An emerging ethical and medical dilemma: should physicians perform sex assignment surgery on infants with ambiguous genitalia?

INTRODUCTION • 2 I. THE REMARKABLE CASE OF JOHN/JOAN • 5 II. THE DEVELOPMENT OF A SURGICAL STANDARD OF CARE • 12 A. Standards of Care Within the Medical Community • 12 B. The Surgical Standard in Treatment ofAmbiguous Genitalia . 16 C. Standard Care and Malpractice Claims 27 III. PARENTAL CONSENT TO GENITAL SURGERY AND SEX REASSIGNMENT ON BEHALF OF CHILDREN • 34 A. The Doctrine of Informed Consent • 34 B. Informed Consent and Parental Decision Making on Behalf. of Infants • 37 C. The Problems of Informed Consent and Infant Genital Surgery • 42 1. The Aura of Urgency • 43 2. Imparting Incomplete Information 47 3. Perpetuating Secrecy and Deception • 50 4. Failing to Disclose The Uncertainty of the Long-Term Outcome • 56 5. Ignoring the Child's Right to an Open Future • 57 IV. LEARNING FROM THE PAST: WHAT SHOULD THE FUTURE HOLD? • 59 CONCLUSION • 61