Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual development, and early gender-defining surgeries have (...) potentially lifelong consequences. We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult. (shrink)

This article discusses the ethics of the use of preimplantation genetic diagnosis to prevent the birth of children with intersex conditions/disorders of sex development , such as congenital adrenal hyperplasia and androgen insensitivity syndrome . While pediatric surgeries performed on children with ambiguous genitalia have been the topic of intense bioethical controversy, there has been almost no discussion to date of the ethics of the use of PGD to reduce the prevalence of these conditions. I suggest that PGD (...) for those conditions that involve serious medical risks for those born with them is morally permissible and that PGD for other “cosmetic” variations in sexual anatomy is more defensible than might first appear. However, importantly, the arguments that establish the latter claim have radical and disturbing implications for our attitude toward diversity more generally. (shrink)

Feminist studies of female genital cutting (FGC) provide ample evidence that many women exercise effective agency with respect to this practice, both as accommodators and as resisters. The influence of culture on autonomy is ambiguous: women who resist cultural mandates for FGC do not necessarily enjoy greater autonomy than do those women who accommodate the practice, yet it is clear that some social contexts are more conducive to autonomy than others. In this paper, I explore the implications for autonomy (...) theory of these understandings of the relation between culture, FGC, and women’s agency. I review the range of worldwide FGC practices – including “corrective” surgery for “ambiguous genitalia” in Western cultures as well as the various initiation rites observed in some African and Asian cultures – and the diverse cultural rationales for different forms of FGC. I argue that neither latitudinarian, value‐neutral accounts of autonomy nor restrictive, value‐saturated accounts adequately explain women’s agentic position with respect to FGC. I then analyze a number of educational programs that have enhanced women's autonomy, especially by strengthening their introspection, empathy, and imagination. Such programs, which engage women's autonomy skills without exposing them to autonomy‐disabling cultural alienation, promote autonomy‐within‐culture. This understanding of autonomy as socially situated, however, entails neither endorsement of FGC nor resignation to its persistence. (shrink)

Feminist studies of female genital cutting (FGC) provide ample evidence that many women exercise effective agency with respect to this practice, both as accommodators and as resisters. The influence of culture on autonomy is ambiguous: women who resist cultural mandates for FGC do not necessarily enjoy greater autonomy than do those women who accommodate the practice, yet it is clear that some social contexts are more conducive to autonomy than others. In this paper, I explore the implications for autonomy (...) theory of these understandings of the relation between culture, FGC, and women’s agency. I review the range of worldwide FGC practices – including “corrective” surgery for “ambiguous genitalia” in Western cultures as well as the various initiation rites observed in some African and Asian cultures – and the diverse cultural rationales for different forms of FGC. I argue that neither latitudinarian, value‐neutral accounts of autonomy nor restrictive, value‐saturated accounts adequately explain women’s agentic position with respect to FGC. I then analyze a number of educational programs that have enhanced women's autonomy, especially by strengthening their introspection, empathy, and imagination. Such programs, which engage women's autonomy skills without exposing them to autonomy‐disabling cultural alienation, promote autonomy‐within‐culture. This understanding of autonomy as socially situated, however, entails neither endorsement of FGC nor resignation to its persistence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standing at the Intersections: Navigating Life as a Black Intersex ManSean Saifa WallAs I sit down to write this narrative, my mind is reflecting on the past year. This year has seen numerous protests against state–sanctioned violence with the declaration that “Black Lives Matter”. As a Black intersex man, I have witnessed the impact of state–sanctioned violence on my family and my community, both from the police state and (...) medical community. I charge the police state and the medical community with state– sanctioned violence: Each targets non–normative bodies—the former through incarceration and execution, and the latter by means of surgical and hormonal intervention. As a Black intersex man, I stand at the intersection bearing witness to how this violence has incarcerated my friends and loved ones as well as being subjected to medically unnecessary surgical intervention. Although this is where I stand now, both socially and politically, I have not always existed here.I was born in the winter of 1978 at Columbia–Presbyterian Hospital in New York City. I was the youngest of five children and one of three children in my family who were born with an intersex trait now known as androgen insensitivity syndrome (AIS). At the time, AIS was referred to as “testicular [End Page 117] feminization syndrome.” Upon receiving my medical records years later at the age of twenty–five, I noticed scribbling and a barrage of notes indicating the process by which the doctors assigned my gender as female. Although I had ambiguous genitalia, which caused some initial confusion among the doctors, XY chromosomes were not enough for me to be raised as male. My mother was told I would be raised as a girl and, according to the medical records, “function as such.”Unlike my sisters who were also born with AIS, my mom was not swayed by the surgical recommendations doctors made about my body. As a matter of protocol, my sisters’ gonads were removed in infancy, however, my mom made the decision that my testes would remain with me until they had to be removed.Because of intense pain in my groin area, my testicles were removed when I was thirteen years old. The pain that I felt following the surgery was perhaps the worst pain that I have experienced in my entire life. After surgery, my pediatrician prescribed estrogen and Provera as a hormonal replacement regimen. Fatty deposits changed the shape and contours of my face. Once robust and chiseled thighs now harbored cellulite. The beginnings of facial hair and prominent body hair became wispy and nonexistent. What was hard and defined became soft.At no point did anyone ask me what I wanted to do with my body.I actually missed the effects of my natural testosterone such as a deepening voice, increased hair and muscle mass; when I asked if I could take both testosterone and estrogen after surgery, my mother remarked, “You would look too weird.”The hormone therapy was coupled with intense social conditioning. I feel as if the social conditioning for young women raised with AIS is suffocating. When doctors prescribed hormones for me to take, my mother constantly reminded me how “beautiful” the little yellow pills would make me. As a means of reassurance, my pediatrician told my mom that “a lot of fashion models” have AIS and that I would most certainly be beautiful. In our dominant US culture, gender norms can already be oppressive, but for women with AIS, there is the impact of gender norms and the underlying fear that women with AIS are not really women since they have XY chromosomes. I did not succumb to the pressure to be more feminine, but actually gravitated toward masculinity. Before transitioning to live as a man, I considered myself a butch woman. When I came out of the closet at fourteen years old and presented as a masculine young woman, I never felt safe. Because I dated women who were more feminine than I, my relationship with these women seemed threatening to men who repeatedly reminded me through harassment and threats that “I was not a man.” Of course, I wasn’t trying to be a... (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)

In lieu of an abstract, here is a brief excerpt of the content:Game ChangeMaximo CortezOn November 17, 1983, I was born with a condition called mixed gonadal dysgenesis, and ambiguous genitalia. My gender was not of a big concern at that time. The more urgent matter was that I had a heart murmur, which was repaired when I was twelve months old. [End Page E5]It was not until I turned five, and by issue of the Texas Children’s Protective (...) Services (CPS), that my mother was forced to authorize providers to perform normalization surgeries on me. An anonymous caller tipped the CPS that my mother was raising a boy as a girl. The state intervened and explained to my mother that she would have to consent to these surgeries or else she would lose custody of me. This included a gonadectomy and a clitorectomy. Without any consent, these surgeries were performed “in my best interests.” My mother was an epileptic, Hispanic, Mormon, single parent.I was raised to be a socially acceptable female, though as early as five, I played with “boy” toys and enjoyed TV programs aimed at male youth, like Teenage Mutant Ninja Turtles. It was not until I had those normalization surgeries performed on me that I felt different. I knew that something major had happened to me. I woke up in a hospital bed in a gown. I raised the covers and noticed that I had an “X” carved in my groin area. Doctors mutilated my clitoris by reducing its size, which made me feel alienated and angry that something was wrong with my body.I had a surgery performed on me that was to be kept secret and never talked about. This sense of fear and shame was instilled in me shortly after the surgery. I do not recall any psychological evaluations or counseling to help me cope with such surgeries. Seeing everyone else my age going through puberty during my teenage years, I felt behind. I wasn’t becoming a boy with a deep voice or facial hair. Instead, I visited the doctor’s office with my mom and was told that I would be taking oral estrogen to become a woman. I wasn’t until that moment that I understood I was seeing a doctor to foster the development of female secondary characteristics. I felt betrayed by the medical community and by my own mother.Just a few years later, I saw a urologist to find out whether I was ready for a vaginal construction surgery (vaginoplasty). Thankfully the urologist suggested that I was not ready to move forward with an invasive and irreversible vaginal construction surgery. I never pursued it as an adult, as I have always felt male gendered.Social sexual relationships have always been difficult for me but more so with my attraction to women. I first realized my attraction to women in early middle school. Being raised Mexican and a Mormon and knowing that I was homosexual created a lot of conflict for me. I felt that I was a male–gendered person forced into a castrated, mutilated, and medically created female body. I suffered through depression from an early age and it continues today. My conservative Mormon upbringing brought me much shame. The Mormon religion, as most people understand it, expresses a great intolerance to homosexuals and transgender people. I felt like I was a heterosexual male in a female’s body, but the Mormons would never accept me.My later teenage years and mid–twenties were a dark time in my life. I even attempted suicide in my early twenties. My depression was treated with antidepressants and talk therapy. Once I began testosterone, I gradually stopped taking antidepressants. When I was only on estrogen, I felt very moody, angry, and in an emotional funk. I would cry easily and would become very irritable and emotional without cause. With testosterone therapy, I began to think more clearly, had balanced emotions, and began to think more logically.I began to research intersex online and found a women’s androgen insensitivity (AIS) support group. At one of their national conferences, I met another intersex individual who was raised as a female and who had transitioned to male. Like me... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Finding My Compass*Laura Inter+I was born in the 1980s, and much to my parents surprise, the doctors could not say whether I was a boy or a girl because my body had ambiguous genitalia. They then conducted a chromosome test and the result was XX chromosomes. I was assigned female and only later was diagnosed with congenital adrenal hyperplasia (CAH). Fortunately for me the endocrinologist who treated (...) me did not mention the option of surgery, so my medical treatment consisted only of taking cortisol. Apart from this, from the time I turned one, I was subjected to genital examinations twice a year, during which the endocrinologist would touch my genitals and look to see how they were developing.These unnecessary and intrusive examinations had a profound effect on me. As a young child, I did not understand why I had to lower my pants in front of a stranger—the endocrinologist—and let him touch me. The fact that my mother was present, and approved of this was something that made me feel completely helpless. All this seemed very strange to me; I found it confusing, and terribly uncomfortable, and I just felt it wasn’t right.I remember the doctor always spoke as if I wasn’t right there, and I did not always understand everything the doctor said when I was young, because of all the medical terms he used. I grew up with a feeling of being “inadequate,” of having a sense that something was wrong with me, though I didn’t know exactly what. These exams lasted until I was about 12 years old. Years later, as I began my adult, sexual life, I realized how much those displays had affected me emotionally.I discovered what was “wrong” with me during sex education classes in the first year of high school. There was a class session in which two images were shown: one displaying the external female sex organs, and the other the male sex organs. I noticed that my body was not like either of them. I was very distressed, thinking “I have deformed genitals!” I feared I could not perform sexually as either a man or a woman. I became very depressed. I was sure nobody would want me, that I would never have a relationship. I was unacceptable, “abnormal,” or at least that is what the doctors had said. And in any case my parents never spoke of it, and I didn’t know that I had CAH.Skip forward a few years: I was still looking for answers, I found my medical file and read in the documents “pseudo–hermaphrodite,” and [End Page 95] “congenital adrenal hyperplasia.” I searched the internet, but only found medical opinions that said that in the case of genital ambiguity, the best option was surgery. I wondered to myself: “Why didn’t they operate on me?”I put the question to my parents, and, at fifteen, I found myself being examined once more in the doctor’s office, this time to consider the possibility of a genital surgery which might once and for all, I believed, make me a “normal” person.I have never told anyone outside my family before, but one of those exams was the most humiliating experiences of my life. One doctor wanted to speak with me alone, so she made my mother wait outside the exam room. My mother agreed, thinking that after the doctor talked with me, my mother would be able to be present during the rest of the exam. The doctor asked me questions, some of which made me very uncomfortable: “Do you feel good about being a woman”? Did you ever feel like a man? Why don’t you dress up more, use more makeup? Are you a lesbian? Have you ever had sex? She then said she wanted to see my genitals. I felt awful and wanted my mother present, but I also wanted it to be over quickly, and said nothing. Examining my genitals, the doctor told me they “would not be adequate for sex,” and that she needed to “perform surgery.” Something else that made me uncomfortable was the presence of another doctor in... (shrink)

Since the late 1980s, intersex adults and activists have critiqued the clinical recommendations defined in the 1950s to treat children born with ‘ambiguous genitalia’ with normalising medicine. While their struggles continue, in particular to halt the practice of genital surgery in early infancy, some European surgeons travel to African countries to transfer standards of care that have become highly controversial in the North, including in the medical community. Simple disapproval of these tours as ‘surgical safaris’ forecloses the possibility (...) of analysing more complex situations in which the so-called transfer of competence involves surgeons who promote ‘less cutting and more talking’. Such is the case – and the interest – of the surgical missions in West Africa in which I conducted recent fieldwork, accompanying a team of paediatric surgeons from a European university hospital collaborating with a renowned international NGO. This article analyses the ways in which a variation of sex development called hypospadias is framed and managed in this context through what I call a surgical script for hypospadias. I examine the conditions of (im-)possibility for Northern surgeons to operationalise, and sometimes revise, this script at the missions (but also closer to home). I discuss what the surgeons do in practice to reflect critically on the normative work of the surgical script for hypospadias as a social script on morphological ideals of sex, gender and reproductive heterosexuality. I consider in what sense genital surgery can be said to (re-)construct ‘normal’-looking genitalia, but also, fundamentally, the very idea of genitalia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Promoting Health and Social Progress by Accepting and Depathologizing Benign Intersex TraitsHida ViloriaI was born with ambiguous genitalia and it was a doctor who, by honoring my bodily integrity and not “fixing” me, gave me the greatest gift I’ve ever received. Because my body and its sexual traits are a positive, fundamental part of my experience and identity as a human being, I know that having my (...) genitals removed or altered according to someone else’s vision would have deeply damaged me, both physically and psychologically.The doctor who protected my autonomy was, unsurprisingly, my father. I say “unsurprisingly” because in my experience parents are typically more protective of their children than doctors are of their patients. Also, doctors do not discuss cases with other doctors in the same way they do with laypeople, as doctors know more about medical issues such as the risks involved in infant genital surgery.Other than having clitoromegaly (a large clitoris), my reproductive anatomy is typically female, and so I was assigned female and raised as such without incident. My parents didn’t discuss my intersex traits with me, and I grew up thinking of myself and being accepted as, a girl.When I began menstruating, my father told me I’d need to take pills to “grow taller.” I thought this unusual, as I wasn’t short, and later overheard my mother arguing with him, saying that the pills were “experimental”. I was reminded of this discussion years later, when she told me that the pills had actually been hormones to make my breasts grow. I never took them though as she convinced my father not to make me.Article 7 of The International Covenant on Civil and Political Rights states that, “No one shall be subjected without his free consent to medical or scientific experimentation,” and I’m grateful to both my parents for protecting my civil rights as they protected my health.Due to my Catholic upbringing and schooling, I had no opportunity to compare my genitals to other girls’, and it wasn’t until the age of twelve that I realized, while perusing magazines with friends, that I have atypical sex anatomy. Contrary to common speculation however, this awareness didn’t make me question being female. I simply assumed there must be some genital variation in humans.I feel my parents made the wisest decision possible by registering me as one of the two accepted, available genders but allowing me to live, physically and behaviorally, as who I am. Despite not having developed a stereotypically curvaceous female figure, I was popular and excelled in typically feminine social activities, as well as sports and academics. For example, I was one of four girls selected out of one hundred twenty–five that competed for a spot on my high school cheerleading [End Page 114] squad when I tried out to help a friend who needed a tryout partner.Other than escaping IGM (Intersex Genital Mutilation) and estrogen therapy, I’ve had only a few experiences pertaining to my medical care around being intersex. These experiences fall into two categories: seeing medical doctors who treated me the same after discovering that I have ambiguous genitalia, and seeing ones who didn’t. I feel incredibly blessed that my experiences in the former category vastly outweigh the latter.My first experience came at the age of twenty, when a gynecologist asked me if my clitoris had always been as large as it is. I responded that it had, and she said, while looking at me disapprovingly, that she’d like to do some tests. When I asked her what they were for though, she wouldn’t respond directly. She said I’d reported having some upper lip hair, and acne, on my intake forms. I replied that neither were above average, and asked if there were health issues I should be concerned about. She reluctantly said no. I asked what reason there was then for undergoing tests because of the size of my clitoris.She finally responded, “It’s just not normal.”Fortunately, I’d had positive reactions to my sex traits from the people I’d dated. For example, the first... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:It’s a Human Rights Issue!Daniela TrufferI was born in 1965 in Switzerland with a severe heart defect and ambiguous genitalia. The doctors couldn‘t tell if I was a girl or a boy. First they diagnosed me with CAH and an enlarged clitoris, and cut me between my legs looking for a vagina.Because of my heart condition, the doctors assumed I would die soon. After an emergency baptism, (...) I stayed in the hospital for three months. My mother would travel to the city as often as possible, though she was only allowed to see me through a glass window.When I was two months old, and still in the hospital, doctors opened my abdomen and found healthy testes, which they threw in the garbage bin. According to my medical records, my parents had not provided consent. Further tests showed I am chromosomally male.Later the “castration” was declared a “mistake”: one doctor said I was a boy with hypospadias. As they had already removed the testes, however, they would have “to continue this way and the small patient must be made a girl.”After three months, my parents were finally allowed to take me home.During my childhood, I spent a lot of time in doctor’s offices and hospitals, suffering countless examinations of my genitals and urethral opening. When I was two, our family doctor stuck his finger into my urethral opening; I was screaming very loud, my father says. My mother had to put me into warm water because every time I had to pee I screamed in pain. Later I was hurried to the hospital with a bad infection. Still today my urethra often hurts after going to the toilet.I knew early in my life that I was different.I learned fragments of the truth only after decades of ignorance and denial. I was lucky to obtain my medical records. The hospital initially told me they no longer existed. When I insisted, they eventually sent me some recent files pertaining only to care I received after I was an adult. I kept calling. Once I was put through directly to the archive, where I was told that indeed there were “lots of files on microfilm.” However, it was only when I threatened to return with a lawyer that the hospital sent me a large pile of printouts.Finally I had it in black and white: The doctors had systematically lied to my parents, instructing them to “raise me as a girl” and never talk to me or to anyone else about “the gender issue.” Asked if I could have children, the doctors told them it was “doubtful.” At seven, the doctors still claimed it had been necessary to “remove the ovaries,” and at fourteen told me that I didn‘t menstruate because my “uterus was very small.”Because of the castration, my bone growth was reduced. To this day, I have to deal with health problems like a ruined metabolism, recurring fatigue and vertigo, and osteopenia.I would eventually grow older than doctors had originally predicted. At seven, they decided to operate on my heart septum and valve. I went to the hospital for preparatory cardiac catheterization. However, because of an infection, doctors put off the procedure. Since I had already been admitted, they decided to “use the opportunity to conduct the genital correction already planned in 1965,” and shortened my micropenis to the size of a “very small clitoris,” allegedly with my consent.Fortunately they didn‘t amputate the glans, and I still have sexual feelings left. But I remember the pain and unease, and how I often ran home from [End Page 111] school crying. Today I have a lot of scar tissue, which often hurts and itches.After a few days I was brought back to the cardiologist for the catheterization, and a few months later heart surgery. The doctors saved my life and destroyed it in the same year.I spent my childhood in fear, isolation, and shame. When I had to see a doctor, I was always scared stiff, but I never cried, and endured everything without any protest. I felt sick days in advance, and in... (shrink)

This article discusses how careproviders of all types can help people with differences of sexual development (DSD): people with ambiguous genitalia, who used to be referred to as intersexed. Careproviders may be in a unique position to benefit these people by offering to discuss difficult issues that concern them, even when the discussions are brief. Specific interventions include learning about people with DSD, whether through the literature or in the clinic; treating them with optimal respect; raising difficult topics (...) such as sex, fertility, and social stigma; encouraging them and helping them to meet others with DSD; and sharing the strengths that we can see that they have. We have come far, but have a long way to go. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Navigating Intersex Healthcare: My OdysseyCynthiaI was born in 1965 with what the medical community called “ambiguous genitalia.” My initial announcement as a boy was called into question upon closer assessment of my atypical anatomy by medical specialists at a children’s hospital in Chicago. That team of medical experts included a pediatric urologist and a pediatric endocrinologist, as well as a prominent pediatric surgeon, who was at that (...) time presiding president of the relatively newly established American Pediatric Surgeons Association. I have wondered over the years whether, or to what extent, that status and position had any important impact on the unfolding of my medical case.Just over 100 days after my birth, I was surgically and socially reassigned female, and renamed Cynthia. My mother and physician father, ages 25 and 30, respectively, with two young sons at home, did the best they could to move ahead in life as a young family. Part of our family story is that my unusual birth contributed to my parents’ decision to move away from Chicago, where both of my parents had been raised and wanted to settle, and where my father had many professional opportunities. We relocated to Southern California to make a “fresh start” where no one would know the dark secret too terrible to be shared with any beyond a small circle of close friends and family. It would never be talked about openly.With the exception of the rare and dreaded occasions of medical appointments with my primary care physician, or maybe an endocrinologist to renew hormone prescriptions, my parents chose [End Page E3] to have me travel from our home in San Diego to a clinician in Los Angeles, away from my father’s medical colleagues. This decision was puzzling to me at the time, and maybe more so now. These trips were a source of considerable stress and anxiety, as I had no idea of what to expect; my mother told me only that treatment would “help me get my period started.” I was instructed to tell my friends and teachers that I was taking off school on a weekday to go on a “shopping trip” with my mother. As far as I know, these trips were never discussed at home with my older brothers. I heard years later that my parents disclosed some information about me with my brothers when my parents travelled outside the country. They felt that my brothers should know what had happened to me in the event of a catastrophic accident that might prevent my parents from telling me themselves. I suppose they believed that I wasn’t ready at the time to be told my own life and medical history. I can’t say for sure.I don’t want to judge my parents too harshly for how they handled my medical care. I know that it was an extremely stressful and uncertain time for them, and peer support, which I know now is so vitally important for both parents and young affected individuals like myself, was not made available to us. I never thought to ask about such help, or even consider the idea that anyone else would be in a similar situation like mine. I don’t think I would have been even remotely comfortable or willing to discuss it openly at that point.In my early twenties, I had to face another milestone in my journey and in my interactions with the medical community. I had yet to have the vaginoplasty I was told I “needed.” There was no discussion as to whether or not I wanted it or not. It just had to be done, and I was aware of the limitations I had at this vulnerable time in my life when my peer group was sexually active and I was not. My awareness of the obstacle posed by my difference made me avoid the topic of dating; it was difficult even to think about the possibility of a romantic relationship. I put it out of my mind, but I knew that it was a significant concern for my parents. My physician father did most of the prodding to get me to acknowledge the reality... (shrink)

Recent anxieties about the deterioration of the global environment have had the effect of intensifying the ambiguity that surrounds the social roles of scientists and engineers. This has happened not merely, as suggested at the outset, because the environmental crisis has made their roles more conspicuous. Nor is it merely because recent disasters have alerted us to new, or hitherto unrecognized, social consequences of using the latest science-based technologies. What also requires recognition is that ideas about the social role of (...) modern science and engineering are embedded in, hence mediated by, larger views of the world. Within such American worldviews, moreover, the status of science and engineering is closely bound up with their perceived effect upon the environment.In the dominant culture, accordingly, the respect given to scientists and engineers is in large measure dependent on their ability to play the central role assigned to them in the historical narrative about progress. As the ostensible heroes of that popular story, they are expected to lead the way in realizing the promise of prosperity and general well-being. The environmental crisis surely has diminished the credibility of that story, thereby causing the social role of science and engineering to seem more dubious — more ambiguous. To be sure, the crisis also may have the effect, for very different reasons, of increasing the power and responsibility of organized science. But the late twentieth-century task of damage control cannot possibly elicit anything like the respect accorded to organized science by the earlier belief in progress.It also is important to recall, finally, that the narrative of progress itself has undergone a disillusioning transformation. The early Enlightenment version of the story depicted scientists and engineers working in the service of a social and political ideal that all people could share. But the later technocratic concept of progress, with its sterile instrumentalist notion of advancing the power of science-based technology as an end in itself, is far less likely to inspire trust. Its patent inadequacies have had the effect of enhancing the appeal, if only by contrast, of the seemingly “anti-science” ideologies of pastoralism and primitivism. All of which might be taken to suggest that if the scientific and engineering professions want to recover some of the respect and status they once had, they would be well advised to join with sympathetic humanists and social scientists in recuperating some of the idealism that the project of modern science formerly derived from its place within the ideology of progress. That might entail the sacrifice of their technocratic posture of neutrality, dissociating themselves from people and institutions responsible for environmental degradation, and their help in formulating a new concept — which is to say, new criteria — of progress to which they might commit themselves. A primary test of any proposed social policy under this new dispensation surely would be whether it would improve, or at a minimum protect, the life-enhancing capacities of the global ecosystem. *** DIRECT SUPPORT *** A8402064 00011 *** DIRECT SUPPORT *** A8402064 00012 *** DIRECT SUPPORT *** A8402064 00013. (shrink)

: The aim of this essay is to reclaim Kristeva's concept of the semiotic chora by re-inscribing it as an intervention in the context of two important postmodern debates. The first debate relates to the philosophical problem of "the beginning before the Beginning." The second concerns the necessity and possibility of mediation between incommensurable entities: the "demonic" and the social, desire and the Law, material production and representation. I contend: (1) that the introduction of the chora in RPL is part (...) of Kristeva's effort to restore the legacy of a materialist economy of the beginning, as this is glimpsed in Plato's Timaeus from which Kristeva borrows her controversial term; and (2) that the chora constitutes an attempt on Kristeva's part to explore a third space of ambiguous relationality in the context of which our transcendence to the "demonic" lies less "beyond us" than "in-between.". (shrink)

The aim of this essay is to reclaim Kristeva's concept of the semiotic chora by reinscribing it as an intervention in the context of two important postmodern debates. The first debate relates to the philosophical problem of "the beginning before the Beginning." The second concerns the necessity and possibility of mediation between incommensurable entities: the "demonic" and the social, desire and the Law, material production and representation. I contend: (1) that the introduction of the chora in RPL is part of (...) Kristeva's effort to restore the legacy of a materialist economy of the beginning, as this is glimpsed in Plato's Timaeus from which Kristeva borrows her controversial term; and (2) that the chora constitutes an attempt on Kristeva's part to explore a third space of ambiguous relationality in the context of which our transcendence to the "demonic" lies less "beyond us" than "in-between.". (shrink)

The aim of this essay is to reclaim Kristeva's concept of the semiotic chora by reinscribing it as an intervention in the context of two important postmodern debates. The first debate relates to the philosophical problem of "the beginning before the Beginning." The second concerns the necessity and possibility of mediation between incommensurable entities: the "demonic" and the social, desire and the Law, material production and representation. I contend: that the introduction of the chora in RPL is part of Kristeva's (...) effort to restore the legacy of a materialist economy of the beginning, as this is glimpsed in Plato's Timaeus from which Kristeva borrows her controversial term; and that the chora constitutes an attempt on Kristeva's part to explore a third space of ambiguous relationality in the context of which our transcendence to the "demonic" lies less "beyond us" than "in-between.". (shrink)

The aim of this essay is to reclaim Kristeva's concept of the semiotic chora by re-inscribing it as an intervention in the context of two important postmodern debates. The first debate relates to the philosophical problem of “the beginning before the Beginning.” The second concerns the necessity and possibility of mediation between incommensurable entities: the “demonic” and the social, desire and the Law, material production and representation. I contend: that the introduction of the chora in RPL is part of Kristeva's (...) effort to restore the legacy of a materialist economy of the beginning, as this is glimpsed in Plato's Timaeus from which Kristeva borrows her controversial term; and that the chora constitutes an attempt on Kristeva's part to explore a third space of ambiguous relationality in the context of which our transcendence to the “demonic” lies less “beyond us” than “in-between.”. (shrink)

Previous research shows that people can use the co-occurrence of words and objects in ambiguous situations (i.e., containing multiple words and objects) to learn word meanings during a brief passive training period (Yu & Smith, 2007). However, learners in the world are not completely passive but can affect how their environment is structured by moving their heads, eyes, and even objects. These actions can indicate attention to a language teacher, who may then be more likely to name the attended (...) objects. Using a novel active learning paradigm in which learners choose which four objects they would like to see named on each successive trial, this study asks whether active learning is superior to passive learning in a cross-situational word learning context. Finding that learners perform better in active learning, we investigate the strategies and discover that most learners use immediate repetition to disambiguate pairings. Unexpectedly, we find that learners who repeat only one pair per trial—an easy way to infer this pair—perform worse than those who repeat multiple pairs per trial. Using a working memory extension to an associative model of word learning with uncertainty and familiarity biases, we investigate individual differences that correlate with these assorted strategies. (shrink)

Recent work in the philosophy of biology argues that we must rethink the biological individual beyond the boundary of the species, given that a key part of our essential functioning is carried out by the bacteria in our intestines in a way that challenges any strictly genetic account of what is involved for the biological human. The gut is a kind of ambiguous other within our understanding of ourselves, particularly when we also consider the status of gastro-intestinal disorders. Hegel (...) offers us theoretical tools to describe and understand our relationship to our gut. His description of our selves as continually mediated through otherness is strikingly compatible with the kind of structure contemporary biology presents us with. His accounts of digestion and habit, contextualized by his logic, help point toward an understanding of selfhood as porous and yet still capable of being sufficiently unified for us to make sense of ourselves, one which allows us to acknowledge otherness within us while still having enough unity for agency. (shrink)

Uchiyama et al. propose a unified model linking cultural evolutionary theory to behavior genetics (BG) to enhance generalizability, enrich explanation, and predict how social factors shape heritability estimates. A consideration of culture evolution is beneficial but insufficient for purpose. I submit that their proposed model is underdeveloped and their emphasis on heritability estimates misguided. I discuss their ambiguous conception of culture, neglect of social structure, and the lack of a general theory in BG.

The ordination of women in the Church of England has had a long hard road. Other denominations, and other parts of the Anglican Communion took the step, but it was not until the 1990s that the first women priests were ordained in the Church of England itself. Even then, Emma Percy describes the situation as an ‘ambiguous welcome’. Careful provision has been made at every stage for those who not only will not accept women as priests, but require the (...) service of bishops who have not participated in the ordination of women. The path to acceptance for women bishops has also been lengthy and subject to the same caveats and provisions. Percy argues that this reveals an underlying failure to think theologically about gender. She recognizes that there are still profound inequalities in the Church’s treatment of women in leadership. (shrink)

Intermediate labour markets provide fixed-term work opportunities and coaching for people in disadvantaged positions in labour markets. We study 46 sequences from six audio-recorded recruitment interviews for an ILM job targetted at people who have been unemployed for a prolonged period. Using an ethnomethodological approach to identity, membership categorisation analysis and conversation analysis, we study how interviewers and candidates construct and negotiate who is fit for the ILM job. We present interactional moves through which the participants jointly construct the ‘fit (...) for the ILM job’ category and treat the candidate’s membership in it as a positive matter. Further, we demonstrate how the candidates are put in an interactionally difficult position in the interview as there are contradictory and ambiguous expectations about the ideal candidate. We discuss the results in relation to the interactional and institutional logics of a recruitment interview and suggest that enhancing the transparency might reinforce ethics of recruitment in ILMs. (shrink)

Fundamental terms in the field of ecology are ambiguous, with multiple meanings associated with them. While this could lead to confusion, discord, or even tests that violate core assumptions of a given theory or model, this ambiguity could also be a feature that allows for new knowledge creation through the interconnected nature of concepts. We approached this debate from a quantitative perspective, and investigated the cost of ambiguity related to definitions of ecological units in ecology related to the general (...) term “community.” We did a meta-analysis of tests associated with two bodies of literature, Hubbell’s unified neutral theory of biodiversity and biogeography and Diamond’s assembly rules, that rely on a specific ecological unit that assumes that species are existing within a local area and that they have overlapping resource needs. We predicted that if ambiguous terminology is widespread, then researchers will have tested them with many different ecological units, that in addition some of these ecological units will violate the core assumptions of the theory, and finally that the overall level of support for a theory will be stronger if appropriate ecological units were used. We found that indeed multiple different ecological units were used in the literature to test both theories, with 65 percent appropriate ecological units for neutral theory tests, and only 6 percent for assembly rule tests. Finally, there was some evidence that the support for a theory depended on whether appropriate ecological units were used for neutral tests, but there was not enough data for the assembly rule tests. These results thus show that ambiguous terminology in ecology is having measurable effects on research and is not of solely philosophical concern. We advocate that authors be explicit in their writing and outline core assumptions of theories, that researchers apply these consistently in their tests, and that readers be attentive to what is written and cognizant of their potential biases. (shrink)

This paper reviews the literature on the diffusion and popularity of vague management ideas. Is it the vagueness in itself that makes them so popular, or are there other explanations? Five possible explanations for the attraction of ambiguous management ideas are suggested: (i) concretising; (ii) symbolic legitimisation; (iii) seduction; (iv) unknown use; and (v) challenge. Some of the explanations are explicitly suggested in the literature, whereas others are explanations offered by the present author on the basis of a review (...) of the literature. The five explanations are categorised according to the level of consciousness of the use of vague ideas among the users, and according to whether the ideas are implemented in actual practice or used only in talk. The present paper also discusses what management researchers could do to help those who use vague management ideas. (shrink)

This paper reviews the literature on the diffusion and popularity of vague management ideas. Is it the vagueness in itself that makes them so popular, or are there other explanations? Five possible explanations for the attraction of ambiguous management ideas are suggested: (i) concretising; (ii) symbolic legitimisation; (iii) seduction; (iv) unknown use; and (v) challenge. Some of the explanations are explicitly suggested in the literature, whereas others are explanations offered by the present author on the basis of a review (...) of the literature. The five explanations are categorised according to the level of consciousness of the use of vague ideas among the users, and according to whether the ideas are implemented in actual practice or used only in talk. The present paper also discusses what management researchers could do to help those who use vague management ideas. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Oppression, Normative Violence, and VulnerabilityThe Ambiguous Beauvoirian Legacy of Butler’s EthicsLisa C. KniselyJudith Butler’s most recent writings are a sophisticated theorization of the significance of human vulnerability as a resource for “a non-violent ethics... that is based upon an understanding of how easily human life is annulled” (Butler 2004, xvii). Butler argues that recognition of the constitutive vulnerability of human existence provides the condition of possibility through which (...) we can respond to an ethical “appeal” or “call” for nonviolence (Butler 2009, 165, 170). This recent work carries on the feminist theoretical tradition of theorizing nonviolence via an attention to human vulnerability that has been strongly present in feminist care ethics (Held 2006; Kittay 1999; Ruddick 1989; Noddings 1984; Gilligan 1982). However, rather than turning to the care ethicists to think through the ethical relationship between vulnerability and violence, Butler produces an innovative feminist ethics by turning to a variety of thinkers in continental philosophy and psychoanalysis, such as Hegel, Freud, Cavarero, and especially Levinas. Butler’s recent discussion of the ethical import of human vulnerability therefore extends a long-standing feminist tradition of arguing for nonviolence while also helping to expand the theoretical resources feminists have used for this task.This article places Butler’s recent ethical focus on nonviolence1 in conversation with Simone de Beauvoir’s earlier existentialist feminist ethical writings2 [End Page 145] concerning the ethico-political import of violence. Together, these two thinkers reorient the dominant feminist conversation about violence away from an emphasis on women’s violent and oppressive victimization and toward an idea of gendered actors who are simultaneously ethically enabled and constrained by the bodily, historical, and political situations out of which they act. Ultimately, however, Beauvoir’s argument that ethics are always deeply contextual and are thus normatively ambiguous is a preferable feminist alternative to Butler’s attempt to delineate a specifically nonviolent ethics. This is because Beauvoir gives thorough attention to contexts of oppression as a major mitigating factor that shapes our ethical possibilities.For Beauvoir, there is no guarantee that a nonviolent response to vulnerability is a priori the most ethical response. Beauvoir does not insist on a nonviolent ethics because the ethicality of violence must be derived from within the embodied situations out of which people are acting. Ethicality cannot be determined prior to, or outside of, the lived contexts in which people are situated. Beauvoir’s ethics remind contemporary feminist theorists that both vulnerability, and responses to vulnerability, whether violent or nonviolent, are always contextually mediated by the forces of history, politics, and circumstance. This reminder is essential if we do not wish feminist ethical claims to override the feminist political goal of lessening oppression. Beauvoir’s attention to contextual specificity shows us that our possible responses to vulnerability are ethically ambiguous in the sense that no normative claim about how one ought to respond to human vulnerability, taken in the abstract, can be elucidated without the risk of making our ethics potentially oppressive.By returning to Beauvoir’s ethics, especially Beauvoir’s attention to oppression and freedom, the discussion here is meant to echo the concerns of a growing number of contemporary feminist theorists who express hesitation about the recent “turn” to vulnerability in feminist theory (Bergoffen 2001; Butler 2004, 2005, 2009; Fineman 2008; Oliver 2008)3 and more generally about moral claims that are made in the name of feminism (Murphy 2009; Dean 2008; Halley 2008; Mills 2007; Brown 1995). In addition, the emphasis on Beauvoir’s ethics here is meant to help return the contemporary feminist discussion of violence toward a more general emphasis on the importance of thinking about freedom as a primary feminist concern (Zerilli 2005; Willett 2001, 1995). Beauvoir’s ethics demonstrate that the ethicality of our responses to vulnerability cannot be judged without a thorough attention to the ethical freedom4 of oppressed ethical actors.Feminist ethicists have tended to undervalue attention to specific historico-political contexts in their discussions of violence as they develop normative arguments against violence. As Kimberly Hutchings notes in her article “Simone de Beauvoir and the Ambiguous Ethics of Political Violence,” there are two contemporary feminist positions on violence... (shrink)

Steven Hales and Jennifer Johnson—building off their (2014) work as well as Hales (2015, 2016)—have recently conducted two studies in Philosophical Psychology (2018) that show that there is a relationship between optimism and folk assessments of luck. Hales and Johnson use these results to argue that there is no such thing as luck. Instead, they claim that the concept is highly subjective and a cognitive illusion and that what we are in need of is an error theory. After reviewing Hales (...) and Johnson’s position, I levy four objections against their view. First, they ignore the fact that luck involves a chanciness condition. Second, their standards for what it means to be a useful philosophical theory are too high. Third, their view ignores the fact that there are various accounts of value in the literature and assumes a kind of relativism that few people would be willing to accept. Lastly, their error theory is not supported by the empirical evidence. Because of these problems, Hales and Johnson’s argument is not a serious threat to extant accounts of luck. (shrink)

Does it seem that with each reported state cyberattack, there comes an announcement of discovery, an attribution to one of a handful of usual suspects, some threatening language suggesting imminent retribution, and then nothing more? Increased incidence of cyberattack makes its occurrence seem simultaneously rampant in terms of publicity and minimal in terms of threat of war. If rampant, how can repeated deployment by the same actors carry no punitive consequences? How is such audaciousness tolerated? For some, a cyberattack by (...) a state is an act of war. Its prevalence suggests there must be a void somewhere that facilitates its use without consequence. Others think state cyberattack is like other internet novelties: digital malfeasance, amounting to a nuisance that naturally follows from a digital‐based existence, particularly since non‐state actors are typically involved. Yet, state‐on‐state hostilities are historically perilous on a vast scale, and there is a multilateral system for regulating the use of force in the context of war. Acts of war, even when seeming minimal in impact, are not by‐products of a digital fad, and cyberattack is now described as far more than ‘nuisance’. If anywhere, the place for clarity on hostile state cyberoperations use should be accounted for in International Humanitarian Law. Yet, in its present form, it is ambiguous if not silent on the subject, suggesting that cyberattack currently presents an advantage to perpetrating states. Does this void or these ambiguities make cyberattacks more legally advantageous to states than traditional, kinetic weaponry? I examine whether existing IHL is sufficiently adaptable to state cyberoperations through a mixed legal and theoretical approach and conclude that they do. (shrink)

In his dissertation, Wadge defined a notion of guessability on subsets of the Baire space and gave two characterizations of guessable sets. A set is guessable if and only if it is in the second ambiguous class, if and only if it is eventually annihilated by a certain remainder. We simplify this remainder and give a new proof of the latter equivalence. We then introduce a notion of guessing with an ordinal limit on how often one can change one’s (...) mind. We show that for every ordinal $\alpha$, a guessable set is annihilated by $\alpha$ applications of the simplified remainder if and only if it is guessable with fewer than $\alpha$ mind changes. We use guessability with fewer than $\alpha$ mind changes to give a semi-characterization of the Hausdorff difference hierarchy, and indicate how Wadge’s notion of guessability can be generalized to higher-order guessability, providing characterizations of ${\mathbf{\Delta}}^{0}_{\alpha}$ for all successor ordinals $\alpha\gt 1$. (shrink)