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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.
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    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:

Alice Dreger works with people at the edge of anatomy, such as conjoined twins and intersexed people. In her observation, it's often a fuzzy line between male and female, among other anatomical distinctions. Which brings up a huge question: Why do we let our anatomy determine our fate?

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

English subtitles

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