Abstract：
When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors (\"children\"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or \"endosex\" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from \"cosmetic\" labiaplasty to medicalized ritual \"pricking\" of the vulva, insofar as the procedure is not strictly necessary to protect the child\'s physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child\'s privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter\'s sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians\' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.
摘要：
在道德上什么时候允许临床医生对合法未成年人的生殖器进行手术干预？我们区分自愿和非自愿程序，并专注于非自愿程序，特别是青春期前未成年人(“儿童”)。我们不处理青春期或成年期的程序。关于出生时被归类为女性的儿童，他们的性发育没有明显差异(即，非双性人或“endosex”女性）在全球北方有一个近乎普遍的道德共识。这一共识认为，临床医生不得进行任何非自愿生殖器切割或手术，从“美容”阴唇成形术到外阴的医学仪式“刺痛”，只要程序不是严格必要的，以保护儿童的身体健康。所有其他动机，包括可能的社会心理，文化,主观审美，或由医生或父母判断的预防性益处，被认为是临床医生在该人群中进行非自愿生殖器手术的绝对不适当的理由。我们认为，能够支持这一共识的主要道德原因不是基于经验上可竞争的收益风险计算，但在一个基本的关注尊重孩子的隐私，身体完整性,发展性界限，（未来）生殖器自主性。我们证明了这些道德理由是合理的。然而,正如我们争论的那样，它们不仅适用于endosex女童，而是对所有孩子来说，不管性别特征如何，包括那些有双性特征和内性男性。我们得出结论，因此,作为一个正义的问题，包容性，和医学伦理政策中的性别平等(我们不采取刑法立场)，不应允许临床医生对青春期前未成年人进行任何非自愿生殖器切割或手术，无论后者的性别特征或性别分配，除非迫切需要保护他们的身体健康。相比之下,我们建议老年人的自愿手术，在一定条件下,允许出于更广泛的原因进行，包括自我认同或社会心理健康的原因，根据情况，值,以及相关人员的明确需求和偏好。注意：由于我们的职位与临床医生在受监管的医疗保健系统中广泛接受的特定角色职责有关，我们不考虑在医疗保健背景之外进行的生殖器手术(例如，出于宗教原因)或以专业身份工作的持牌医疗保健提供者以外的人。
