There are some medical issues and points of fact that arise with the redefinition of the word ‘gender’ in the Gender-Based Violence and Domestic Violence Bill, from its hitherto biological certainty of a strictly binary categorisation (which, however is currently simplistic) to the other end of the divide as the Bill being discussed in Parliament.

In this Bill the word ‘gender’ is given a very fluid definition, and the Bill is seeking to redefine the word as an umbrella incorporating the socially constructed roles, expectations, activities, behaviours and attributes that society, at any given time, associates with a person being either a male, female, or any other gender.

Gender issues are complex; there are arguments for a binary representation, but probably a spectrum of conditions is more exact.  There are issues that relate to gender identity as well.

Although a binary classification, wherein the population is strictly divided into males and females is no longer tenable, as there are children born who cannot be pigeonholed into either; gender can never be a socially constructed role.

It is however a true statement that commonly, and in most cases, a binary arrangement is evident, but certainly not all-encompassing and there is a percentage that will fall out of this classification of boy/girl and man/woman.

Furthermore gender is an amalgamation of several elements: chromosomal sex, the actual anatomy with internal sex organs and external genitalia, sex hormones, and the psychological make-up and culture (socially defined gender behaviour).

Another issue is that essentially, the Bill seems to confuse gender roles with gender itself.  In the distant past gender roles were stereotyped for specific responsibilities; the male as a doctor, the female as a nurse, the head of the household and breadwinner, the pater familias as it were.

We are now thankfully aware that women can equally excel in those roles.  They make excellent heads of households (if this concept can apply to the modern families perception, where marriage is more about partners), or bread winners.  What the Bill is trying to inculcate as ‘socially constructed roles’ are actually ‘gender roles’ not gender itself.

Human sexuality incorporates a whole spectrum; however the norm is that it is binary as sexual reproduction is a biological phenomenon that can only happen between a male and a female in nature.  The natural rule is that the genetic markers are the sex chromosomes, which for women are XX and for men are XY.

There are however, biological exceptions to the rule, which in medical practice are called differences or variations of sexual development.  In medicine, these are called biological genetic disorders and can cause disorders of sex development.  No pharmaco-therapy and/or surgical procedures can change the DNA which is imprinted in every single cell of our bodies.

It must be admitted, however, that in certain specific cases this treatment may bring a measure of relief to people in severe distress about their gender identity.

Medicine has documented at least 6,500 genetic differences between males and females and because of these differences, pathologies and their management can affect males and females differently.

For example, women are more prone to develop breast cancer than men; men on the other hand are more predisposed to contract prostatic cancer, a gland that is only present in biological males.  However, all members of society need to be treated along strictly personal lines, with treatment options that are individually tailored; the biological status of patients is important but the medical fraternity is obliged to help everyone in distress.

Gender identity is not about the body but about thoughts and feelings

Research suggests that gender identity (a person’s deep-seated internal sense of who you are as a gender, and not necessarily conforming with the external biological status of the person), is something that we are born with and certainly cannot be changed by any surgical and/or pharmacological intervention.

This ‘gender dysphoria’ is recognised as a clinical entity, and it can be a very distressing situation for the individual concerned. These individuals have perfectly healthy bodies but will still develop a sense of questioning their identity.

Gender identity is not about the body but about thoughts and feelings.  These individuals have nothing to do with those who have a variation of sexual development (previously labelled as intersex). If a child is questioning his or her gender, we need to support the child in this delicate phase which in some particular situation might not always mean actively reinforcing the gender reality that child is born with.

By the same token, we should also not actively promote the concept of gender reassignment.  Certainly, such children should never be exposed to the media.

In these situations of variations of sex development and gender dysphoria, despite all the pharmaco-therapy and surgical procedures that medicine can provide at present, in the end the latter will not alter the natural reproductive status of these persons.

People affected by these biological and psychological/emotional realities need support, care, respect and protection, but this will not happen by dismantling or denying biological facts or by labelling the natural family composed of a male and a female as gender stereotypes, advocating the need to eradicate such stereotypes not to emotionally offend individuals with variations of sexual development.

Exceptions do not invalidate the rule and certainly do not justify the change of what medicine understands to be gender and the proposed eradication of the basic medical gender binary truthsof boy/girl, man/woman and father/mother.  These are not gender stereotypes but gender facts.

The State in effect has already addressed these issues through the Gender Identity, Gender Expression and Sex Characteristic Bill of 2016, which implicitly recognises gender as being male and female but gives the right to a person to feel differently and to be recognised as such in official State documents.

While it is appreciated that the State has an obligation to protect every member of society, and to ensure that people with different sexual orientations are respected and not discriminated against, this can never be achieved by dismantling the de facto binary categorisation of society and denying the basic concepts of what makes us human beings and depict biological facts as negative stereotypes.

The government is thus urged to amend the Bill to define appropriately the term gender, and achieving the noble objectives of protecting primarily women against domestic violence without creating confusion in the biological reality of human nature.

Ray Gatt is a consultant orthopaedic surgeon.

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