Search

Cardiovascular disease is the leading cause of death of women in the United States, yet cardiovascular research is disproportionately conducted using male human subjects and male animal models. This article deploys Katrina Hutchison's (2019) analysis of gender disparity in clinical trials as a moral aggregation problem to address the problem of underrepresentation of women in cardiovascular research. I identify cost concerns, convenience, pregnancy, and negligence as potential reasons for the underrepresentation of women in CVD research. Finally, I suggest that multilevel strategies will be needed to eliminate sex disparity in CVD research and improve patient care. [ABSTRACT FROM AUTHOR]

An important argument against removing donor anonymity is that such state-mandated policies might validate bionormative attitudes about the importance of genetic relatedness in families. Bionormative attitudes can be unjustly disparaging and harmful to a wide range of families including donor-conceived, adopted, and single-parent families. However, studies show that the majority of donor-conceived individuals want donor anonymity removed. This paper explores the question of how to weigh these desires for knowing the donor—which may be grounded in biased and bionormative assumptions—against the competing concern that removing donor anonymity perpetuates attitudes that may be harmful. [ABSTRACT FROM AUTHOR]

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

As a method of family formation, cross-border surrogacy is controversial and beset by risks of exploitation. This article extends the literature on surrogacy by examining the way Australian surrogacy promotion and information events represent cross-border surrogacy. It examines the emerging phenomenon of surrogacy events held by a not-for-profit surrogacy organization to promote cross-border surrogacy in Australia—a country that prohibits commercial surrogacy. The article draws on observations from a series of surrogacy events in Australia and online during the 2019–21 time period. It examines the presentations given at these events by surrogacy facilitators, surrogate mothers, and intended parents. We observed four themes: (1) Intended parents are positioned as consumers, (2) the benefits of cross-border commercial surrogacy are highlighted relative to other methods of family formation, (3) the positive side of cross-border surrogacy is accentuated, and (4) reproductive rights are emphasized. These representations run counter to feminist framings of cross-border surrogacy as exploitative and risky. This paper understands that the framing of surrogacy that occurs at these promotion events to be neoliberal in nature. The conceptualization helps explain their consumerist peppiness and commodifying subjectivity. [ABSTRACT FROM AUTHOR]

This paper aims to problematize pregnancy and support the development of a safe alternative method of gestation. Our arguments engage with the health risks of gestation and childbirth, the value assigned to pregnancy, as well as social and medical attitudes toward women's pain, especially in labor. We claim that the harm caused by pregnancy and childbirth provides a prima facie case in favor of prioritizing research on a method of extra corporeal gestation. [ABSTRACT FROM AUTHOR]

At healthcare facilities worldwide, women during childbirth undergo medical procedures they haven't consented to and experience mistreatment and disrespect. This phenomenon is recognized as obstetric violence (OV), a distinct form of gender violence. The resulting trauma carries both immediate and long-term implications, making it vital to address for promoting women's health. OV is partly shaped by a narrow, paternalistic conception of vulnerability. A flawed conception of the vulnerability of pregnant women and fetuses has opened the door to medical control and coercion during childbirth. In this paper we examine what role notions of vulnerability play in perpetuating OV and consider recent attitudinal shifts in research ethics as a model for addressing it. [ABSTRACT FROM AUTHOR]

Healthism and ableism intertwine through an imperative of normalcy and the ensuing devaluing of those who fail to meet societally dominant norms and expectations around "normal" health. This paper tracks the effect of that imperative of normalcy through current research into gut microbiome therapies, using therapies targeting fatness and autism as examples. The complexity of the gut microbiome ought to encourage us to rethink our conception of ourselves and our embeddedness in the world; instead, the microbiome is transformed into one more tool for controlling unruly bodies and minds. [ABSTRACT FROM AUTHOR]

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers "presumed" or "implied" attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize "medical sexual assault" and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as "penetration," this work aims to reify the intimate reality of the clinical label "pelvic exam" and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. [ABSTRACT FROM AUTHOR]

In this paper, I consider how trust affects the decisions of men who have sex with men (MSM) around using pre-exposure prophylaxis (PrEP) as HIV prevention in their sexual and romantic relationships, and how the use of PrEP affects their relationships with healthcare providers. MSM have to trust their sexual and romantic partners as well as their healthcare providers for PrEP to be successful as a relatively new HIV prevention strategy. This trust includes both interpersonal trust and institutional trust and it is complicated by different kinds of relationship dynamics and the history of prejudice against MSM in healthcare institutions. [ABSTRACT FROM AUTHOR]

Take Frankfurt's example of the unwilling addict that Walker and Mackenzie discuss in the paper. It is not clear, therefore, exactly how this kind of acknowledgment differs from the kind found in the addict described in Walker and Mackenzie's paper, who acknowledges but does not endorse his addictive desires. Walker and Mackenzie insist that the kind of acknowledgment described is not the "gross, literal" attribution found in Frankfurt, because it "may include centrally defining features of one's will" (116, n. 11). [Extracted from the article]

This paper considers an area of research in clinical psychology that focuses on the resilience of members of marginalized groups who have experienced traumas directly related to their social identities. The paper describes these as social group-based traumas and outlines three effects of social group-based traumas that can make the experiences of them, as well as experiences of recovery following them, distinct from those involved in other kinds of traumas. In cases where resilience frameworks are useful for understanding such recoveries, the paper proposes three methodological strategies for designing research to address the characteristics of social group-based trauma. [ABSTRACT FROM AUTHOR]

Using Ursula K. Le Guin's The Left Hand of Darkness as an inspirational backdrop, a novel whose story unfolds on a genderless planet that nevertheless relies on reproductive sex for the sake of generativity, this paper tackles the sex/gender debate, its entanglements with procreation, and its consequences for transgender pregnancies. More specifically, I analyze three issues that pose barriers to thinking about a more inclusive reproductive ethics: state-sanctioned sterilization, nonreproductive futurism, and access to assisted reproductive technology. [ABSTRACT FROM AUTHOR]

While digital pandemic surveillance has promised to decrease infection rates, if not designed and executed carefully, the technology can magnify situational vulnerabilities and make disadvantaged subpopulations pathogenically vulnerable. Our paper ([4]) was written to highlight the need for mitigating vulnerability in COVID-19 tracing technology. [Extracted from the article]

The ethical debate about neurotechnologies has been largely framed around their effects on authenticity. In this paper, we investigate the concept of authenticity and associated conceptions of the self. We develop a conception of authenticity that eschews problematic essentialist or existentialist views of the self and the assumption that the authentic self transcends socialization. In our view, authenticity is a condition for self-governance and can involve either endorsement or acknowledgment. Revisiting the debate about neurotechnologies, we show why framing the ethical debate in terms of authenticity is unhelpful and argue that these ethical concerns are better understood as concerns about autonomy. [ABSTRACT FROM AUTHOR]

To qualify for insurance coverage, healthcare must be classified as "medically necessary," which often excludes transition-related interventions. This access problem raises broader questions about the goals of the healthcare system and the narrow kinds of stories required to access care. Through an examination of gatekeeping and informed consent models of care provision, diagnostic categories related to gender identity, and strategic narratives told to move transgender people into patient categories and render their needs legible to insurance companies, this paper reframes "medical necessity" to extend its selective elasticity and incorporate ideas of well-being into determinations of eligibility for transition-related coverage. [ABSTRACT FROM AUTHOR]

Feminist critiques highlight how neoliberal ideologies withdraw attention from the social and the political toward the cult of individual hard work, thereby obscuring oppression and economic disenfranchisement as merely matters for individuals to "overcome" with hard work. Individuals should see their health as a matter of personal responsibility making disability, class, and gender merely private matters to attend to with proper healthy self-care. In this paper, I expand upon feminist philosophy to think about healthy self-care as requiring a delayed body fantasy and to ask if we might see healthy self-care like a morally neutral hobby rather than a mark of moral and social goodness. [ABSTRACT FROM AUTHOR]

The number of cesarean sections performed in high-income economies has been rising for decades. Feminist scholarship suggests that the likely explanation for this trend is defensive practice in obstetrics. In this paper, I argue that defensive practice harms women by depriving them of the power to choose their means of childbirth. This same harm is also evident when women are denied the opportunity to opt for maternal request cesarean (MRCS). Thus, I seek to demonstrate how routinely offering women MRCS is the best solution to rising cesarean rates in high-income economies. [ABSTRACT FROM AUTHOR]

The dilemma of whether to allow relatives to see or even touch their loved one while she undergoes cardiopulmonary resuscitation (CPR) has been discussed for roughly four decades. However, Family Presence During Adult Resuscitation (FPDR) is still not widely implemented. In this paper, I espouse relational autonomy to make a case for a clinical approach of family-centered care and FPDR. In recent years, family-centered care (FCC) has gained increasing support. I argue that relational autonomy provides a conceptual framework for both FCC and FPDR. In turn, FCC provides a plausible clinical approach to justify FPDR, while the empirical evidence that supports FPDR provides a useful example to justify FCC. [ABSTRACT FROM AUTHOR]

In the United States, roughly one in four births occurs in a certified Baby-Friendly hospital. This paper offers a multidisciplinary perspective on the Baby-Friendly Hospital Initiative (BFHI), including empirical, normative, and historical perspectives. Our analysis is novel in tracing how medical practices of "quality improvement," which have received little attention in breastfeeding literature, may have shaped the BFHI. Ultimately, we demonstrate that a rich understanding of the BFHI can be obtained by tracing how norms of gender/motherhood interact with, and are supplemented by, other normative, historical, and institutional realities. We conclude with suggestions for practical revisions to the BFHI. [ABSTRACT FROM AUTHOR]

Frailty has recently become a medical category with physical symptoms that define its diagnosis. This paper uses the resources of an ethics of care to analyze the relationship between frailty and fragility or vulnerability, the positives of frailty becoming a diagnostic category, and some problematic aspects of the same process. [ABSTRACT FROM AUTHOR]

Sexual assault is a common experience for women and a significant topic for feminist scholarship. However, discussions of forensic evidence collection have been largely neglected. This paper considers the ethics of forensic evidence collection by situating the conversation in the context of the experience of sexual assault. The power of patriarchal norms and rape myths, the impact of trauma, and the systemic sexism in the medical and legal systems are also discussed. With this literature in mind, recommendations are made to improve the medical response to sexual assault survivors and the procedures of forensic evidence collection. [ABSTRACT FROM AUTHOR]

Many social gradients in health appear steeper for men than for women. I refer to this as the "Steepness Puzzle." This paper explores the ethical implications of this Puzzle. First, it identifies potential explanations for the Steepness Puzzle, including methodological problems. Second, it highlights two harms associated with the methodological explanation: the consequences of biased epistemic practices and the marginalization of women. It also demonstrates how attempts to flatten the gradients in health could disproportionately favor men or reinforce troubling gendered norms. Finally, I suggest ways to address the methodological problems underlying the Puzzle. [ABSTRACT FROM AUTHOR]

This paper explores the ethical considerations surrounding human papillomavirus (HPV) vaccination for adolescents in three special circumstances: a) the preadolescent/adolescent vaccination target population; b) the sexually transmitted nature of the virus; and c) the delay in boys' vaccination recommendations as compared to initial girls' recommendations. Examining the gendered components of the HPV vaccine, medical consent, and assent for minors; the changing relationship between medical providers and patients; and the tension between individual and public health, I conclude that, in most cases, parents are ethically required to choose vaccination for their children. [ABSTRACT FROM AUTHOR]

This paper proposes a novel relational view of autonomy designed to overcome the inadequacies of procedural and substantive views of autonomy as they relate to physician-assisted suicide (PAS) requests for individuals with diminished cognitive functioning. Traditional and other relational views of autonomy regard a patient as an "isolated monad," ignore patients with limited personal autonomy, and overlook the contexts in which decisions like PAS are made. However, these weaknesses become the strengths of a synthesized relational view of autonomy, which enhances the personal autonomy of those with limited personal autonomy so that their PAS requests can be granted. [ABSTRACT FROM AUTHOR]

The general aim of this paper is to provide insight into the relevance of critical phenomenology for the study of the patient-provider relationship in health care systems in U.S. jails, prisons, and detention facilities. In particular, I utilize tools from the work of scholars studying phenomenological approaches to health care and structural forms of oppression to analyze several harms that arise from the provision of medical care under the punitive constraints of carceral facilities. [ABSTRACT FROM AUTHOR]

In this paper, I argue that women who experience fibromyalgia may find themselves in a double bind. They may feel the need to describe their pain as extreme weakness or violence to convince health care providers and loved ones of the severity of it, but having to describe themselves repeatedly in these ways may be internalized and lead to a diminished sense of agency, especially in a culture that already systematically denigrates the strength and credibility of women. [ABSTRACT FROM AUTHOR]

In this paper, I argue that Jonathan Glover, a prominent advocate of human genetic engineering, relies on a limited naturalistic account of normal human function in his defense of genetic engineering as a means of decreasing future instances of disability. I show that his concept of disability and the normative argument informed by it in his Choosing Children: Genes, Disability, and Design fails to incorporate the phenomenological dimension of embodiment, and that this dimension should be included in any account of disability and human flourishing. Such inclusion, however, requires us to consider seriously the counterintuitive view that racial minorities are constitutionally disabled in racist societies. [ABSTRACT FROM AUTHOR]

At the core of Saudi Arabian bioethics' moral foundation is a strict reliance on religious scripture. This methodology is far from perfect; religious interpretations often lack sufficient moral analysis and intellectual engagement. Women are the most affected by this limited religious understanding, which is often influenced by entrenched patriarchal norms. In this paper, I argue that Saudi bioethics must shift from its current unreflective practice to a more contemplative understanding of Islamic texts. The Saudi women's movement--an effort that utilizes a methodology of religious textual reexamination to offer feminist understandings of Islamic values--is presented as a model for Saudi bioethics. [ABSTRACT FROM AUTHOR]

Epistemic injustice is the idea that social power ensures that the knowledge of some groups is excluded from the collective epistemic resources. In this paper, I argue that there are distinctive features of disabled life that, because they shape the processes through which knowledge is gathered, evaluated, judged, and disseminated, also influence the ways in which epistemic injustice is experienced by disabled people. These features include the ascription of a global epistemic incapacity to people affected by impairment. Against a background of contemporary political shifts and biotechnology innovation, the implications of epistemic injustice for disabled people are serious. [ABSTRACT FROM AUTHOR]

In this paper, I consider Michael Bratman's account of self-governed agency as a lens through which to understand and respond better to patient noncompliance. I argue that, to the extent we ought to understand patients as ordinary people in their capacity to evaluate, choose, and act, we ought to accept that noncompliance could be a rational decision deserving of respect. Understanding noncompliance as rational can benefit the doctor-patient relationship in that the two can work toward mutually agreed upon goals--even when those goals prioritize nonhealth-related values. I argue that this promises benefits both to patient health and medical efficiency. [ABSTRACT FROM AUTHOR]

The cluster of symptoms now called post-traumatic stress disorder (PTSD) had its beginning in ''hysteria,'' a syndrome that affected only women. This paper explores the way that the perniciously essentialist beginnings of trauma research have bled into our understanding and treatment of trauma today. I use the work of Sandra Lee Bartky, who argues that psychological fragmentation forms the basis of the oppression of women, to show the way that the psychological landscape has been shaped in parallel ways for the traumatized veteran. Understanding trauma in nongendered ways illustrates that the trauma response is an adaptive mechanism born of resilience. [ABSTRACT FROM AUTHOR]

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro fertilization. I quote liberally from Anne's work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. [ABSTRACT FROM AUTHOR]

It has been argued that the Kumari worship of Nepal is a form of hierodulic slavery and should be abolished. In this paper, I provide a history of the notion as an instance of Shakti reverence, and I analogize it to the devadasi practice in many Indian temples. [ABSTRACT FROM AUTHOR]

Some kinds of public health messages are unjust and unethical, and feminist analyses of oppression and autonomy can assist in explaining why. Using public health anti-obesity campaigns to provide context, I explore, in this paper, how manipulative public health campaigns oppress the targets of these messages and undermine people's ability to be self-directed decision makers. I begin with an analysis of what it means to communicate in a manipulative way. This leads to the argument that such campaigns are both oppressive and incompatible with the self-authorization required for health-related behavioral changes. [ABSTRACT FROM AUTHOR]

Traditional models of analysis of informed consent are often used to analyze ethical consent. However, these models ignore sociocultural factors that may affect the patients' willingness to consent. This paper uses the case of nondiagnostic tumor biopsies obtained for research to show how the culture surrounding a disease could influence the consent process. I examine how the mainstream breast cancer movement's rhetoric may affect breast cancer patients' willingness to engage in clinical research that does not provide a direct benefit. Ultimately, I argue that a sociological feminist consent approach should be used in evaluating informed consent. [ABSTRACT FROM AUTHOR]

Since its inception, the global female genital cutting (FGC) movement has been led by Westerners and framed along the lines of eradication. Unfortunately, the success of harm reduction strategies such as medicalization has been met with stiff opposition in favor of a rights-based framework of FGC eradication. In this paper, I join with others who have advocated for medicalization as beneficence. I question the Western paternalistic FGC eradication strategy and support the autonomy and empowerment of non-Western women in FGC-practicing communities. [ABSTRACT FROM AUTHOR]

In this paper, I investigate the ethical aspects of sex selection for "family balancing." Advocates of the practice make two claims: first, that it is ethically permissible because it creates gender diversity and entails no harm from sexism; and, second, that it benefits families, as gender diversity offers richer experiences. I test these claims through an empirical study with Australian sex selectors. I argue that the claims are flawed because they are grounded in a narrow understanding of sexism that disregards gender essentialism. As family balancing is based on the selection of children to fit preconceived binary gender roles, it denies diversity and reinforces sexism. [ABSTRACT FROM AUTHOR]

This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices. [ABSTRACT FROM AUTHOR]

In this paper, I review some of the discussions on procreative beneficence and procreative autonomy in the context of postponed motherhood and compare the considerations to the context of advanced paternal age. In doing so, I will give an overview of the main scientific findings with regard to how older age in men affects the health of future offspring. I shall demonstrate how the discrepancy between the media coverage and policies on postponed motherhood and postponed fatherhood mistakenly suggests that women are more responsible than men for the health of offspring. [ABSTRACT FROM AUTHOR]

Debate has raged in Canada recently over whether in vitro fertilization (IVF) should be funded through public health insurance. Such a move would require that the provinces classify IVF as a medically necessary service. In this paper, I defend the position I have taken publicly–especially in Ontario, my own province–that IVF is not medically necessary. I contend that, by funding IVF on grounds of medical necessity, governments like Ontario's violate their commitments to equality and fairness, and cause harm. They do the last by suggesting that the lives of people who forgo procreation, and perhaps have children in other ways (e.g., through adoption), will be stunted. [ABSTRACT FROM AUTHOR]

In this paper, I argue that the pervasive assignment of the psychiatric diagnosis of borderline personality disorder (BPD) to female survivors of chronic childhood trauma pathologizes their life experiences, behavior, and survival strategies. I build on Nancy Potter's argument that diagnostic and clinical practices related to BPD are significantly informed by cultural and gender norms. I maintain that clinicians and society need to appreciate better the life experiences, social situations, and moral virtues of survivors. I conclude with a consideration of Judith Herman's alternate diagnosis of complex post-traumatic stress disorder (C-PTSD) and discuss various limitations of current mental health treatment of survivors. [ABSTRACT FROM AUTHOR]

Women are typically seen as gatekeepers in the acceptance of genetically modified (GM) foods because they perform the majority of food related activities in the home. At the same time, it has been reported that they are more opposed to GM foods than men are. We conducted a qualitative study to explore women's attitudes to and values associated with GM foods and situated those attitudes and values in the context of everyday food choices. In this paper, we illustrate that attitudes toward GM foods, ethical food choices, and risk arise from the complex and simultaneous interactions of women's activities as professionals, carers, and the providers of "good food". [ABSTRACT FROM AUTHOR]

This paper critiques a recent study on the placental microbiome and specifically its recommendations to women for preventing premature births, which were exaggerated and embellished in the media coverage it received. We contend that these preventive recommendations contribute to a pernicious, growing trend of policing women's bodies and argue that the study provides no empirical evidence to justify them. We emphasize how the recommendations ignore important social and environmental risk factors for preterm birth that lie beyond individual choices and bodies and suggest that research on the placental microbiome, and especially media reports about it, should take these problems into account. [ABSTRACT FROM AUTHOR]

The development of a new field such as synthetic biology provides an opportunity to establish new models for bioethics. In this paper, I describe an experimental course aimed at developing bioethical practices through feminist pedagogy. Based in principles of action-orientation and self-reflective learning, the course provided students from diverse fields with the opportunity to work together at the intersections of science, ethics, and community. As greater interdisciplinarity spreads across campuses, I argue that feminist studies departments are well positioned to transform the production of scientific knowledge through bioethics education based in social justice. [ABSTRACT FROM AUTHOR]

In this paper, I explore the social and cultural implications of the transition of nonmedical 3D ultrasound from a clinical to a social context. The photorealistic quality of 3D ultrasound images displaces sonographers and other medical professionals from their authoritative roles as the translators of fetal images and recasts the ultrasound machine as a technology of communication between women and their fetuses. 3D fetal images, because they are immediately visually accessible, can be transmitted and understood far from the site of their generation, removing women from the transmission of fetal knowledge. The introduction and growth of ''boutique'' fetal ultrasound, in which women pay for these images, recasts them as consumers of information about their fetuses rather than as the sources of that information. [ABSTRACT FROM AUTHOR]

In this paper, I introduce the idea of a queer epistemic privilege that applies to issues of family and parenthood. I ground this privilege in the specific nature of queer people's marginalization--their displacement from family, which leads them to occupy an ''insider-outsider'' status. After laying out the case for such a privilege, I take up an application of it by offering a queer critique of two representative examples from the reproductive ethics literature: J. David Velleman's opposition to donor conception and Elizabeth Anderson's objections to commercial surrogacy. [ABSTRACT FROM AUTHOR]

Highlights from the article: The Donchin and Holmes Emerging Scholar Prize was established in 2016 on the occasion of the twentieth anniversary of the founding of the International Network on Feminist Approaches to Bioethics. The name of the prize honors the two cofounders of FAB, Anne Donchin and Helen (Becky) Bequaert Holmes. The prize is awarded for the best paper by a graduate student or early-career scholar accepted for presentation at the biennial FAB World Congress.