Some accounts of the fiduciary relationship place trust and autonomy at odds with one another, so that trusting a fiduciary to act on one’s behalf reduces one’s ability to be autonomous. In this chapter, we critique this view of the fiduciary relationship (particularly bilateral instances of this relationship) using contemporary work on autonomy and ‘relational autonomy’. Theories of relational autonomy emphasize the role that interpersonal trust and social relationships play in supporting or hampering one’s ability to act autonomously. We argue (...) that fiduciary relationships, understood through the lens of relational autonomy, can provide a means of enhancing, rather than diminishing, beneficiaries’ autonomy. (shrink)

We propose the ‘patient-worker’ as a theoretical construct that responds to moral problems that arise with the globalization of healthcare and medical research. The patient-worker model recognizes that some participants in global medical industries are workers and are owed worker's rights. Further, these participants are patient-like insofar as they are beneficiaries of fiduciary relationships with healthcare professionals. We apply the patient-worker model to human subjects research and commercial gestational surrogacy. In human subjects research, subjects are usually characterized as either patients (...) or as workers. Through questioning this dichotomy, we argue that some subject populations fit into both categories. With respect to commercial surrogacy, we enrich feminist discussions of embodied labor by describing how surrogates are beneficiaries of fiduciary obligations. They are not just workers, but patient-workers. Through these applications, the patient-worker model offers a helpful normative framework for exploring what globalized medical industries owe to the individuals who bear the bodily burdens of medical innovation. (shrink)

Clinical Labor: Tissue Donors and Research Subjects in the Global Bio-economy presents an impressive and informative exploration of a form of labor that is rarely acknowledged as labor at all: the work performed by surrogates, tissue providers, and research subjects. Authors Melinda Cooper and Catherine Waldby refer to this type of work as clinical labor, which they describe as a form of embodied service work that relies on “in vivo, biological processing and the utilization of the worker’s living substrate as (...) essential elements in the productive process”. Providing historical context together with insightful analysis of the rise of clinical labor, Cooper and Waldby give readers a... (shrink)