PRISM: Human Rights issues relating to Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (SOGIESC) in Aotearoa New Zealand - A report with recommendations diagnosis and full treatment history, while others are not. 242 Surgical interventions on healthy tissue can result in sterilisation, scarring, pain, trauma, reduced function and sensation of sexual organs, and loss of fertility or potential fertility complications.243 International literature shows that delaying medical interventions until a person is old enough to participate in decision-making processes about their body has positive effects on psychosocial outcomes.244 Genital-normalising surgeries are usually performed when an intersex person is an infant; too young to be part of the decision-making process. The intersex human rights movement seeks to end non-life preserving surgical interventions where they can be deferred until a person is old enough to decide for themselves. That is, either at the age of 16 years; or for a child younger than 16, when they have sufficient maturity and intelligence to understand the nature and implications of treatment.245 In its General Comment No. 20 on the rights of the child during adolescence, the UN Committee on the Rights of the Child stated that, “[t]he voluntary and informed consent of the adolescent should be obtained whether or not the consent of a parent or guardian is required for any medical treatment or procedure.”246 Therefore, consent of the parent for surgery cannot be considered as the consent of the child. This is not an ‘anti-surgery’ position; medical procedures can be justified in cases of conditions that pose a health risk or are considered lifethreatening, such as when an infant is unable to urinate.247 The World Health Organization (WHO) states that, “parents often consent to medical intervention for their children in circumstances where full information is lacking and without any discussion of alternatives.”248 WHO has documented the call for deferment of intersex genital surgeries until the individual is old enough to make decisions for themselves.249 Intersex participants at the Commission’s hui noted that the historic harm done by health professionals to intersex people in New Zealand has not been acknowledged to date.250 Further, there is no medical reparation available, as a form of retrospective justice, for those who have been surgically or otherwise altered. The surgical practice of genital normalisation has been described as torture and condemned by the United Nations as a grave violation of the rights to bodily integrity, bodily autonomy, and privacy.251 New Zealand’s practices have also been identified as a failure to meet our obligations under the Convention on the Rights of the Child.252 The Committee on the Elimination of Discrimination Against Women, during its 2018 review of New Zealand, expressed concern about “the conduct of medically unnecessary procedures United Nations Office of the High Commissioner for Human Rights Background Note on Human Rights Violations against Intersex people (October 2019) at 3: The root causes of human rights violations against intersex people include harmful stereotypes, stigma, taboos, and pathologization (i.e. treating intersex persons as necessarily ill or disordered). 243 Milton Diamond and Jameson Garland “Evidence regarding cosmetic and medically unnecessary surgery on infants” (2014) 10 Journal of Pediatric Urology p2. See also New Zealand Human Rights Commission Intersex roundtable report 2016: The practice of genital normalisation on intersex children in Aotearoa New Zealand (Wellington, 2016); New Zealand Human Rights Commission Intersex roundtable report 2017: Ending the practice of genital normalisation on intersex children in Aotearoa New Zealand (Wellington, 2018). 244 Katrina Roen “Intersex or diverse sex development: Critical review of psychosocial healthcare research and indications for practice” (2019) 56 The Journal of Sex Research p511. 245 This is often referred to as ‘Gillick competence.’ See Richard Griffith “What is Gillick competence?” (2016) 12 Human Vaccines & Immunotherapuetics p244. 246 Committee on the Rights of the Child General comment No. 20 (2016) on the implementation of the rights of the child during adolescence UN Doc CRC/C/GC/20 (6 December 2016) at [39]. 247 United Nations Office of the High Commissioner for Human Rights Background Note on Human Rights Violations against Intersex people (October 2019) at 10. 248 World Health Organization Sexual health, human rights and the law (Geneva, 2015) at 26. 249 Ibid at 17 and 27. 250 New Zealand Human Rights Commission Stakeholder Engagement Meeting Notes: Sexual orientation, gender identity, and sex characteristics (SOGISC) consultation (Auckland, 13 February 2018). 251 Juan E. Méndez Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment UN Doc A/ HRC/22/53 (1 February 2013). 252 Committee on the Rights of the Child Concluding observations on the fifth periodic report of New Zealand UN Doc CRC/C/NZL/CO/5 (21 October 2016) at [25(b)]-[25(e)]. 242 42