Am J Bioeth. 2024 Jul 17:1-50. doi: 10.1080/15265161.2024.2353823.
When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between and procedures and focus on procedures, specifically in prepubescent minors ("children"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or "endosex" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform nonvoluntary genital cutting or surgery, from "cosmetic" labiaplasty to medicalized ritual "pricking" of the vulva, insofar as the procedure is not strictly necessary to protect the child's physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child's privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter's sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.
临床医生在伦理上何时可以对合法未成年人的生殖器进行手术干预？我们区分了不同类型的手术，并重点关注针对青春期前未成年人（“儿童”）的手术，特别是。我们不涉及青春期或成年期的手术。对于出生时被归类为女性且没有明显性发育差异的儿童（即非双性人或“生理性别的”女性），全球北方地区存在几乎普遍的伦理共识。这一共识认为，临床医生不得进行非自愿的生殖器切割或手术，从“美容性”阴唇整形到医学化的外阴仪式性“穿刺”，只要该手术并非严格保护儿童身体健康所必需。所有其他动机，包括医生或父母判断的可能的心理社会、文化、主观美学或预防益处，都被视为临床医生对该群体进行生殖器手术的绝对不适当理由。我们认为，能够支持这一共识的主要伦理理由并非基于经验上有争议的利益风险计算，而是基于对尊重儿童隐私、身体完整性、发展中的性界限以及（未来的）生殖器自主权的根本关注。我们表明这些伦理理由是合理的。然而，正如我们所论证的，它们不仅适用于生理性别的女性儿童，而且适用于所有儿童，无论其性别特征如何，包括那些具有双性特征的儿童和生理性别的男性儿童。因此，我们得出结论，从医学伦理政策中的正义、包容性和性别平等角度来看（我们不对刑法表态），临床医生不应被允许对青春期前未成年人进行任何非自愿的生殖器切割或手术，无论后者的性别特征或性别指定如何，除非为保护其身体健康而紧急必要。相比之下，我们建议在某些情况下，出于更广泛的原因，包括自我认同或心理社会福祉等原因，对年龄较大的个体进行手术可能是允许的，这与相关人员的情况、价值观以及明确的需求和偏好相符。注意：由于我们的立场与临床医生在规范的医疗保健系统中作为医疗从业者被广泛接受的特定角色职责相关，我们不考虑在医疗保健背景之外进行的生殖器手术（例如出于宗教原因），也不考虑由非持牌医疗保健提供者以其专业身份以外的人员进行的手术。
