Sydney,
Australia — Medical and ethical experts
yesterday questioned a landmark Australian court ruling
allowing a 13-year-old girl to begin sex change
treatment. <http://www.austlii.edu.au/au/cases/cth/family_ct/2004/297.html>
The Family Court in
Melbourne heard that the girl, known only as Alex, became
suicidal at the onset of puberty and genuinely believed
that she was a boy trapped in a girl's body.
The court was told that
Alex was raised as a boy by her father, who died when she
was six. She believed she was a boy until the age of five
and dressed as a male.
She was the only girl on
her primary school cricket team, regularly beat the boys
at arm wrestling and would wear nappies to school rather
than use the girls' lavatories.
But she has no male
chromosomes and has female reproductive organs and
hormone levels typical of a teenage girl.
Despite claims that the
child was too young to make an informed choice, the court
ruled in favour of allowing preliminary sex change
processes.
This would involve
reversible treatment to prevent menstruation until the
age of 16, followed by two years of irreversible
testosterone treatment to promote muscle growth,
enlargement of the clitoris and development of a deep
voice, then genital surgery at 18.
It is the first time that
the family court has allowed a minor to begin sex change
processes based purely on psychiatric grounds.
"I have
uncontroverted evidence not only that the procedure is
entirely consistent with Alex's wishes but also that
the expert evidence as to the best interests of Alex
accords with those wishes,"
Chief Justice Alastair
Nicholson said.
He said that Alex, a ward
of the state, was "suffering in a body which feels alien
to him and disgusts him". A state welfare department
initiated the legal action for the child.
The outgoing judge had
received submissions from Alex's school principal,
psychiatrists, case workers and specialists in children's
gender identity.
He said that he was
satisfied Alex knew the risks of the treatment and that
steps had been taken to counter "challenges in his chosen
identity in respect of peer relationships, possible
bullying and ostracism".
Bill Glasson, President
of the Australian Medical Association
<http://www.ama.com.au/>,
said that he was surprised by the decision and added that
society had to treat such cases cautiously, particularly
when the person involved was so young.
"It puts a huge
amount of responsibility on the child," he said. "Is
that child informed enough of the consequence of the
action? Are we actually doing the right thing in the
long term? I think that's for the community to debate
the issue."
Nick Tonti-Filippini, a
bio-ethicist and a member of the Catholic Church's John
Paul II Institute for Family and Marriage in Melbourne,
condemned the decision.
"There is no evidence of
the benefits of the procedure in adults let alone a
13-year-old who is undergoing the changes of
adolescence," he said.
"The court is endorsing
an experimental treatment for a psychiatric
problem."
He said that Alex's
condition, formally known as gender identity dysphoria,
was commonly treated as a mental illness, not through
invasive and ineffective surgery.
"The girl won't become a
man and what's being obliterated won't be replaced," he
said.
However, Louise Newman, a
spokeswoman for the Royal Australian and New Zealand
College of Psychiatrists <http://www.ranzcp.org/>,
said that the court had made a sensible decision in
Alex's case.
"Here the degree
of stress is so great that going through the hormonal
and bodily changes of puberty would actually be too
distressing for the child to tolerate," she told ABC
radio.
One man who had undergone
a sex-change that he later regretted spoke out against
the decision. Alan
Finch, who became
Helen when he was 19, told the Australian Associated
Press that two years after he had his penis and testicles
removed he realised he had made a mistake.
He said that yesterday's
decision outrageous.
"How can someone who is
suicidal, threatening self-harm, be capable of making a
stable decision about having irreversible therapy done?"
he said.
Mr Finch said that he no
longer believed it was possible to have a successful sex
change. Those who realised they had made a mistake were
left with ruined lives, he said.
"They are left with a
body that has been mutilated, which is what has happened
to me."
Mr Finch is now suing
Southern Health <http://www.southernhealth.org.au/>
for inadequate counselling and for encouraging him to
have the sex change.
