Boundaries of Parental Consent: The Example of Hypospadias Surgery

Human rights organisations raise concerns about medical interventions on children with intersex variations, particularly when these interventions impinge on the child's bodily autonomy and are without a sound biomedical basis. Psychosocial literature and legal literature have made very different contributions to thinking about the healthcare of people with intersex variations, but both literatures pay attention to the process of informing patients about elective interventions and the workings of consent. The present paper addresses the absence of dialogue across medical, legal, and psychosocial literatures on the surgical treatment of children with intersex variations. The analysis presented in this paper focusses on the assumptions underpinning the practice of allowing parents to consent on behalf of their children to elective surgery in the instance of hypospadias. In this paper, we (i) introduce consent from a medico-legal perspective, (ii) analyse selected documents (including medical, psychosocial, and human rights documents) in relation to the concept of parental consent on behalf of a child, and (iii) reconsider the current practice of inviting parents to give consent for elective genital surgery on infants. What emerges from our analysis is a picture of long-term relationships and interactions over time within which the consent process is located. The focus is not whether consent is granted, but whether free and informed consent is granted. This picture allows us to expand the understanding of "informed consent," highlighting the importance of producing ethical interactions between health professionals and patients with the view that these relationships last for years. Understanding consent as a process, considering information as dynamic, partial, and negotiated, and understanding the doctor-patient interaction as relational might enable us to imagine the kind of informed consent process that genuinely works for everyone concerned. Our examination of selected legal, medical, and psychosocial texts raises doubt about whether current hospital practice meets the requirement of informed parental consent on behalf of children undergoing hypospadias surgery.