A/HRC/22/53 fix their sex”,107 leaving them with permanent, irreversible infertility and causing severe mental suffering. 78. In many countries transgender persons are required to undergo often unwanted sterilization surgeries as a prerequisite to enjoy legal recognition of their preferred gender. In Europe, 29 States require sterilization procedures to recognize the legal gender of transgender persons. In 11 States where there is no legislation regulating legal recognition of gender,108 enforced sterilization is still practised. As at 2008, in the United States of America, 20 states required a transgender person to undergo “gender-confirming surgery” or “gender reassignment surgery” before being able to change their legal sex.109 In Canada, only the province of Ontario does not enforce “transsexual surgery” in order to rectify the recorded sex on birth certificates.110 Some domestic courts have found that not only does enforced surgery result in permanent sterility and irreversible changes to the body, and interfere in family and reproductive life, it also amounts to a severe and irreversible intrusion into a person‟s physical integrity. In 2012, the Swedish Administrative Court of Appeals ruled that a forced sterilization requirement to intrude into someone‟s physical integrity could not be seen as voluntary. 111 In 2011, the Constitutional Court in Germany ruled that the requirement of gender reassignment surgery violated the right to physical integrity and self-determination.112 In 2009, the Austrian Administrative High Court also held that mandatory gender reassignment, as a condition for legal recognition of gender identity, was unlawful.113 In 2009, the former Commissioner for Human Rights of the Council of Europe observed that “[the involuntary sterilization] requirements clearly run counter to the respect for the physical integrity of the person”.114 79. The mandate has noted that “members of sexual minorities are disproportionately subjected to torture and other forms of ill-treatment because they fail to conform to socially constructed gender expectations. Indeed, discrimination on grounds of sexual orientation or gender identity may often contribute to the process of the dehumanization of the victim, which is often a necessary condition for torture and ill-treatment to take place.”115 “Medically worthless” practices of subjecting men suspected of homosexual conduct to non-consensual anal examinations to “prove” their homosexuality 116 have been condemned by the Committee against Torture, the Special Rapporteur on the question of torture and the Working Group on Arbitrary Detention, which have held that the practice contravenes the prohibition of torture and ill-treatment (A/HRC/19/41, para. 37). 5. Persons with disabilities 80. Persons with disabilities are particularly affected by forced medical interventions, and continue to be exposed to non-consensual medical practices (A/63/175, para. 40). In the case of children in health-care settings, an actual or perceived disability may diminish the 107 108 109 110 111 112 113 114 115 116 A/HRC/19/41, para. 57. Commissioner for Human Rights of the Council of Europe, Discrimination on Grounds of Sexual Orientation and Gender Identity in Europe (2011), pp. 86-87. D. Spade, “Documenting gender”, Hastings Law Journal, vol. 59, No. 1 (2008), pp. 830-831. XY v. Ontario, 2012 HRTO 726 (CanLII), judgement of 11 April 2012. Mål nr 1968-12, Kammarrätten i Stockholm, Avdelning 03, http://du2.pentagonvillan.se/images/stories/Kammarrttens_dom_-_121219.pdf, p. 4. Federal Constitutional Court, 1 BvR 3295/07. Available from www.bundesverfassungsgericht.de/entscheidungen/rs20110111_1bvr329507.html. Administrative High Court, No. 2008/17/0054, judgement of 27 February 2009. “Human rights and gender identity”, issue paper (2009), p. 19. A/56/156, para. 19. See also E/CN.4/2001/66/Add.2, para. 199. Working Group on Arbitrary Detention, opinion No. 25/2009 (2009), para. 29. 19