TERM PAPER NURSING 352

Sandra Sasse June 28, 2011 Ethics and Law

There is a line that calls to be drawn when it comes to the advancement of science and the fragility of humanity. We seem to find numerous cases that tragically cross ethical lines in the name of "science". We as scientists yearn and push for the rapid progression of science yet, there are times we are horrified at the blood that is spilt along the way. The case I will examine and discuss is horrific and saddening but it teaches us all a lesson on how we must always keep humanity and ethics in mind. After discussing the details of the case I will examine the ethics that are firmly placed within the healthcare profession that were violated and discuss how the tremendous case changed our laws in the United States and globally. David's parents were young Canadians from farm country. They fell in love and on August 22, 1965 had twins, twin boys to be exact. Their first few months of life were like any others but Davids mother noticed that her twin boys were having difficulty urinating. Naturally concerned, his mother took her sons to the doctor and was advised to have them both circumcised. (Altered Dimensions, 2008) Her doctor "used an electro cautery needle, instead of a scalpel, to excise Davids foreskin during a routine circumcision, burning off his entire penis as a result." (Altered Dimensions, 2008) Devastated, the parents were referred to Johns Hopkins Hospital in Baltimore, home of the world's leading expert in gender identity, psychologist Dr. John Money, who recommended a surgical sex change, from male to female.(Calpinto, 2004) David's parents agreed to the radical procedure, believing Dr. Money when he claimed this would be the only hope

for their child to have a normal life. For Dr. Money, David was the ultimate opportunity for an experiment to prove that nurture, not nature, determines gender identity and sexual orientationan experiment all the more irresistible because David was an identical twin. His brother, Brian, would provide the perfect matched control, a genetic clone raised as a boy. (Calpinto, 2004) David's infant "sex reassignment" was the first ever conducted on a normal child. The procedure was considered successful and it was documented that the twins were adjusting quite well to their new roles. Dr. Money was gaining a lot of attention and this radical idea of nurture overruling nature got him featured in Time magazine. (Calpinto, 2004) Sadly, David was having a horrible time adjusting to his new Brenda role. He became very angry and would tear the dresses he wore off and would fight his brother to play with his toys instead of playing with the dolls that were given to him. Dr. Moneys discovery or success experiment was in fact a disaster. Understandably Davids frustrating grew as he got older, he felt so out of place and dreaded the annual visits to Dr. Money where his insistence to be more feminine was reinforced. Davids turmoil didnt end with him, it affected the entire family. His mother feeling horribly guilty attempted suicide and his father became an alcoholic. The most tragic was what happened to his twin brother, due to all the issues the family had with

Brenda his brother David felt ignored and acted out with drug use and getting in trouble with the law. (Altered Dimensions, 2008) When Brenda (David) was 14, a local psychiatrist convinced his parents to finally be honest with their child. David stated that "Suddenly it all made sense why I felt the way I did. I wasn't some sort of weirdo. I wasn't crazy." (Calpinto, 2004) Soon after being told the truth he went through several procedures to change him back into a man. All of his procedures were quite long and painful and though the scares may have physically healed his emotional scares were still open. In his twenties he attempted suicide twice; he was convinced he could never marry since he was physically unable to have children. (Milton & Beh, 2005) Things began to turn around in Davids life when met a woman and fell in love and got married. Unfortunately, he still had not recovered from his horrific past and it did cause a lot of problems in his marriage. By chance David happened to meet Dr. Milton Diamond, a psychologist at the University of Hawaii and a longtime rival of Dr. Money. To Davids shock he found out that Dr. Money considered his sex reassignment surgery a success and his case was used to legitimize the widespread use of infant sex change in cases of hermaphroditism and genital injury. It was as if David could never escape the shadow of Dr. Money. Outraged, David agreed to participate in a follow-up by Dr. Diamond, whose myth-shattering paper (coauthored by Dr. Keith Sigmundson) was published in Archives of Pediatrics

and Adolescent Medicine in March 1997 and was featured on front pages across the globe. (Calpinto, 2004) Now David had a voice and helping Dr. Diamond expose Dr. Money propelled him to agree to conduct several interview about what happened to him and eventually he wrote a book called As Nature Made Him: The Boy Who Was Raised as a Girl (Milton & Beh, 2005) Davids motive for writing his book was partly therapeutic and partly to raise awareness. Sadly, things began to go downhill again for David, his twin Brian died of an overdose of antidepressants in the spring of 2002. David became depressed; he also made some bad investments with his money and had marriage problems. Eventually, his traumatic life became too much for him and he ended his life. (Milton & Beh, 2005) Genetics almost certainly contributed to David's suicide. His mother has been a clinical depressive all her life; his brother suffered from the same disease. How much of the Reimers' misery was due to inherited depression, and how much to the nightmare circumstances into which they had been thrown? (Ellis & Hartley, 2001) I would imagine it was a combination of both. Perhaps with the right amount of drugs and therapy he could have overcome his unfortunate past. David is a very good example of a patient becoming a victim of science. He was used to prove an over ambitious scientists theory that gender was determined by nurture, not nature. Dr.

Money theory was proven wrong and it cost an entire family to suffer as a result of his selfish motives. Clearly Dr. Maloney was not completely honest with David's parents. They were young farm teenagers from Canada and could be easily manipulated. Dr. Maloney used them for his own theory and research. He never bothered to explain the possible outcomes from the gender reassignment surgery. They blindly agreed to his recommendation not knowing the tragedy that was to come. As a result this case pushed the requirement of informed consent. (Lloyd, 2005) Informed consent requires the health provider to explain the negative and positive outcomes of the procedure. It is now required that they also provide other possible options. Dr. Maloney did not keep in mind and violated several areas of his ethical laws. The first ethical law he violated is justice. The poor child did not get justice, he was definitely just used a tool for Dr. Maloneys theories. Justice is the obligation to be fair to all people clearly justice was not evident with Dr. Maloney and the patient. (Pozgar, 2005) He was in fact unfair to the innocent child. There is nothing fair in deciding to change a childs gender and observe the reactions in order to prove his own theory. They only result of justice from this sad story was that it aided in the requirement of informed consent. Thanks to Mr. Reimers bravery in coming forward with his story he

was able to further convince the world that informed consent was necessary in order to protect patients.

The second ethical principle he broke was autonomy which requires that the patient have autonomy of thought, intention, and action when making decisions regarding health care procedures. (Stanford University, 2005) Therefore, the decision-making process must be free of coercion or coaxing. Dr. Maloney was definitely in violation of this ethical requirement! He definitely persuaded and misleads Mrs. Reimer when he convinced her to go ahead with the procedure without fully informing her of the possible consequences. He was actually currently performing the experiment to his theory that nurture is more powerful to nature when it comes to gender; yet he was convincing her that it was already proven.

The third ethical law that was neglected was beneficence. This ethical principle requires that the procedure be provided with the intent of doing good for the patient involved. Demands that health care providers develop and maintain skills and knowledge, continually update training, consider individual circumstances of all patients, and strive for net benefit. Doing good also requires that the healthcare provider have knowledge of the beliefs, culture, values and preference of the patient. (Pozgar, 2005) In the Reimer case the doctor did not consider the preference of the patient but his

actual preference when it came to David Reimer. There was nothing good about forcing David to be a girl when he was born a boy. His suffering could have been far less if they had raised him a boy and treated him as such.

Lastly, non-maleficence was also violated. Requires that a procedure does not harm the patient involved or others in society. There is no doubt that Reimer was affected and harmed on so many levels. Dr. Money capitalized on his success with the Reimer experiment until Milton Diamond's research and a BBC documentary in 1980 questioned the "success" of the experiment. Dr. Moneys false experiment was incorrectly used as an argument to preform gender reassignments on babies. (Pozgar, 2005) Due to the gross negligence of Dr. Maloney there was a push for protection of patients and their rights. The Reimer case definitely had a huge influence on the requirement of informed consent. Their used this case in particular to drive the point that doctors are required to explain exactly what the patient is getting and what are the alternatives. According to our book Legal and Ethical Issues, informed consent is a legal concept that provides that a patient has a right to know the potential risks, benefits and alternatives of a proposed procedure. (Pozgar, 2005) Dr. Money did not inform the Reimers of any of this information. If Reimer would have known about the potential risks I seriously doubt that any parent would be willing to put their child in that predicament. I believe the biggest disservice that the

Reimers received was not to inform that of alternatives. Basically they were lead to believe that the radical gender change was their only option. Imagine if Reimers mother was clearly informed there is no doubt it could have completely changed the whole course of David Reimers life. Perhaps he would still be with us if his mother was properly informed. Sadly, it took cases like Reimer to change the laws that protect us today. A belief in the fundamental adult human right to determine what will be done to his own body is the foundational principle leading to the doctrine of informed consent in the doctor-patient relationship. (Martin, 2002). If Dr. Maloney just went by the ethical code all health professional promise to abide by this tragedy could have been avoided. Now Dr. Maloney has blood on his hands all if in the name of research and science.

References

1.

Altered Dimensions- Institute for Paranormal and Esoteric Research (2008) The Story of David Reimer- a boy in girls clothing http://www.altereddimensions.com

2. Colapinto, John (2004) Gender Gap

http://www.slate.com/id/2101678/
3. MILTON DIAMOND, PH.D. & HAZEL GLENN BEH, PH.D., J.D. (2005) The

Right to be Wrong- Sex and Gender Decisions http://www2.hu-berlin.de/sexology/BIB/DIAM/right.htm

4. Ellis, Janice R. and Celia L. Hartley (2001) Nursing In Today's World:

Challenges, Issues and Trends, 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins Publishing

5. Lloyd, Erin (2005) From the Hospital to the Courtroom: A STATUTORY

PROPOSAL FOR RECOGNIZING AND PROTECTING THE LEGAL RIGHTS OF INTERSEX CHILDREN

https://litigation-essentials.lexisnexis.com/webcd/app? action=DocumentDisplay&crawlid=1&doctype=cite&docid=12+Cardo zo+J.L.+ %26+Gender+155&srctype=smi&srcid=3B15&key=8ede8c02d34161 436a9c3ed85d7a6851

6. Stanford University (2009) What are the Basic Concepts of Medical

Ethics http://www.stanford.edu/class/siw198q/websites/reprotech/New %20Ways%20of%20Making%20Babies/EthicVoc.htm

7. Martin, Patricia (2002) Moving toward an international standard in

informed consent: the impact of intersexuality and the Internet on the standard of care http://findarticles.com/p/articles/mi_go2943/is_2002_Summer/ai_n7042 230/
8. Pozgar, George (2005) Legal and Ethical Issues For Health Professionals. Sudbury: Jones and Bartlett.