Name and sex assigned at birth

Like many others, the Italian legal system is based on a dualism whereby every person, at birth, must be assigned to either the female or the male sex, and given a name in keeping with it. The law requires that a birth declaration be made within three days of the birth at the Health Directorate of the hospital or clinic where the birth took place, or within ten days at the Civil Status Office of the municipality where the baby was born or the municipality of residence of the parents (Presidential Decree No. 396, Nov. 3, 2000, Article 30). The “sex of the child” is explicitly required in the declaration (Art. 29), and the chosen name must correspond to it (Art. 35). In many countries —Italy included— surgeries are often performed to modify sexual characters to make the child's body conform to canons considered to be “normal”, in order to “resolve” the doubt about registry assignment. The expert opinion of the National Committee for Bioethics on this issue recommends that any intervention on a child’s body be guided by the principle of acting in the best interest of the child, avoiding non-medically necessary and non-urgent mutilations, as well as properly informing the family (Comitato nazionale per la Bioetica, I disturbi della differenziazione sessuale, parere del 25.2.2010, available at www.governo.it/bioetica/pareri.html).

Whereas, for assigning a sex and a name, it is possible to wait and see how the child’s body develops in the first few months, wherever ambiguity in the genital apparatus would make surgery complex and uncertain. Profiting from the time a “late declaration” entails (Art. 31, Presidential Decree 396/2000), one could wait for the body to develop naturally, and assign the minor to the “prevailing sex.” This would avoid surgery, or at least delay it until the person can express their consent.

Medical-surgical treatment, in fact, should be practised only when necessary and urgent, verifying, on a case-by-case basis, what therapies are feasible, and properly informing the parents and the person concerned about the available options. This approach could avoid merely cosmetic treatments, which often generate a negative impact on the person's entire existence, as scientific studies on the subject have shown. The issue of informed consent is problematic because it presupposes full awareness by the person concerned, or by those who have the right to make decisions on their behalf, about the consequences and impact generated by a medical health treatment. In fact, intersex people regularly report poor awareness, for example, about the actual degree of well-being attainable, and parental consent may never justify practices that are detrimental to the integrity of the minor.