Ethics in Research: The "John/Joan" Case

I. This study fell into the lap of Dr. John Money, a psychologist and sexologist pioneering gender identity, back in the 1960's. Bruce Reimer was born in Winnipeg, Manitoba, Canada in 1965 as a perfectly healthy boy, with an exception of phimosis, a condition of the penis in which the foreskin cannot be fully retracted. He had a twin with the same condition. At the age of 8 months, he underwent surgery for a circumcision. However, the surgeon used a Bovie cauterization machine, which is unsuitable for small appendages such as the penis. The penis was destroyed beyond repair. Therefore, it was converted into a vagina following a suggestion by Dr. Money, who believed that one's sexual identity could be molded at an early age. He used Reimer as a case study to determine the effects of the sex change. This was ideal, because his twin, who did not have surgery for the condition, was a perfect control for the study because their genes, environment, and overall condition were exactly the same.
Money believed that identity was relatively plastic in infancy and proposed that it was influenced by social learning in early childhood. Also, while a destroyed penis is completely dysfunctional, a constructed vagina would be more likely to become a successful, functional organ. Money convinced Reimer's parents that sexual reassignment would be in his best interest, so they consented to a surgery to have his testes removed.
After the surgery, Bruce was renamed Brenda and was raised as a girl. "She" continued to see Dr. Money for psychological treatment and outcome assessment. Money believed his case was successful, citing how much more feminine Bruce was than her twin brother. Estrogen was given to Bruce upon adolescense to induce secondary female sex characteristics.
Bruce viewed these visits to Money as highly traumatic. He began pressuring the family to consent to a second reconstructive surgery to create a vagina, but because Bruce was so psychologically stressed by the visits, they discontinued them. He threatened to commit suicide if he had to visit Money again. Money published nothing afterward that suggested his study was not successful.
Bruce admitted that he never identified as female. He was made fun of by peers, and experienced suicidal depression at a young age. At age 15, his parents told him the truth about his past, at which point he began to assume a male identity. He named himself David.
His twin Brian, experienced a pattern of mental disturbances and developed schizophrenia after learning of his relationship with his now "ex-sister". Years later, Bruce underwent treatment to reverse his previous sex change, including testosterone injections and several surgeries. He married a woman and became a stepfather to her three children. He gained popularity and financial security by making his story public, however he separated from his wife, had severe problems with his parents, and experienced the death of his brother from a toxic combination of alcohol and antidepressants. In 2004, at the age of 38, Bruce committed suicide.

II. This study was unethical in myriad ways. According to the Nuremberg Code, the first item is that consent is required, and must be voluntary. Because Bruce was too young to consent, his parents did. However, they were pressured into it by Dr. John Money, who assured them that this was for their son's own good. He also failed to inform them of any possible dangers of the study, including psychological distress, possible physiological malfunction, trauma experienced by friends and family members, etc.
The second item is that the study must be conducted only to benefit society, and only if no other means of study will work. The knowledge gained can certainly benefit society. However, the study was only performed because Money made it so. There could have been other ways to learn.
This case yielded immeasurable amounts of unnecessary physical and emotional suffering, which violates the fourth item of the Code.
Although Bruce eventually was able to terminate his "treatment", he was able to only after threatening to end his own life. Money pressured him and his parents into continuing the treatment until that point. According the the ninth item of the Code, subjects should be able to end the experiment at any point they wish, with discouragement or pressure to continue.
The tenth item states that the researcher must be able to end the study if he believes it will result in any type of injury. John Money ignored the fact that Bruce was being severely mentally harmed by the experiment. Even after Bruce terminated the treatment, Money claimed it was a successful procedure. He neglected to include any data in his publishings that did not concur with his beliefs about sexual identity.

III. David Reimer. (n.d.). Wikipedia. Retrieved September 23, 2007, from Wikipedia
Web site: http://en.wikipedia.org/wiki/David_Reimer