Monday, 13 April 2009

Independent: Confusing sexual orientation with gender identity
12.4.9 by Ms Gabi Calleja; Coordinator MGRM

In an article by Prof. Pierre Mallia that appeared on 1 April [see below], a number of references were made to sexual orientation in relation to gender issues. It appears that despite being a qualified medical practitioner and a university lecturer, Prof. Mallia confuses sexual orientation with gender identity. So, perhaps some clarifications are in order.

Sexual orientation refers to the attraction an individual has to a person of the opposite sex (heterosexuality), of the same sex (homosexuality) or to either of the two (bisexuality). Lesbian, gay or bisexual individuals do not feel they are in the wrong body. However, much of the prejudice they experience is often related to society’s expectations of men and women and how these should relate to each other, behave and dress. Therefore, for example, a lesbian couple may be seen as challenging the patriarchal role of men in families and the notion that a male breadwinner is necessary. The way that domestic work is divided in same sex families can also challenge the stereotypical gender role expectations for male/female households.

Moreover, lesbians have often played an important role in feminist movements all over the world, such as in the suffragette movements of the USA and the UK. The common perception of gay men as effeminate is another clear example of the manner in which gender expression is linked to sexual orientation and the bullying, harassment and discrimination that gay men are often subjected to. Emancipation that challenges gender stereotypes and allows for a wider range of expressions and identities by both men and women therefore benefits individuals of all sexual orientations.

Gender Identity refers to whether one identifies as male or female. For an individual whose gender identity does not match the sex that was assigned to them at birth, the term transgender/transsexual and not homosexual applies. Many transsexual people will seek hormonal and/or surgical treatment in order to bring their body into alignment with their gender identity. Once again, contrary to the opinion of Prof. Mallia, discrimination on the grounds of gender identity has been recognised by the European Court of Justice as discrimination on the grounds of gender. Recital 3 of Council Directive 2006/54/EC on the equal treatment of women and men in employment states: “The Court of Justice has held that the scope of the principle of equal treatment for men and women cannot be confined to the prohibition of discrimination based on the fact that a person is of one or other sex. In view of its purpose and the nature of the rights it seeks to safeguard, it also applies to discrimination arising from the gender reassignment of a person.”

Equality between men and women is not threatened but only enhanced when issues of gender identity and sexual orientation are also considered since sexual minorities often challenge deep-seated prejudices and stereotypes of how men and women should be and what they can or cannot do.

Independent: Gender issues – separating the categories
1.4.9 by Prof. Pierre Mallia

Gender issues are an important area in bioethics, especially when it comes to understanding the delivery of health care. Ample studies, albeit done mostly by women, which in itself may be of great significance in showing who gives importance to these issues, have shown that in the United States, more importance was, and perhaps still is, given to the health of men than that of women. For example, in the treatment and detection of heart attacks, men were given prominence. It is not the point here to enter into these debates, but anyone who wants to express an honest opinion cannot deny that we are still coming out of an androgenic society.

Gender issues delve into three particular areas. First the health of the man and the woman. Especially in primary care, GPs are now more sensitive to the screening needs of both. It is hoped that a system which will register patients will facilitate a recall system for regular check ups, which in turn will have a positive outcome on prevention and thus decrease waiting lists in the hospital secondary care setting. It is in this area that we must beware of subtle preferences based on utility – a utilitarian ethics, if you may.

Second, there are gender issues of ambiguous sex. In these medical conditions, such as Klienefelter’s syndrome, the male has chromosomes such as to render him infertile. However the typical ‘spot diagnosis’ of Klienefleter’s is now under review as many of these patients have gone by undetected. Many have had ambiguous genitalia and were brought up as males because they had small genitalia. It is highly relevant that during the development in the uterus, the Y-chromosome makes the female develop into a male, and obviously an imbalance will produce these ambiguous features. The problem is that at certain stages of life, they realise that the female component has taken over. The person is indeed a female but has been caught for a long while on the biological borders.

These conditions have nothing, on the other hand, to do with gender issues regarding homosexuality. The world was taken by force over recent years and homosexuals have been gaining a lot of recognition. Vide the recent intervention on Xarabank by Fr Gouder admitting finally that they are part of God’s plan. Of course one has to reconcile this with sexual activity and unions, which are more of a social issue. We have to accept that what major religions have traditionally kept as immoral, need not be illegal.

With regards to sexual activity, the Church, for example, would not condone sex outside marriage. Period. Sex is a function of procreation and should be done within the context of marriage. Therefore there is no discrimination in telling homosexuals what one says to heterosexuals – to abstain from sexual contact outside marriage.

In a social context it is quite a different matter and we must look more closely into the biological, social and psychological well-being of individuals. While it may be fine to tell young adults to abstain, it may be acceptable on a legal basis, for social stability, to understand the nature of such variants of human nature without condemning them. One has to accept however that it would be very dangerous to live in a relativistic society where if what I do seems morally right for me, then I don’t care what society has to say. The fabric of society is built on mutual understanding of natural moral rules; natural in so far as man, living in a community, can with reason, come to understand what is good and what is bad for that society. Since by nature man is a reasoning being (or animal, if one wants), then it is only natural (hence natural law – as opposed to divine law, which is also consequential), that man comes to understand those laws of nature which will help him cope as a society.

Now there is a danger here, expressed once by C.K. Chesterton. Those who challenge societies’ moral rules are taking a free ride on the fabric of morality which has been built through this natural process over millennia. Once we have a solid social structure, some feel that the privilege of modifying some of those structure translates immediately into a right. In many instances man has come so far as to understand that this is true. Today, for example, there may not be that need as before that the man is the only bread winner. But it is only right that all of society engage in discourse aimed at understanding what is morally right and what is wrong. If we give in to pragmatic and relativistic moralities, without giving time to a clear moral understanding and perspective, then that very fabric which has taken much time to build will certainly suffer.

The third is more social and perhaps outside my area of expertise, but is pertinent to this argument. Take for example the traditional family. Do we still all feel that children have a right to a mother and father? There is certainly a difference between paternal and maternal love. One is perhaps more conditional and authoritative. I used to give in to feminist (as opposed to the more recent feminine philosophical position) thought that nurture overtakes nature, until I had my own children, where I observed that no matter what I did to treat my children equally, at the age of two my daughter would choose nothing but pink and my son watches nothing but Ben 10. One may argue that the nurture here is television, but certainly one cannot deny that there are biological differences between male and female children, which translate into significant psychological and social expressions.

If we are to speak of gender equality on a social aspect we must pay attention to this classification. I will mention one, whose case I know, of a lady who graduated, out of government investment, of course, in social services and indeed worked into her sixties. There was no one to take her position and her supervisor strived hard to keep her in the services. As a family doctor for almost two decades I can vouch for the thirst there is for good, competent, and experienced social workers. The parliamentary secretary told her that there is no doubt that her services are required, but she can do so only voluntarily! Now this is where our social fabric will break down. There are so many males continuing, rightly so, to be on government payrolls because we as a society (or the government) still require their services. Not to say that some males are not kept, even though they are needed, and women must accept that this may hit them as well. But to ask one to continue working voluntarily is not only unfair and inconsiderate, not to mention a total breach of ethics; it can be interpreted legally as offensive to the male/female issue if it is found to have been an abusive statement because of the person’s sex.

Conversely we should not confuse the gender issues of female emancipation, with the other gender issues. Where medical conditions as described come into play, the understanding allow the progress to be swifter. But to confuse emancipation with understanding of sexual orientation is confusing two separate issues. This is where perhaps, programmes like Xarabank can be more helpful. When we are discussing discrimination of women, we are not discussing discrimination of homosexuals, even if they insist on being called females and using female facilities. Here we are entering a field which is about sexual orientation, which may be fine and acceptable to us all, but it seems that the latter is taking a free ride on the former, which has been in progress for more than two centuries. One may hinder the progress of the other.

We must treat them separately, one as pure discrimination because you are a woman; the second as discrimination because you are homosexual (you may indeed psychologically feel to be a woman but in a man’s body). If we cannot understand this difference we will indeed remain on the Xarabank. Xarabanks were intended to take us from one place to another and not to give us merely a tour of the island. I am sure that the producers want this progress as well. Indeed this is what one expects from a national television. At the end it will dedicate appropriate time to both issues.

While any form of discrimination is illegal, there are different types of discrimination. For example bioethics can help much in gender issues which I have classified as the first and second type, but not third, which is a sociological issue more than anything else. If we truly want progress we have to respect the academia of it. Ethics is not only an opinion; as moral law, it is based on rational thought.

Pierre Mallia is Associate Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta; he is also Ethics Advisor to the Medical Council of Malta

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