This review essay critically examines Catherine Mills’s Biopolitics and Camisha Russell’s The Assisted Reproduction of Race. Although distinct works, the centrality of race and reproduction provides a point of connection and an opening into reframing contemporary debates within bioethics and biopolitics. In reviewing these books together I hope to show how biopolitical theory and critical philosophy of race can be useful in looking at bioethical problems from a new perspective that open up different kinds of analyses, especially around historically embedded (...) problems like institutional racism and the legacies of colonialism in healthcare. (shrink)
The pharmaceutical industry plays an increasingly dominant role in healthcare, raising concerns about “conflicts of interest” on the part of the medical professionals who interact with the industry. However, there is considerable disagreement over the extent to which COI is a problem and how it should be managed. Participants in debates about COI have become entrenched in their views, which is both unproductive and deeply confusing for the majority of medical professionals trying to work in an increasingly commercialized environment. We (...) used a modified meta-narrative review method to analyse debates about COI in the academic and grey literature. We found two Discourse Models: The Critical Discourse Model sees COI in health and biomedicine as a major problem that both can and should be addressed, while the Defensive Discourse Model argues that current efforts to control COIs are at best unnecessary and at worst harmful. Each model is underpinned by profoundly differing views about how society should be organized—in particular whether market forces should be encouraged or curtailed—and how the dangers associated with market forces should be managed. In order to make any headway, academics and policymakers must recognize that these debates are underpinned by profoundly differing worldviews. (shrink)
This article critically examines current responses to multi-drug resistant tuberculosis and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities—thus moving beyond the orthodox medical/public health frame of reference.
This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial minorities that (...) impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research. (shrink)
Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of resource allocation or clinical procedures such as bariatric surgery. However, prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences. This article critically examines (...) two problematic aspects of Singer and Callahan's respective approaches. First, there is an uncritical assumption that individuals are autonomous agents responsible for health-related effects associated with food choices. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, this view alone does not justify intervention. Both Singer and Callahan recognize that individuals are free to make foolish choices so long as they do not harm others. It is at this point that the second problematic aspect arises. To interfere legitimately in the liberty of individuals, they invoke the harm principle. I contend, however, that in making this move both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. I argue that the mobilization of the harm principle and corresponding focus on individual behaviours without careful consideration of the empirical research is itself a form of harm that needs to be taken seriously. (shrink)
This paper critically examines the proliferation of conflicts of interest discourse and how the most common conceptions of COI presuppose a hierarchy of primary and secondary interests. I show that a form of professional virtue or duty is commonly employed to give the primary interest normative force. However, I argue that in the context of increasingly commercialized healthcare neither virtue nor duty can do the normative work expected of them. Furthermore, I suggest that COI discourse is symptom of rather than (...) solution to the problems of market forces in contemporary medicine. I contend that COI, as it is commonly conceived, is an inadequate concept through which to attend to these problems. It is used as a procedural short-cut to address ethico-political problems. That is, it is an economic and policy concept expected to do significant moral and political work. Like most short-cuts, this one also leads to entanglements and winding roads that fail to reach the destination. As such, I suggest that we need a different set of ethico-political tools to address normative fluidity of medical practice in the absence on a primary interest. (shrink)
This paper examines the power relations in “patient-centred communication”. Drawing on the work of Michel Foucault I argue that while patient-centred communication frees the patient from particular aspects of medical power, it also introduces the patient to new power relations. The paper uses a Foucauldian analysis of power to argue that patient-centred communication introduces a new dynamic of power relations to the medical encounter, entangling and producing the patient to participate in the medical encounter in a particular manner.
On the Importance of the Institution and Social Self in a Sociology of Conflicts of Interest Content Type Journal Article Category Case Studies Pages 1-2 DOI 10.1007/s11673-012-9355-1 Authors Christopher Mayes, Rock Ethics Institute, The Pennsylvania State University, 201 Willard Building, University Park, PA 16802-1601, USA Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.
Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians’ willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been (...) negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. ‘Conflicts of interest’ policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine. We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue. (shrink)
Medical and non-medical experts increasingly argue that individuals, whether they are diagnosed with a specific chronic disease or condition or not (and whether they are judged at minimal risk of these consequences or not), have an obligation to make ‘healthy’ food choices. We argue that this obligation is neither scientifically nor ethically justified at the level of the individual. Our intent in the article is not simply to argue against moralization of the value of prudential uses of food for nutritional (...) health, but to situate nutritional advocacy in the context of Western liberal democracy that values free choice. We have two objectives: (i) to untangle and examine the substance of discourses on ‘healthy’ food choice that simplify nutrition science and place a moral obligation on individuals and (ii) to establish a more comprehensive view of the relationship among food, ethics and health. Although critical of certain features of the liberal political and moral tradition, we argue that John Stuart Mill’s notion of experiments in living provides fertile ground for an improved ethical understanding of individual obligation and of the interconnections among food, health and well-being. (shrink)
Concerns over conflicts of interest in academic research and medical practice continue to provoke a great deal of discussion. What is most obvious in this discourse is that when COIs are declared, or perceived to exist in others, there is a focus on both the descriptive question of whether there is a COI and, subsequently, the normative question of whether it is good, bad or neutral. We contend, however, that in addition to the descriptive and normative, COI declarations and accusations (...) can be understood as performatives. In this article, we apply J.L. Austin’s performative speech-act theory to COI discourses and illustrate how this works using a contemporary case study of COI in biomedical publishing. We argue that using Austin’s theory of performative speech-acts serves to highlight the social arrangements and role of authorities in COI discourse and so provides a rich framework to examine declarations, accusations and judgements of COI that often arise in the context of biomedical research and practice. (shrink)
Public health advocates, government agencies, and commercial organizations increasingly use nutritional science to guide food choice and diet as a way of promoting health, preventing disease, or marketing products. We argue that in many instances such references to nutritional science can be characterized as nutritional scientism. We examine three manifestations of nutritional scientism: the simplification of complex science to increase the persuasiveness of dietary guidance, superficial and honorific references to science in order to justify cultural or ideological views about food (...) and health, and the presumption that nutrition is the primary value of food. This paper examines these forms of nutritional scientism in the context of biopolitics to address bioethical concerns related to the misuse of scientific evidence to make claims regarding the effect of diet on health. We argue that nutritional scientism has ethical implications for individual responsibility and freedom, concerning iatrogenic harm, and for well-being. (shrink)
This paper will address Foucault’s analysis of the Hebrew and Christian pastor and argue that Foucault’s analysis of pastoral power in Security, Territory, Population neglects an important characteristic of the shepherd/pastor figure: violence. Despite Foucault’s close analysis of the early development of the Hebrew pastor, he overlooks the role of violence and instead focuses on sacrifice. However the sacrificial pastor does not figure in the Hebrew Scriptures. The Hebrew pastor is called to lead, feed and protect the flock, not sacrifice (...) for them. This is not to suggest that the theme of sacrifice is absent in the Hebrew Scriptures but that sacrifice is not a role attributed to the pastor until Jesus’ reinterpretation of the “good shepherd” in Chapter 10 of The Gospel of John.4 In distinguishing the Hebrew and Christian formulations of the pastor, the roles of violence and sacrifice in each can be understood more clearly. Beginning with the Hebrew Scriptures I will demonstrate the importance of violence in the figure of David as the first “shepherd of men”. I will argue that violence and the ability to protect the flock was a significant and determining characteristic of the Hebrew pastor. Contrary to Foucault’s assertion I will demonstrate that sacrifice was not a role attributed to the Hebrew pastor. While the words and life of Jesus provide a new sacrificial paradigm for understanding the “shepherd of men,” it is Paul who provides the foundation on which the practice of the Christian pastor is established in the Church. Therefore I will examine the writing of Paul to demonstrate the way violence operates in the Christian pastorate. I will argue that sacrifice does not replace violence but violence is subsumed in the sacrificial pastor and continues to operate. Finally I will suggest that the introduction of violence into Foucault’s analysis establishes a deeper connection between pastoral power and biopower. Thus, this connection engenders a richer understanding of the tension in Foucault’s work between care and violence in the poles of biopower: to make live and let die. (shrink)
At once historical and philosophical, Michel Foucault used his genealogical method to expose the contingent conditions constituting the institutions, sciences and practices of the present. His analyses of the asylum, clinic, prison and sexuality revealed the historical, political and epistemological forces that make up certain types of subjects, sciences and sites of control. Although noting the originality of his work, a number of early critics questioned the normative framework of Foucault's method. Nancy Fraser argued that Foucault's genealogical method was ‘normatively (...) confused’ as it implied political critique yet claimed to be value-neutral. Jürgen Habermas and Charles Taylor also questioned the normative basis of Foucault's appeals to critique, arguing it was self-refuting as Foucault left no room for the subject to escape power. Although a debate among these scholars was planned for the mid-1980s, Foucault's death in 1984 meant this could not occur. A number of edited volumes sought to fabricate a debate, with defenders of Foucault excavating his published monographs to construct responses to his critics. While the monographs remain the central texts of Foucault's oeuvre, over the past decade his Collège de France lectures have been published and translated into English. This article offers a schematic survey of the influence of the Collège de France lectures in recasting different points in the debates over normativity, critique and resistance. (shrink)
I have been invited to reflect on “Discourse communities and the discourses of experience” a paper co-authored by Little, Jordens, and Sayers and discuss how their analysis of discourse communities has influenced the development of bioethics and consider its influence now and potential effects in the future. Their paper examines the way different discourse communities are shaped by different experiences and desires. The shared language and experiences can provide a sense of belonging and familiarity. These can be positive aspects of (...) a discourse community, but there are also risks restricting the voices and experiences that can be heard and recognized. In this essay I hope to weave together three threads: an analysis of Little, Jordens, and Sayer’s research on discourse communities; the narrative interview I conducted with Little about his own experiences in establishing a bioethics centre; and my own experience of the bioethical discourse community established by Little. (shrink)
This paper explores the influence and use of agrarian thought on collective understandings of food practices as sources of ethical and communal value in urban contexts. A primary proponent of agrarian thought that this paper engages is Paul Thompson and his exceptional book, The Agrarian Vision. Thompson aims to use agrarian ideals of agriculture and communal life to rethink current issues of sustainability and environmental ethics. However, Thompson perceives the current cultural mood as hostile to agrarian virtue. There are two (...) related claims of this paper. The first argues that contrary to Thompson’s perception of hostility, agrarian thought is popularly and commercially mobilized among urban populations. To establish this claim I extend Charles Taylor’s notion of a social imaginary and suggest that urban agriculture can be theorized as an agrarian imaginary. Entwined with the first claim is the second, that proponents selectively use agrarian history to overemphasis a narrative of virtue while ignoring or marginalizing historical practices of agrarian violence, exclusion and dispossession. I do not discount or deny the significance of agrarian virtue. By situating agrarian thought within a clearer virtue ethics framework and acknowledging potential manifestation of agrarian vice, I suggest that the idea of agrarian virtue is strengthened. (shrink)
Conflicts of interest, stemming from relationships between health professionals and the pharmaceutical industry, remain a highly divisive and inflammatory issue in healthcare. Given that most jurisdictions rely on industry to self-regulate with respect to its interactions with health professionals, it is surprising that little research has explored industry leaders’ understandings of conflicts of interest. Drawing from in-depth interviews with ten pharmaceutical industry leaders based in Australia, we explore the normalized and structural management of conflicts of interest within pharmaceutical companies. We (...) contrast this with participants’ unanimous belief that the antidote to conflicts of interest with health professionals were “informed consumers.” It is, thus, unlikely that a self-regulatory approach will be successful in ensuring ethical interactions with health professionals. However, the pharmaceutical industry’s routine and accepted practices for disclosing and managing employees’ conflicts of interest could, paradoxically, serve as an excellent model for healthcare. (shrink)
Nourishment is a rich and ambitious text that situates human existence in its ecological materiality to broaden our ethical and political responsibilities beyond currently living individuals. With food procurement and nourishment as her focus, Pelluchon asks what do we owe our ancestors, what are our duties to future generations, and how are we to relate to nonhuman beings with whom we share the world.The objective of the book is “to propose a philosophy of existence that integrates what ecology teaches us (...) about ‘living form,’ and to deduce from this a political organization connected to the elaboration of a new social pact”. The book is structured in two parts. The first part outlines “what ecology teaches us... (shrink)