Intersex people in theUnited Kingdom face significant gaps in legal protections, particularly in protection from non-consensual medical interventions, and protection from discrimination. Actions byintersex civil society organisations aim to eliminate unnecessary medical interventions and harmful practices, promote social acceptance, and equality in line withCouncil of Europe andUnited Nations demands.[1][2] Intersex civil society organisations campaign for greater social acceptance, understanding of issues of bodily autonomy, and recognition of the human rights of intersex people.
The island ofJersey has enacted limited protections from discrimination. These do not protect an intersex person from unwanted medical interventions, nor address other issues raised in theMalta declaration.
Hywel the Good's laws,c. 940 CE, include a definition on the rights of hermaphrodites in Wales.[3]Henry de Bracton'sDe Legibus et Consuetudinibus Angliae ("On the Laws and Customs of England"),c. 1235,[4] classifies mankind as "male, female, or hermaphrodite",[5] and "A hermaphrodite is classed with male or female according to the predominance of the sexual organs."[6] The 17th-century English jurist and judgeEdward Coke (Lord Coke), wrote in hisInstitutes of the Lawes of England on laws of succession stating, "Every heire is either a male, a female, or an hermaphrodite, that is both male and female. And an hermaphrodite (which is also calledAndrogynus) shall be heire, either as male or female, according to that kind of sexe which doth prevaile."[7][8] TheInstitutes are widely held to be a foundation ofcommon law.
Accounts of intersex people includeHerefordMappa Mundi, a medieval map of the known world (c.1300), includes a hermaphrodite, outside the borders of the world known to its makers.[9][10] In the mid 19th-century,The Welshman newspaper published an account of a child on 7 November 1851.[11] Another case was reported in 1906 byThe Cambrian newspaper in Wales, on the death in Cardiff of an intersex child who, at post-mortem examination, was determined to be a girl.[12] Known historical intersex figures in the UK includeSir Ewan Forbes (1912–1991), 11th Baronet of Craigievar,Dawn Langley Simmons (1937 or 1922 to 2000), English author and biographer, andGeorgina Somerset (née Turtle) (1923–2013), the first openly intersex person in the UK.[13] Prominent present day individuals include "national LGBT treasure"Seven Graham, writerIain Morland,Lady Colin Campbell, author ofGuide to Being a Modern Lady,Lisa Lee Dark, Welsh opera singer and voice actress,Dee Palmer ofJethro Tull, andCaroline Cossey.
The first recorded suggestion to replace the term 'hermaphrodite' with 'intersex', in medicine, came from British physician Cawadias in the 1940s.[14] This suggestion was taken up by other physicians in the UK during the 1960s.[15][16]
Intersex UK co-founder Holly Greenberry spoke at the "firstUnited NationsHuman Rights Council side event on intersex issues" in March 2014, alongsideMauro Cabral and representatives ofOrganisation Intersex International Australia andZwischengeschlecht.[20] She was also quoted in a feature inThe Independent stating: "We are at a tipping point ... Most intelligent human beings would be completely surprised and utterly dismayed at the civil inequality and human rights abuses that healthy intersex children and young adults are facing."[19]
In a 2017 BBC News report, a representative of the Androgen Insensitivity Syndrome Support Group stated that doctors routinely withheld truth about patients' diagnoses from their patients up until 2012.[21]
Specialists at the Intersex Clinic at University College London began to publish evidence in 2001 that indicated the harm that can arise as a result of inappropriate interventions, and advised minimising the use of childhood surgical procedures.[22][23][24][25][26][27][28][29][30] Data presented in recent years suggests that little has changed in practice. Creighton and others in the UK have found that clitoral surgeries on under-14s have increased since 2006, and "recent publications in the medical literature tend to focus on surgical techniques with no reports on patient experiences".[31]
Parents are frequently considered able to consent to feminising or masculinising interventions on their child, and this may be considered standard for the treatment of physical disorders. However this is contested, particularly where interventions seek to address psychosocial concerns. ABMJ editorial in 2015 stated that parents are unduly influenced by medicalised information, may not realise that they are consenting to experimental treatments, and regret may be high.[32] The editorial described current surgical interventions as experimental, stating that clinical confidence in constructing "normal" genital anatomies has not been borne out, and that medically credible pathways other than surgery do not yet exist.[32]
A footnote to aHouse of Commons report on transgender equality in 2016 suggested thatintersex medical interventions were matters of the past,[33] and the country denied such practices in statements to the UNCommittee on the Rights of the Child later the same year.[34] However, this was belied by data presented to the UN Committee byintersex civil society organisations later in 2016, includingNational Health Service Hospital Episode Statistics and clinical publications.[35] In its concluding observations, the Committee expressed concern at "medically unnecessary surgeries and other procedures on intersex children before they are able to provide their informed consent, which often entail irreversible consequences and can cause severe physical and psychological suffering, and the lack of redress and compensation in such cases". It called on the government to "guarantee bodily integrity, autonomy and self-determination to children concerned, and provide families with intersex children with adequate counselling and support", educate professionals, and provide redress.[36]
In 2017, the president of the British Association of Paediatric Urologists stated that "irreversible surgery is rarely performed in infancy" with parents fully involved in decision-making. Holly Greenberry ofIntersex UK stated that parents remain coerced into making early surgical decisions.[21]
In October 2017, within a framework on protecting the integrity of the person, the UN Committee on the Rights of Persons with Disabilities called on the United Kingdom government to "repeal all types of legislation, regulations and practices allowing any form of forced intervention or surgery, and ensure that the right to free, prior and informed consent to treatment is upheld and that supported decision-making mechanisms and strengthened safeguards are provided, paying particular attention to women, intersex persons, girls and boys".[37]
Intersex people are protected from discrimination inJersey. Since 1 September 2015,Discrimination (Jersey) Law 2013 includes intersex status within its definition of sex. Sex is one of the prohibited grounds under the act, meaning that discrimination on this basis is prohibited. The act provides that:
"Sex"
(1) Sex is a protected characteristic. (2) In relation to the protected characteristic – (a) a reference to a person who has that characteristic is a reference to a man, a woman or a person who has intersex status; (b) a reference to persons who share the characteristic is a reference to persons who are of the same sex. (3) In this paragraph, a person has intersex status if the person has physical, chromosomal, hormonal or genetic features that are – (a) neither wholly male or female; (b) a combination of male or female; or (c) neither male nor female
— Discrimination (Jersey) Law 2013, Schedule 1, as amended[38]
The United Kingdom does not permit intersex people to change sex classification, except by declaring that they are transgender and following relevant medical protocols including a diagnosis ofgender dysphoria.[39]
Intersex people’s right to life can be violated in discriminatory “sex selection” and “preimplantation genetic diagnosis, other forms of testing, and selection for particular characteristics”. Such de-selection or selective abortions are incompatible with ethics and human rights standards due to the discrimination perpetrated against intersex people on the basis of their sex characteristics.[1]
Notable intersex rights organisations includeIntersex UK,OII-UK and the UK Intersex Association. Notable advocates includeAnick Soni, co-founder of charity InterconnectedUK and aFellow of the Royal Society of Arts,[42][43][44] andSeven Graham.[45]Iain Morland has written extensively on intersex issues, including through personal testimony.[46][47][48] Morland also co-foundedCritical Sexology in 2002, a continuing interdisciplinary seminar series on gender and sexuality.[49]
^E Coke, The First Part of the Institutes of the Laws of England, Institutes 8.a. (1st Am. Ed. 1812).
^Greenberg, Julie (1999). "Defining Male and Female: Intersexuality and the Collision Between Law and Biology".Arizona Law Review.41:277–278.SSRN896307.
^Somerset, G. T. (1992)A Girl Called Georgina – Over the Sex Border, London, The Book Guild.
^Cawadias, A. P. (1943)Hermaphoditus the Human Intersex, London, Heinemann Medical Books Ltd.
^Armstrong, C. N. (1964) "Intersexuality in Man", IN ARMSTRONG, C. N. & MARSHALL, A. J. (Eds.)Intersexuality in Vertebrates Including Man, London, New York, Academic Press Ltd.
^Dewhurst, S. J. & Gordon, R. R. (1969)The Intersexual Disorders, London, Baillière Tindall & Cassell.
^Creighton, Sarah M.; Minto, Catherine L.; Steele, Stuart J. (14 July 2001). "Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood".The Lancet.358 (9276):124–125.doi:10.1016/S0140-6736(01)05343-0.PMID11463417.S2CID1390872.
^Minto, Catherine L; Liao, Lih-Mei; Woodhouse, Christopher R. J.; Ransley, Phillip; Creighton, Sarah M (12 April 2003). "The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study".The Lancet.361 (9365):1252–1257.doi:10.1016/S0140-6736(03)12980-7.PMID12699952.S2CID10683021.
^Crouch, Naomi S.; Minto, Catherine L.; Liao, Lih-Mei; Woodhouse, C R J; Creighton, Sarah M. (2004). "Genital sensation after feminizing genitoplasty for congenital adrenal hyperplasia: a pilot study".BJU International.93 (1):135–138.doi:10.1111/j.1464-410x.2004.04572.x.PMID14678385.S2CID6928518.
^United Kingdom; House of Commons; Women and Equalities Committee (January 2016),Transgender Equality(PDF),archived(PDF) from the original on 2 October 2017
^Morland, Iain (2005). "'The Glans Opens Like a Book': Writing and Reading the Intersexed Body".Continuum: Journal of Media & Cultural Studies.19 (3):335–348.doi:10.1080/103043110500176586.S2CID145009069.
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