Putting the ethical tools of philosophy to work, Ellen K. Feder seeks to clarify how we should understand "the problem" of intersex. Adults often report that medical interventions they underwent as children to "correct" atypical sex anatomies caused them physical and psychological harm. Proposing a philosophical framework for the treatment of children with intersex conditions—one that acknowledges the intertwined identities of parents, children, and their doctors—Feder presents a persuasive moral argument for collective responsibility to these children and (...) their families. (shrink)

Ellen Feder's monograph is an attempt to think about the categories of race and gender together. She explains and then employs some critical tools derived from Foucault, in order to advance her main argument: that the institution of the family is the locus of the production of gender and race, and that gender is best understood as a function of a "disciplinary" power that operates within the family, while race is the function of a "regulatory" power acting upon (...) the family from outside. Her interdisciplinary work will be of interest to feminist philosophers and theorists because it plays into a recent expansion of interest in the family, as well as to literary scholars of Foucault, to scholars of race and race theory, and to other feminist scholars in political science, sociology, anthropology, and cultural studies. (shrink)

Cheryl Chase has argued that “the problem” of intersex is one of “stigma and trauma, not gender,” as those focused on medical management would have it. Despite frequent references to shame in the critical literature, there has been surprisingly little analysis of shame, or of the disgust that provokes it. This paper investigates the function of disgust in the medical management of intersex and seeks to understand the consequences—material and moral—with respect to the shame it provokes.Conventional ethical approaches may not (...) provide quite the right tools to consider this affective dimension of the medical management of intersex, but we find in Nietzsche's Genealogy of Morality a framework that allows us a profound appreciation of its moral significance (Nietzsche 1887/1998). Understanding doctors' disgust—and the disgust that they promote in parents of those born with atypical anatomies—as a contemporary expression of ressentiment directs us to not focus on the bodies of those born with intersex conditions, which have been the privileged objects of attention both in medical practice and in criticisms of it, but moves us to consider instead the bodies of those whose responses constitute the motivating force for normalizing practices in the first place. (shrink)

: Even as feminist analyses have contributed in important ways to discussions of how gender is raced and race is gendered, there has been little in the way of comparative analysis of the specific mechanisms that are at work in the production of each. Feder argues that in Michel Foucault's analytics of power we find tools to understand the reproduction of whiteness as a complex interaction of distinctive expressions of power associated with these categories of difference.

Katrina Karkazis, Fixing sex: Intersex, medical authority, and lived experience, Durham, N.C.: Duke University Press, 2008, reviewed by Ellen K. Feder Elizabeth Reis, Bodies in doubt: An American history of intersex, Baltimore: Johns Hopkins University Press, 2009, reviewed by Ellen K. Feder.

Ladelle McWhorter's Bodies and Pleasures provides an unusual and important reading of Michel Foucault's later work. This response is an effort to introduce McWhorter's project and to describe the challenge it presents to engage in askesis, the transformative exercise of thinking, which McWhorter's work itself exemplifies.

Even as feminist analyses have contributed in important ways to discussions of how gender is raced and race is gendered, there has been little in the way of comparative analysis of the specific mechanisms that are at work in the production of each. Feder argues that in Michel Foucault's analytics of power we find tools to understand the reproduction of whiteness as a complex interaction of distinctive expressions of power associated with these categories of difference.

The recent publication of Michel Foucault’s 1974-75 and 1975-76 lectures at the Collège de France provides an opportunity to reconsider the potential contribution of Foucault’s “analytics” of power for understanding the contemporary operation of race. Unlike the deployment of gender, which, I argue here, is best understood as a function of “disciplinary” power, the deployment of race is primarily a function of “biopower,” an expression of power that is bound up with the state apparatus. The announcement of the federal Violence (...) Initiative in the 1990s provides an illuminating example of the operation of this power, and the chiasmic function of discourse that Foucault famously termed “power/knowledge.”. (shrink)

Ethical questions in medicine tend to emphasize the intentions of researchers and physicians. Questions concerning harm have more often been addressed in terms of legal culpability. This commentary proposes that normalizing interventions for atypical sex anatomies, both historical and ongoing, be recognized as a kind of medical error, and that attention be focused not simply on prevention, but on repair.

Intersex—the fact of bodies neither typically male nor female, together with the grim history of its medical management—was a topic for feminist theory before there was such a thing as intersex activism. Indeed, critical academic scholarship about intersex supported the consciousness raising that made an intersex activist movement possible. Activist engagement, in turn, has expanded the understanding of the theorists whose work is responsive to that activism. Central to the thinking about intersex are the questions of identity and its limits (...) that are an important focus of the work of Gloria Anzaldúa, whose narrative suggests she had a condition associated with intersex. While her work largely predates intersex activism, it powerfully encapsulates the tensions displayed in contests over identity that have become central over the last 15 years, and furthermore offers insight into the challenges that lie ahead. (shrink)

Intersex—the fact of bodies neither typically male nor female, together with the grim history of its medical management—was a topic for feminist theory before there was such a thing as intersex activism. Indeed, critical academic scholarship about intersex supported the consciousness raising that made an intersex activist movement possible. Activist engagement, in turn, has expanded the understanding of the theorists whose work is responsive to that activism. Central to the thinking about intersex are the questions of identity and its limits (...) that are an important focus of the work of Gloria Anzaldúa, whose narrative suggests she had a condition associated with intersex. While her work largely predates intersex activism, it powerfully encapsulates the tensions displayed in contests over identity that have become central over the last 15 years, and furthermore offers insight into the challenges that lie ahead. (shrink)

One of two commentaries on “Normalizing Atypical Genitalia: How a Heated Debate Went Astray,” by Josephine Johnston, from the November‐December 2012 issue.

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to the history (...) of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations. Critical attention is directed at recent investigations by the U.S. Food and Drug Administration (FDA) and Office of Human Research Protections (OHRP); we argue that the weak and unsupported conclusions of these investigations indicate major gaps in the systems meant to protect subjects of high-risk medical research. (shrink)

The essays of this volume consider how acknowledgement of the fact of dependency changes our conceptions of law, political theory, and morality, as well as our very conceptions of self.

In this paper, I apply Michel Foucault’s analysis of normalization to the 2006 announcement by the US and European Endocrinological Societies that variations on the term “hermaphrodite” and “intersex” would be replaced by the term, “Disorders of Sex Development” or DSD. I argue that the change should be understood as normalizing in a positive sense; rather than fighting for the demedicalization of conditions that have significant consequences for individuals’ health, this change can promote the transformation of the conceptualization of intersex (...) conditions from “disorders like no other” to “disorders like many others.” Understood in these terms, I conclude, medical attention to those with atypical anatomies should be recast from a preoccupation with “normal appearance” to the concern with human flourishing that is the proper object of medical attention. (shrink)

Apology is arguably the central act of the reparative work required after wrongdoing. Claudia Card’s (1940-2015) analysis of complicity in collectively perpetrated evils moves one to ask whether apology ought to be requested of persons culpably complicit in institutional evils. To better appreciate the benefits of and barriers to apologies offered by culpably complicit wrongdoers, this article examines doctors’ complicity in a practice that meets Card’s definition of an evil, namely, the non-medically necessary, nonconsensual “normalizing” interventions performed on babies born (...) with intersex anatomies. It argues that in this instance, the complicity of doctors is culpable on Card’s terms, and that their culpable complicity grounds rightful demands for them to apologize. (shrink)

The question of a genealogy of race and gender is first and foremost a question of methodology. By bringing to bear the critical tools provided by Foucauldian methodology on the construction of race and gender in the specific historical case of Levittown, this chapter explores the manner in which the stories that inform our sense of “the way things are,” are shaped historically. Moreover, the chapter argues that the significance of the institutions and discourses becomes apparent only once they are (...) placed within the context of the play of relations of power and the deployment of bodies of knowledge. A genealogical analysis of Levittown reveals that the concepts of race and gender are not only essential to any conception of modern subjectivity, but also for the products of a network of relations of power. (shrink)

Apology is arguably the central act of the reparative work required after wrongdoing. The analysis by Claudia Card of complicity in collectively perpetrated evils moves one to ask whether apology ought to be requested of persons culpably complicit in institutional evils. To better appreciate the benefits of and barriers to apologies offered by culpably complicit wrongdoers, this article examines doctors’ complicity in a practice that meets Card's definition of an evil, namely, the non-medically necessary, nonconsensual “normalizing” interventions performed on babies (...) born with intersex anatomies. It argues that in this instance the complicity of doctors is culpable on Card's terms, and that their culpable complicity grounds rightful demands for them to apologize. (shrink)

The author analyses the design of her collaborative animation about inattention blindness, the phenomenon of not being able to see things that are actually there, and compares it to related scientific research.1 The term was coined by Arien Mack and Irvin Rock in 1992. Stealing Attention, co-created by the author and neuroscientist Michael E. Goldberg, Director of the Mahoney Center for Brain and Behavior at Columbia University, explored inattention blindness. Animated images of hands playing the con game Three-Card Monte were (...) superimposed over images of antiquities stolen from Iraq. The flashing cards, yellow circles and stated instructions distracted the viewer from seeing the images of stolen antiquities, which disappeared from depicted shelves one by one over the time span of approximately three minutes. The author considers five questions: What is perceived without attention What does attention select Under what circumstances can attention be shifted Is an observer trained in art less likely to be distracted Can attention be trained. (shrink)

The author examines the social construction of racial-ethnic identity and expectations for alliances based on identity in two feminist organizations. She considers the conditions in which assumed alliances work and fail, finding that race played a different role in the search for friendship and political connection among white women and among women of color. Women of color saw racial alliances as crucial in settings dominated by whites and often felt betrayed when alliances failed. White women did not speak of their (...) connections with one another as racial alliances, nor did they express betrayal when they failed. When assumed alliances failed, women were often surprised by unanticipated cross-racial connections. Such connections provided insight to the politically constructed nature of all alliances, even those based on identities. These insights, created in and through the differences between these activists, represent the opportunity for chosen alliances, what June Jordan calls “partnerships for change.”. (shrink)

Despite the 1970s middle-class feminist dream that women could have it all—families characterized by equitable distributions of household labor and interesting careers—the decades since have told a different story. In the U.S. context of a neoliberal labor market and privatized systems of family care, mothers still struggle to negotiate the conflicting demands of family and employment, particularly when caring for children with disabilities. Though an extensive literature examines labor market participation for mothers of children with disabilities, few scholars have examined (...) the emotional impact of their altered career plans. Drawing from a sample of 40 single- and two-parent families, the author examines mothers’ accounts of care for children with disabilities, focusing on their emotional experiences of their changed employment trajectories. (shrink)

Using longitudinal, ethnographic data, the authors examine how the pursuit of self-sufficiency in the context of welfare reform may unintentionally encourage some women to develop alternative dangerous dependencies on abusive or potentially abusive men. In this article, the authors document how women ended up relying on men who have been abusive to them either for instrumental assistance or for more direct financial assistance as they struggled to move from welfare to work. The authors also document how some extremely disadvantaged and (...) vulnerable women became enmeshed in even more dangerous dependencies as they hit time limits and fell through public and private safety nets into drug addiction and sex work. The authors frame this discussion of dangerous dependencies with the recognition that dependency relations are necessary and inevitable components of carework. They argue that the discourse of self-sufficiency should acknowledge the fact that careworkers are productive citizens to the same extent as paid laborers and grapple with the question of the means through which they can support that productivity when personal resources are limited and paid labor is temporarily or permanently impossible. (shrink)

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)