From Intersex to Disorders of Sex Development: A Foucauldian Analysis of the Science, Ethics and Politics of the Medical Production of Cisgendered Lives Open Access

[摘要] This dissertation takes up the revised treatment model for intersex conditions introduced in 2006, which controversially reclassified them as Disorders of Sex Development (DSDs). It provides a critical Foucauldian analysis of the science, ethics, and politics underwriting medical efforts that aim at securing cisgendered futures for patients unable to provide informed consent. These include not only pediatric management strategies for intersexed children, but also certain efforts used to treat children diagnosed with Gender Dysphoria (GD). Motivated by critiques of both the DSD treatment model, and of the arguments issued by those intersex activists and feminist academics who strategically endorsed it, I review the entangled histories of clinical medicine, feminist scholarship, and intersex activism that constitute the background out of and against which this revision in treatment model and nomenclature emerged in 2006. Those who strategically endorsed DSD had hoped to bring about a reduction in the frequency with which genital normalizing surgeries were performed by rhetorically shifting both clinical and parental focus on to properly medical issues of ;;health and human flourishing,” and away from cultural concerns regarding gender and identity, the latter of which were seen as motivating and justifying these surgeries. Unfortunately, this strategy appears to have failed and almost a decade after the adoption of DSD, it is accepted within the literature that the genital normalization of intersex infants occurs as frequently as it did before. I diagnose the failure of DSD, situating it in the biomedical model itself, and the binary nature/culture logic underwriting the objectivist account of pathology it appeals to. This logic paved the way for further problematic binaries—most importantly sex/gender and impairment/disability—as well as the adoption of a sovereign or juridico-deductive account of power. This conceptual scheme misrepresents the ways in which medical knowledge/power functions to render certain lives unliveable, and obscures the historical constitution of sex/gender and impairment/disability as binaries under biopower. Through a review of the DSD nomenclature and clinical recommendations, I conclude that insofar as the primary aim of intersex management is securing a cisgendered future for the intersex infant, the core pathology of intersex conditions is constituted in terms of Cisgendered Function—that is, the function of one’s physical sex characteristics are presumed to perform insofar as they are taken to provide a stable ground upon which reliable predictions about one’s future gender identity, behaviors, and preferences or desires can be made. I go on to reconstruct and then critique the most compelling philosophical answers to the question that clinicians tacitly believe has a self- evident response, and which partially determines both the biopolitical correctness and ethicality of the use of efforts to secure cisgendered futures for those unable to provide informed consent: Is being gender variant or non-cisgendered a pathology? I then defend the position that pathologies of Cisgendered Function are not only socially constituted, but primarily bureaucratic in nature, licensing the medical normalization of certain populations with regards to gender, and the withholding of such forms of normalization from others. For those diagnosed intersex or trans* children unable to provide informed consent, this normalization defaults towards the production of cisgendered lives, and where this cannot be achieved, such efforts aim at the production of lives that can pass as such. Finally, I consider the implications of these conclusions for ethical medicine and political resistance in the aftermath of DSD. Using a Foucauldian account of ethics and freedom, I defend a moratorium on medical efforts to secure cisgendered futures for those unable to provide informed consent, and timely and affordable access to medical forms of gender-confirming normalization for those trans* and intersex individuals who can.

[发布机构] University of Alberta

[效力级别] Medicine