Albospeyre Thibeau Raphaël

PhD student in Sociology, EHESS

Postgraduate program: Health, Population and Social Policies

Research grant from the Île-de-France Region/Ifris (DIM IS2-IT) (December 2012 - December 2015)

Contact: at.raphael(at)orange.fr

 

Dissertation defended on 19 December 2019: Between "how" and "whether". Professional uncertainties and commitments about early genital surgeries in clinicians of atypical sex development

Under the supervision of Ilana Löwy

This PhD dissertation analyzes from a sociological point of view the evolutions in clinical care of atypical sex development, or intersex. It focuses mainly on the different ways specialized clinicians approach the controversy surrounding genitals normalization surgeries in pediatrics. From the observation of highly contrasted stances between, on one hand, movements of intersex people and national or international institutions defending human rights; and, on the other hand, dominant clinical discourses, this dissertation questions the conditions of the upholding or challenging of clinical practices, in a given time and location. The research is based on a qualitative inquiry and cross-analysis of hospital teams’ discourses and practices in France, the United-States and Switzerland, as well as on medical publications. It mainly shows that even though we tend towards a fair homogenization of medical discourses about “how” to proceed (protocols to use, care and techniques to offer, medical teams organization), the question of “whether” or not clinicians and parents should use the available techniques in order to change a child’s body, is subject to high internal tensions within the medical community, however often made invisible by consensus building. It shows how professional commitments, including on moral grounds, are tying clinicians to certain practices, as well as the specific dilemmas and uncertainties to which these practices confront them. This dissertation also shows that both supportive and critical views about those practices coexist most of the time in clinicians’ discourses. By comprehending clinical approaches of early genital surgeries from the point of view of their diversity and of the tensions that characterize them, this research highlights that the conceptions of what makes “good” care and of who is the patient are subject to variable interpretations, some of which question fundamentally the mandate granted exclusively to medicine until now.

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