February 23, 2024

Have ‘male’ and ‘female’ become cusswords in contemporary bioethics?

The Journal of Controversial Ideas is an unusual academic publication. Its articles are peer-reviewed and rigorously edited. Its editors are leading philosophers and bioethicists -– Jeff McMahan, Francesca Minerva, and Peter Singer. Yet unlike other journals, it offers authors the possibility of publishing under pseudonyms if they fear being abused or attacked because their views “might be regarded by many people as morally, socially, or ideologically objectionable or offensive”.

The editors are no strangers to controversy. Singer, for instance, has been reviled for his views on animal rights, abortion, infanticide, and euthanasia.

In the latest issue of the journal is an article (“Sex Categories in Healthcare Contexts―A Consequentialist Analysis”) which argues in favour of an idea which once seem utterly uncontroversial – that hospital paperwork should require patients to inform doctors of their sex. The authors, Susanna Flavia Boxall, of California State University, Chico, and Becky Cox-White, approach the problem from a consequentialism perspective. Their conclusion is:

As we have shown, the practical uses of this binary in the practice of medicine have had—and continue to have—practical utility. We have further shown that the negative consequences of removing the sex question from healthcare forms—which will not solve the problems the Authors identify—are extensive, intense, enduring, certain, and will affect millions of people. These significant harms outweigh the uncertain benefits to many fewer trans and non­binary patients. Finally, we have shown that correctly identifying a patient’s sex is relevant to appropriate and therapeutically successful healthcare—for trans and non­binary patients as well as binary patients. For these reasons, we reject the suggestion to remove the sex question from healthcare forms as both immoral and impractical.

What’s remarkable about this article, which is well-informed and competently argued, is not its content but its location – in the Journal of Controversial Ideas. The idea of the sex binary has become so objectionable that it could find no other home. A sign of the times.