All fields of knowledge have histories in which concepts and objects have been developed through enactments of discourse and participation in practices by professionals or experts in the particular field of study. For the history of medicine this is doubly true: methods of experimentation and ethical issues as well as understanding experiments are developed through time and in the context of institutionally organized knowledge, subject to the influences of political economy and social relations. Perhaps this is common sense following the influence of Michel Foucault. But less well known is that Foucault developed his approach to understanding the history of systems of thought under the influence of his teachers, George Canguilhem and Gaston Bachelard (Gutting, 1989).

According to Canguilhem (1988), the proper study of the history of science, conducted by the philosopher or historian, is such that the development of concepts and objects in the discourse of the particular science are traced and explained. In his work Canguilhem mixes his own words with those of Bachelard who more than any other has shown how to approach the historical exploration of science from a position grounded in epistemology.
 

[In] Le Materialisme rationnel the notion of epistemological discontinuity in scientific progress is supported by arguments based on the history and teaching of science in the twentieth century. Bachelard concludes … “Contemporary science is based on the search for true facts and the synthesis of truthful laws.” By truthful Bachelard does not mean that scientific laws simply tell a truth permanently inscribed on objects or intellect. Truth is simply what science speaks. How, then, do we recognize that a statement is scientific? By the fact that scientific never springs fully blown from the head of its creator. A science is a discourse governed by critical correction. If this discourse has a history whose course the historian believes he can reconstruct, it is because it is a history whose meaning the epistemologist must reactivate. “Every historian of science is necessarily a historiographer of truth. The events of science are linked together in a steadily growing truth…. At various moments in the history of thought the past of thought and experience can be seen in a new light.” Guided by this new light, the historian should not make the error of thinking that persistent use of a particular term indicates an invariant underlying concept or that persistent allusion to similar experimental observations connotes affinities of method or approach. (Canguilhem, 1988, pp. 11-12)

In using this approach to study infant sex reassignment, we will map out change and stability in the concepts that construct our understanding of inter-sexuality, and especially of the concepts of experiment and of ethics that inform it. To that end I will discuss a case of sex reassignment of an infant, and then analyze the changes and stability of concepts of experiment and ethics.

A Case of Medical Experimentation: How Bruce Became Brenda

During the decade of the 1960s, to be precise, on 22 August 1965, twin boys were born to a family living in Alberta Canada. They were named Bruce and Brian Reimer. Normal enough as newborns, they were left uncircumcised until around seven months of age when they were experiencing difficulty urinating. Their mother had become alarmed at their crying even after change of wet diapers and brought them to a pediatrician. He diagnosed the condition as “phimosis” saying it was not rare and could be remedied by circumcision. Surgery was scheduled for 27th April in St. Boniface Hospital (NOVA, 2002).

The parents were not unusually worried except for the normal concerns of parents for a child undergoing surgery, and the hospital was prepared for a fairly routine procedure undertaken by pediatric surgeons on a regular basis. What was to transpire was anything but ordinary. The pediatrician experienced in circumcisions was unavailable for reasons lost to history. Instead a forty-six year old general practitioner named Dr. Jean-Marie Huot inherited the duty of performing the surgery. It was purely happenstance that Bruce was selected as the first to be surgically altered. The inexperienced Dr. Huot used a Bovie cautery machine to cut the foreskin rather than clamps and scalpel typically used for circumcising (Colapinto, pp. 11-12). The cataclysmic resulted from this procedure. The foreskin as well as the entire penis of infant Bruce went up in smoke, looking like a piece of charcoal, in a matter of a few days it shattered, crumbling in pieces. With nothing left of the penis surgical reconstruction was impossible. No surgery was attempted on Bruce’s twin brother Brian.

One can only imagine the horror and emotional upheaval that Bruce’s parents underwent following such a tragedy. Bruce’s parents, Ron and Janet Reimer, with the help of one of Canada’s Winnipeg plastic surgeons who discussed the case of Bruce with doctors at the Mayo Clinic, became aware of the work of Harvard educated, New Zealand born psychologist John Money (1999). Dr. Money was a specialist in cases of adult transgender identity and of infants with ambiguously formed genitalia and sexual identity. His dissertation was entitled Hermaphroditism: An Inquiry into the Nature of a Human Paradox (1952). He approached hermaphrodites from a psychological perspective heavily based on Freud, understanding the repercussions both emotionally and mentally of growing up as neither anatomically a boy nor a girl.  He was hired to work at the first clinic in the United States and world devoted to treating adults that were confused in their gender identity and infants that were hermaphroditic. This clinic known as the “Psychohormonal Research Unit” was directed by Lawson Wilkins, a pioneering pediatric endocrinologist, who “teamed Money with two married psychiatrists, Drs. Joan and John Hampson, to study the mental and emotional makeup of the inter-sexual patients treated in the clinic” (Colapinto, pp. 31-32).

John Money, educated at Harvard, easily gained status among medical researchers at Johns Hopkins, the premiere American research university. He was the driving force behind the hospital’s adoption and promotion of the surgical alteration of intersexed infants. But, he wasn’t chiefly interested in intersexes.

 
He recognized the scientific worth of intersexes primarily as what he called “experiments of nature”—as a cohort of research subjects who could shed light on the question of sexual development in normal humans—who could in fact resolve one of the longest-running debates in science; namely, whether it is primarily nature or nurture that shapes our sexual sense of self. (Colapinto, p. 33)

 
The evidence of hermaphroditism lends support to a conception that, psychologically, sexuality is undifferentiated at birth and that it becomes differentiated as masculine or feminine in the course of the various experiences of growing up. (Colapinto, pp. 33-34)

Money’s theorization of newborns as psychological blank slates may indeed strike readers of today as something out of a sci-fi movie but in the 1950s it was universally accepted by clinicians and scientists. This was only a recent development. What was witnessed during the 1950s was a pendulum swing away from the view established among medical scientists at the end of the nineteenth century based on the discovery of male and female hormones—testosterone and estrogen—which claimed that sexuality was more the result of naturist influences. Testosterone was the masculinizing agent and estrogen was the agent of feminization. Predictions were made that too much estrogen in a boy would make him homosexual rather than heterosexual—gay not straight. But “Minute analysis of the urine and blood of adult homosexual men … revealed no such hormonal imbalances. Under the microscope a straight and a gay man’s internal secretions are identical” (Colapinto, p. 34). Lack of confirmed hormonal differences, made credible the social learning explanation of homosexuality.

 
Simultaneously, the first half of the twentieth century and the advent of Freud and modern psychology saw a rapid increase in social learning models for human behavior. Against this background, the Johns Hopkins team’s conclusions that sexual identity and orientation were solely shaped by parents and society fit perfectly into an intelligent zeitgeist in thrall to behaviorist theories. (Colapinto, pp. 34-35)

It lasted long enough for Bruce to be made into Brenda. Dr. Money recommended the surgical alteration of Bruce nearly two years of age; Bruce was surgically altered at Johns Hopkins through a procedure that in effect cut out his testes. Through surgical reconstruction of his empty scrotum, a make-shift vagina was created by suturing a valley midway between the left and right sides of what had previously been his scrotum, fashioning what might be the labia of a normal vagina. From photographs shown on the PBS television production Sex Undefined it was not a very convincing job of plastic surgery. Perhaps that was a hint of what was to follow?

Money believed that surgical alteration could be performed without deleterious effect to the infant before age two and one-half. He had been transfixed by the case of Christine Jorgensen. In 1952, American ex-GI George Jorgensen had undergone surgical transformation to become Christine. That operation performed in Denmark, had been roundly criticized by American hospitals, which refused to perform the surgeries (Colapinto, p. 18).

 
Money saw tantalizing proof of his theory that environment, not biology, determines psychological sex, for here was a person born with apparently normal male biological makeup and genitals whose inner sense of self had differentiated as female—in direct contradiction to his chromosomal, gonadal, hormonal, reproductive, and anatomic sex. (Colapinto, pp. 35-36).

But this was the 50s & 60s: from television shows in America such as “Father-Knows-Best” and the “Ozzie and Harriet Show” the nuclear family was the norm with all the stereotypical divisions in labor between men and women shaping through role modeling the behaviors of young boys and girls. In retrospect it might indeed seem as though sexual or gender identity was completely accomplished through what we call socialization. Knowing one’s gender identity was clear for those with no ambiguities or alterations in their genitals.

But for Bruce-who-was-raised-as-Brenda it was hardly routine. And once puberty arrived hormones disrupted the experimental intervention in making Bruce who had after all been born clearly a well-defined boy a proper girl. Once Brenda reached young adulthood she/he was more comfortable with her-/himself as a man and had surgical reconstruction. The PBS television interviews reveal that he has come-out as a speaker for letting nature take its course.
 

So far I have presented the case of medical experimentation (or surgical alteration) of Bruce into Brenda recommended by John Money as if there were no evidence to the contrary. There were indeed reports by a younger medical research endocrinologist named Milton Diamond using animal studies to strongly suggest that not only did hormones have an effect in guiding the development of sex organs in the fetus but that they might also have a developmental impact on the fetus’s growing neurons and synapses of the brain. “Shift[ing] their focus from the role played by hormones in the mature organism to the role played by hormones in the womb,” a Kansas team of researchers to which the young graduate student Milton Diamond belonged sought to build upon the research of Soviet scientists on guinea pig studies and determine whether these prenatal hormonal effects on the anatomy, described in the quoted passage below, were mirrored in the brain.

 
Earlier researchers had shown that, in humans, in the early stages of gestation, the male and female fetus’s internal and external sex organs are identical to one another. Between six and eight weeks, however, changes start to take place. If the fetus’s cells bear the male (XY) chromosome, the fetal gonads differentiate as testicles, which begin to pump out testosterone. This prenatal androgen is the agent that masculinizes the developing fetus’s external genitals—turning the undifferentiated genital tubercle into a penis, causing the open genital sinus to fuse along the midline and form the scrotum, into which the testicles descend—and at the same time masculinizes the internal reproductive system by spurring the growth of the seminal ducts (another testicular secretion suppresses growth of the rudimentary female internal structures.) If, on the other hand, the fetus bears the female (XX) chromosome, the gonads develop as ovaries, no testosterone is produced, in the absence of which the external genitals and internal anatomy differentiate as female, the genital tubercle develops as a clitoris, the genital sinus remains open and becomes the entrance to the vagina, and the internal structures develop as fallopian tubes and uterus. (Colapinto, pp. 40-41)

Fortified by the encouraging research findings of the Kansas team, Milton Diamond decided to publish an article that was critical of the Johns Hopkins theory of psychosexual neutrality. In a paper entitled “A Critical Evaluation of the Ontogeny of Human Sexual Behavior,” Diamond rejected outright the Money and Hampsons theory of inter-sexuality.

 
[He] pointed out that such individuals had experienced “a genetic or hormonal imbalance” in the womb, and he argued that even if human hermaphrodites could be steered into one sex or the other as newborns (as Money claimed), this was not necessarily evidence of their gender neutrality at birth. It might simply suggest that the organization of their nervous systems and brains had undergone in utero a similar ambiguous organization as their genitals. In short, they had an inborn neurological capability to go both ways—a capability, Diamond hastened to point out, that genetically normal children certainly would not share. As for transsexuals, who showed no observable anatomic ambiguity of sex, Diamond postulated that they, too, might possess an as yet undiscovered biological condition that hardwired their brains to a program opposite to the evidence of their bodies—a possibility that Diamond was able to back up with evidence from no less an authority than Dr. Harry Benjamin himself, who had recently reported that in forty-seven out of eighty-seven of his patients, he “could find no evidence that childhood conditioning” was involved in their conviction that they were living in the wrong sex.  (Colapinto, pp. 44-45)

 
The Canadian doctors took precautions that the Johns Hopkins team had not. To prevent subjective tainting of their results, the Canadians split their research team in two: one to study the patients from an endocrinologic perspective, the other to study the patients from a psychological perspective. For comparative purposes, [they] also carried out research on a control group of nonhermaphrodites, as well as on a series of homosexuals and transvestites.

The team’s results showed that it was dangerous indeed to suppose that no link existed between an intersexual child’s biological makeup and its gender identity; that in fact the status of the chromosomes, gonads, or hormones might predispose a hermaphrodite child to identify more with one sex than the other in adulthood. Stating that the Johns Hopkins team had based its recommendations to surgeons on “shaky theory,” the Canadians had expressed particular unease about the recommendation that males born with tiny or nonexistent penises should, without exception, be castrated and converted into girls. Such sex-changed children, the Canadians had warned, “were liable to be brought up tragically incongruously with the main somatic sex.” (Colapinto, pp. 45-46)

Developing Our Conceptions of Experiment and Ethics
 

 John Colapinto (2001) described infant sex reassignment as an experiment in psychosexual engineering. He captures the dilemma felt by research scientists about how to test the opposing interpretations and research findings concerning gender identity differentiation in the following.

The ultimate test of the thesis that gender identity differentiation is not preordained in toto by the sex chromosomes, the prenatal hormonal pattern, or the postnatal hormone levels would be undertaken, if one had the same ethical freedom of working in experiments with normal babies as with animals, Money wrote. Since planned experiments are ethically unthinkable, one can only take advantage of unplanned opportunities, such as when a normal baby boy loses his penis in a circumcision accident. (Colapinto, p. 47)

In the previous section I outlined the events that occurred in and around the unfortunate accidental surgical procedure performed on Bruce-who-was-raised-as-Brenda, and the further surgeries that were performed following the recommendation of the Johns Hopkins team which made Bruce into a girl. In light of subsequent research evidence it appears that Money was wrong in the case of Bruce. Brenda never developed into a normal adjusted girl. Later developments show that Brenda as an adult had surgery (reconstructing a penis instead of the vagina given to him/her as an infant) to convert her back into a male and he now lives in a marriage with wife and kids as John Reimer.
 

I would argue that to understand the historical moment of recommendation and events that followed upon it, we need to consider in more detail something of the ethical climate of the sixties when Money made his recommendation to alter Bruce who was unmistakably an infant boy. We need to be clear that hindsight is always easier than working in the midst of the dilemma. Scientific evidence did support Money: together with the prevailing and well accepted Freudian theory of psychosexual development there were strides made in the research of Social Learning Theory. And these experimental and research developments did not occur in a vacuum. During the sixties opportunities for study in college and graduate school were afforded to groups who had heretofore not been granted entrance to higher education. This meant that increasingly more women and students with more outwardly declared sexual orientations began to study and have an impact on the curriculum in colleges. It also gave impetus and direction to the exploration of human sexuality. We need not rehearse the wild sexual times of the sixties. However, it was the inclusion of these identity-groups, i.e., women, lesbians, and gay men, which shifted the kinds of questions that academic research addressed because the voices of those being studied were now shaping and influencing the emerging approaches and perspectives.  Feminism and lesbian/gay liberation movements are fingered by the historically short-sighted as the culprits in drawing attention to the plight of inter-sexed infants. But in the sexual history told by Meyerowitz (2002) it was transsexuals that led the field in changing our attitudes toward sexually different individuals.

Since my goal is to provide an understanding of the transformation of the phenomena of hermaphrodites into intersexuals and the notions of experiment and ethics which informed them, following the method of Canguilhem/Bachelard/ Foucault, it is necessary to define some of the terms which guide exploration of surgical intervention/sex reassignment in sexually ambiguous, inter-sexed infants. “Sex,” “gender,” and “sexuality” have become staples in the discussion. Meyerowitz (2002) distinguishes between these three terms as follows: sex refers to the division of male and female reproductive capacity accorded by differentiation in fertilized ovum that might have a pair of X-chromosomes, thus a female or a pair of chromosomes of XY combination, thus a male. Gender designates the results of socialization which manifests in differentiation of sex roles for males and females such that males acquire and exhibit characteristics or traits we call masculine and females acquire and exhibit characteristics or traits we call feminine. Sex applies to the structure of reproductive organs and gender to existential ways of being in the social world. Sexuality refers to the activities through which a person expresses his or her self in achieving bodily erotic and/or orgasmic pleasure. An enormous variety of combinations and permutations will follow from distinguishing sex, gender, and sexuality. All these distinctions had their origins in the work of Freud’s theory of psychosexual development.
 

That medicine had absorbed and incorporated Freudian psychosexual theory of development is in itself remarkable given the conservative nature of the medical profession. At the same time some of the trouble, as I will diagnose it, stems from the same conservative values of the biomedical establishment. We are better off from Freud’s speculations on the grounds of our bi-sexuality. As a medical doctor Freud recognized the homologous nature of the development of the genitalia and reproductive systems of the male and female. All fetuses are originally female but those with Y-chromosomes develop male genitals and gonads and females with only X-chromosomes continue to develop female genitals and gonads. These are two paths of biological development in a species such as our own that is sexual dimorphism—specialized in capacity for reproduction. Nature however sometimes doesn’t respect this division of labor in reproductive activity of males and females. Sometimes, perhaps more than many know, nature produces a fetus that has both reproductive capacities of male and female which we have called hermaphrodites. Figures have been suggested that as many as one for every two thousand births in the United States are infants with the condition of inter-sexuality (Nussbaum, 2000).
 

As a fitting tribute to the enormous influence of Freudian psychoanalysis on our and John Money’s understanding of sexuality I want to draw upon the considered opinion of Jonathan Lear who is a philosopher that has become a psychoanalyst. Lear, in assessing the disruptive influence of the Freudian notion of the unconscious on the field of ethical inquiry, states that

We live at a time when the promising approaches to ethics are broadly Aristotelian in spirit. Philosophical culture has grown weary of rule-based approaches to ethics. By now, the critiques of Kant’s attempt to ground morality on the moral law are well known. In briefest outline, from the moral law it is impossible to derive any specific conclusions about how to act in a specific set of circumstances… Because it is impossible to specify a set of rules on how to act well that one must turn to a psychologically informed account of how to build good character… This is an approach that Freud himself ignored. Freud’s critique of ethical value is itself addressed to a certain law-based interpretation of the Judeo-Christian tradition… Being brought up in the Law tended to produce in individuals cruel superegos, set up over against the ego, judging it harshly and inflicting ever-greater punishments and inhibitions … Freud more or less equated life within the Law and life within the ethical, and he thereby overlooked this alternative, Aristotelian approach … an ethics based on an integrated psyche in which values are harmoniously expressed in a genuinely happy life. (Lear, pp. 5-6)

We have learned something of Money’s justification for taking Bruce and his brother Brian as “an experiment in nature.” Money did not botch the circumcision but he was fully responsible for recommending the operation, and the surgeons carry the burden of having performed the operations, first in damaging Bruce and then trying to correct the damage. In every sense these responsibilities for harm are ethical issues today in large part because the actions of people in social movements have made them prominent. With hindsight we might say they further damaged Bruce by trying to make him anatomically a girl and to raise him as one.

In contrast with the time Money was developing his theory of intersexuals, the medical profession today is ensconced in thinking about medical ethics. For example Fundamentals of Clinical Trials, a medical textbook in its third edition and first published in 1980 provides a short discussion of the ethics of clinical trials, investigating surgical and drug treatments. Arguments regarding the ethics involved in clinical trials “center around the issues of the physician’s obligations to patients vs. societal good, informed consent, randomization, and the use of placebo” (Friedman, p. 8). Continued enrollment of participants after trends in data appear and controversy is raised, is another issue that might be especially relevant to the case of Bruce Reimer. At the outset of the surgical alteration, castration and creation of a pseudo-vagina for Bruce, Money was not aware of the data and criticisms that were suggested especially by Milton Diamond. But eventually he was aware of it (he actually was asked to review Diamond’s article before publication) and continued to argue against any change in his social behaviorist theory of psychosexual development. Had Money heeded the thoughtful critique Bruce might have been spared many years of distress, confusion and hardship.
 

According to Fundamentals of Clinical Trials “well-designed and conducted trials are ethical” as long as they “answer important public health questions without impairing the welfare of individuals” (Friedman, p. 8). However, the authors say that investigators should “update consent forms during trials when any important information is derived from the current or other studies” (Friedman, p. 9). This addresses Money’s continued adherence to raising Bruce as a girl. But should Money be held to the ethical standards of our time, after all Fundamentals is a recent text which embodies state of the art standards for ethical treatment of patients in clinical trials? There were no acknowledged standards promoted either by the American Psychological Association or the American Medical Association at the time of Money’s selection of treatment through surgery and drugs/hormones. Milgram’s obedience studies were being reported and discussed in the mid-1960s. The work of H. K. Beecher (1966) only made apparent the need for informed consent, but what consent could be gotten from an infant of only two years of age. And that raises the issue as to whether either the parents or the experts were really in a position to know what was in the best interests of the child (Levine, 2002).
 

Keeping in mind that one of Money’s requirements for successful rearing of Brenda as a girl was that the parents be steadfast in raising her as a girl; this conflicts with revising the letter of informed consent. We now turn to address the concept of randomized clinical trials often referred to as the gold-standard of medical experimentation. Randomization is, according to the opinion expressed in Fundamentals, more of a problem for physicians and investigators than for patients: “If physicians cannot say which therapy is better than another, then no problem with randomization arises. Objection is warranted when preferred therapy exists” (Friedman, p. 8). For just such cases where the physician has a preferred treatment, and that is in most cases (why else would they be trying out the treatment as an experimental condition in the first place?) the concept of clinical equipoise was developed. Clinical equipoise denotes the “presence of uncertainty as to the benefits or harm among medical community is justification when investigator has a preference” (Friedman, pp. 9-10). And of course placebo group doesn’t mean no care is received. Superior medical care is always provided in such cases, which if it was not for inclusion in the clinical trials, it is assumed none would be provided for or obtained by the patients/subjects.
 

We need to be mindful of the contested nature of some of the assertions mentioned above that were culled from Fundamentals. Though gay activist groups under the banner of ACT-UP (AIDS Coalition to Unleash Power) have brought about changes in the way that conventional clinical trials are conducted, it was little evident in Fundamentals. Demonstrations and civil disobedience performed at Burroughs Welcome (manufacturer of AZT, therapeutic drug for AIDS patients that was originally given to cancer patients and had been discontinued decades earlier because of its high toxicity) and at the National Institutes of Health during the mid-1980s brought changes in randomization and placement in control groups where placebos were administered. The outcome was to refrain from use of placebo in the control group as this was regarded as lacking in compassion for those with AIDS since it was at the time considered a death sentence. Some valid treatment was to be administered and not just medical care. Those who did not meet the strict protocols for particular drugs were given access to the experimental drugs on a compassionate use basis. It is important to recognize what little regard is evident on the part of the authors and editors of this medical textbook for the accomplishments of social movements such as the women’s and lesbian and gay movements.

How Experimentation on Intersexuals Might Be Understood Ethically Today
 

As part of the history of medical and philosophical thinking about sexuality, I am going to consider some of the history of change and stability in ethical concepts as a way to come up with a better framework in which treatment of sexually ambiguous infants might be formulated that doesn’t see nature and nurture as competing forces. As an example, Tobach (2001) reports that Comparative Psychobiologist T. C. Schneirla posited a theory of levels of integration where in all sources—physical-chemical, physiological, and biosocial—contribute to non-hierarchical development of human sexuality.
 

The British philosopher and novelist, Iris Murdoch is a rich source for my alternative view of intersexuality and for reflecting on the state of ethics during the 1950s and 1960s. She discerned that the nineteenth century had strayed from serious ethical analysis; the work of Marx, Freud, and Sartre seemed to nail the coffin shut on ethics, at least in Murdoch’s estimation. Through her serious philosophical writing and numerous novels Murdoch sought to return to the metaphysics of Plato in order to revive ethical inquiry. In a paper entitled “Existentialists and Mystics” Murdoch (1997) assesses the difference between novels of the nineteenth and twentieth-centuries which captures the drift in ethical thinking in society as follows:

 
Religion, reason, and work were indeed the great stays of the nineteenth century and it was typical of that expansive time that the three should associate naturally and equally together, without religion for instance trying to lord it over the other two. Society looked after them all and gave them proper places…. In the past it could be assumed that robust individualistic common sense would look after things on the public front, while personal morality, working on quite different principles, would look after the private sector.

Against this background I want now to suggest, for purposes of diagnosis, a distinction between two types of recent novel. The existentialist novel is natural heir and outcome of Western nineteenth-century thought and is the child of the Romantic Movement. The mystical novel is both newer and more old-fashioned. What is characteristic of this novel is that it keeps in being, by one means or another, the conception of God. Man is still pictured as divided, but… in a new way between a fallen nature and a spiritual world.

Moral thinking is, I suggest, in process of executing a kind of somersault. The existentialist thought that was valuable was freedom, thought of as will-power. The mystic thought that what was valuable was spirit, magnetic and remote. Now we are being driven to think in a much more immediate and, in the philosophical sense, naturalistic way that is valuable as food and shelter and work and peace. But because of the Machiavellian separation of ends and means, morals and politics, in our thinking about the world, and also because of an evident lack of technological power to alter situations, these fundamental goods were never able to take a central place and to let other values radiate from them. (Murdoch, pp. 222-231)

Murdoch also acknowledges how Marx tried to mend a fissure in human nature upon which Kant insisted. But she claims that :

 
Perhaps there are more commonsensical ways of mending it. Because human beings are what they are and have the needs which they do have, freedom, democracy, truth, and love are important…. Of course any extended picture of human nature involves a movement from the obvious to the less obvious. (Murdoch, p. 233)

Although Jonathan Lear and Iris Murdoch recognize in their own way the failure of rule-based or principle-based or law-based ethics to provide guidance in concrete situations, they nonetheless point in the direction of more grounded ethical approaches that incorporate the realm of human feeling. This is brought out in Iris Murdoch’s position that story-telling is the most human of tendencies, and that we do what is right by sensing what is needed in the immediacy of a situation with which we are confronted and that calls for our attention.

John Dewey (1948), amongst twentieth century ethicists, understood how to make ethics an embodied act and situationally embedded decision/ under-standing /choice. Through his instrumentalism, he integrated experimental inquiry with ethics, making ethics experimental and experimentation ethical. Of key significance in Dewey’s philosophy is the concept of “intelligence.” In Dewey’s words:

It is a shorthand designation for great and ever-growing methods of observation, experiment and reflective reasoning which have in a very short time revolutionized the physical and, to a considerable degree, the physiological conditions of life, but which have not as yet worked out for application to what is distinctively and basically human. (Dewey, pp. viii-ix)

Dewey wants no part of such metaphysically conceived individuals but prefers a process understanding of the inherently social nature of individuals as getting their attributes by developing among relationships and forms of association, e.g., family, friendship, work, school, church, or state; all are collectively understood as comprising institutions that are shaped by social and historical forces. Human beings are not to be thought of as a dialectical relationship between individual and society; that is too abstract in either its version as organic theory or Hegelian version of dialectics manifesting as a spiritual determination informing matter and the world.
 

 For Dewey,

 
We plunge into the heart of the matter, by asserting that these various theories suffer from a common defect. They are all committed to the logic of general notions under which specific situations are to be brought. What we want light upon is this or that group of individuals, this or that concrete human being, this or that special institution or social arrangement. We need guidance in dealing with particular perplexities in domestic life. (Dewey, pp. 188-189)

 
When the liberating of human capacity operates as a socially creative force, art will not be a luxury, a stranger to the daily occupations of making a living. Making a living economically speaking will be at one with making a life that is worth living. And when the emotional force, the mystic force one might say, of communication, of the miracle of shared life and shared experience is spontaneously felt, the hardness and crudeness of contemporary life will be bathed in the light that never was on land or sea. (Dewey, pp. 211-213)

This history of ethical concepts shows how our understanding of ethics has changed from something personal and private and most of all separate from politics to something communal, public and social. For me Dewey’s thinking is the way to go; as with Dewey I understand that social movements are collective actions of individuals in association with others. And as our forms of association change so too do our very selves. Once the distinction between private and public is disrupted we must rethink the ethical issues that we meet in the immediacy of lived social situations. And we can never carry around a set of preordained principles or rules or laws that will aid us in ethical/moral decision-making. We must develop ourselves through association with others and follow the ways that we are called upon to remedy deficiencies which are for Dewey temporary evils. Of course life lived in this way is not easy or perhaps it is not difficult once we learn to disrupt our tendency to escape the immediacy of our attention—of our embodiment and interrelations with others.
 

I can only imagine how this attitude might have helped Bruce Reimer avoid the troubles that were the quality of his life in the first two decades of his childhood and adolescence. And just imagining is surely not sufficient to remedy the damage perpetrated upon countless intersexuals. According to Kessler (2000), it is a mark of our times that our language is free of the heterosexist bias that drove medicine to diagnose hermaphrodites as abnormal. Shouldn’t all infants follow the socially constructed dichotomy of being male or female? Nature has always answered with a resounding no. But we have not listened. Our responses to intersexuals need to be more fully aesthetic. By that I mean that a truly appreciative stance should afford us the experience of the uniqueness and beauty that bodies forth from all human beings regardless of whether they conform to our ideas of them or of what they should be instead of who they are.

Copyright - The Author

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About the Author:

Dr. Jonathan Lang is an Associate Professor of Philosophy and Psychology in the Department of Social Science at the Borough of Manhattan Community College of The City University of New York, and a Research Associate in History of Public Health and Medicine in the Division of Sociomedical Sciences at the Mailman School of Public Health of Columbia University. His current research is on the History of Public Health at the American Museum of Natural History and on the question of the repatriation of Native American remains and funerary objects under the title “Who Owns the Bones? Native Americans or Archaeologists?” He has PhDs in both philosophy and psychology, and is completing a Masters of Public Health.

Research Associate in History of Public Health and Medicine
Division of Sociomedical Sciences
Mailman School of Public Health
Columbia University

Email: jl2070@columbia.edu