normalising cosmetic genital surgery on intersex infants should be avoided until a child can fully participate in decision-making.142 This is the extent of the AMA’s position on this specific issue. The Senate report, Involuntary or Coerced Sterilisation of Intersex People (see [3.3.10]), 3.4.34 raised concern regarding the lack of standardised objective measures by which ‘normal’ is referenced in relation to sex characteristics. The Senate Committee noted lack of medical consensus regarding the practice, prevalence and necessity for normalisation procedures. The committee also observed that it is unclear how, if at all, medical practitioners factor diversity in the appearance of genitals into their clinical practice. The Victorian Decision-making Principles provide an example of guidelines aimed at 3.4.35 achieving consistency of practice. However, as noted above, these principles continue to endorse gender normalisation as a therapeutic procedure in many circumstances. Given the complexity and diversity of medical, health and social perspectives on this 3.4.36 issue, it is unclear how practicable it would be for the Tasmanian Department of Health to develop decision-making principles that give effect to the Senate’s recommendations for endorsement by the medical profession. However, in light of the significant consequences for intersex people, it may be worth pursuing regardless of the difficulty. To some extent, practice standards such as these could exist in conjunction with other approaches, which may alleviate some of this difficulty by reducing the burden on the drafting of the practice standards.

######## Education and support

3.4.37 of any substantive law reform, the Institute considers it would be desirable to 3.4.37 of any substantive law reform, the Institute considers it would be desirable to produce and disseminate materials to better inform Tasmanians regarding the issues and realities facing intersex people, including the potential mental health effects of normalisation procedures. A persistent problem in this area is a lack of understanding of intersex people and intersex 3.4.38 status. As discussed in Part 1 of this Issues Paper, there are a number of misconceptions about ‘binary sex’, the biological features that make up a person’s sex, and intersex variations of those features. The practical effect of this lack of understanding is that the needs and desires of the intersex community are often poorly addressed, or not addressed at all. Education and support is not an end in itself, although improved awareness and 3.4.39 understanding will go some way towards further action. Instead, education and support should supplement any of the other approaches adopted in this area. The JRL Act has introduced a range of explicit provisions in relation to counselling for 3.4.40 minors regarding registering a change of gender. In particular, an application to register a change of gender from a person under 18 is to be accompanied by evidence that they have received counselling from someone they consider to be qualified and experienced to advise them on the consequences of their application (s 28C). Similar emphasis should be placed on the importance of counselling prior to making any decisions regarding medical procedures on intersex children.