Reconsidering Classical Fiqh’s Approach to Disorders of Sexual Development: A Study in View of Current Medical KnowledgeMine Doğan, Merve Özaykal
Disorders of sexual development (DSD) is the term used to denote intersexuality, hermaphroditism, and androgyny, and has been subjected to examination in different disciplines such as medicine, ethics, philosophy, theology, psychology, sociology, and law due to its critical multidimensional structure. This article reexamines the understanding of DSD in fiqh, which is based on classical medicine, in light of current medical knowledge. This study aims to re-evaluate within the framework of current medicine the classical Islamic jurists’ definition of DSD and the legal norms they determined based on the medical knowledge of their period. Issues such as how DSD are defined in classical Islamic law, what categories they include, how the methods for diagnosis and treatment are developed, and what criteria are set for sex assignment are assessed in light of current medical knowledge. As a result, this study establishes that the perception of DSD in classical Islamic law, as based on the medical knowledge of the period, is broader in one sense and narrower in another when compared to that of contemporary medicine. In this context, modern medicine and classical Islamic law share the view that people with ambiguous genitalia are classed within the category of DSD. Despite this, the condition of having no external genitalia of any sex, which constitutes another category that Islamic law considers to fall within the scope of DSD, has been evaluated as an anomaly (or more specifically, cloacal malformation) that occurs during the development of the digestive system, but does not fall within the scope of DSD according to contemporary medicine.
Klasik Fıkhın Cinsiyet Gelişim Bozukluklarına Bakışını Yeniden Düşünmek: Güncel Tıbbî Bilgi Açısından Bir İncelemeMine Doğan, Merve Özaykal
Cinsiyet gelişim bozuklukları (CGB) olgusu veya farklı adlandırmalarıyla interseksüalite, hermafroditizm, hünsâlık ya da çift cinsiyetlilik kritik ve çok boyutlu yapısı sebebiyle tıp, etik, felsefe, din, psikoloji, sosyoloji ve hukuk gibi farklı disiplinlerin inceleme konusu olmuştur. Bu makalede, klasik dönem tıbbî bilgisi üzerine inşa edilmiş fıkhın cinsiyet gelişim bozuklukları anlayışı güncel tıbbî bilgiler ışığında incelenmiştir. Çalışmanın amacı, dönemlerinin tıbbî verilerine dayanarak CGB (hünsâlık) olgusunu tanımlayan ve hukukî normlar düzenleyen klasik fakihlerin, içtihat ürünü olarak ortaya koyduğu bu bilgileri günümüz tıbbî verileri çerçevesinde yeniden değerlendirmektir. Bu doğrultuda makalede, klasik fıkhın cinsiyet gelişim bozukluklarını nasıl tanımladığı, hangi kategorilere ayırdığı, tanı ve tedavisi için nasıl yöntemler geliştirdiği ve cinsiyetin atanması için hangi kriterleri düzenlediği gibi meseleler tıbbî veriler ışığında değerlendirilmiştir. Çalışma sonucunda, dönemin tıbbî bilgisini esas alan klasik fıkhın cinsiyet gelişim bozuklukları anlayışının güncel tıbbınkinden bir anlamda daha geniş bir anlamda da daha dar olduğu saptanmıştır. Bu bağlamda muğlak genital yapılı kimselerin (ambiguous genitalya) cinsiyet gelişim bozuklukları kategorisine dâhil edileceği konusunda güncel tıp ve klasik fıkıh birleşirken, fıkhın kabul ettiği diğer sınıf olan kendisinde hiçbir cinsin dış genital organları bulunmayan kimseler, güncel tıbba göre sindirim sisteminin gelişimi esnasında meydana gelen anomaliler olarak (kloakal malformasyonlar) değerlendirilmiştir.
Determining or assigning the sex of a newborn baby can be a complicated matter. Those with a male chromosomal structure may look like a typical woman, and those with a female chromosomal structure may look like a typical male, or people may have ambiguous external genitalia. This phenomenon is expressed through concepts such as disorders of sexual development (DSD), intersexuality, hermaphroditism, and androgyny, and came under the guidance of religion and law as well as medicine even prior to Islam; as of the 20th century, however, such matters have come increasingly under the supervision of medicine, due to surgical interventions having allowed for the removal of unwanted sexual organs or tissues from the bodies of individuals with DSD who have been assigned a specific sex. However, this does not mean that the sciences of religion and law are isolated from medical data in addressing DSD. Individuals with DSD certainly existed in society in the early classical periods of Islamic law. Because the phenomenon of DSD primarily concerns the human body, the classical period Islamic jurists necessarily had to first deal with the medical aspect of the issue. The jurists thought that sex should be assigned before establishing legal norms for individuals with DSD. To this end, they first tried to analyze who would be included in the taxonomy of DSD. Thus, jurists developed methods for assigning sex, after DSD phenomena became identifiable by being distinguished from other sexual variations. Without imaging methods such as ultrasound, genitography, or MRI in classical times, Islamic jurists developed sex assignment methods by comparing the anatomy of other humans and animals. As is understood from the sex assignment methods they established, they were aware of internal and external genital organs and hormonal changes. They were also aware that sex has not only biological but also psychological aspects. Even by considering that typologies of sex had complex structures, individuals were still found with DSD’s whose sex could not be assigned at that time. Although classical Islamic jurists could not determine the sex of these individuals biologically, they did legally include them in one of the binary configurations of sex and prepared special legal norms for them.
This article discusses the DSD optimal care standards in classical Islamic law comparatively with the standards of care in contemporary medicine and aims to reveal how classical Islamic law approached DSD from a medical point of view. By using comparative analysis and personal interview methods, this study focuses on where the optimal care standards of classical Islamic law regarding DSD stand in relation to data regarding contemporary medicine. In this context, the study discusses topics such as how both disciplines define DSD, what categories they classify, their diagnosis and treatment methods, and which sex assignment criteria they regulate. The study takes the decisions of the Intersex Consensus Meeting that was held in Chicago in 2005 and have since been continuously updated into consideration and as a result has determined the perceptions of classical Islamic law toward DSD on one hand to parallel that of contemporary medicine while on the other to also differ. Classical Islamic law defines DSD (al-khunūthah) as individuals with external genitalia of both sexes (ambiguous genitalia) or individuals without external genitalia of any sex. This definition shows that classical Islamic law and contemporary medicine agree that individuals with ambiguous genitalia should be included in the DSD classification. In contrast, classical Islamic jurists’ inclusion of people with no external genitalia of any kind in the category of DSD is deemed to result from anomalies that occur during the development of the digestive system (cloacal malformations) in contemporary medicine. This difference is because DSDs in classical Islamic law are not seen as a disorder of sexual development but rather to involve conditions that make phenotypic sex uncertain. Therefore, certain cloacal malformations are included in the DSD taxonomy of classical Islamic law as they make external genitalia atypical.
Classical Islamic jurists sought a solution to the phenomenon of DSD with the limited medical facilities of their time. They developed unique definitions, taxonomies, and sex assignment methods for this phenomenon. However, when considering that their judgements were made according to the medical possibilities of their time, the solutions should be updated using developments in medicine. Thus, by drawing attention to the issues of DSD, for which classical Islamic law laid the foundations, this study aims to benefit modern Islamic jurists’ production of up-to-date and original solutions to DSD-related problems.