sub secretum - Bishops And Cardinals Only - he doesn't know it.

One thing we have found out is that it authorises SRS in "extreme cases" - such cases being people diagnosed with GID.

See What is the Church's position on the Intersexed and Transsexed? on the Catholic Answers Forum.

Anonymous said...

There's been a lot of transphobia around lately, on this blog and others, but I expected more from you, Milt.

Psycho Milt said...

Not transphobia, merely a respect for accuracy. Boy and girl are terms based on sex, not gender. I'm happy to call Alex a boy and use male pronouns for him if that's what he wishes, but that's a matter of respect for other people, not an expression of facts.

Louise said...

Psycho-Milt, the idea of 'facts' and 'accuracy' are sometimes subjective and also influenced by power dynamics. Although I understand your comment that you respect the use of male pronouns etc the use of language such as fact and accuracy is, in my opinion, problematic for discussion between trans-advocates, trans people and society.
Facts and accuracy about sex/gender and biology is influenced by medical developments, social understanding and personal lives. Stating something is 'fact' closes the door to people being able to discuss how they perceive their sex/gender. Yes, generally we assign sex (male/female) at birth based on genitals....but really is that it?

Anna said...

This all brings up the issue of what biological characteristics we consider to be indisputably female or male.

The ethicist's negative response to Alex's case suggests that having breasts is key to female identity. What about women with small breasts? Women who have breast reductions? Blokes with man-boobs? Blokes who have accidents which damage or destroy their genitals? All gender traitors?

You can argue this one ad infinitum, and probably end up saying that it's a person's chromosomes which ultimately make them male or female. There's really no other physical characteristic which can give you a definitive sex classification. And Alex can't change his chromosomes, so that's not an issue.

Ultimately, the ethicist is not arguing about Alex changing his sex - he's arguing about Alex changing his presentation in a way that doesn't square with the ethicist's own idea of gender. And that assumes that there are particular ways men and women should present themselves - which apparently for women means having boobs, or at least wanting them.

Psycho Milt said...

"Stating something is 'fact' closes the door to people being able to discuss how they perceive their sex/gender."

I don't believe it does. Sex is not gender, and trying to use language to conflate them only degrades the meaning of the words used. My sex is male; I might do things like have my genitals removed/altered, take female hormones, acquire breasts etc - however, these things would not change my sex from male to female, merely disguise it as female. That isn't something that can be altered by language or influenced by power dynamics.

It also doesn't matter. If someone identifies as male, we should treat them as male. I couldn't use the phrase "Alex is a boy," because it's factually untrue, but treating Alex as a boy is basic courtesy, and anyone calling himself an "ethicist" should know it.

V said...

however, these things would not change my sex from male to female, merely disguise it as female.

Wow, what an intolerable, transphobic douchebag you are.