Sundheds- og Ældreudvalget 2014-15 (2. samling)
SUU Alm.del Bilag 44
Offentligt
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04/2015
The fundamental rights
situation of intersex people
Most European societies recognise people as either male or female. However, this does not
account for all variations in sex characteristics. As a result, intersex people experience
fundamental rights violations ranging from discrimination to medical interventions without
their consent.
This paper examines the legal situation of intersex people from a fundamental rights
perspective. It draws on evidence from the Agency’s updated legal analysis on homophobia,
transphobia, and discrimination on grounds of sexual orientation and gender identity, which
now includes a section on intersex issues.
Key facts
Many Member States legally require births
to be certified and registered as either male
or female.
In at least 21 Member States, sex
‘normalising’ surgery is carried out on
intersex children.
In 8 Member States, a legal representative
can consent to sex ‘normalising' medical
interventions independently of the child’s
ability to decide.
18 Member States require patient consent
provided the child has the ability to decide.
Intersex discrimination is better covered by
sex discrimination rather than
discrimination on the basis of sexual
orientation and/or gender identity as it
concerns physical (sex) characteristics.
Key conclusions
Legal and medical professionals should be
better informed of the fundamental rights
of intersex people, particularly children.
Gender markers in identity documents and
birth registries should be reviewed to better
protect intersex people.
Member States should avoid non-
consensual ‘sex-normalising’ medical
treatments on intersex people.
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The fundamental rights situation of intersex people
Introduction
‘Intersex’ is used in this paper as an umbrella
term to denote a number of different variations
in a person’s bodily characteristics that do not
match strict medical definitions of male or
female.
These
characteristics
may
be
chromosomal, hormonal and/or anatomical and
may be present to differing degrees. Many
variants of sex characteristics are immediately
detected at birth, or even before. Sometimes
these variants become evident only at later
stages in life, often during puberty. While most
intersex people are healthy, a very small
percentage may have medical conditions which
might be life-threatening, if not treated
promptly.
Intersex is a collective term for many natural
variations in sex characteristics. It is not a
medical condition.
Medically, some of these variants are grouped
under ‘disorders of sexual development’.
However, this is rejected by many, including
activists and intersex people themselves, who
perceive it to be stigmatising and pathologising.
1
It should also be noted that some intersex people
may not wish to identify as such.
Practices, such as issuing birth certificates and
medical treatments, can have an impact on the
fundamental rights of intersex people. For
example, Article 1 of the Charter of Fundamental
Rights of the European Union, protects human
dignity. Other Charter rights include: the right to
integrity of the person (Article 3); respect for
private and family life (Article 7); the right to
found a family (Article 9); and rights of the child,
including the right of children to express their
views freely and to have their views taken into
consideration on matters which concern them in
accordance with their age and maturity (Article
24). Intersex people also benefit from the
prohibition of discrimination under the Charter
(Article 21).
When basic aspects of a person’s legal status
(e.g. birth or death registration), social status
(e.g. access to services) or health conditions are
frequently defined by the so-called ‘sex binary’
classification of being either ‘male’ or ‘female’
intersex people are often discriminated against.
This is because their sex characteristics cause
them to fall outside of this classification. It can
also lead to grave violations of their rights to
physical and psychological integrity as well as
other fundamental rights.
Background
In the European Union intersex issues have
progressively
emerged
as
relevant
to
fundamental rights protection. However, they
are still largely treated as medical issues falling
outside the scope of public scrutiny. A number of
developments at EU level in recent years have
contributed to a better understanding of the
problems intersex people face. For example, in
2013, the ‘working definitions’ laid down by the
Council of the European Union stated that
traditional notions of maleness and femaleness
are culturally established.
2
The ‘Lunacek Report’
of the European Parliament, also adopted in
2013, recommended that the European
Commission, EU Member States and relevant
agencies address the current lack of knowledge,
research and relevant legislation on the human
rights of intersex people.
3
Member States have also raised the issue of
intersex. For instance, in 2010, the Italian
Committee on Bioethics published a report
reinforcing the exclusively medical approach to
intersex issues, reinstating sex binary as an
“indispensable element of personal identity”.
4
However, the Committee also stressed the
importance of acting in the best interest of the
child, following a case-by-case approach, and
avoiding surgical and medical intervention until
the child is able to give informed consent. In
2012, the German Ethics Council (Ethikrat)
published a comprehensive Opinion on intersex
issues, providing a range of recommendations to
safeguard the rights of intersex people.
5
The
Opinion argues that legal systems presume a
strict sex binary that does not always occur in
nature. Thus, intersex issues should concern legal
professionals and policy makers, and not only
health and healthcare professionals. However,
most organisations concerned with protecting
the rights of intersex people in the EU support the
recommendations developed by the Swiss
National Advisory Commission on Biomedical
Ethics instead of those adopted in EU Member
States. The Swiss recommendations emphasise
that, as a rule, sex assignment treatment should
only be performed when the person concerned
agrees. They also emphasise that intersex
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FRA Focus 04/2015
children and their parents should be given
psychological counselling and support. The
recommendations consider protecting the child’s
integrity as being essential.
6
A study of intersex people published by the
Netherlands Institute for Social research in 2014
found that virtually all the intersex people
interviewed encountered problems in their social
situation. They talked about being ‘different’,
feeling lonely and experiencing shame and
embarrassment.
7
The study called for further
research into their experiences.
Intersex issues are increasingly emerging also
among the activities of civil society, including
lesbian, gay, bisexual and transgender
organisations. For example, ILGA-Europe started
working on intersex issues in 2008.
8
The
Organisation Intersex International Europe (OII)
has been established as a cooperation platform
for intersex organisations in several European
countries.
9
In Austria for instance, the
Homosexual Initiative Salzburg (Homosexuelle
Initiative
Salzburg,
HOSI)
assigned
a
representative for intersex issues (Intersex-
Beauftragte).
Specific intersex NGOs have also
been established, such as the Association of
Intersex People Austria (Verein
Intersexueller
Menschen Österreich),
and the Intersex Platform
Austria (Plattform
Intersex Österreich)
- an
independent network of NGOs, scientists and
activists that aims to foster public discussion, and
offer advice and information.
10
policy. This is an area where the EU has exercised
its competence in several specific domains which
touch on the protection of intersex people, such
as employment, access to goods and services,
and free movement.
Unequal treatment of intersex people has been
frequently addressed in EU policies and advocacy
as part of discrimination on the ground of sexual
orientation and/or gender identity. However,
such treatment can better be addressed as
discrimination on the ground of sex, as it is linked
to the sex assigned to a person at birth and its
direct consequences. For example, an intersex
person incorrectly assigned a female sex at birth,
may be prevented from marrying a woman in
those countries where civil marriage is not
possible for same-sex couples.
It is also important to bear in mind that intersex
refers to the bodily characteristics of a person.
There is no evidence linking specific sex
characteristics with either gender identity or
sexual orientation. Thus, intersex people might
be as likely as non-intersex people to self-
identify as heterosexual, bisexual, homosexual,
trans, etc. However, regardless of the sexual
orientation or gender identity of intersex people,
they should benefit from protection from
discrimination on the ground of sex under Article
21 of the EU’s Fundamental Rights Charter.
Regarding secondary EU law, it should be noted
that the Lunacek Report has called on the
European Commission, together with relevant
agencies to “issue guidelines specifying that
transgender and intersex persons are covered
under ‘sex’ in Directive 2006/54/EC [Gender
Equality Directive (recast)]” (para. C. ii).
17
So far, however, it appears that the directive has
not been implemented in this way. FRA’s
research did not find sufficient legislation or case
law to find out whether or not intersex people
are actually protected from discrimination on the
grounds of sex in the Member States. In this
regard, the German Ethics Council clarified that
discrimination against intersex people is
generally intended to be covered under the
category of sex. However, the explanatory note
of the German General Law on Equal Treatment
subsumed intersex issues under the ground of
‘sexual identity’.
18
Intersex civil society organisations are
advocating that a specific ground, ‘sex
characteristics’, best identifies their needs when
it comes to protection from discrimination.
19
Grounds for protection from
discrimination
The Council of the European Union,
11
and the
European Parliament
12
, as well as the Council of
Europe,
13
the UN High Commissioner for Human
Rights,
14
and the UN Special Rapporteur on
Torture
15
, have all pointed out that intersex
people can suffer from discrimination that may
result in ill treatment, especially during
childhood. An overview of the key human rights
at stake in the protection of intersex people can
also be found in the Commissioner for Human
Rights of the Council of Europe’s
Issue Paper on
human rights and intersex people.
16
The provision of protection from discrimination
under Article 21 of the EU’s Fundamental Rights
Charter is of special relevance for EU law and
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The fundamental rights situation of intersex people
Malta recently became the first (and only) EU
Member State to explicitly provide protection
against discrimination on the ground of ‘sex
characteristics’. The recently-adopted ‘Gender
Identity,
Gender
Expression
and
Sex
20
Characteristics Act’ requires public services to
eliminate
unlawful
discrimination
and
harassment on the ground of sex characteristics.
It also requires public services to promote
equality of opportunity for all, irrespective of
these characteristics.
21
Two other positive examples were identified in
Spain and the United Kingdom, both at the
regional level. In Spain, the Basque Country
Act 14/2012 on non-discrimination based on
gender identity includes references to “intersex
persons”.
22
In the United Kingdom, the Scottish
Offences (Aggravation by Prejudice) Act 2009
includes intersex issues in its very wide definition
of gender identity i.e. “not standard male or
female”
23
- thus also equating intersex with a
form of gender identity.
In at least 10 EU Member States (Bulgaria,
Estonia, Hungary, Italy, Luxembourg, Poland,
Portugal, Romania, Spain and Slovakia) the law
has an open list of grounds of discrimination.
Here, intersex may be included under the
protected characteristics or social groups
category of ‘other’. This could help protect
intersex people from discrimination. However,
given the social and legal invisibility of intersex
issues in society and in the legal system,
considering such an approach can perpetuate this
invisibility. It could also result in acts of
discrimination against intersex people remaining
unchallenged. Using this ground of protection
remains largely untested and unclear in practice,
given the scarcity of case law.
In seven EU Member States, policy makers or
courts embrace broader concepts. These may
implicitly cover intersex, for instance: gender (in
Austria,
[i]
Denmark,
[ii]
Finland
[iii]
and the
Netherlands
[iv]
); gender identity (in Romania
[v]
and Slovenia
[vi]
); or both gender and gender
identity (in Sweden
[vii]
).
Intersex covers a large and diverse variation of
sex characteristics. Therefore, it is likely that in
the absence of specific protective legislation,
intersex cases will be legally approached in
different ways, even within the same legal
system.
Registration of sex at birth
Apart from a few recent pieces of legislation
described below, birth registration legislation in
EU Member States tends to consider all
individuals as either male or female.
Consequently, in most Member States it is
required, but not always possible, to assign a sex
to intersex new-borns. The moment when birth
certificates and registration takes place is
frequently the first instance in which intersex
people are confronted with a legal issue. This is
very problematic for intersex children as it forces
those involved in certifying and registering birth
(particularly parents or other family members
responsible for the child, health professionals,
and birth registry officials) to legally choose
between the ‘male or female’ options. In
addition, parents frequently lack psychological
support services. Such support would allow them
to adequately face parenthood of intersex
children, and better respond to the challenges
posed by the social expectations, and legal and
medical requirements which they, and their
children, face.
In this way, legal requirements for birth
certification and registration reinforce social
expectations that a child fits into existing sex
categories. This influences the perceived
‘medical need’ for treatment and intervention.
The interplay of legal, social, and medical
expectations creates a context in which the
child’s rights to physical and mental integrity, and
to express views freely can be easily overridden.
Such views should be taken into consideration on
matters which concern the child in accordance
with the child’s age and maturity.
Concerning birth certificates, 18 EU Member
States allow a certain delay in the registration of
a new birth: within a week in Austria, Belgium,
Bulgaria, France, Luxembourg and Slovakia;
longer in Cyprus, Denmark, Greece, Hungary,
Ireland, Italy, Malta, Portugal, Romania, Slovenia,
Spain and the United Kingdom. Sometimes
certification follows a preliminary communication
that has been immediately filed by the medical
staff. For some intersex children, this delay may
be sufficient to allow for the medical
identification of a ‘preponderant’ sex, however
this may be defined. This leads to the legal
imposition of a ‘male’ or ‘female’ sex. However,
medical treatments, including surgery, on very
young intersex children is common.
24
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FRA Focus 04/2015
At least four EU Member States allow a sex-
neutral identification to be registered in birth
certificates, such as ‘unknown sex’ in the United
Kingdom. In Latvia, sex is not included on the
birth certificate, but ‘unclear sex’ is allowed in
medical certificates issued by medical staff.
25
In the Netherlands, if the sex of a child is
unclear, the birth certificate can state that the
sex could not be determined. Within three
months of the date of birth, a new birth
certificate should be drawn up and the first one
destroyed. In the new birth certificate, the sex
of the child should be mentioned based on a
medical statement. If no medical statement is
submitted or if the sex cannot yet be
determined, the new birth certificate should
indicate that it is not possible to determine the
sex of the child. It is assumed that once an
intersex person has decided on their sex
identity, they can change the registration
according to Article 1:24 of the Civil Code, but
no time limit is set. In Portuguese intersex
cases, a person reporting the birth at the civil
registry office is advised to choose a first name
that is easily adapted to either sex. It is
expected that the birth certificate will be
amended accordingly, once a sex can be
attributed with some precision.
26
The German Ethics Council has recommended
allowing the ‘other’ sex category in
certifications.
27
In Germany, it is possible to issue
birth certificates without a sex identifier or
marker; since 1 November 2013, there is no
deadline to include such a marker.
28
In Malta, the entry of a sex marker on the birth
certification can be postponed until the gender
identity of the child is determined. This follows
the adoption of the ‘Gender Identity, Gender
Expression and Sex Characteristics Act’ in April
2015.
29
Malta has also committed to recognising
gender markers other than male or female, as
well as the absence of such markers, from a
competent foreign court or responsible authority
acting in accordance with the law of that country.
To a limited extent it is also possible to issue birth
certificates without a sex identifier or marker in
France and Finland. In France, ministerial
guidelines advise parents to check with their
doctor what the sex of the new-born is ‘most
likely’ to be. This should be based on the
expected results of medical treatments, where
appropriate.
30
In this case, it is possible not to
specify a child’s sex, with the public prosecutor’s
consent as long as sex determination can be
reasonably expected after a maximum of three
years of medical treatment.
31
In Finland, the lack of sex certification implies
that an intersex child gets an incomplete
personal identity code. This has potentially
negative consequences. For example, a personal
code is needed for contact with authorities, for
the payment of wages and salaries, or to open a
bank account.
In cases of errors in birth certificates, it is possible
for intersex people to change the sex identifier
later in life in EU Member States, such as
Denmark, France and the Netherlands, without
meeting the requirements demanded for trans
people. In France these requirements include: the
diagnosis of gender dysphoria; hormonal
treatment or physical adaptation; a court order; a
medical opinion; and genital surgery leading to
sterilisation.
In general, intersex people and those who are
responsible for caring for intersex children,
largely need to rely on external, medical
assessments when it comes to the certification of
an intersex person’s sex.
Medical treatment of
intersex children
In May 2014, various UN bodies released an
interagency statement noting that “Intersex
persons, in particular, have been subjected to
cosmetic and other non-medically necessary
surgery in infancy, leading to sterility, without
informed consent of either the person in question
or their parents or guardians. Such practices have
also been recognized as human rights violations
by international human rights bodies and national
Courts.” These bodies included the World Health
Organisation (WHO), the Office of the High
Commissioner for Human Rights (OHCHR), UN
Women, the Joint United Nations Programme on
HIV/AIDS (UNAIDS), the UN Development
Programme (UNDP), the UN Population Fund
(UNFPA) and the UN’s Children’s Fund (UNICEF).
In Europe, there are no comprehensive statistical
data on medical treatments or surgeries
performed
on
intersex
children.
The
Commissioner for Human Rights of the Council of
Europe has repeatedly pointed out that intersex
children are often subjected to surgery and
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The fundamental rights situation of intersex people
hormonal or other medical treatments aimed at
imposing a sex on them.
32
Such surgery,
performed on intersex babies and toddlers,
which can be cosmetic rather than medically
essential, may result in irreversible sex
assignment and even sterilisation.
33
The Parliamentary Assembly of the Council of
Europe in its Resolution 1952 (2013) on a child’s
right to physical integrity called on its Member
States to “ensure that no-one is subjected to
unnecessary medical or surgical treatment that is
cosmetic rather than vital for health during
infancy or childhood, [and to] guarantee bodily
integrity [...] to persons concerned”.
34
The UN Special Rapporteur on torture has
similarly called upon States
“to repeal any law allowing intrusive and irreversible
treatments, including forced genital-normalizing surgery,
involuntary sterilization, unethical experimentation,
medical display, ‘reparative therapies’ or ‘conversion
therapies’, when enforced or administered without the
free and informed consent of the person concerned.”
The UN Special Rapporteur on torture has also
called on States to outlaw forced or coerced
sterilisation in all circumstances and to provide
special protection to individuals belonging to
marginalised groups.
35
When not dictated by medical emergency,
surgery and medical treatments without the
consent of the patient or legal representatives
are recognised by international human rights law
as a form of cruel, inhuman and degrading
treatment. Genital surgery performed on intersex
people was equated to female genital mutilation
(FGM) by the Conference of State (Länder)
Ministers for Equality of Germany.
36
FGM is
internationally recognised as a violation of the
human rights of women and a form of child
abuse, and has been strongly condemned by the
EU Commission
37
and Council.
38
In Malta, the
‘Gender Identity, Gender Expression and Sex
Characteristics Act’
39
forbids sex assignment
treatments and/or surgical intervention on the
sex characteristics of a child which can be
deferred until the person to be treated can
provide informed consent, unless in exceptional
circumstances.
Agreement
between
an
interdisciplinary team, appointed by the equality
minister, and those with parental authority, or
the child’s tutor, is also required.
40
There is little information on the existence of
medical protocols concerning the treatment of
intersex people across the EU. In Austria, Estonia,
Spain, Finland, France, Hungary, Ireland, Italy,
Luxembourg and the United Kingdom no official,
general medical protocol is applied. In Sweden,
the National Board of Health and Welfare
(Socialstyrelsen) has produced guidelines
regarding the treatment of intersex children. The
procedure specifies that examinations and
genital surgical procedures should not be
performed between the ages of 2 and 12.
However, in most cases genital surgery is
reportedly performed before the age of six
months.
41
In Austria the recommendations of the
previously mentioned German report
42
and the
Lawson Wilkins Pediatric Endocrine Society (USA)
and the European Society for Paediatric
Endocrinology are referenced. These two
institutions have published the so-called
‘Consensus
Statement on the management of
intersex disorders’
(also known as ‘the Chicago
Consensus’) which proposed changes in
terminology.
43
However, this document has been
criticised by intersex organisations as it intro-
duced the term ‘disorders of sex development’ to
describe intersex characteristics. Intersex
organisations consider that the use of this term
pathologises the sex characteristics of intersex
people, and can justify ‘sex normalising’ medical
treatment.
44
In the Netherlands, it is also common practice to
follow ‘the Chicago Consensus’, but this may not
apply to all hospitals.
45
In any case, the issue is
not how ‘good’ the treatment becomes, but
whether it meets human rights standards if
administered without consent when the
‘condition’ is not life threatening or will not lead
to significant harm.
In the United Kingdom, there are specific medical
protocols for specific types of intersex
characteristics. In addition, there is a general
information page on the National Health Service
website.
46
In Spain, protocols for specific forms of
intersex characteristics are followed, such as the
protocol developed by the Spanish Association of
Paediatrics (Asociación
Española de Pediatría)
47
or the protocol of the European Association of
Urology.
48
In France, the protocol on the
management of a specific form of intersex
(congenital adrenal hyperplasia due to 21-
hydroxylase deficiency) refers to surgical
treatment in the first months after birth.
Although there is no reference to consent, the
protocol notes that “patients and parents should
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FRA Focus 04/2015
be accompanied psychologically in the surgical
project”.
49
There is also little case law on medical
treatments of intersex people. In one important
case in Germany, the Cologne District Court
recognised the pain and suffering of an intersex
person who had been subjected to medical
surgery 30 years earlier without adequate
information.
50
The claimant brought a suit for
damages - on the grounds of erroneous
assignment of a sex and physical mutilation -
against the surgeon who, when the claimant was
18 years old, had removed her uterus and
fallopian tubes. In its decision, the court ruled that
the operation had been conducted without the
necessary consent and that the claimant had not
been comprehensively informed by the
defendant surgeon. The court later awarded
damages of €100,000 plus interest.
51
Sex (re)assignment or sex-related surgery seems
to be performed on intersex children, and young
people, in at least 21 EU Member States (Austria,
Belgium, Bulgaria, the Czech Republic, Denmark,
Estonia, Finland, France, Germany, Hungary,
Ireland, Italy, Latvia, Lithuania, Malta, the
Netherlands, Poland, Slovakia, Spain, Sweden
and the United Kingdom). However, it is not
known how frequently such operations are
conducted. In all these countries, informed
consent for surgery is required from the patient
and/or legal representatives, except in cases of
medical emergency.
In eight Member States (Austria, Belgium,
Bulgaria, the Czech Republic, Estonia, Hungary,
Poland and Sweden), the legislation or medical
practice requires consent by the legal
representative, independently of the child’s
ability to decide. In Spain, this is the case if
medical interventions entail ‘a serious risk’ for
the child.
Patient consent seems to be legally required in at
least 18 Member States (Austria, Belgium,
Bulgaria, Denmark, Finland, France, Germany,
Ireland, Italy, Latvia, Lithuania, Malta, the
Netherlands, Poland, Slovakia, Spain, Sweden
and the United Kingdom). This is provided that
the child is considered to possess adequate
cognitive faculties and the ability to decide. In 14
Member States (Austria, Belgium, Bulgaria,
Denmark, Germany, Ireland, Lithuania, Latvia, the
Netherlands, Poland, Slovenia, Spain, Sweden
and the United Kingdom), the child is presumed
to have such abilities after a certain age.
However, there is often flexibility in assessing
these abilities, both in Member States where a
certain reference age exists (for example, 12
years in Belgium; 14 in Austria, Bulgaria, and
Germany; 15 in Slovenia; and 16 in Lithuania and
the United Kingdom) and in Member States
where there are individual assessments (for
example, Finland, France and Italy). Such
flexibility, while necessary in view of the
variation in cognitive development, runs the risk
that medical procedures may be imposed on
children against their will.
This is a broader issue concerning the
involvement of children in decision-making on
matters that concern them. While adequate child
participation mechanisms are particularly
important, in this context the key determinants
appear to be:
(i) the minimum age from which a child is
involved in the decision-making process: this is
complicated by variations in sex development
that arise or are found before or at puberty. From
this perspective, ages of consent around or
higher than 15 years old, as, for example, in
Denmark, Ireland, Lithuania, Poland, Slovenia,
Spain and the UK might be too high.
(ii) whether intervention is postponed or consent
is sought from parents, when the child is
considered to be unable to decide: in at least six
EU Member States, Austria, Germany, Hungary,
Malta, the Netherlands and Sweden, current
practices or government guidelines show a
tendency to postpone medical treatments that
are not strictly necessary to safeguard health,
until a child is considered capable of deciding.
However, ‘sex normalising’ and/or cosmetic
surgeries may still be performed on children
without their informed consent.
(iii) what happens in cases of disagreement
between the child, and parents or legal
representatives when a child can decide, but
parental or a legal representative’s consent is
also necessary: the situation varies between
Member States. In Italy and Poland, for example,
the decision is made by a guardianship court; in
Lithuania and Latvia the decision is made by the
medical staff involved. In a German Federal Court
of Justice case – not directly related to intersex
issues – the parents’ right to decide on medical
treatment was limited by the child’s opposition
to it given that the postponement of the
intervention did not endanger the child’s
health.
52
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The fundamental rights situation of intersex people
Concluding remarks
Intersex people face several challenges which
relate to the law and medical intervention. Legal
and medical professionals should be better
aware of these challenges to ensure that the
fundamental rights of intersex people are fully
respected - particularly when they are children.
Intersex people will remain vulnerable to
discrimination as long as birth, and other,
registries do not record sex identities
appropriately, and as long as they are medically
diagnosed as men or women with a health
disorder.
Alternatives to gender markers in identity
documents should be considered to protect
intersex people. The possibility of including a
gender-neutral marker could also be considered.
This is particularly important for birth
registration/certificates in situations where the
new-born child’s sex is unclear.
EU Member States should avoid ‘sex-normalising’
medical treatments on intersex people without
their free and informed consent. This would help
prevent violations of the fundamental rights of
intersex people, especially through practices
with irreversible consequences.
1
2
3
4
5
6
7
8
9
10
11
OII Intersex Network (2012),
The Terminology of
Intersex.
Council of the European Union (2013),
Guidelines
to promote and protect the enjoyment of all
human rights by lesbian, gay, bisexual,
transgender and intersex (LGBT) persons,
Foreign
Affairs Council Meeting, Luxembourg,
24 June 2013, p. 4.
European Parliament (2014),
Report on the EU
Roadmap against homophobia and discrimination
on grounds of sexual orientation and gender
identity
(2013/2183(INI)), Plenary sitting, No. A7-
0009/2014, 7 January 2014, Strasbourg,
(para. G. iv)
Italy, National Committee on Bioethics (Comitato
Nazionale di Bioetica)
(2010),
The disturbances of
sexual differentiation in children: Bioethics aspects
(I
disturbi della differenziazione sessuale nei
minori: aspetti bioetici),
Rome, Presidenza del
Consiglio dei Ministri, p. 18.
Germany, German Ethics Council (Deutscher
Ethikrat)
(2012),
Intersexualität,
Berlin, Pinguin
Druck.
Switzerland, Swiss National Advisory Commission
on Biomedical Ethics (2012),
On the management
of differences of sex development. Ethical issues
relating to ‘intersexuality’,
Berne, November
2012, p. 18.
Lisdonk, J. (2014),
Living with intersex/dsd. An
exploratory study of the social situation of persons
with intersex/dsd,
Netherlands Institute for Social
Research, The Hague, August 2014, p. 60.
ILGA-Europe’s intersex work
See,
http://oiieurope.org
Austria, Federal Ministry for Education, the Arts
and Culture (Bundesministerium
für Unterricht,
Kunst und Kultur)
(2012),
Really intimate
(ganzschönintim), p. 69.
Council of the European Union (2013),
Guidelines
to promote and protect the enjoyment of all
human rights by lesbian, gay, bisexual,
transgender and intersex (LGBT) persons,
Foreign
Affairs Council Meeting, Luxembourg,
24 June 2013.
12
13
14
15
16
17
18
19
20
European Parliament (2014),
Report on the EU
Roadmap against homophobia and discrimination
on grounds of sexual orientation and gender
identity
e2013/2183(INI)),
Plenary sitting, No.
A7-0009/2014, 7 January 2014, Strasbourg.
Council of Europe (2013),
Children’s right to
physical integrity,
Resolution 1952, Parliamentary
Assembly, Strasbourg. See also Council of Europe
(2014), Commissioner for Human Rights
Comments,
A boy or a girl or a person – intersex
people lack recognition in Europe,
9 May 2014.
United Nations (UN), High Commissioner for
Human Rights (2011),
Discriminatory laws and
practices and acts of violence against individuals
based on their sexual orientation and gender
identity,
Human Rights Council, Nineteenth
session, Report No. A/HRC/19/41,
17 November 2011.
United Nations (UN), Special Rapporteur on
Torture (2013),
Report of the Special Rapporteur
on torture and other cruel, inhuman or degrading
treatment or punishment, Juan E. Méndez,
Human
Rights Council, Twenty-second session, Report No.
A/HRC/22/53, 1 February 2013.
Council of Europe Commissioner for Human Rights
Issue Paper, forthcoming.
European Parliament (2014),
Report on the EU
Roadmap against homophobia and discrimination
on grounds of sexual orientation and gender
identity
e2013/2183(INI)),
Plenary sitting, No.
A7-0009/2014, 7 January 2014, Strasbourg.
Germany, Federal Parliament (Bundestag) (2006),
BT-Drs. 16/1780,
8 June 2006, p. 31; Germany,
German Ethics Council (Deutscher
Ethikrat)
(2012),
Intersexualität,
Berlin, Pinguin Druck, p. 133.
European Intersex Meeting (2014),
Statement of
the European Intersex Meeting,
8 October 2014,
point 2.
Malta (2015), Act for the recognition and
registration of the gender of a person and to
regulate the effects of such a change, as well as
the recognition and protection of the sex
characteristics of a person (Att
għar-
rikonoxximent u reġistrazzjoni tal-ġeneru ta’
8
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1543762_0009.png
FRA Focus 04/2015
21
22
23
[i]
[ii]
[iii]
[iv]
[v]
[vi]
[vii]
24
25
26
27
28
persuna u sabiex jirregola l-effetti ta’ dik il-bidla,
kif ukoll għarrikonoxximent u l-protezzjoni tal-
karatteristiċi tas-sess ta’ persuna),
2 April 2015.
Ibid.,
Article 14.
Spain (2012), Ley 14/2012, de 28 de junio,
de no
discriminación por motivos de identidad de género
y de reconocimiento de los derechos de las
personas transexuales.
United Kingdom, Scottish Parliament (2009),
Offences (Aggravation by Prejudice) (Scotland)
Act 2009,
asp 8, sections 2 (2) and 2 (8).
Austria, Ombudsperson for Equal Treatment
(Gleichbehandlungsanwaltschaft) (2013),
Gleichbehandlung für transgender Personen und
intersexuelle Menschen.
Denmark, Board of Equal Treatment
(Ligebehandlingsnævnet) (2013),
Decision
No. 249/2013,
27 November 2013.
Finland, Ombudsperson for Equality (2012),
Selvitys sukupuolivähemmistöjen asemasta,
Helsinki, Tasa-arvovaltuutettu.
Netherlands, Arnhem Court of Appeal
(Gerechtshof
Arnhem)
(2005),
Case No.
ECLI:NL:GHARN:2005:AU7290,
15 November 2005.
Information by the NCCD Centre for Legal
Resources.
Slovenia, Advocate of the Principle of Equality
(Zagovorniknačelaenakosti),
Opinion No. 0921-
22/2010-7;
Slovenia, Advocate of the Principle of
Equality (Zagovorniknačelaenakosti),
Opinion No.
0921-41/2011-UEM/10.
Sweden, Swedish Government (2007), Report by
the Gender Identity Investigation (Betänkande
av
Könstillhörighetsutredningen),
Modified gender
identity: A proposal for a new law
(Ändradkönstillhörighet
– förslag till ny lag),
Stockholm, SOU 2007/16., p. 39.
Agius, S. and Tobler, C. (eds.), European
Commission (2012),
Trans and intersex people:
Discrimination on the grounds of sex, gender
identity and gender expression,
Report by the
European Network of Legal Experts in the non-
discrimination field, Brussels.
Latvia (2012),
Law on the Registration of the Civil
Status Acts
(Civilstāvokļa
aktu reģistrācijas
likums),
29 November 2012,
Latvian Herald
(Latvijuas
Vēstnesis)
197(4800),
14 December 2012, available at: ; Latvia, Cabinet
of Ministers (Ministru
kabineta)
(2006),
Regulations No. 265
On the record-keeping
procedures for medical documents
(Noteikumi
Nr.
265 ”Medicīnisko dokumentu lietvedības
kārtība”),
4 April 2006, 39. pielikums,
Latvian
Herald
(Latvijas
Vēstnesis)
57(3425), 7 April
2006.
Information by the Institute of Registration and
Notary Affairs (Instituto
dos Registos e Notariado,
IRN)
Germany, German Ethics Council (Deutscher
Ethikrat)
(2012),
Intersexualität,
Berlin, Pinguin
Druck.
Germany (2013), Act to Amend Civil Status
Regulations (Gesetz
zur Änderung
29
30
31
32
33
34
35
36
37
38
39
40
41
personenstandsrechtlicher Vorschriften
(Personenstandsrechts-Änderungsgesetz –
PStRÄndG)),
7 May 2013.
Malta (2015), Act for the recognition and
registration of the gender of a person and to
regulate the effects of such a change, as well as
the recognition and protection of the sex
characteristics of a person (Att
għar-
rikonoxximent u reġistrazzjoni tal-ġeneru ta’
persuna u sabiex jirregola l-effetti ta’ dik il-bidla,
kif ukoll għarrikonoxximent u l-protezzjoni tal-
karatteristiċi tas-sess ta’ persuna),
2 April 2015,
article 21.
France, Minister of Justice (Ministère
de la Justice)
(2011),
Instruction about particular rules for
various acts of civil status concerning birth and
filiation
(Circulaire
relative aux règles particulières
à divers actes de l’état civil relatifs à la naissance
et à la filiation),
28 October 2011.
Dan Christian Ghattas (2013),
Human Rights
between the Sexes. A preliminary study on the life
situations of inter* individuals,
Heinrich-Böll-
Stiftung, p. 39.
Council of Europe, Commissioner for Human Rights
(2014),
A boy or a girl or a person – intersex
people lack recognition in Europe
Human Rights
Comment, Strasbourg.
Council of Europe, Commissioner for Human Rights
(2014),
LGBT children have the right to safety and
equality,
Human Rights Comment, Strasbourg.
Council of |Europe, Parliamentary Assembly (PACE)
(2013), Resolution 1952 (2013) Final version on
Children’s right to physical integrity, 1 October
2013, para. 7.5.3..
UN Special Rapporteur on torture (2013), p. 23.
This was stated by the Conference of State
(Länder) Ministers for Equality of Germany. See
further Germany (2014), 24. Konferenz der
Gleichstellungs- und Frauenministerinnen und -
minister, -senatorinnen und - enatoren der Länder
am 1./2. Oktober 2014 in Wiesbaden, TOP 8.1
Paragraph 3.
European Commission (2013),
Towards the
elimination of female genital mutilation,
COM(2013) 833 final, Brussels, 25 November
2013, p. 4.
Council of the European Union (2014), Council
conclusions –
Preventing and combating all forms
of violence against women and girls, including
female genital mutilation,
Justice and Home Affairs
Council meeting, Luxembourg, 5 and 6 June 2014,
p. 2.
Malta (2015), Act for the recognition and
registration of the gender of a person and to
regulate the effects of such a change, as well as
the recognition and protection of the sex
characteristics of a person (Att
għar-
rikonoxximent u reġistrazzjoni tal-ġeneru ta’
persuna u sabiex jirregola l-effetti ta’ dik il-bidla,
kif ukoll għarrikonoxximent u l-protezzjoni tal-
karatteristiċi tas-sess ta’ persuna),
2 April 2015.
Ibid.,
Article 15.
Sweden, National Board of Health and Welfare
(Socialstyrelsen) (2010),
Transsexuals and other
9
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The fundamental rights situation of intersex people
42
43
44
45
46
47
people with gender identity disorder: Legal
conditions for determination of sex as well as care
and support
(Transsexuella
och övriga personer
med könsidentitetsstörningar – Rättsliga villkor för
fastställelse av könstillhörighet samt vård och
stöd),
30 June 2010.
Germany, German Ethics Council (Deutscher
Ethikrat)
(2012),
Intersexualität,
Berlin, Pinguin
Druck.
‘The Chicago Consensus’, see: Lee, P.A.
et al.
(2006), ‘Consensus statement on management of
intersex disorders’,
Pediatrics,
Vol. 118, No. 2, pp.
e488–e500.
OII Intersex Network (2012),
The Terminology of
Intersex.
See also: Switzerland, Swiss National
Advisory Commission on Biomedical Ethics (2012),
On the management of differences of sex
development. Ethical issues relating to
‘intersexuality’,
Berne, November 2012, p. 9.
De Volkskrant
(2010),
Kiezen om te leven als man,
als vrouw of allebei tegelijk,
22 May 2010.
NHS Choices (2014),
Disorders of sex
development,
12 November 2014.
Spain, Spanish Association of Pediatrics
(Asociación
Española de Pediatría)
(2011),
48
49
50
51
52
Anomalies of sexual differentiation
(Anomalías
de
la diferenciación sexual).
European Association of Urology (2010),
Guía
clínica sobre urología pediátrica.
France, High Authority for Health (Haute
autorité
de santé,
HAS) (2011),
Congenital adrenal
hyperplasia due to 21-hydroxylase defic iency:
National protocol for diagnosis and care
(Hyperplasie
congénitale des surrénales par déficit
en 21-hydro xylase: Protocole national de
diagnostic et de soins pour les maladies rares),
p. 16.
Germany, Cologne District Court (Landgericht
Köln)
(2008), Case No. 25 O 179/07, 6 February 2008.
It should be noted that this ruling was
criticised by
intersex organisations
for endorsing a medicalised
approach.
Germany, Cologne District Court (Landgericht
Köln),
(2009), Case No. 25 O 179/07,
12 August 2009.
Germany, Federal Court of Justice
(Bundesgerichtshof) (2006),
VI ZR 74/05,
10 October 2006.
10