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.

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.

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)

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia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)

Companies disclosing negative aspects in sustainability reports often employ legitimation strategies to present mishaps in a favorable light. In incentivized experiments, we find that nonprofessional investors divest from companies with a negative sustainability-related incident, and that symbolic legitimation (which only evasively explains a negative incident) is not a strong enough signal to counter this divestment behavior. Even substantial legitimation (which reports on measures and behavioral change) mitigates the divestment decisions only if the company reports on concrete remediation actions in morally (...) charged situations, such as social or environmental incidents. We elaborate these results in light of signaling and screening theory, and suggest the conceptual extension of “costly signals” to what we call “valuable signals.” We argue that valuable signals need be not only costly for the sender from an economic perspective but also perceived as appropriate by the receiver from a noneconomic perspective. (shrink)

During periods of scarcity, or the fear of it, many health systems create or adopt triage protocols to determine how to best allocate limited resources. Interest in such protocols has become acute...

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)

The first-ever compilation of articles that highlights the intersection of Derridean and feminist theories--a work that represents the extensive and diverse response feminist theorists have had to Derrida, particularly to the issues of gender, identity, and the construction of the subject.

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)

Many formerly incarcerated people have civil legal needs that can imperil their successful re-entry to society and, consequently, their health. We categorize these needs and assess their association with cardiovascular disease risk factors in a sample of recently released people. We find that having legal needs related to debt, public benefits, housing, or healthcare access is associated with psychosocial stress, but not uncontrolled high blood pressure or high cholesterol, in the first three months after release.

: 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.

In the face of a perceived lack of widespread understanding of the theoretical issues underlying the development, dissemination and implementation of clinical guidelines, the Royal College of General Practitioners Guidelines Group developed a 2-day course aimed at teaching the theory in these areas. The course was targeted at potential opinion formers and ran on six occasions. Postal questionnaire assessment of the course revealed high levels of satisfaction with all aspects of the course and high levels of reported use of the (...) knowledge gained. Further developments of the course are discussed. (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)

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)

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.

Johann Georg Heinrich Feders Schriften bieten einen repräsentativen Einblick in die Entwicklung des philosophischen Denkens, die der deutschsprachige Empirismus zwischen den späten 1760er und den frühen 1790er Jahren nahm. Mit dieser ersten, kommentierten Edition der Schriften des berühmtesten zeitgenössischen Kant-Kritikers entsteht ein plastisches Bild der,Neuen Göttinger Wissenschaften‘ während der Spätaufklärung. Neben zahlreichen Zeitschriftenbeiträgen und Rezensionen werden paradigmatische Auszüge aus schwer zugängigen Monographien Feders präsentiert. So wird erstmals wird Feders einflussreiche Dissertation „De sensu interno“ im Original und in einer Übersetzung vorgestellt. (...) Auch viele der bislang unberücksichtigen Kritiken an Kants Transzendentalphilosophie werden in kommentierter Form präsentiert. Darüber hinaus dokumentiert der Band die Bandbreite des federschen Schaffens in Schul- und Popularphilosophie. Insgesamt entsteht ein facettenreichen Bild der philosophischen und publizistischen Schriften eines der produktivsten Philosophen der Spätaufklärung. (shrink)

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.

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.

Despite the upsurge of research on disgust, the implications of this research for the investigation of cultural pollution beliefs has yet to be adequately explored. In particular, the sensitivity of both disgust and pollution to a common set of elicitors suggests a common psychological basis, though several obstacles have prevented an integrative account, including methodological differences between the relevant disciplines. Employing a conciliatory framework that embraces both naturalistic and humanistic levels of explanation, this article examines the dynamic reciprocal process by (...) which contamination/contagion appraisals in individuals serve to shape—and are in turn shaped by—culture-specific pollution beliefs. This complex interrelationship is illustrated by examining ancient Near Eastern and modern ethnographic documentation of pollution beliefs, highlighting the underappreciated function of these pollution beliefs as folk theories for the spread of infectious disease. By evaluating how pollution beliefs shape contamination appraisals in individuals, it will be argued that cultural inheritance has played a much larger role in guiding disease avoidance behavior than has been previously recognized. (shrink)

Critics of the gaps in our nation’s health insurance decry the absence of a health insurance “system” and the resulting “patchwork” of private and public insurance that leaves so many Americans unprotected. There is no question that these gaps are unconscionable; but they are also no accident. They are the result of policy and political choices with substantial consequences for those who remain uncovered. In my view, the fundamental political barrier to universal coverage is that our success in insuring most (...) of the nation’s population has “crowded out” our political capacity to insure the rest. This paper will explain how we arrived at the mix of private and public insurance we now have, how that mix impedes efforts to achieve universal coverage, and how “crowd-out” affects strategy for improving coverage in the future. (shrink)

Critics of the gaps in our nation’s health insurance decry the absence of a health insurance “system” and the resulting “patchwork” of private and public insurance that leaves so many Americans unprotected. There is no question that these gaps are unconscionable; but they are also no accident. They are the result of policy and political choices with substantial consequences for those who remain uncovered. In my view, the fundamental political barrier to universal coverage is that our success in insuring most (...) of the nation’s population has “crowded out” our political capacity to insure the rest. This paper will explain how we arrived at the mix of private and public insurance we now have, how that mix impedes efforts to achieve universal coverage, and how “crowd-out” affects strategy for improving coverage in the future. (shrink)

This article challenges the common tendency in modern research to treat impurity as a religious phenomenon divorced from mundane concerns. Employing the cross-cultural psychological notion of “contagion,” this investigation examines the usage of terms for pollution and purity in Hittite and Akkadian as they relate to distinct domains of human experience, specifically uncleanness, infection, and transgression. Special attention is given to the use of these terms in reference to infectious disease. This analysis demonstrates the real-world experiential basis for notions of (...) impurity and also provides a new perspective to shed light on the peculiarities of each culture. The article concludes with a detailed excursus on the etymology of Akkadian musukku and its relation to Sumerian uzug. (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)

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.

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)