The controversy over treating congenital adrenal hyperplasia prenatally.
Offline About 1/1500 newborns suffer from this condition with the following manifestations:
Due to inadequate mineralocorticoids:
- vomiting due to salt-wasting leading to dehydration and death
Due to excess mineralocorticoids:
- hypertension (11beta[OH] deficiency)
Due to excess androgens:
- ambiguous genitalia, in some females, such that it can be initially difficult to determine sex
- early pubic hair and rapid growth in childhood
- precocious puberty or failure of puberty to occur (sexual infantilism: absent or delayed puberty)
- excessive facial hair, virilization, and/or menstrual irregularity in adolescence
- infertility due to anovulation
The treatment is with glucocorticoids such as Dexamethasone and limited studies have shown the benefits of this treatment prenatally. The controversy surrounding this treatment is detailed in the following time article:
http://www.time.com/time/health/article/0,8599,1996453,00.html#ixzz0sXZidGII
The significant controversy lies in the narrow social definition of gender. Without treatment, women in particular will not only develop the physical problems requiring surgeries in the future but also the psychosocial problems regarding their gender identity.
The people who are against this are mainly feminists who have no qualms if a woman were to abort a Down's Syndrome fetus but are up in arms if a woman chooses prenatal corticosteroids to prevent CAH.
We can argue till the cows come home on how society has a very rigid and narrow view of gender. But in my mind it would be unfair to withold treatment and have a child suffer the pain of social rejection and alienation. Also he/she would have to endure surgeries to correct their birth defects in order to conform.
Yes there are risks to the fetus with exposure to corticosteroids but there are risks with any medical treatment. If a woman chooses this treatment for her unborn child, isn't this being pro-choice? Would feminists be supportive if she chose to abort the fetus instead?
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It ain't my fucking business what a family chooses to do. Nor what the mother chooses to do. That is my take on the feminist view. IOW, MYOB.
-- I feel so much better since I stopped trying to believe.
"We are entitled to our own opinions. We're not entitled to our own facts"- Al Franken
"If death isn't sweet oblivion, I will be severely disappointed" - Ruth M.
Yah, I kinda throw in with cj on this one. There are people who need to make some really hard decisions. I am not there and I am not affected by the outcome. Honestly, whatever the parents of such a kid do, it is going to suck to be them.
On the other hand, what about the eventual kid should a birth happen?
Parents have the power to order surgery. In this case, power is not the same thing as wisdom.
If we are talking about a kid who will vomit to death before (s)he is three years old, then sure, the parents are authorizing surgery that fits in my definition of wisdom.
If we are talking about a kid who has parts of both sexes, then we are in an odd gray area as far as what ethical matters need to be considered.
The worst case that I can see is that the person simply does not have the junk they need to get the rocks off. If that is the case, then it sucks to be that person but it is what it is.
If the person is someone who can get the rocks off in some way, well, people are quite good at figuring out how to do that. If the situation is such that the person will never get busy with another person, that does not mean that they will never have an orgasm. If a beat off is the only thing that will ever happen then whatever.
If the parents decided to go for surgery to “fix” the problem, well, what if the fix takes away the part that the eventual adult needs to cum? That really, really, really, sucks.
What do the parents say to the kid? Not that the conversation will ever happen but the general idea is along this line:
Hi dad! You decided that my ability to cum was less important than your desire to have a kid that was something that I am not.
=
I am only pro-choice because of the social implications of forcing people to do things (or not do things) they don't want (or do want) to do. In short, consequentialist libertarianism.
I recognize that this is up to the parents only because I can't do anything about it.
If I could (without the social consequences- such as if I had an army of robots that could dictate to society and make any resistance futile [an unlikely scenario at best]), I would give the parent the choice of treatment or abortion in the severe cases [that is, where it maybe profoundly dangerous in the future]- it is unacceptable to bring a child into the world who will have to suffer like that when it's preventable.
In the mild cases of slightly ambiguous gender- does it really matter? No matter what you look like, there's almost always going to be *somebody* who will like it. Seems like there's not as clear cut an answer on that one as to what will happen to the child; although a do-over (abortion) never seems to be a bad choice in uncertain circumstances. If they decided they had to go through with it, and wouldn't treat the mild case, it seems like a mandatory trust fund for the future surgery, if chosen, would be reasonable for the sake of the child.
What I find very peculiar is how groups who seem pro-choice on abortion suddenly take a 180 degrees ethically. Basically, prenatal corticosteroids in treating CAH will allow the infant to be born such that she conforms to the social standards of gender. Those groups (namely feminists and transgender groups) are up in arms over this narrow binary definition of gender to which we all conform to and this decision is being made for a hapless unborn child who has been prenatally diagnosed with this condition. And indeed it would be wonderful if we lived in a utopian society wherein gender is transcended. But in the here and now, we do have a binary definition of gender and the option to treat prenatally and prevent future surgeries in my mind is a good thing.
This IMO is no different than aborting a fetus who will suffer from Down's Syndrome. We have a social definition of intelligence which can be argued as being just as narrow as the social binary definition of gender. Yet those same groups that protest this prenatal treatment seem to have absolutely no qualms over aborting a fetus with Trisomy 21 or any other genetic disorder.
Except I should have to pay for the fetus if she wants to abort or treat it in the womb. I should pay for the treatment of the children with this condition. Isn't that the real feminist view? Having your cake and eating it too.
Don't you see the hypocrisy of hands off my body but then society should pay for whatever comes out of the body? So the feminists that support socialized medicine actually make it my business.
Taxation is the price we pay for failing to build a civilized society. The higher the tax level, the greater the failure. A centrally planned totalitarian state represents a complete defeat for the civilized world, while a totally voluntary society represents its ultimate success. --Mark Skousen
I will begin by saying that CAH has a broad spectrum of presentation. In certain cases there will be normal lifespan, fertility & corrective surgerycan adequately address physical appearance.
Karyotypic gender can still be determined eg XY or XX and the appropriate surgery carried out (depending on severity). Plenty of people will require surgery in their life & plenty will develop psychosocial issues without physical ill health. Are they good enough reasons to terminate a pregnancy? In the UK it is mum's decision. However as I said baby could lead a relatively normal life, unlike Down's or Turner's Syndrome etc
Why are they against steroids? Steroids are a very common obstetric drug frequently given for premature birth