Five New Principles to Govern Intersex Pediatric Surgery: A Reply to Kevin G. Behrens

Individuals with intersex conditions are biological males and females who have, through various disorders/differences of sexual development, an (epistemically) unclear biological sex. Intersex pediatric surgery (IPS) is clarification surgery which seeks to restoratively, functionally, and aesthetically clarify or disambiguate the sex of a child with intersex conditions. IPS is performed in healthcare institutions by a urologist, ideally one with technical certification in pediatric urology. The pediatric urologist is (or may be) part of the multidisciplinary healthcare team assigned to the child with intersex conditions and his or her family. Formal philosophical arguments against IPS have been found to be implausible. As such, contemporary clinical recommendations for the care of individuals with intersex conditions head in this direction. Because surgical moratoria over IPS are consequently inappropriate, regulatory ethical principles serve to protect and promote the flourishing of children with intersex conditions. This commentary has two goals: the first is to articulate and philosophically challenge Kevin G. Behrens' principled ethical approach to IPS, which stands to date as a novel and strong approach to IPS, and the second is to articulate and defend five plausible ethical principles to govern IPS decision-making that partially replace Behrens'.