Sex Re-Assignment Surgery: Violence or Nonviolence?

It’s a privilege to read an essay as thoughtful, biblical and wise as Mr. Fast has given us. The church has much thinking to do on sexuality, and this kind of careful, clear and patient exploration of the scriptures—with all the questions—will finally resolve this and move us forward. And resolve it we will, eventually.

I learned a lot reading his essay. I have some thoughts on the question that I would like to add; I suggest this should come before we embark on the patient exegetical work he does. I want to add a question to the discernment that seems to bring a different landing in the end. But I submit this for discernment.

Mr. Fast concludes (tentatively) that there are times when sex re-assignment surgery may be acceptable for a Christian. A key question for him is the framework one uses to justify the surgery. Is the surgery being justified as an honest, evidence-backed medical intervention to alleviate suffering, analogous to the removal of an inflamed appendix? Or is it being justified as secular self-expression, the act of an enthroned “I” hovering above the body, imposing its will on the body’s biological structure? That is an important question.

Mr. Fast is surely correct that we cannot simply blurt, as many do, that people just need to “accept” the way they are created. As he points out, the Bible allows some substantial body alteration. Circumcision is an example that is commanded by God. Christ also makes the hyperbolic command to cut off a hand or gouge out an eye if it causes sin. Clearly Jesus is fine with some serious body alteration if it leads to holy living. And yet, there are some bodily alterations the Bible condemns. How do we differentiate these?

We do need to understand the cultural meanings of the actions—this is important discernment, but before we get to those questions, I would like to suggest that we ask, is the procedure of sex-reassignment itself violent or nonviolent towards the body? Once we are assured that an action is truly nonviolent, we can proceed to the cultural, religious and personal discernment Mr. Fast suggests, and ask: what does this action mean to the person doing it, and to the society in which it is carried out?[1]

It’s notoriously difficult to define exactly what makes an action violent. When is an act violent? One current way of answering this is to ask, was there consent to the action? If there is consent, it was nonviolent, if there was no consent, it was violence. Consent is surely an important part of nonviolence, but is it sufficient? A teenager cutting his own arm is consenting to it, but I would want to insist he is doing violence to his body.

Another more venerable way to determine violence/nonviolence is to look at the “consequences” of the action. If the “consequences” of the action are good, then the act was good. If the “consequences” are evil, the act was evil. In this reasoning, if sex-reassignment surgery results in the alleviation of psychological suffering and allows the person to live a happier, more normal life, then the surgery was a good thing, even if at first glance it seemed violent. Where this surgery resulted in more suffering and mental anguish, the surgery must be seen as evil, a violence against the person, even if initially they consented to it. In this view, it is the end that justifies the means.

But, the question I am interested in here is not whether there is genuine consent to the surgery or whether the consequences of the surgery are good.[2] I am asking whether the act of sex-reassignment surgery is, in itself, an act of violence? Are there actions that just in themselves are violent, no matter if there was consent, and no matter how good the consequences are? In my thinking those actions would be evil. Christians don’t commit violence.

Indulge me in this a little. I heard one author (who I won’t name) arguing against Mennonites and such, saying that Christians should accept that violence is a normal and necessary part of life. He said that even God is violent sometimes. But, he said, God’s violence is for our good. Divine violence is like the violence of surgery. If you think of it, this author said, a surgeon and a mugger are both people wielding knives cutting people open—but the surgeon’s violence is justified because it’s done so that people become healed and healthy.

In my thinking, that is wrong. The surgeon and the mugger are not doing the same act. They are not both participating in this thing called violence, one for good and the other for ill. This is like saying that a man who pushes an old lady into the path of a train and a man who pushes an old lady out of the path of train are doing similar things. They are both men who push around old ladies. No, the motion of pushing might be the same, but the actions are opposite.[3] One man is saving a life, and the other is killing a life. It doesn’t matter what the consequences are. Say the killer thinks that by pushing this one lady onto the train tracks he will provoke city council to finally install guard-rails at the train station and this will, hopefully, save the lives of ten drunks a year. He may say that his murder is justified, but he cannot say that he is doing the same thing as the man pushing the lady off the tracks. Hopefully he would go to jail for his “lifesaving” murder. One is a violent action of murder, and the other is a nonviolent action of saving a life. It’s not the “consequences” that make one act violent, it’s the act itself.

As an aside, this is important when we talk about “divine violence” in the Bible. I think it’s absurd (blasphemous!) to say that God and a rapist both do something called violence, but that God’s violence is justified because it’s for good consequences, while the rapist’s violence is unjustified because it results in evil consequences. No, God is not like a rapist in any way and even having to say that makes one shudder. God is not violent in the sense I am defining it here.[4]

So, what then makes an action violent or nonviolent if it’s not non/consent or consequences?[5] This is important in the question of sex-reassignment surgery because this surgery is mostly justified today by these two considerations. If we do what a person asks and re-assign their sex by altering their body, they will have less suffering and will finally be able to lead a normal life. Thus, we are told, it’s justified. The question is, is that surgery like a man pushing a woman out of the way of a train (just a good action, full-stop), or is that like a man pushing a woman into the way of a train, hoping for good consequences from this violence later? Is this really like a surgeon removing a cancerous tumour? I think that is an important ethical question.

To take this one step further then, we need clarity on how to discern when a certain action is violent and when it is nonviolent. Here is my suggestion: to understand when something or someone has had violence done to it, we need to know what this thing is for. What was it made for? Perhaps the language of violation helps us see better what constitutes violence. When has something or someone been violated? I say, when a thing’s ability to do what it is for has been destroyed or misused for some hopefully good consequence in the future, it has been violated. To use a crass analogy, if I use my wristwatch to bash a nail into a wall, I am violating the watch because that is not what a watch is for. The damage done to the watch is a result of me violating it. But to call that a violation of the watch, I must know that a watch is for telling time. It’s not for hammering nails. To understand when a person has been violated, we need some understanding of what a person is intended for.

So, to understand whether removing or altering a person’s physical sex differences through surgery is violence against the body, we need some account of what those sex differences are for. Why were we created with those sex differences? What did God want these sex differences to do for us?[6] An action that intentionally destroys or misuses sex differences so that they no longer do what God created them to do, would, in my mind, be an act of violation or violence against the body. If I destroy my healthy appendix or prevent it from doing what it was meant to do, I am acting violently against my body. This is true even if I do this action for a consequence that I think could be good (perhaps to alleviate my fixated loathing of appendices). But if my appendix is infected and threatening to toxify my body and I remove it, I am not committing an act of violence against my body. Removing a toxic appendix is not an act of violence that I hope has the justifiable consequence of saving my life. Removing a toxic appendix is an act of nonviolence, period.

Likewise, when we talk about sex-reassignment surgery: with this bodily alteration, are we removing something like an inflamed appendix, a body part whose toxicity is threatening the rest of the organism? To have one’s genitals removed because of cancer would be such an example and would be nonviolent. Or, on the other hand, are we removing (destroying) a healthy part of the body for what I consider to be some good consequence—say, the alleviation of my mental suffering?

I would suggest that it’s the latter. Sex-reassignment surgery should be seen as an act of violence against the body that cannot be justified by its consequences. But to discern that we need to know what sexual differences are for. And for that we need to read the Bible.

What is bodily sexual difference for?

Sexed bodies are bodies distinguished from one another biologically, emotionally and spiritually by masculine or feminine traits. Why did God distinguish humans in this way? What are these differences for?

The creation story of man and woman in Genesis 2 sheds light on what sexual difference is for. Sexual difference arises when God answers the problem of the Adam’s aloneness with the creation of woman.[7] In the creation story of woman we should note that much recent scholarship rejects the translation of the Hebrew word tsela as the “rib” of the Adam, in favour of tsela being a “side” of the Adam.[8] One “side” of the Adam is now taken, and woman is formed from this “side” to be Adam’s counterpart. This is the creation of sexed difference. Humanity now is distinguished into two sides to answer the problem of aloneness. This suggests that where humankind was originally a unity of singularity with the resultant problem being the Adam’s aloneness, with the formation of woman, humanity will now be a unity of duality when the two “sides,” man and woman, become one flesh.

This has profound implications. What was originally a singular unity has now become two differentiated poles that belong back together (bone of my bones and flesh of my flesh). The Adam will no longer be alone when man and woman come together in the unity of their two sides. With the creation of sex difference, the Adam is now referred to for the first time as ish and issha, man and woman. Unity now comes not just by being one, but by overcoming the distance between the two sides and uniting difference. The aloneness of the Adam is not merely overcome by there being two, but by this similar but also dissimilar pair coming together into one. Which is to say, the unity of the Adam now comes by using sexual difference to arrive at love. Through the long travail of reaching out, speaking, listening, and creating a common life together as man and as woman humanity becomes one again, but no longer alone. After the fall, this work towards unity will involve struggle and suffering, pain and forgiveness. But it will always come about by the unification of these two differentiated by their sex differences.

This, I would suggest, is what sexual difference is for in the creation story. It is the way in which God differentiates the Adam into two sides that now need to come together through love. The sex differences differentiate but also unify the two sides. That is what sexed bodies are for. They are the difference, but also precisely the capacity we have for uniting the difference, thus ending the aloneness of the Adam.

What should also be pointed out is that in creating Eve, God has created the potential for an even more devastating loneliness than existed when the Adam was one. Now Eve is set apart from Adam and Adam from Eve, and if by some future catastrophe they are alienated from each other, humankind will know a deformity far more degrading than the aloneness the Adam felt before woman’s creation. The Adam alone was “not good,” but man alone and woman alone is worse; it’s deformed, lonely humanity.

All this suggests what our sexed bodies are for, and therefore what their violation is. They are the biological, psychological and spiritual gifts given by God to man and woman by which they will reconcile the separation of the “sides” and resolve the Adam’s aloneness in a unity of love. Masculinity is essentially a distinctively male capacity to reach out to and love woman in a male way. Femininity is essentially a distinctively female capacity to reach out to and love man in a female way. We might call our different biology, psychology and spirituality the hardware of love, the unique ways God has equipped male and female to be good to each other across this divide.

It’s important to point out that these biological, psychological and spiritual capacities for love are pre-subjective though not a-subjective; these are natural capacities given to us that we can wield as we subjectively choose, but these capacities are not something we conjure for ourselves. In the creation story, male and female join other dualities like heaven and earth, land and sea, light and darkness as cosmological realities that when joined together bring harmony and peace to the world—the sabbath of rest. But unlike the other dualities that just are, humans can choose, to some extent, how they will in fact deploy their masculine and feminine capacities. Obviously, the human community is rife with the abuse of our feminine and masculine capacities. Women’s shelters are full because of it. Each of us has a mighty sanctification, a long, slow struggle to undergo before we can whole-heartedly subjectively live into and deploy the capacities for love we have been given with our sex-differentiated selves.

But the point to be made here is that, as created by God, humans are given two different ways of reaching across the two divided “sides” of the Adam—one masculine and the other feminine. As these two capacities reach across to clasp hands, build families and accompany one another in a world of much sin and brokenness, a delightful reconciliation of the Adam happens.

It should be added that marriage is based on this mutual recognition and embrace of man and woman, but it is only the chief example of it, not its entire application. “For this reason, a man shall leave….” Marriage between man and woman, lively friendship between the sexes, the relation of parents with children, and finally the union of men and women in Church are all ways in which the basic capacities of our sexed selves for love reach aching across the divide to clasp hands. All of it uses our sexual difference.

We can then make the point I have been angling toward regarding sex-reassignment surgery; it seems to me that to destroy the sexed capacity for love embedded in our genes, hormones, genitalia, reproductive organs, souls, minds and spirits is to violate the created purpose of our sexed bodies. It destroys our pre-subjective, created, unique capacities for the reunion of the Adam in Adam and Eve. These are our basic powers to love in a masculine way, to love in a feminine way.

We must be incredibly gracious and understanding with ourselves and others who often don’t know how to use these capacities. To some degree we all have bio-chemical, psychological, spiritual and social brokenness making a love in tune with these capacities for reunion seem near impossible. None of us fundamentally knows how to use the powers of our whole person for loving the man or woman on the other side of creation. We are all born with crooked timber, to use an image from David Brooks. The struggle of sanctification is untwisting that timber by painful character formation. Till we reach the New Heaven our reconciliation as men and women will be partial, feeble and tentative. But let us not violently destroy the very capacities God has given us to resolve this original alienation in the human community for the sake of some possible future consequences.

Ordered to Procreation

There is an additional end to which these sexed bodies of ours are directed which is deeply entwined with this capacity for love. The unique capacities of masculine love and the unique capacities of feminine love are created to come together and “create” new life in procreation. When the differences of our sexed bodies are united in marriage, they generate new life. This is how love works; it creates new life. In the words of Genesis 1:27–28, “…male and female he created them. God blessed them and God said to them, be fruitful and multiply and fill the earth….” In the words of Roman Catholic ethics, our sexed bodies are ordered toward procreation. The different capacities of the masculine and the feminine to love across the divide are charged with the potential to create new life in the children we bring into the world. The birth of a one child from the two loves is the unification of the two “sides.” Over and over by the billions, the Adam’s aloneness is overcome with procreation. Here are the words of Old Testament scholar Gerhard Von Rad:

“The story [of woman’s creation] … was told to answer a quite definite question. A fact needs explanation, namely, the extremely powerful drive of the sexes to each other. Whence comes this love ‘strong as death’ (S.of Sol. 8:6) and stronger than the tie to one’s own parents, whence this inner clinging to each other, this drive toward each other which does not rest until it again becomes one flesh in the child? It comes from the fact that God took woman from man, that they actually were originally one flesh. Therefore they must come together again and thus by destiny they belong to each other.”[9]

What this means, and what Protestants have sometimes overlooked, is that sexual difference is for procreation. In this way also, the Adam’s aloneness is overcome. Any practice of sexuality not ordered towards procreation, or any destruction of the body’s created ability to procreate must surely be considered a violation of what our sexed bodies are for. One purpose of masculinity and femininity is reconciliation through procreation. The masculine and the feminine each bring a whole world of biological, psychological and spiritual capacities to not only conceiving but also birthing and rearing and adulting children. This includes everyone. All people, married and single, are called in their own way to use their sexual difference in the work of procreation, nurturing and training children.[10]

Protestants have a habit of immediately cutting this off by retorting; Well, what about infertile couples, or couples past the age of childbearing? If sexuality should be ordered to procreation, should seniors not have sex if they are past childbearing age? This is a misunderstanding of what it means to be ordered to procreation. Not all sexuality will be procreative, but all can be ordered to procreation. The sexual choices we make should work in cooperation with the basic ordering of our bodies to procreate, whether or not this results in procreation.

An analogy to the brain and thinking is helpful. The human brain is ordered towards thinking. That’s what it’s for. But this does not mean that sleeping, for example, is a violation of the brain. A sleeping human brain is ordered toward thinking even if right now it’s not doing much of it. But to intake some chemical or perform some surgery that would destroy the brain’s ability to think would be a violation of the purpose of the brain. In the same way, the activities of our sexed bodies can be ordered to procreation even when they do not result in children. This is one of the fundamental reasons why same-sex intercourse is disordered.

For this reason, I would suggest that attempts to deface, remove, or redirect our bodies’ capacity to procreate are violent. Whether by chemicals, surgery or illicit contraception, these actions are violations of what sexed bodies are for. Actions such as this, especially when multiplied across society will result in a surge in aloneness, the very problem God sought to remedy with his creation of sexual difference.

And, it needs to be emphasized, in a fallen, broken, disordered world, this kind love between men and women, leading to an earth filled with happy children is for everyone now a painful struggle at the level of daily life. The whole question of LGBT people and their place in the Church is only the most recent episode in the age-long work of overcoming the tendency to dominate and the pain in childbearing forecasted for Adam and Eve after their deadly meal. This redemption happens by the Spirit through grace, faith, and “a long slow obedience in the same direction.”[11]

Conclusion

When asking whether sex-reassignment surgery is appropriate for people who struggle with gender dysphoria, I think these are the kinds of questions we need to ask. Is this intentionally destroying our masculine and feminine capacities for love? Does it intentionally hamstring the ability of this person in their created sexual difference to reach longingly, achingly across the divide to build some common life? Does this intentionally foreclose the possibility of reconciliation in some happy baby somewhere and sometime, in the hope of some good consequences sometime?

When we have decided that an act of whatever sort is fundamentally ordered toward these created capacities, and thus nonviolent, we can move on to the other decisions that bring into play the wisdom that Mr. Fast suggested in his essay. Is this act associated with an idol-worship in our culture? Will this act truly alleviate suffering? Has there been genuine consent? Is it safe? And so on.

What is missing in so many of our debates about sexuality, whether about gender dysphoria, same-sex attraction, asexuality, the use of pornography, abortion and masturbation is that these are all symptoms of a sickness that is preventing us men from loving women, and us women from loving men in truly redemptive, creation-restoring ways. Though we have a raging thirst for love, we don’t know how to be good to each other using our created capacities for love. In our fallen condition we each have profound biological, emotional and spiritual deformities in our ability to love as intended by God. This is our inheritance from the fall, and it is goaded and inflamed by cultural delusions. Patriarchalism, individualism, the solipsism of the online world, the rampant narcissism of our age, secular feminism as well as the physical degradation of our bodies brought on by our sinful abuse of creation; these all contribute to a pathology in which we struggle to be good to one another as men and women. Woman and Man, the two poles of the human community intended to come together to overcome the aloneness of the Adam have become unintelligible to each other. Alienated from each other, they each descend into dysphoria—a state of dis-ease, dis-orientation and dis-memberment.

The mission and calling of the church is now to re-member men and women into one body so that they can again be good to each other. This is the reconciliation of the Spirit that Paul envisioned in Galatians 3:28, a new creation reality of the Spirit in which male and female would no longer exist as alienated and zero-sum competitors, but live like heaven and earth united, land and sea united, light and darkness united in one cosmos. May it be, yes, may it be.

[1] In the terms used by some theological ethicists, once you have determined that an action is essentially good, you can proceed to ask, what is the right way to do that action.

[2] This is where so much of the debate happens today. Can teenagers genuinely consent to sex-reassignment surgery or hormone treatments? Does sex-reassignment surgery really help people with gender dysphoria in the long run? What about people who come to regret it? I am not saying these are bad questions, only that one does first need to ask whether sex-reassignment surgery in itself is a good or evil, nonviolent or violent action.

[3] I am swinging an axe, chopping down a rotten spruce. My motion is swinging an axe, my action is chopping down a spruce, and the consequences might be the tree accidentally falling on my neighbor’s Tesla. Decency would expect me to pay his deductible, another consequence. But what if he decides to get even by smashing my Chevette with his oak tree? His motion is swinging his axe, his action is smashing my Chevette with an oak tree, and the consequences are him in the jailhouse. My neighbour and I are not doing the same thing. I am cutting down a rotten spruce and he is smashing my car.

[4] To be clear, I am not saying that God does not destroy the wicked. Ananias and Saphira are dead because God willed it. But when God destroys the wicked, we should not use the word “violence” to describe it as though God is doing something analogous to murder, only justified. God never breaks his own sixth commandment, even when he destroys the wicked. In the language of ethics, killing a human cannot be considered intrinsic evil like, say, sexual assault.

[5] To be clear, I am not saying that we shouldn’t consider the consequences of our actions. When I have two good choices before me, it’s wise to ask what the possible consequences of each action will be. Consequences can help me determine which good action is the right action to pursue at this moment. But consequences don’t determine whether an action is a good or evil action in the first place.

[6] These kinds of questions are of course verboten in the modern world. To admit that a human body is for something beyond one’s own personal and subjective use of that body is to immediately acknowledge that we are not our own, that we have been put here for some reason by someone other than ourselves. That is to confess belief in a Creator and thus to spell the end of secularism. This is why a society that has forgotten that the world has a Creator will run into hopeless dilemmas in determining what violence is. To discern violence, we need to know what the Creator intended for animals, trees, ecosystems and humans, et al.

[7] I try to use “the Adam” for how Genesis uses “Adam” as a generic word for the human, or what older English would call “man.” “Adam” will refer to the proper name of the specific man alongside Eve.

[8] Here is Old Testament scholar, Iain Provan: “The ESV translator here, along with many interpreters historically, understands this process as involving the extraction of a “rib” from the earthling. But this is unlikely to represent the best understanding of the Hebrew. More likely the idea is that the earth-creature is cut in half, resulting in two “sides” one of which becomes male and the other female. These are now two separate beings, but of course they exist in the closest possible relationship. She is, as the male affirms, “bone of my bones and flesh of my flesh”—a combination that refers elsewhere to a member of one’s family.” Iain Provan, Cuckoos in Our Nest: Truth and Lies about Being Human (Wipf and Stock Publishers, 2023), 68.

[9] Gerhard Von Rad, Genesis, Westminster Press, Philadelphia, p. 82-83.

[10] An uncle and an aunt, a grandpa and a grandma, a husband and a wife, a neighbor man and woman, in all their individual uniqueness bring their sexual difference, among other things, to the work of filling the earth with happy children. The biological act of procreation is a necessary but not sufficient aspect of this entire work.

[11] With a nod to the book title by Eugene Peterson.