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Carolina Infant's Mistaken Sex Assignment Surgery More Than a Case of Malpractice

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When the child identified in court papers only as "M.C." was 16 months old and a ward of the state, doctors and health officials in South Carolina decided that he would become a girl. Born intersex (a term that encompasses individuals with some variation of both male and female sexual and reproductive anatomy), M.C. had "ambiguous genitals" and "both male and female reproductive organs," according to Reuters.

Doctors removed M.C.'s male reproductive organs and eliminated any potential he had "to procreate as a male," said court filings.

But that surgery did not so neatly turn M.C. into a girl. Now age 8, he identifies as a boy.

A lawsuit filed earlier this month by M.C.'s adoptive parents contends that medical professionals sworn to protect the child failed him catastrophically.

Represented by the Southern Poverty Law Center and Advocates for Informed Choice, they argue that doctors convinced the child's state-appointed guardians to go through with surgery without fully disclosing the procedure's enormous risks, which include sterilization and diminished sexual sensation.

The lawsuit also alleges that the state of South Carolina in turn violated M.C.'s constitutional rights by failing to hold a court hearing to determine whether surgery was in the child's best interest. The plaintiffs go on to argue that beyond questions of procedural due process, the government does not have any legitimate, defensible claim to the kind of life-altering power that South Carolina exercised over M.C.

That last bit is most crucial when evaluating the case's implications, because to see this simply as an instance of medical malfeasance and negligence is to miss the larger cultural point. Doctors didn't just treat a condition or a disease incorrectly or too hastily. They didn't treat a medical disease at all. The procedure was done without any medical justification whatsoever, as is historically the case with most intersex infants who undergo such operations.

Instead, they treated a social illness, for which the remedy is making bodies deemed "abnormal" conform to society's strict sex and gender guidelines, and in the process they mutilated a child in their care.

M.C. will spend the rest of his life paying for his caretakers' actions. Should he choose reparative surgery, he'll face multiple expensive operations that might be categorized as elective procedures by an insurance carrier determined not to cover them. He also faces psychological peril. As sociologist Sharon Preves writes in an essay titled "Intersex Narratives: Gender, Medicine, and Identity," "intersexuals who [unknowingly] underwent medical sex assignment in childhood experienced consistently negative and confusing messages about their bodies and their identities."

However, putting aside for a moment the instinct to mourn the fact that M.C. is a boy without a penis, we should recognize that M.C. was violated and victimized long before his identity as a boy emerged. The tragedy is not only physical and psychic; his disfigurement symbolizes his denied right to control his own body and identity. Even if M.C. had grown up to identify as a girl, identify with her surgically altered genitalia and live out her days as a female-bodied woman, the surgery would have been just as problematic and alarming.

To think otherwise is to consent to systemic forces that force us into boxes of pink and blue. These are the same forces that justify reparative therapy or gay "cures," limit women's reproductive rights and so dehumanize intersex bodies that, like M.C., they essentially become science experiments.

After all, it's easier to alter or defile a vulnerable body like M.C.'s to enforce an entrenched social norm than it is to change that norm. For decades, doctors rationalized these surgeries by saying that they saved children from a lifetime of torment. Granted, medical consensus is now a bit vaguer. In 2006, around the time of M.C.'s surgery, the journal Pediatrics published a paper signed by 50 international experts that stated that no proof exists that infant cosmetic genital surgery improves the recipient's quality of life.

Obviously, we have a long way to go from that. And M.C.'s case only challenges the state's ability to take such medical action. It does not address the wide legal dominion that parents have over medical decisions for their children. Either way, the lawsuit will send a strong message. It's fair to assume that parents want what's best for their children, but too often, "best" is interpreted as forcing children (of any stripe) to fit social expectations.

Instead, we need to fight against the norms that rationalize violence against those who, like M.C., fail to fit within arbitrary boundaries of what's "normal," or who present a threat to those boundaries, more precisely. Make no mistake: M.C., with his heretical little body, was a threat. And as an infant unable to give consent and articulate what he wanted, he was, and is, a victim of institutionalized violence, not just bureaucratic error and negligence.

There's nothing Earth-shatteringly new about the current way society polices sex and gender, or about the fact that many find it unnerving when they can't read a human being's gender or, in the case of infants, aren't privy to his or her sex. (Perhaps the internalized debate goes something like, "Do I pick up this mushy body mass gently or really gently?")

For proof, one need only look at the hostile response over the last few years to parents who refused to reveal the sex of their children. They were ridiculed, ostracized, even accused of child abuse, simply because they didn't want to limit their kids to such arbitrary and strict gender distinctions.

Why such an outcry? Infants and, until a certain age, toddlers all look and act pretty much the same. The only things that notably differ are our own reactions to their blue or pink bows, their short or long hair or their skirts or pants.

That doctors should advise families to postpone surgery for intersex infants and toddlers is so obvious that it's almost not worth mentioning. But let's be sure that they're not waiting because there's an inevitable choice to be made between those pink or blue boxes. There should be no expectation of choice, because not only are there too many options to name but there is also this choice: none at all. (M.C. might have been perfectly content enjoying sex from a less limited perspective and labeling himself as he saw fit.) There is nothing wrong with a body that defies social expectations, but there is something abhorrent and ghastly about a compulsion for and obsession with clear gender and sex distinctions that shortchange us all and result in victimizing and mutilating people like M.C.