AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. October 2000, Volume 2, Number 10.

Journal Discussion

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Preventing Sex-Based Competitive Advantage

Articles and books on bioethics continue to expand in both number and the range of topics discussed. Between 1989 and 1998, more than 4000 articles alone were published in MEDLINE-cited journals. Some of the major topics examined are the patient-physician relationship, end-of-life care, reproductive medicine, genetics, and the allocation of scarce medical resources. From these publications, we will be selecting a handful of articles and chapters, some of which reflect issues of perennial concern to physicians, others reflect more recent quandries resulting from advances in biomedical technology.

A new article or book chapter will be featured every month, accompanied by questions intended to guide readers along the path of ethical reasoning.

Simpson JL, Ljungqvist A, Ferguson-Smith MB. Gender verification in the Olympics. JAMA 2000; 284 (12): 1568.

Questions for Discussion

The issue of determining an athlete's sex to protect against competitive advantages of males competing against females challenges our seemingly obvious assumptions about what constitutes one's gender. At first glance, visual inspection of genitalia would appear to answer the question, but male pseudohermaphrodism - genetic males whose genitalia fail to develop - confuses that distinction. Laboratory-based gender verification attempts to side-step that issue by determining gender for the purposes of athletic competition on the basis of androgen production levels. This test however discriminates against athletes who are intersexual - those who are genetically male but physically appear to be female and socialized as such. Although the International Olympic Committee has officially abolished on-site gender verification preceding athletic events in an effort to protect the rights and privacy of athletes, the fact remains that competitions are divided into men's and women's events. On what basis therefore, if not physically, chemically, or genetically, do we assign a gender to the individual?

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