Parental and Patient Procedural Consent for Surgical Interventions in DSD

Historically and in common practice, a child born with DSD is considered a social emergency rather than a medical one. This is understandable considering parental anxiety to learn and announce the sex of their child as well as individual and societal pressure to conform to the normal binary of male and female sexes. Hence, the parents and caregivers are under understandable stress of discovery and decision-making. Further, the sex of the child has to be conveyed and documented in the birth registry of local authorities in a finite time frame. It puts the treating physician under the scanner, especially a pediatric surgeon who is often asked to opine on the sex of the child. If the child requires an emergency or elective surgical procedure, issues of consent and its legality stare us in the face in the light of increasing government legislation restricting interventions. This chapter will deal with issues of procedural consent in DSD cases and how to navigate our way through this moral and ethical quagmire so that the best interests of the child and future adult are served.