Medicine, sexuality and power: Transgender discourses and the ethics of possibility

Biomedicine is not only a practice that focuses on healing diseased bodies. It is also a field of knowledge in the Foucauldian sense, a set of discourses that plays an important role in the constitution of subjects. As such, medicine is a cultural force that defines bodies and determines the very forms of selfhood through which gender is experienced. I argue that medical interventions of various kinds are routinely implemented whose main purpose is to enforce gender conformity according to a binary, heteronormative model. Understood as 'medically necessary,' these practices tend to conceal their own role in the production and enforcement of normative gender. Gender variant subjects, in refusing the terms of gender set forth by biomedicine, press the serious challenge they already present to binary gender by refusing to allow their gendered differences to be subsumed under categories of pathology. Because they fail to follow the preordained patterns or gender scripts of mainstream culture, gender variant or "transgender" subjects must find a way to become viable in a society that insistently denies them any legitimacy. I argue that the nature of such a struggle and the subjectivities it produces is something to which biomedical ethics must pay attention. A responsible bioethics must reflect awareness of (1) biomedicine as a normalizing force and (2) the subject positions that lie outside 'normal' gender. A key responsibility of the philosopher vis-a-vis biomedicine is to expose the contingency of biomedical knowledge. In working to make visible and intelligible the multiplicity of genders that can be found in our culture, biomedical ethics can help to disturb and de-center what I call here "the physician's gaze," to change the power relations that render a wide range of gendered subjects illegible.