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Is anatomy destiny? | Alice Dreger | TEDxNorthwesternU

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    I want you to imagine two couples
    in the middle of 1979
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    on the exact same day,
    at the exact same moment,
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    each conceiving a baby, OK?
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    So two couples each conceiving one baby.
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    Now I don't want you to spend too
    much time imagining the conception,
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    because if you do,
    you're not going to listen to me,
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    so just imagine that for a moment.
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    And in this scenario,
    I want to imagine that, in one case,
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    the sperm is carrying a Y chromosome,
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    meeting that X chromosome of the egg.
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    And in the other case,
    the sperm is carrying an X chromosome,
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    meeting the X chromosome of the egg.
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    Both are viable; both take off.
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    We'll come back to these people later.
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    So I wear two hats in most of what I do.
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    As the one hat, I do history of anatomy.
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    I'm a historian by training,
    and what I study in that case
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    is the way that people
    have dealt with anatomy --
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    meaning human bodies, animal bodies --
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    how they dealt with bodily fluids,
    concepts of bodies;
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    how have they thought about bodies.
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    The other hat that I've worn
    in my work is as an activist,
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    as a patient advocate --
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    or, as I sometimes say,
    as an impatient advocate --
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    for people who are patients of doctors.
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    In that case, what I've worked with
    is people who have body types
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    that challenge social norms.
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    So some of what
    I've worked on, for example,
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    is people who are conjoined twins --
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    two people within one body.
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    Some of what I've worked on
    is people who have dwarfism --
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    so people who are much
    shorter than typical.
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    And a lot of what I've worked on
    is people who have atypical sex --
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    so people who don't have the standard male
    or the standard female body types.
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    And as a general term,
    we can use the term "intersex" for this.
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    Intersex comes
    in a lot of different forms.
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    I'll just give you a few examples
    of the types of ways you can have sex
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    that isn't standard for male or female.
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    So in one instance,
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    you can have somebody
    who has an XY chromosomal basis,
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    and that SRY gene on the Y chromosome
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    tells the proto-gonads,
    which we all have in the fetal life,
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    to become testes.
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    So in the fetal life,
    those testes are pumping out testosterone.
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    But because this individual
    lacks receptors to hear that testosterone,
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    the body doesn't react
    to the testosterone.
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    And this is a syndrome called
    androgen insensitivity syndrome.
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    So lots of levels of testosterone,
    but no reaction to it.
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    As a consequence, the body develops
    more along the female typical path.
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    When the child is born,
    she looks like a girl.
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    She is a girl, she is raised as a girl.
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    And it's often not until she hits puberty
    and she's growing and developing breasts,
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    but she's not getting her period,
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    that somebody figures
    out something's up here.
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    And they do some tests and figure out
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    that, instead of having
    ovaries inside and a uterus,
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    she has testes inside,
    and she has a Y chromosome.
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    Now what's important to understand
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    is you may think of this
    person as really being male,
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    but they're really not.
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    Females, like males,
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    have in our bodies something
    called the adrenal glands.
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    They're in the back of our body.
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    And the adrenal glands make androgens,
    which are a masculinizing hormone.
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    Most females like me --
    I believe myself to be a typical female --
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    I don't actually know
    my chromosomal make-up,
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    but I think I'm probably typical --
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    most females like me
    are actually androgen-sensitive.
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    We're making androgen,
    and we're responding to androgens.
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    The consequence is that somebody like me
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    has actually had a brain
    exposed to more androgens
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    than the woman born with testes
    who has androgen insensitivity syndrome.
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    So sex is really complicated --
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    it's not just that intersex people
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    are in the middle
    of all the sex spectrum --
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    in some ways,
    they can be all over the place.
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    Another example:
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    a few years ago I got a call
    from a man who was 19 years old,
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    who was born a boy, raised a boy,
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    had a girlfriend,
    had sex with his girlfriend,
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    had a life as a guy,
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    and had just found out
    that he had ovaries and a uterus inside.
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    What he had was an extreme form
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    of a condition called
    congenital adrenal hyperplasia.
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    He had XX chromosomes,
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    and in the womb, his adrenal glands
    were in such high gear
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    that it created, essentially,
    a masculine hormonal environment.
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    And as a consequence,
    his genitals were masculinized,
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    his brain was subject to the more typical
    masculine component of hormones.
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    And he was born looking like a boy --
    nobody suspected anything.
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    And it was only when he had
    reached the age of 19
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    that he began to have enough medical
    problems from menstruating internally,
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    that doctors figured out that, in fact,
    he was female, internally.
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    OK, so just one more quick example
    of a way you can have intersex.
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    Some people who have XX chromosomes
    develop what are called ovotestis,
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    which is when you have ovarian tissue
    with testicular tissue wrapped around it.
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    And we're not exactly sure
    why that happens.
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    So sex can come
    in lots of different varieties.
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    The reason that children
    with these kinds of bodies --
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    whether it's dwarfism,
    or it's conjoined twinning,
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    or it's an intersex type --
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    are often "normalized" by surgeons
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    is not because it actually leaves them
    better off in terms of physical health.
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    In many cases, people are actually
    perfectly healthy.
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    The reason they're often subject
    to various kinds of surgeries
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    is because they threaten
    our social categories.
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    Our system has been based
    typically on the idea
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    that a particular kind of anatomy
    comes with a particular identity.
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    So we have the concept
    that what it means to be a woman
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    is to have a female identity;
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    what it means to be a black person
    is, allegedly, to have an African anatomy
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    in terms of your history.
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    And so we have
    this terribly simplistic idea.
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    And when we're faced with a body
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    that actually presents us
    something quite different,
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    it startles us in terms
    of those categorizations.
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    So we have a lot of very romantic ideas
    in our culture about individualism.
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    And our nation's really founded on
    a very romantic concept of individualism.
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    You can imagine how startling then it is
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    when you have children who are born
    who are two people inside of one body.
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    Where I ran into the most heat
    from this most recently
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    was last year when South African runner,
    Caster Semenya,
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    had her sex called into question
    at the International Games in Berlin.
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    I had a lot of journalists
    calling me, asking me,
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    "Which is the test they're going to run
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    that will tell us whether or not
    Caster Semenya is male or female?"
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    And I had to explain to the journalists
    there isn't such a test.
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    In fact, we now know
    that sex is complicated enough
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    that we have to admit:
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    Nature doesn't draw the line
    for us between male and female,
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    or between male and intersex
    and female and intersex;
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    we actually draw that line on nature.
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    So what we have is a sort of situation
    where the farther our science goes,
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    the more we have to admit to ourselves
    that these categories
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    that we thought of as stable
    anatomical categories,
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    that mapped very simply
    to stable identity categories
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    are a lot more fuzzy than we thought.
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    And it's not just in terms of sex.
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    It's also in terms of race,
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    which turns out to be
    vastly more complicated
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    than our terminology has allowed.
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    As we look, we get into all sorts
    of uncomfortable areas.
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    We look, for example, about the fact
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    that we share at least 95 percent
    of our DNA with chimpanzees.
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    What are we to make of the fact
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    that we differ from them
    only, really, by a few nucleotides?
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    And as we get farther
    and farther with our science,
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    we get more and more
    into a discomforted zone,
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    where we have to acknowledge
    that the simplistic categories we've had
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    are probably overly simplistic.
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    So we're seeing this
    in all sorts of places in human life.
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    One of the places
    we're seeing it, for example,
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    in our culture,
    in the United States today,
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    is battles over the beginning
    of life and the end of life.
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    We have difficult conversations
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    about at what point we decide
    a body becomes a human,
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    such that it has a different
    right than a fetal life.
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    We have very difficult
    conversations nowadays --
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    probably not out in the open
    as much as within medicine --
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    about the question
    of when somebody's dead.
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    In the past, our ancestors
    never had to struggle so much
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    with this question
    of when somebody was dead.
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    At most, they'd stick
    a feather on somebody's nose,
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    and if it twitched,
    they didn't bury them yet.
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    If it stopped twitching, you bury them.
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    But today, we have a situation
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    where we want to take
    vital organs out of beings
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    and give them to other beings.
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    And as a consequence,
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    we have to struggle
    with this really difficult question
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    about who's dead,
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    and this leads us
    to a really difficult situation
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    where we don't have such simple
    categories as we've had before.
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    Now you might think that all this
    breaking-down of categories
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    would make somebody like me really happy.
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    I'm a political progressive,
    I defend people with unusual bodies,
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    but I have to admit to you
    that it makes me nervous.
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    Understanding that these categories
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    are really much more unstable
    than we thought makes me tense.
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    It makes me tense from the point of view
    of thinking about democracy.
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    So in order to tell you
    about that tension,
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    I have to first admit to you
    a huge fan of the Founding Fathers.
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    I know they were racists,
    I know they were sexist,
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    but they were great.
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    I mean, they were so brave and so bold
    and so radical in what they did,
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    that I find myself watching that cheesy
    musical "1776" every few years,
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    and it's not because of the music,
    which is totally forgettable.
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    It's because of what happened in 1776
    with the Founding Fathers.
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    The Founding Fathers were,
    for my point of view,
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    the original anatomical activists,
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    and this is why.
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    What they rejected
    was an anatomical concept
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    and replaced it with another one
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    that was radical and beautiful
    and held us for 200 years.
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    So as you all recall,
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    what our Founding Fathers were
    rejecting was a concept of monarchy,
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    and the monarchy was basically based
    on a very simplistic concept of anatomy.
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    The monarchs of the old world
    didn't have a concept of DNA,
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    but they did have a concept of birthright.
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    They had a concept of blue blood.
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    They had the idea that the people
    who would be in political power
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    should be in political power
    because of the blood being passed down
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    from grandfather to father
    to son and so forth.
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    The Founding Fathers rejected that idea,
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    and they replaced it
    with a new anatomical concept,
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    and that concept
    was "all men are created equal."
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    They leveled that playing field
    and decided the anatomy that mattered
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    was the commonality of anatomy,
    not the difference in anatomy,
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    and that was a really radical thing to do.
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    Now they were doing it in part
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    because they were part
    of an Enlightenment system
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    where two things were growing up together.
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    And that was democracy growing up,
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    but it was also science
    growing up at the same time.
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    And it's really clear, if you look
    at the history of the Founding Fathers,
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    a lot of them were very
    interested in science,
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    and they were interested
    in the concept of a naturalistic world.
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    They were moving away
    from supernatural explanations,
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    and they were rejecting things
    like a supernatural concept of power,
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    where it transmitted because
    of a very vague concept of birthright.
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    They were moving
    towards a naturalistic concept.
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    And if you look, for example,
    in the Declaration of Independence,
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    they talk about nature and nature's God.
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    They don't talk about God
    and God's nature.
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    They're talking about the power of nature
    to tell us who we are.
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    So as part of that,
    they were coming to us with a concept
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    that was about anatomical commonality.
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    And in doing so, they were really
    setting up in a beautiful way
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    the Civil Rights Movement of the future.
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    They didn't think of it that way,
    but they did it for us, and it was great.
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    So what happened years afterwards?
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    What happened was women, for example,
    who wanted the right to vote,
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    took the Founding Fathers' concept
    of anatomical commonality
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    being more important
    than anatomical difference
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    and said, "The fact that we have
    a uterus and ovaries
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    is not significant enough
    in terms of a difference
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    to mean that we shouldn't
    have the right to vote,
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    the right to full citizenship,
    the right to own property, etc."
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    And women successfully argued that.
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    Next came the successful
    Civil Rights Movement,
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    where we found people like Sojourner Truth
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    talking about, "Ain't I a woman?"
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    We find men on the marching lines
    of the Civil Rights Movement
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    saying, "I am a man."
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    Again, people of color
    appealing to a commonality of anatomy
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    over a difference of anatomy,
    again, successfully.
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    We see the same thing
    with the disability rights movement.
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    The problem is, of course,
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    that, as we begin to look
    at all that commonality,
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    we have to begin to question
    why we maintain certain divisions.
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    Mind you, I want to maintain
    some divisions,
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    anatomically, in our culture.
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    For example, I don't want to give a fish
    the same rights as a human.
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    I don't want to say
    we give up entirely on anatomy.
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    I don't want to say a five-year-old
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    should be allowed to consent
    to sex or consent to marry.
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    So there are some anatomical divisions
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    that make sense to me
    and that I think we should retain.
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    But the challenge is trying
    to figure out which ones they are
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    and why do we retain them,
    and do they have meaning.
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    So let's go back to those two beings
    conceived at the beginning of this talk.
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    We have two beings, both conceived
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    in the middle of 1979
    on the exact same day.
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    Let's imagine one of them, Mary,
    is born three months prematurely,
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    so she's born on June 1, 1980.
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    Henry, by contrast, is born at term,
    so he's born on March 1, 1980.
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    Simply by virtue of the fact
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    that Mary was born
    prematurely three months,
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    she comes into all sorts of rights
    three months earlier than Henry does --
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    the right to consent to sex,
    the right to vote, the right to drink.
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    Henry has to wait for all of that,
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    not because he's actually
    any different in age, biologically,
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    except in terms of when he was born.
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    We find other kinds of weirdness
    in terms of what their rights are.
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    Henry, by virtue of being
    assumed to be male --
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    although I haven't told you
    that he's the XY one --
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    by virtue of being assumed to be male
    is now liable to be drafted,
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    which Mary does not need to worry about.
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    Mary, meanwhile, cannot in all the states
    have the same right
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    that Henry has in all the states,
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    namely, the right to marry.
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    Henry can marry, in every state, a woman,
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    but Mary can only marry today
    in a few states, a woman.
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    So we have these anatomical
    categories that persist,
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    that are in many ways
    problematic and questionable.
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    And the question to me becomes:
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    What do we do, as our science
    gets to be so good in looking at anatomy,
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    that we reach the point
    where we have to admit
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    that a democracy
    that's been based on anatomy
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    might start falling apart?
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    I don't want to give up the science,
    but at the same time,
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    it feels sometimes like the science
    is coming out from under us.
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    So where do we go?
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    It seems like what happens in our culture
    is a sort of pragmatic attitude:
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    "We have to draw the line somewhere,
    so we will draw the line somewhere."
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    But a lot of people get stuck
    in a very strange position.
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    So for example, Texas has at one point
    decided that what it means to marry a man
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    is to mean that you don't have
    a Y chromosome,
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    and what it means to marry a woman
    means you have a Y chromosome.
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    In practice they don't test people
    for their chromosomes.
  • 14:03 - 14:05
    But this is also very bizarre,
  • 14:05 - 14:07
    because of the story I told you
    at the beginning
  • 14:07 - 14:09
    about androgen insensitivity syndrome.
  • 14:09 - 14:12
    If we look at one of the Founding Fathers
    of modern democracy,
  • 14:12 - 14:14
    Dr. Martin Luther King,
  • 14:14 - 14:17
    he offers us something of a solution
    in his "I have a dream" speech.
  • 14:17 - 14:20
    He says we should judge people
    "based not on the color of their skin,
  • 14:20 - 14:22
    but on the content of their character,"
  • 14:22 - 14:24
    moving beyond anatomy.
  • 14:24 - 14:27
    And I want to say, "Yeah, that sounds
    like a really good idea."
  • 14:27 - 14:28
    But in practice, how do you do it?
  • 14:28 - 14:31
    How do you judge people based
    on the content of character?
  • 14:32 - 14:33
    I also want to point out
  • 14:33 - 14:37
    that I'm not sure that is how we should
    distribute rights in terms of humans,
  • 14:37 - 14:40
    because, I have to admit, that there
    are some golden retrievers I know
  • 14:40 - 14:44
    that are probably more deserving of social
    services than some humans I know.
  • 14:44 - 14:47
    I also want to say there are probably
    also some yellow Labradors that I know
  • 14:47 - 14:50
    that are more capable of informed,
    intelligent, mature decisions
  • 14:50 - 14:53
    about sexual relations
    than some 40-year-olds that I know.
  • 14:53 - 14:57
    So how do we operationalize
    the question of content of character?
  • 14:57 - 14:59
    It turns out to be really difficult.
  • 14:59 - 15:01
    And part of me also wonders,
  • 15:01 - 15:03
    what if content of character
  • 15:03 - 15:06
    turns out to be something
    that's scannable in the future --
  • 15:07 - 15:09
    able to be seen with an fMRI?
  • 15:09 - 15:11
    Do we really want to go there?
  • 15:11 - 15:12
    I'm not sure where we go.
  • 15:12 - 15:15
    What I do know is that it seems
    to be really important
  • 15:15 - 15:18
    to think about the idea
    of the United States being in the lead
  • 15:18 - 15:20
    of thinking about this issue of democracy.
  • 15:20 - 15:23
    We've done a really good job
    struggling with democracy,
  • 15:23 - 15:25
    and I think we would do
    a good job in the future.
  • 15:25 - 15:28
    We don't have a situation
    that Iran has, for example,
  • 15:28 - 15:30
    where a man who's sexually
    attracted to other men
  • 15:30 - 15:31
    is liable to be murdered,
  • 15:31 - 15:33
    unless he's willing
    to submit to a sex change,
  • 15:33 - 15:35
    in which case he's allowed to live.
  • 15:36 - 15:38
    We don't have that kind of situation.
  • 15:38 - 15:41
    I'm glad to say we don't have
    the kind of situation with --
  • 15:41 - 15:43
    a surgeon I talked to a few years ago
  • 15:43 - 15:45
    who had brought over a set
    of conjoined twins
  • 15:46 - 15:48
    in order to separate them,
    partly to make a name for himself.
  • 15:48 - 15:52
    But when I was on the phone with him,
    asking why he'll do this surgery --
  • 15:52 - 15:56
    this was a very high-risk surgery --
    his answer was that, in this other nation,
  • 15:56 - 15:59
    these children were going to be treated
    very badly, and so he had to do this.
  • 15:59 - 16:02
    My response to him was, "Well,
    have you considered political asylum
  • 16:03 - 16:04
    instead of a separation surgery?"
  • 16:04 - 16:07
    The United States has offered
    tremendous possibility
  • 16:07 - 16:09
    for allowing people
    to be the way they are,
  • 16:09 - 16:13
    without having them have
    to be changed for the sake of the state.
  • 16:13 - 16:15
    So I think we have to be in the lead.
  • 16:15 - 16:17
    Well, just to close,
    I want to suggest to you
  • 16:17 - 16:20
    that I've been talking
    a lot about the Fathers.
  • 16:20 - 16:22
    And I want to think
    about the possibilities
  • 16:22 - 16:25
    of what democracy might look like,
    or might have looked like,
  • 16:25 - 16:27
    if we had more involved the mothers.
  • 16:27 - 16:30
    And I want to say something
    a little bit radical for a feminist,
  • 16:30 - 16:34
    and that is that I think that there may be
    different kinds of insights
  • 16:34 - 16:37
    that can come from different
    kinds of anatomies,
  • 16:37 - 16:39
    particularly when we have
    people thinking in groups.
  • 16:39 - 16:42
    For years, because
    I've been interested in intersex,
  • 16:42 - 16:44
    I've also been interested
    in sex-difference research.
  • 16:44 - 16:47
    And one of the things
    that I've been interested in
  • 16:47 - 16:49
    is looking at the differences
    between males and females
  • 16:49 - 16:52
    in terms of the way they think
    and operate in the world.
  • 16:52 - 16:54
    And what we know
    from cross-cultural studies
  • 16:54 - 16:56
    is that females, on average --
  • 16:56 - 16:58
    not everyone, but on average --
  • 16:58 - 17:03
    are more inclined to be very attentive
    to complex social relations
  • 17:03 - 17:04
    and to taking care of people
  • 17:05 - 17:07
    who are, basically,
    vulnerable within the group.
  • 17:08 - 17:10
    And so if we think about that,
  • 17:10 - 17:12
    we have an interesting situation in hands.
  • 17:12 - 17:14
    Years ago, when I was in graduate school,
  • 17:14 - 17:17
    one of my graduate advisors
    who knew I was interested in feminism --
  • 17:17 - 17:19
    I considered myself
    a feminist, as I still do,
  • 17:19 - 17:21
    asked a really strange question.
  • 17:21 - 17:24
    He said, "Tell me what's feminine
    about feminism."
  • 17:24 - 17:27
    And I thought, "Well, that's the dumbest
    question I've ever heard.
  • 17:27 - 17:30
    Feminism is all about undoing
    stereotypes about gender,
  • 17:30 - 17:32
    so there's nothing
    feminine about feminism."
  • 17:32 - 17:34
    But the more I thought about his question,
  • 17:34 - 17:37
    the more I thought there might be
    something feminine about feminism.
  • 17:37 - 17:40
    That is to say, there might be
    something, on average,
  • 17:40 - 17:43
    different about female
    brains from male brains
  • 17:43 - 17:48
    that makes us more attentive
    to deeply complex social relationships,
  • 17:48 - 17:50
    and more attentive
    to taking care of the vulnerable.
  • 17:50 - 17:53
    So whereas the Fathers
    were extremely attentive
  • 17:53 - 17:57
    to figuring out how to protect
    individuals from the state,
  • 17:57 - 18:01
    it's possible that if we injected
    more mothers into this concept,
  • 18:01 - 18:04
    what we would have is more of a concept
    of not just how to protect,
  • 18:04 - 18:07
    but how to care for each other.
  • 18:07 - 18:09
    And maybe that's where
    we need to go in the future,
  • 18:09 - 18:12
    when we take democracy beyond anatomy,
  • 18:12 - 18:15
    is to think less about the individual body
    in terms of the identity,
  • 18:15 - 18:17
    and think more about those relationships.
  • 18:17 - 18:21
    So that as we the people
    try to create a more perfect union,
  • 18:21 - 18:24
    we're thinking about what we do
    for each other.
  • 18:24 - 18:25
    Thank you.
  • 18:25 - 18:28
    (Applause)
Title:
Is anatomy destiny? | Alice Dreger | TEDxNorthwesternU
Description:

America's democratic institutions have historically been restricted - and then opened up - based on appeals to anatomy. Voting, for one, was first essentially restricted to white men. Over time, groups with other anatomies struggled their way into being seen as "created equal." Civil rights movements of all sorts - for sex equality, racial equality, dis/ability equality - have tended to be based on the idea that our common anatomy is more important than our anatomical differences. Yet even today, many legal restrictions are based on anatomical distinctions: age in voting and drinking, viability in abortion and withdrawal of life support, and sex where marriage and the draft are concerned.

As our democracy has matured, it has still retained an ancient reliance on anatomy as deeply meaningful. Yet at the same time, science has been dissolving the bright lines between anatomical categories. So what's next? What could - what will - democracy look like after anatomy?

Alice Dreger, PhD, is a professor of clinical medical humanities and bioethics in the Feinberg School of Medicine at Northwestern University in Chicago. For seven years, she served as chair of the board and director of medical education for the Intersex Society of North America (ISNA), a non-profit policy and advocacy organization for people born with atypical sex. Dreger's scholarship and patient advocacy have focused on the social and medical treatment of people born with norm-challenging body types, including intersex, conjoinment, dwarfism, and cleft lip. She has frequently collaborated with healthcare professionals on improving the care of families with children whose bodies vary from the average.

In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.

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Video Language:
English
Team:
TED
Project:
TEDxTalks
Duration:
19:11

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