5. E.

Cosmetic Surgery and Sexual Reassignment

1. Reconstructive and Cosmetic Surgery
Reconstructive surgery raises no special ethical questions, as long as the purpose is
clearly one of restoring or improving normal function.
Cosmetic surgery is not directed at restoring normal function, but at improving
appearance. Human appearance can hardly be called a “function” of the body, yet it is
certainly very important in human life, both with regard to sexual attraction and with regard
to all our social relationships and sense of personal worth.
It is ethically justified if the purpose (of cosmetic surgery) is to acquire, when lacking,
what is generally regarded as a normal, attractive appearance for one’s gender or even to
enhance it. Certainly when the defect in question is real and serious, and especially when it is
associated with some functional defect, such as cleft palate, deformation of facial features,
unsightly birthmarks, etc., such surgery is wholly reasonable.
But when the purpose is simply the enhancement of sexual attractiveness or the
concealment of normal aging, such as face lifting, breast enhancement, liposuction, etc., it is
pertinent to ask whether the expense, the risks, and rationale of such procedures can really be
justified. Society and style often promote stereotypes of youth and beauty which are illusory and
harmful. It is to be feared also that some physicians promote such expensive procedures simply
for their own profit and not for the real welfare of the patient. The fact that people request such
procedures and are willing to pay for them is not a sufficient ethical justification for
physicians to cooperate. While this is not one of the major problems of bioethics, it is
symptomatic of mistaken priorities in the promotion of human health.
The Christian attitude, from New Testament times, has always been that it is wrong to
promote the idea that human worth is to be measured by appearances rather than by
character. Certainly it is unjust for a society to devote so much of its resources to vanity when
the poor lack necessities.

2. Sexual Reassignment
Sexual reassignment is a type of reconstructive surgery by which the sexual
phenotype of a male is altered to resemble that of a female, or vice versa. Such surgery,
along with hormonal treatment and psychotherapy is often used to treat transsexualism when
psychiatric treatment fails. Transsexualism is described in the Diagnostic and Statistical
Manual of Mental Disorders (DSM IV) as involving the following five criteria:
a. Sense of discomfort and inappropriateness about one’s anatomical sex;
b. Wish to be rid of one’s own genitals and to live as a member of the other sex;
c. The disturbance has been continuous (not limited to periods of stress) for at least two
years;
d. Absence of physical intersex or genetic abnormality; and
e. Not caused by another mental disorder, such as schizophrenia.
Transsexual surgery involves radical mutilation: castration and construction of a
pseudovagina for the male, mastectomy and hysterectomy (sometimes also the construction of
a nonfunctional pseudopenis and testes) for the female, along with hormonal treatments with
possible serious side effects. This raises the ethical question of whether the attempt to change a
person’s biological sex is ever a legitimate aim of medical care.
Catholic moralists: where a child is born with ambiguous genitalia, the parents should
raise the child as belonging to that sex in which the person is most likely to be able to
function best. Also, there seems to be no objection to the use of surgery or hormones to improve
the normal appearance or function of such persons in accordance with the sex in which they are
to be or have been raised. The reasoning behind this traditional position is that a person must
“live according to nature” insofar as this is humanly knowable.
Among these possible abnormalities, homosexuality is a highly varied condition,
probably having many etiological factors. In this case a person who is phenotypically
unambiguously male or female and in no doubt about his or her gender is conscious of greater
sexual attraction to those of his or her own sex than to others and who, consequently, is unable to
enter into a satisfactory marriage. Transvestism is a condition in which a person, usually
heterosexual in orientation, is more comfortable sexually while wearing clothing symbolic of the
opposite sex. Transsexualism differs from these because of gender dysphoria syndrome, that is,
an anxiety, sometimes reaching suicidal depression as the result of the obsessive feeling that
one’s “real” sex is the opposite of one’s phenotypic sex.

3. Pros and Cons of Sexual Reassignment

The argument of psychotherapists and surgeons: victims find no relief in other therapies,
are insistent on surgery even to the point of threatening suicide, and are generally satisfied with
its results.
At present, we do not believe this case can be demonstrated for several reasons. First, it
has not yet been established that the cause of gender dysphoria syndrome is biological. The
gender ambiguity in question is primarily psychological and should be treated
psychotherapeutically.
Second, when candidates for surgery are required to undergo psychotherapy in
preparation for surgery, many are found to be ambiguous about really wanting it and in the
end decide against it. Moreover, most transsexuals who have been carefully diagnosed appear
to be suffering from serious psychological problems, sometimes subtle and not immediately
recognized, other than their gender dysphoria.
Third, although when this type of surgery was first introduced there were enthusiastic
reports of its success, as experience accumulates there is less agreement that it does much
good.
Fourth, from a theological point of view, it is clear that surgery does not really solve
these persons’ life problem because it does not enable them to achieve sexual normality or
to enter into a valid Christian marriage and have children.
Pastoral Approach: The fundamental aim of the therapist, as well as of the pastoral
counselor: to restore the patient’s sense of personal self-worth. He or she must be helped to
see, as should homosexuals and those having other sexual problems, that today’s culture is
grievously mistaken in its exaggerated stress on sexual identity and activity as a primary
determinant of human worth. They must be assisted to find interests—spiritual, intellectual,
and social—that will enable them to escape their preoccupation with their sexual identity
and discover their more fundamental as human persons.