Part I of this Note will examine the "paternalistic" approach traditionally taken by the medical community in response to intersexed infants. Part II will argue for a moratorium on infant genital-normalizing surgery because (A) intersexuality is not a medical condition that needs to be treated and (B) parents are not legally able to consent to irreversible cosmetic surgery on their infants. Part III will explore the benefits of the medical and legal shift to an informed consent model as an incremental step toward the ultimate goal of a moratorium. Part IV will examine the problems with current informed consent proposals and will suggest ways to tailor those proposals to preserve the potential for further change in the way intersexuality is addressed. This Note will conclude by asserting that advocates should be wary of simply settling for an informed consent approach and should concurrently push for a moratorium on all genital-normalizing surgery until the medical community can demonstrate a medical need for "treating" intersexed infants without life-threatening conditions.

I. THE TRADITIONAL PATERNALISTIC TREATMENT MODEL

Until the late 1990s, the medical community viewed an intersexed infant as an anomaly that required surgical correction. After surgery, doctors would assure parents that the anomaly was corrected and that, based on the doctor's determination, the child should be raised as a girl or boy. [FN12] This model considered sexual ambiguity unacceptable and a "psychosocial" emergency (as opposed to a medical emergency) because "parents and clinicians are uncomfortable with the sexual ambiguity of the child." [FN13]

A. JOHN MONEY AND THE ORIGINS OF CORRECTIVE GENITAL SURGERY

Much of this early paradigm was based on the work of one man: John Money, Ph.D., a psychologist and sex researcher at Johns Hopkins University. [FN14] Money viewed parents as passive participants in the decisionmaking process regarding their intersexed infant; doctors were to make decisions regarding surgery and sex assignment. [FN15] Money believed that the "nurture" of a child was the most important factor in establishing the child's gender identity. [FN16] In order to properly nurture the child, the sex assignment of the child needed to be established *132 immediately and the external genitalia had to conform to that assignment. [FN17] Proponents of Money's model believed that the "normal" appearance of the genitals was an essential factor in childhood gender and psychosexual development. [FN18]

Money based his research on his 1960s John/Joan case study. [FN19] As a baby, John's penis was accidentally burned to ablation during circumcision. [FN20] Based on his belief that individuals are psychosexually neutral at birth, Money recommended that John be raised as a girl. [FN21] Money believed that because it is more difficult to construct male than female genitals, the decision of sex assignment should be based almost entirely on the size of the phallus. [FN22] Because John's penis was almost completely destroyed, the decision to perform "feminizing surgery" was made, and John was raised as Joan, ostensibly to great success. [FN23]

B. DISCREDITING THE PATERNALISTIC SYSTEM

For years, Money's John/Joan case study was used as evidence that raising intersexed children as either girls or boys after genital assignment surgery was a successful treatment. [FN24] However, as early as 1994, Money himself retreated from some of his initial views--most notably, his opinion that healthy psychosexual development is dependent on genital appearance. [FN25]

Additionally, in 1997, a researcher tracked down John/Joan and found that the operation had not been a success after all. [FN26] John now lives as a man, is married, takes testosterone to replace what would have been produced by his removed testes, and has had a mastectomy to remove his estrogen-enhanced breasts. [FN27] Because of his early childhood surgeries, which included castration, John no longer has the capacity to reproduce. His reconstructive surgery was difficult and of limited success; he has problems with urethral closure, and much of his penis is without sensation. [FN28]

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