The clinical management of intersex has undergone a significant change in values. Whereas in former times, benevolent medical paternalism was the rule, today, the patient’s right to respect for dignity and self-determination is given priority. This paper discusses ethical considerations shaping the modern therapeutic management of intersex conditions that do not entail acute health risks. It concludes with basic ethical guidelines for clinical practice.

1.
Beh HG, Diamond M: An emerging ethical and medical dilemma: should physicians perform sex assignment on infants with ambiguous genitalia? Mich J Gend Law 7:1–63 (2000).
2.
Briffa T: Intersex surgery disregards children’s human rights. Nature 428:695 (2004).
3.
Chase C: Surgical progress is not the answer to intersexuality. J Clin Ethics 9:385–392 (1998).
4.
Chase C: What is the agenda of the intersex patient advocacy movement? Endocrinologist 13:240–242 (2003).
5.
Council of Europe: Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and Biomedicine. Orviedo, 1997. http://conventions.coe.int/Treaty/EN/Treaties/html/164.htm (accessed April 28, 2010).
6.
Creighton SM, Minto CL, Steele SJ: Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood. Lancet 358:124–125 (2001).
7.
De Lourdes Levy M, Larcher V, Kurz R; Members of the Ethics Working Group of the CESP: Informed consent/assent in children. Statement of the Ethics Working Group of the Confederation of European Specialists in Paediatrics. Eur J Pediatr 162:629–633 (2004).
8.
Dreger AD: When medicine goes too far in the pursuit of normality. Health Ethics Today 10:2–5 (1999).
9.
Dreger AD: Intersex and Human Rights: The Long View, in Sytsma SE (ed): Ethics and Intersex, pp 73–86 (Springer, Dordrecht 2006).
10.
Frader JE, Alderson P, Asch A, Aspinall C, Davis D, et al: Health care professionals and intersex conditions. Arch Pediatr Adolesc Med 158:426–428 (2004).
11.
Greenberg JA: International legal developments protecting the autonomy rights of sexual minorities: who should determine the appropriate treatment for an intersex child?, in Sytsma SE (ed): Ethics and Intersexuality, pp 87–102 (Springer, Dordrecht 2006).
12.
Hughes IA, Houk SF, Ahmed SF, Lee PA; LWPES/ESPE Consensus Group: Consensus statement on management of intersex disorders. Pediatrics 118:e488–500 (2006).
13.
Kipnis K, Diamond M: Pediatric ethics and the surgical assignment of sex. J Clin Ethics 9:398–410 (1998).
14.
Thyen U, Richter-Appelt H, Wiesemann C, Holterhus PM, Hiort O: Deciding on gender in children with intersex conditions: considerations and controversies. Treat Endocrinol 4:1–8 (2005).
15.
United Nations: The Convention on the Rights of the Child. New York, 1989. http://www2.ohchr.org/english/law/crc.htm (accessed April 28, 2010).
16.
Wiesemann C, Ude-Koeller S, Sinnecker GH, Thyen U: Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents. Eur J Pediatr 169:671–679 (2010).
17.
Wilson BE, Reiner WG: Management of intersex: a shifting paradigm. J Clin Ethics 9:360–369 (1998).
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