BackgroundIn 2006 the Chicago consensus statement on the management of people with variations of sex characteristics (VSC) acknowledged the importance of a multidisciplinary team (MDT) approach. The consensus update from 2016 reinforced the call for multidisciplinary collaborations between medical professionals, parents and support groups, and proposed guidelines to improve shared decision making and patient-centred care embedded in ethical principles of self-determination and child participation. But there is little evidence that successfully MDTs have been implemented in clinical practice.Methods and aimsA scoping review was conducted to identify studies that address the collaboration and decision making process of MDTs providing care of people with VSC to identify ideal and actual (1) team composition; (2) models of collaboration and (3) ethical principles that MDTs follow. Six databases were systematically searched: CINAHIL, Medline, Psychinfo, Scopus, Socindex and Web of Science. No restriction was placed on the type of methodology used in the studies. To frame the research, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used.ResultsThe MDTs in the literature include mainly medical professionals: endocrinologists, urologists and surgeons. The collaboration among medical professionals in MDTs lacks cooperation as one team member sets the tasks of the team while each professional works separately. Despite the importance of psycho-social support the involvement of psychologists remains secondary. The implementation of ethical principles tends to exclude people with VSC.ConclusionThe care of people with VSC described in the papers is medically oriented as the team members are mainly medical professionals working separately. MDT tend to exclude people with VSC despite references to shared decision making processes and informed consent. There was no mention of adult care and lack of inclusion of patient’s perspective in the care process. The future research should do more empirical research of MDTs.
"The complex treatment of intersex people in medicine has for too long neglected the support for their families. Decision-making process included parental concerns and wishes, but the emotional and peer support of families with intersex people may not always be provided. We investigate access and availability of psychological and peer support for families with intersex children. Even though the 2005 Consensus statement on DSD strongly recommended new protocol in which families should be provided psychological and peer support during decision-making process, we claim that this is still not the case. Even if there is a psychologist or psychiatrist in the multidisciplinary team during the process, that does not mean that families are provided with psychological support. Based on the scoping review method we want to identify existing professional-peer support and intervention tools for parents with intersex children. We investigate the implementation strategies for professional psychosocial interventions and examine the literature assessing their effectiveness. Our claim is that psychological and peer support are not fully implemented in the treatment process of intersex people, because the role of psychologist, psychiatrist or peer groups is seen as secondary in comparison to the one on surgeons within the multidisciplinary team of medical professionals. This leads to lack of psychosocial and peer support and to mental distress of families and their intersex children. "
By engaging with Giorgio Agamben’s article on the Italian government’s measures during the first wave of the COVID-19 pandemic, we argue that COVID-19 points to the limits of the classical biopolitical and thanatopolitical logics of analysis and therefore requires a new conceptual framework. The outbreak of COVID-19 is an example of zoonotic globalisation in which the human species as a biological and geological actor is merely one among many other species that influence biological and geological processes on Earth, thus challenging humanist conceptualisations of politics. Here, the human role in politics is decentralised by thinking the virus as one of the actors that exert influence on how the political sphere is governed. We argue that the virus is the epitome of the ungovernable – an entity or broadly a historical challenge that cannot be subjected to existing mode(s) of governing – due to its interstitial and borderline character, resting between the ontological roots of the dominant modes of governing bios (life) and geos (nonlife), and challenging them by merely existing. We draw upon the works of Ghassan Hage, Nils Bubandt, Elizabeth Povinelli, and Donna Haraway to interrogate the limits of biopolitics and diagnose theoretical conundrums stemming from the division of nature vs. culture and life vs. nonlife entrenched in the existing social-political paradigms. Rather than providing finite answers about the role of the virus as a non-human actor in the political sphere, we raise questions as to how and why it should matter.
Background Intersex people are exposed to human rights violations all over the world. Ongoing practices of sex-normalising surgery and other medical interventions on minors too young to give informed consent encroach on their bodily autonomy. Little is known about the public health implications of bodies with variations of sex characteristics (VSC). What key issues do VSCs raise? Methods In 2020 the INIA international consortium began work on a large research programme to address intersex people's wellbeing and human rights from a variety of new and innovative perspectives. The programme will train a cohort of 10 early-stage researchers working collaboratively to develop knowledge that will inform policy making and practice across a range of key sectors. Drawing on critical intersex studies, the research projects are relevant to stakeholders who are concerned with supporting the wellbeing and rights of intersex people through knowledge sharing and development. The project received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 859869. Please see https://www.intersexnew.co.uk/. Results Indicative findings show that VSC could be an important area of public health work concerning diversity and equality. Early-stage results show a dearth of intersex visibility in key areas including social policy, education, and elder care. Intersex people and those with VSC face major health challenges and discrimination. There is a pressing need for appropriate healthcare. Conclusions The interdisciplinary INIA programme surfaces multiple discourses about intersex people and those with variations of sex characteristics. Projects of particular interest to public health practitioners and policy makers include those concerning multi-disciplinary healthcare, ethics, social policy, education, aging, and service user participation.
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