Feminist Bioethics

Anne Donchin attended graduate school while raising four children, received her doctorate from the University of Texas in 1970, taught for 18 years in Texas and New York, then joined the philosophy department at Indiana University–Purdue University Indianapolis in 1982. Here she developed a Women’s Studies program, specialized and in numerous ways pioneered in feminist bioethics, and won two prestigious grants. She co-edited two books, published some forty articles, and co-founded and co-ordinated The International Network on Feminist Approaches to Bioethics. (...) Before and after retiring she served on the editorial boards of an encyclopedia, several international bioethics collections and nine prestigious journals. Her publications have influenced many scholars here and abroad. At the time of her death she was at work on a book: Procreation, Power and Personal Autonomy: Feminist Reflections, which is now available on IUPUIScholarWorks. Laura Purdy has generously edited, organized, and, where possible, updated the manuscript. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

I am a feminist bioethicist whose work focuses on the ethics of eating. Though COVID-19 is not a foodborne illness, it has had significant impacts on eating around the world, including increases in food insecurity, dining restrictions and closures of restaurants, interruptions in supply chains, and rising food prices. Many people have been eating at home more often—some alone, others with members of their households—and emotional or stress eating is on the rise.A feminist perspective is indispensable for understanding and responding (...) appropriately to these changes. The costs of these changes have not been distributed equally, and drawing attention to how disproportionate harm tracks gendered and intersectional... (shrink)

This paper uses the figure of the nomad from the work of Rosi Braidoti to critically examine rhetoric about vaccine and masking mandates, and the science of covid more broadly. I draw out the tensions and ambivalence felt as we navigate this on-going crisis in ways epitomized by the phrase “I have a healthy mistrust of authority, and I am still vaccinated.” Though ambivalent, the nomadic subject finds an affirmative ethics, navigating the “right” response to incite positive change and expose (...) our current states of subjectivity. Recognizing the ambivalence of this state may be useful for feminists who critique medicine for its historical sexist and racist “objectivism,” while also supporting medical science and trust in the case of vaccine mandates. (shrink)

ABSTRACT This article takes Judith Butler’s epistemological problem of “framing” alongside Dana S. Belu’s notion of “reproductive enframing” to analyze whose bodies lie outside the borders of who is considered the appropriate reproductive citizen. Are all bodies subject to reproductive enframing under a totalizing technological ideology that Martin Heidegger refers to as Gestell? Or, does Belu’s notion of “partial enframing” allow a space to queer, or upset, our current understanding of such ideology? By queering the way that we currently view (...) assisted reproductive technology, can we widen the frame or cross its borders? In this article, I am primarily concerned with the necessity to queer French reproductive policy, though the questions I raise can be extended to any critiques of ART. (shrink)

In May of 2020, reports of so-called "long-COVID" began to surface. Long COVID is a collection of post-COVID-19 physical, cognitive and psychological symptoms, such as depression, brain fog, fatigue, and dizziness. As long-COVID is considered a "new" disease, it is not always covered by health insurance or government programs, moreover it is a set of constantly evolving symptoms.While severe cases of COVID-19 itself tend to be mostly in males over fifty-years-old, those individuals affected by long-COVID tend to be mainly female (...) and younger in age. Data supporting the existence of the long-COVID syndrome... (shrink)

The ongoing COVID-19 pandemic has made explicit what many of us already knew and some of us are constantly made to feel: good health and the abilities of our bodies & minds1 are fluid and uncertain. We can only ever hold them precariously (Butler, 2004; Scully, 2014). In the end, we are all vulnerable beings. And, yet, vulnerability, perhaps especially in times of crisis, can never be fully universalised, nor is it distributed equally: the value and definition of what our (...) bodies & minds can do, what they mean, and how they are expected – and often pushed – to function, are intrinsically unstable, as they depend on the socio-cultural, political, and economic context. This is perfectly echoed by the title Rosi Braidotti (2020) gave to one of her recent articles on the ongoing COVID-19 crisis and the current posthuman predicament: ‘“We” Are in This Together, But We Are Not One and the Same’. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S21-S23, March‐April 2022.

My mother died within the first few months of the pandemic. Her sudden and rapid decline from Alzheimer's disease is difficult to separate from the COVID-19 restrictions put in place by her nursing home just two months prior. We went from visiting her daily to not at all, then to a strictly enforced twenty-minute hospice visit to say goodbye. After her passing, and still amidst the pandemic, I could not write. The conventional methods and outputs of bioethics inquiry felt impossible.Making (...) art is the only thing that felt possible then. Perhaps that's the function of art, to make things feel more possible. I began by collecting materials from work—package inserts, empty prescription bottles and gelatin capsules—to... (shrink)

The COVID-19 pandemic has changed the world. The depth and breadth of changes are still unfolding. What is the place of feminist bioethics in this new world? It's important to point out that COVID-19 is only one of a few major catastrophes we are facing as humans. The ongoing and worsening effects of climate change, along with the paltry efforts of politicians to address it, are an urgent concern. Humanitarian crises caused by climate change, by COVID-19, or crises unrelated to (...) either but surely worsened by both, are also... (shrink)

The COVID-19 pandemic is not the first pandemic that many of us have faced in our lives. The HIV/AIDS pandemic continues to affect women, racialized people, and LGBTQ2S+ people around the world today, and there are significantly fewer resources to address, and less political will and news coverage of, this other pandemic.1 Although many see COVID-19 as an unprecedented public health crisis that is challenging our societies and our relationships with each other in unique ways, I argue that we actually (...) have a lot to learn from our responses to HIV/AIDS and that feminist bioethicists can help us understand how the present situation is actually an extension of several underlying medical and social issues and... (shrink)

This paper tackles the concept of alterity through an embodied perspective. By questioning my lived experience of cancer and how illness—as a disruptive event (Carel, 2008, 2016, 2021)—enables philosophical reflection and the exploration of ‘other’ ways of being-in-the-world (Merleau-Ponty 2012 [1945]), I ask if an embodied ‘chimeric-thinking’ can be used to question established notions of alterity and reshape our relationship with ‘otherness’ (Leistle 2015, 2016b). Building on a phenomenological approach to illness (Carel 2012, 2014, 2016, 2021), and a feminist post-humanist (...) approach (Haraway 1990, 1991, 2016), I present a case in which an autoethnographic and phenomenological approach focused on embodied experience may help revise dominant perspectives, providing access to understanding and engaging with profound biopsychosocial and somatic transformations. (shrink)

Introductory and advanced textbooks in bioethics focus almost entirely on issues that disproportionately affect disabled people and that centrally deal with becoming or being disabled. However, such textbooks typically omit critical philosophical reflection on disability, lack engagement with decades of empirical and theoretical scholarship spanning the social sciences and humanities in the multidisciplinary field of disability studies, and avoid serious consideration of the history of disability activism in shaping social, legal, political, and medical understandings of disability over the last fifty (...) years. For example, longstanding discussions on topics such as euthanasia, physician aid-in-dying, pre-implantation genetic diagnosis, prenatal testing, selective abortion, enhancement, patient autonomy, beneficence, non-maleficence, and health care rationing all tend to be premised on shared and implicit assumptions regarding disability, especially in relation to quality of life, yet with too little recognition of the way that “disability” is itself a topic of substantial research and scholarly disagreement across multiple fields. This is not merely a concern for academic and medical education; as an applied field tied to one of the largest economic sectors of most industrialized nations, bioethics has a direct impact on healthcare education, practice, policy, and, thereby, the health outcomes of existing and future populations. It is in light of these pressing issues that the Disability Bioethics Reader is the first reader to introduce students to core bioethical issues and concepts through the lens of critical disability studies and philosophy of disability. The Disability Bioethics Reader will include over thirty-five chapters covering key areas such as: critical histories and state-of-the-field analyses of modern medicine, bioethics, disability studies, and philosophy of medicine; methods in bioethics; concerns at the edge- and end-of-life; enhancement; disability, quality of life, and well-being; prenatal testing and abortion; invisible disabilities; chronic illness; healthcare justice; genetics and genomics; intellectual disability and neurodiversity; ethics and diagnosis; and epistemic injustice in healthcare. (shrink)

The Routledge Handbook of Feminist Bioethics is an outstanding resource for anyone with an interest in feminist bioethics, with chapters covering topics from justice and power to the climate crisis. Comprising 42 chapters by emerging and established scholars, the volume is divided into six parts: Foundations of Feminist Bioethics Identity and Identifications Science, Technology and Research Health and Social Care Reproduction and Making Families Widening the Scope of Feminist Bioethics The volume is essential reading for anyone with an interest in (...) bioethics or feminist philosophy, and will prove an invaluable resource for scholars, teachers, and advanced students. (shrink)

Sometimes, people who are otherwise eligible to donate blood are unduly deferred from donating. “Unduly” indicates a gap where a deferral policy misstates what exposes potential donors to risk and so defers more donors than is justified. Since the error is at the policy-level, it’s natural and understandable to focus criticism on reformulating or eliminating the offending policies. Policy change is undoubtedly the right goal because the policy is what prevents otherwise safe eligible donors from donating needed blood. But focusing (...) exclusively at the policy-level passes over a largely undiscussed question: if policy change takes time and there is an urgent need for blood now, then what should unduly deferred donors do in the meanwhile? Blood banks and federal agencies recommend that deferred donors donate their time or money until they become eligible, but blood is a non-fungible good: donated cash or volunteered time cannot replace a transfusion. Further, this request ignores that otherwise eligible donors could safely donate their blood in addition to their time and money. Here is the central question I will focus on in this paper: is a donor morally justified in lying on a questionnaire to donate blood if they justifiably believe that their blood poses no risk to a recipient and knows that honestly answering a donor questionnaire would unduly defer them from donating? (shrink)

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system activity; (...) and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

Adoption may be defined as ‘the legal process through which the state establishes a parental relationship, with all its attendant rights and duties, between a child and a (set of) parent(s) where there exists no previous procreative relationship’ . In adoptions from care, state intervention effectively converts an established, or nascent, adult– child relationship into ‘family’ in the legal sense. From the state’s perspective, adoption thus entails the transfer of parental responsibilities for a child in public care to a private (...) family unit, enabling the state to permanently delegate its duties towards a child to this new unit. This seemingly straightforward legal act raises deeper philosophical questions relating to such state ‘family creation’, particularly when the child’s perspective is taken. Such a child- centric approach normatively regards children as equal moral beings, who ought to be included in actions concerning them, regardless of their capacity to form and express an opinion. Accordingly, adoption from care can be described as a moral decision, aimed at doing what is in the child’s best interests. The purpose of this chapter is to explore a suspicion of a lack of child- centrism in adoption from care practice, and to illustrate how adopted children’s rights are inferior to those of their non- adopted peers. This will shed light on a practice currently lacking transparency and accountability and will increase our understanding of how we fail to treat children as equal moral individuals in decision- making that severely impacts children’s lives. (shrink)

Should the remains of aborted fetuses be treated as human corpses or medical waste? How can feminists defend abortion rights without erasing the experiences of women who mourn fetal death or lending support to pro-life constructions of fetal personhood? To answer these questions, I trace the role of abjection and mourning in debates over fetal remains disposal regulations. Critiquing pro-life views of fetal personhood while challenging feminists to develop richer and more compelling accounts of fetal remains, I argue that embracing (...) the ambiguity and diversity of pregnant bodies can strengthen rather than undermine reproductive autonomy. I conceptualize reproductive autonomy relationally, contending that it entails the pregnant subject’s authority to construct as well as to interpret her lived body, including the fetus. Additionally, because the embodied self is inextricable from social context, reproductive autonomy also requires community support. To support these claims, I develop an account of pregnant bodies as ontologically multiple and advocate embracing abjection rather than suppressing it. Finally, I object to fetal remains regulations because they inscribe fetal grievability into the law. (shrink)

This exciting new Handbook offers a comprehensive overview of the contemporary state of the field in feminist philosophy. The editors' introduction and forty-five essays cover feminist critical engagements with philosophy and adjacent scholarly fields, as well as feminist approaches to current debates and crises across the world. Authors cover topics ranging from the ways in which feminist philosophy attends to other systems of oppression, and the gendered, racialized, and classed assumptions embedded in philosophical concepts, to feminist perspectives on prominent subfields (...) of philosophy. The first section contains chapters that explore feminist philosophical engagement with mainstream and marginalized histories and traditions, while the second section parses feminist philosophy's contributions to numerous philosophical subfields, for example metaphysics and bioethics. A third section explores what feminist philosophy can illuminate about crucial moral and political issues of identity, gender, the body, autonomy, prisons, among numerous others. The Handbook concludes with the field's engagement with other theories and movements, including trans studies, queer theory, critical race, theory, postcolonial theory, and decolonial theory. The volume provides a rigorous but accessible resource for students and scholars who are interested in feminist philosophy, and how feminist philosophers situate their work in relation to the philosophical mainstream and other disciplines. Above all it aims to showcase the rich diversity of subject matter, approach, and method among feminist philosophers. (shrink)

Bioethics scholarship considering the possibility of gestating an embryo to full term in an artificial womb (ectogenesis) often overstates the capacities of current technologies and underestimates the barriers to the development of full ectogenesis. Moreover, this debate causes harm by (1) neglecting more immediate problems in the development of artificial wombs, (2) treating abortion as a “problem with a technological solution,” bolstering anti-abortion rhetoric, and (3) presuming the stability of women’s reproductive rights. The ectogenesis conversation must consider anticipated uses of (...) the technology (neonatal intensive care) and acknowledge the immediate context (recognizing abortion as essential healthcare and existing reproductive inequities). (shrink)

One branch of bioethics assumes that mainly agents of the state are responsible for public health. Following Susan Sherwin’s relational ethics, we suggest moving away from a “state-centered” approach toward a more thoroughly relational approach. Indeed, certain agents must be reconstituted in and through shifting relations with others, complicating discussions of responsibility for public health. Drawing on two case studies—the health politics and activism of the Black Panther Party and the work of the Common Ground Collective in post-Katrina New Orleans—we (...) argue for the need to attend more carefully to the limitations of states and state-driven public health programs. (shrink)

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting (...) patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (shrink)

Love enhancement can give us as a say on whom we love and thus ‘free’ us from our brain chemistry, which is mostly out of our control. In that way, we become more autonomous in love and in our life in general, as long as love enhancement is a free, voluntary choice. So goes the argument in favour of this addition to medical interventions of relationships. In this paper, I show that proponents of love enhancement have overlooked, or at least (...) underestimated, the fact that love itself impacts people’s choices. Since this could include the choice for love or anti-love drugs, I call for a re-formulation of the underlying view on autonomy before this medical intervention is made available to the public. (shrink)

Conscience in Reproductive Health Care responds to the growing worldwide trend of health care professionals conscientiously refusing to provide abortions and similar reproductive health services in countries where these services are legal and professionally accepted. Carolyn McLeod argues that conscientious objectors in health care should prioritize the interests of patients in receiving care over their own interest in acting on their conscience. She defends this "prioritizing approach" to conscientious objection over the more popular "compromise approach" without downplaying the importance of (...) health care professionals having a conscience or the moral complexity of their conscientious refusals. McLeod's central argument is that health care professionals who are gatekeepers of services such as abortions are fiduciaries for their patients and for the public they are licensed to serve. As such, they owe a duty of loyalty to these beneficiaries and should give primacy to their beneficiaries' interests in accessing care. This conclusion is informed by what McLeod believes is morally at stake for the main parties to the conflicts generated by conscientious refusals: the objector and the patient. What is at stake, according to McLeod, depends on the relevant socio-political context, but typically includes the objector's integrity and the patient's interest in avoiding harm. (shrink)

Influenced by critical disability studies, feminist thought and participatory and emancipatory approaches to research, this paper explores new ways of thinking about the ethics of developing a literature review during doctoral study. It questions what kind of knowledge the literature review values, whose lens is upheld and more importantly whose is ignored. It is argued that reimagining the literature review as a ‘community of knowledge’ and drawing on a variety of sources and voices, not only contributes to the overall transparency (...) and integrity of the thesis, but enables the literature review to become a space in which dominant discourses can be challenged and unequal relations of power disrupted. (shrink)

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate in (...) the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected. (shrink)

Penelope Deutscher’s book, "Foucault’s Futures: A Critique of Reproductive Reason" engages with the recent interest in reproduction, futurity, failure, and negativity in queer theory, but also the historical and ongoing investments in the concept of reproduction in feminist theory as well as (US) social movements. "Foucault’s Futures" troubles the forms of subjectivation presupposed by “reproductive rights” from a feminist perspective, exploring the “contiguity” between reproductive reason and biopolitics—specifically the proximity of reproduction to death, risk, fatality, and threat: its thanatopolitical underbelly.

Liminal Bodies, Reproductive Health, and Feminist Rhetoric presents composition professor Lydia McDermott's "sonogram" methodology of rhetorical listening, an exercise that discloses feminine voices muted or unjustly disciplined within texts ostensibly written on women's behalf. The texts examined by McDermott range from eighteenth-century pregnancy manuals to speeches by Favorinus, the ancient sophist, who is described from antiquity as a hermaphrodite. Part of McDermott's purpose in sonogramming is to critique modern and contemporary feminists. She objects to the feminist trend of perpetuating and (...) answering a "disability" rhetoric about women, or of demonstrating that women can overcome a... (shrink)

In this peer commentary on Maura Priest's "Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm", I argue against the "mismatch" model of trans identity. On this model, which is prevalent in institutional and medical contexts, to be trans is to have one's gender identity "mismatch" with one's sexed body.

This paper argues that it is not incoherent to think that abortion should be “legal but rare.” The argument draws upon virtue ethics, feminism, critical theory, and the theory of biopolitics to argue that the idea that abortion should be legal but rare is best understood as aiming at the elimination of unwanted pregnancies. Some pro-choice defenders of abortion rights worry that the “legal but rare” idea stigmatizes women who choose abortion. But when this idea is unpacked using the tools (...) of intersectional analysis, biopolitical theory, and virtue ethics it can be understood as pointing toward a transformation of social reality that empowers women. (shrink)

Analyzing two harm reduction comics campaigns—one early in the AIDS crisis and one more recent, I explore tensions between queer safer sexual erotics and national discourses of sexual norms/deviation raised by Cindy Patton and William Haver at the height of AIDS discourse theory in 1996, approximately halfway between the comics. Using these theorists’ reflections on the history of AIDS activism/representation as a hinge, I explore the manifestation/transformation a decade later of the ethical, educational, and erotic issues they raise. Both foreground (...) the ways that HIV, safer sex, and/or eroticism pose difficulties for systems of linguistic and visual representation. Combining text and image, comics—a common harm reduction medium—epitomize this representational issue. While the GMHC addresses an immediate need for information about safer sex, Alex attempts to tackle the unrepresentability/unthinkability of safer and/or seropositive sex. Safer Sex Comix, while largely prioritizing directness above formal experimentation, employ strategies of transgressing the borders of the comics panel to emphasize a plethora of lower-risk sexual acts. The most visually inventive moments in Alex represent Alex’s feelings of unintelligbility post-diagnosis, but the comic restricts its representation of sex only to anal intercourse, and it proves unable to visualize alternative formulations of the erotic, turning to more normative narratives and images as earlier, visually explicit unsafe sexual encounters are replaced with more a/illusive representations post-conversion, literalizing the unrepresentability of seropositive erotic life. (shrink)

In the United States, roughly 1 out of 4 births takes place at a hospital certified as Baby-Friendly. This paper offers a multi-disciplinary perspective on the Baby-Friendly Hospital Initiative (BFHI), including empirical, normative, and historical perspectives. Our analysis is novel in that we trace how medical practices of “quality improvement,” which initially appear to have little to do with breastfeeding, may have shaped the BFHI. Ultimately, we demonstrate that a rich understanding of the BFHI can be obtained by tracing how (...) norms of gender/motherhood interact with, and are supplemented by, other normative, historical, and institutional realities. We conclude with suggestions for practical revisions to the BFHI. (shrink)

Volume 25, Issue 1, March 2019, Page 1-2.

As a feminist bioethicist, I have frequently wondered why the exclusion of pregnant women has been the default position for most clinical research and how social values have influenced this decision. Relatedly, I wonder what responsible research involving pregnant women would look like. As a theorist who conducts research on the concept of vulnerability, I have often wanted to know why there has been so little research into the harmful effects of the routine exclusion of pregnant women, including questions such (...) as: What do pregnant women actually think about participating in research? How should we treat pregnant women and their fetuses for the purposes of consent (are they two separable persons or one complex... (shrink)

Background: Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers’ perceptions and attitudes, as well as facility policies. Objective: This article aims to clarify how to approach capacity determinations as it relates to sexual activity, propose how to theorize about patient autonomy (...) in this context, and suggest some considerations for finding an ethically responsible and practically feasible way to respect the sexual rights of this population. Research Design: The focus is on residents with early to moderate dementia in states of daily dependency on professional caregivers. The article critically examines existing empirical research on sexuality among persons with dementia, caregivers’ attitudes, and institutional roadblocks to enabling residents’ sexuality. A relational lens and insights from disability studies are used in the philosophical analysis. Participants and Research Context: No research participants were part of this analysis. Ethical Considerations: This article offers a conceptual analysis and normative framework only. Findings: The analysis highlights the delicate balance that capacity assessments for sexual activity have to strike; while caregivers should protect those who cannot give adequate consent, the denial of sexuality among residents can cause deep, long-ranging harms. Sexual agency features into an ongoing sense of self for many individuals with dementia, and the imposition of inappropriate standards and expectations for sexual autonomy can lead to unwarranted obstacles to sexual activity. Discussion: Recommendations include developing clear and inclusive institutional policies and practices of care, providing education for caregivers on how to discuss and document residents’ sexual preferences over time, and taking advantage of ethics consultation services. Conclusion: This analysis establishes the need for more research and discussion on this sensitive topic. Future research should investigate the specific responsibilities of caregivers in furthering the sexual interests of residents, how exactly to modify existing capacity instruments, and how best to support historically marginalized patients in their sexual identities. (shrink)

This paper argues that common social narratives about unhealthy eaters can cause significant damage to agency. I identify and analyze a narrative that combines a “control model” of eating agency with the healthist assumption that health is the ultimate end of eating. I argue that this narrative produces and enables four types of damage to the agency of those identified as unhealthy eaters. Due to uncertainty about what counts as healthy eating and various forms of prejudice, the unhealthy eater label (...) and its harms to agency are more likely to stick to some people than others and may reinforce patterns of oppression. I argue that fat people are especially vulnerable to this identification and the damage it can do. I then consider possible “counterstories” about unhealthy eaters, alternative narratives that might be less damaging to agency than the control narrative. I identify one promising counterstory but suggest that it may be limited when it comes to repairing damage to the agency of fat people. Overall, this paper illustrates some of the complex ways that healthism about eating affects agency, and emphasizes the ethical importance of the ways we think about and discuss eating and eaters. (shrink)

This positional paper explores the role of personal networks (family and friends) in caring for people with mental health problems. Since the eighties, major changes have been made in the organization and focus of professional mental healthcare. Correspondingly, new expectations and changes in the division of care responsibilities between people with mental health problems, their personal networks and their professional care providers were created. In this paper, I investigate how the transition in mental healthcare changed the allocation of care responsibilities (...) between personal networks, people with mental health problems and professional caregivers. I will consider why care responsibilities of personal networks have been taken for granted in these processes, and discuss whether personal networks should have a more prominent voice in the assignment of care responsibilities, and how this can be done. A theoretical framework of feminist care ethics inspired by scholars such as Margaret Urban Walker, Joan Tronto and Hilde Lindemann is used to reflect on the need for social inclusion. (shrink)

This article explores projects of art and biology as joyful acts of insurrection. It presents critical and creative perspectives to generate alternative structures of subjec-tivity. These alternative structures gain relevance when intersectional variables of privilege and discrimination as political tools are set in crisis by a postanthropocen-tric awareness. The thesis of this article is that in order to understand and develop postanthropocentric intersectional positions, the microbial posthuman joins thecartographies of the posthuman as a material possibility from microscopic biologicalmatter and philosophical (...) and artistic thought. This microbial posthuman also allows for a reframing in the light of microbiopolitics, a redistribution of pain, life and deathwithin a broader notion of life. (shrink)

Individuals with disabilities face significant challenges, both physically and socially. To claim a disability, therefore, is not something one ought to do lightly. Pregnancy, however, presents a very difficult and interesting case. Pain, discomfort, and inconvenience are often daily aspects of pregnancy, and pregnancy itself can cause physical, as well as social, impediments that can substantially interfere with one's day-to-day work and life. In practice, based on our current laws concerning family leave, ailments brought on by pregnancy can be cited (...) as a temporary disability in certain circumstances. However, the kind of "pregnancyrelated disability" that is built into such leave policies and laws falls short of... (shrink)

Second edition of Property in the Body, containing about fifty percent new and updated material, including a chapter on surrogacy.

In “Prozac or Prosaic Diaries?”, Ginger Hoffman and Jennifer Hansen examine gendered messages in popular depression memoirs, using narrative self-constitution theory to emphasize the damaging effects such messages can have on women readers. In doing so, they bring a welcome feminist perspective to matters of mental health, as well as raising thought-provoking questions about depression memoirs, a genre that can have a far-reaching impact on public opinions about mental illness. Overall, Hoffman and Hansen do an excellent job of explaining the (...) philosophical concepts that form a basis for their arguments. This work allows even relative newcomers to philosophy to follow along, co-inspecting the... (shrink)

Ginger Hoffman and Jennifer Hansen’s study of gender dynamics in psychiatric disability memoirs makes several fruitful moves for the study of psychic diversity. Perhaps the most important is that the article encourages analytic philosophers to contribute to understanding how individual mental life is affected by the larger cultural context—which we can think of as the “mind/culture” problem. This is an important move because, for the most part, analytic philosophers have paid more attention to the mind/body problem than they have to (...) the mind/culture problem. Hoffman and Hansen are right that it would be valuable for analytic philosophy to join in the study of this equally complicated conceptual problem.... (shrink)

Recent explorations of the territory between epistemology and ethics identify a distinctively epistemic form of injustice through which an individual can be harmed in their capacity as a knower. Starting with Miranda Fricker’s important account, the growing literature on epistemic injustice has broadened our understanding of this capacity to include an individual’s participation in epistemic practices of questioning, justification, communication, and evaluation of truth. Theorists challenge Fricker’s account of prejudicial identity bias as the source of harm of epistemic injustice. An (...) overarching goal for this paper is to provide a framework for ethical analysis of epistemic injustice that accounts for a broader conception of such epistemic harms. In particular, when scaling up our analysis of epistemic injustice from the level of individual transactions to the systemic level, monitoring identity prejudice fails to account for the bad cumulative effects that can result from a series of epistemically just interactions. The work of this paper begins with showing that such a narrow conception of bias in epistemic injustice obscures our ability to properly situate just epistemic practices within a normative framework. I introduce the notion of epistemic labor to account for the complex management of bias and argue that Fricker’s concept of innocent epistemic negligence, an intuition that one may not be blameworthy for certain instances of credibility downgrading, leads to a displacement of a shared responsibility to ensure an epistemically just interaction. I identify the source of harm of epistemic injustice as the unequal burden of this labor and argue that institutional approaches to alleviate epistemic injustice are necessary. Finally, tracking epistemic labor given a shared and pervasive risk of bias is essential in the assessment of epistemically just practices. I propose epistemic labor accountability as a framework to assess instances of epistemic injustice and use it to evaluate a dilemma in bioethics of disclosure requirements in the clinical encounter. (shrink)

Childfree females encounter greater obstacles in obtaining voluntary sterilizations than childfree males. This paper discusses what might explain this and it proposes that female patients encounter particular credibility deficits that undermine their ability to grant informed consent. In particular, the paper explores Miranda Fricker’s recent suggestion that members of structurally disadvantaged groups encounter a particular sort of injustice that harms them in their capacity as knowers: they sustain testimonial injustice. The task of the paper is to investigate whether and in (...) what sense this holds. (shrink)