IJFAB Blog | Official Blog of IJFAB: the International Journal of Feminist Approaches to Bioethics

Persons as Producers: Why bioethics should be concerned with work culture and the structure of labor

Posted on May 1, 2018 by Alison ReiheldMay 1, 2018

Today, May 1, is known in the labor rights movement as May Day or International Workers’ Day. It celebrates the dignity of laboring humans and the right to be seen as and live as fully human. I want to use this day to revisit the implications of the US culture and structure of work for health and caregiving. In particular, I raise concerns about how the valuation of persons as producers is inextricable from problems of access to health care.

May 1 provides an important opportunity for such reflection. In the United States, the concept of the 40 hour work week, and the 8-hour-workday-with-an-hour-for-lunch, exists because of the movements celebrated today. Without these movements, the notion of a “9 to 5” job 5 days a week would not exist (and we’d be short one fantastic satirical Dolly Parton song and related film). In France, the 35-hour working week—above which overtime must be paid–was adopted in 2000 and is also a legacy of labor rights activism. Many other nations celebrate worker safety protections, compensation laws, and more on this day. And many nations see protests, marches, and rallies on this day to continually advance the rights of laboring humans.

But the power of International Workers’ Day is defused in the United States. As Chris Morris at Fortune noted today, “for most people in the U.S., it’s just another Tuesday.” This is particularly odd as the origins of this day tie back to the United States and the 1886 campaign for an 8-hour work day.

But the 40 hour work week and 8-hour-workday-with-an-hour-for-lunch no longer reflect the worklife of most workers in the US today for whom long hours at salaried jobs and precarious hourly jobs are the norm, without reliable access to sick leave or health insurance. And as always in the US, race, gender, and educational access affect our work chances enormously.

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Individualization, Access, and Bias: ACOG issues new consensus call for improvements to maternal health care, but there are serious pitfalls to watch out for

Posted on April 24, 2018 by Alison ReiheldSeptember 5, 2018

I am struck by what health care disparities and the lived experiences of postpartum patients mean for implementation of the American College of Obstetrics and Gynecology’s new guidelines on postpartum care. These guidelines valuably refocus the medical establishment’s focus on the health needs of persons who have been pregnant, not just on the health needs of babies. The merits of this document are many, including but not limited to (A) systematic guidelines to regularize contact with postpartum patients after labor & delivery, (B) attention to connecting postpartum patients with health care providers who can provide continuity of care for other health conditions, and (C) attention to postpartum patients who have experienced miscarriage, stillbirth, or neonatal death.

However, I have three serious concerns with how this document will be implemented as well as with the document itself. First, I am concerned about the individualization of responsibility. Second, I am concerned about whether the guidelines will benefit all birthing persons, especially black women. And third, the fact that lack of benefit to all birthing persons could involve bias in the way that providers respond to postpartum black women. These concerns are not adequately addressed by the ACOG guidelines and I fervently hope that obstetricians, nurse midwives, midwives, and obstetrical nurses reading this will take these concerns seriously and share them with colleagues.

Before we get to these points, let’s clear about the facts on the ground in the U.S. Pregnancy health care in the U.S. is quite poor. In fact, we rank last in the developed world for maternal mortality and things are only getting worse.

This image shows the maternal mortality curves for most other developed nations dropping , or at least staying low, since 1990. US rates stay steady and then begin to increase markedly beginning in 2000 at which point all other developed nations have mortality rates begin to steadily decrease to the present day. We now exceed the next closest maternal mortality rate by over 2.5 times.

IMAGE CREDIT: Rob Weychert/ProPublica. DATA SOURCE: The Lancet

According to journalist Nina Martin, for the 700 women who die each year in the US of complications from pregnancy and childbirth, an estimated 50,000 more suffer life-threatening and often debilitating complications. In a 2017 investigative report, Pro Publica and National Public Radio (NPR) found that 60% of these maternal deaths in the US are potentially avoidable. The problem, in their view? Pregnancy care focuses on fetuses and, post-partum, on babies rather than on pregnant and post-partum women. You can see, perhaps, why the ACOG opinion statement is so welcome.

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King’s Words on Health Injustice: what did he actually say?

Posted on April 19, 2018 by Charlene GalarneauApril 19, 2018

Editor’s Note: This blog is a short version of the issue that author and feminist bioethicist Charlene Galarneau wrestles with in her article “Getting King’s Words Right” in the most recent issue of the Journal of Health Care for the Poor and Underserserved. For a more accurate image meme to circulate, scroll to the bottom for one that IJFAB Blog has made for just this purpose.

This image shows the most widely circulated version of the King quote. But is it accurate?

You may have read these commonly cited words of the Rev. Dr. Martin Luther King Jr.:

Of all the forms of inequality, injustice in health care is the most shocking and the most inhumane.

Or you may have read a slightly different quote that says, “injustice in health” rather than “in health care.”

The distinction between health and health care is crucial, and especially so as it relates to injustice. And so, I wondered, which did King actually say?

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The public health response that drug addiction should always have gotten is coming into play for opioids in a way it never did for crack

Posted on April 12, 2018 by EditorApril 12, 2018

Whenever there is a disparate social response to a problem that afflicts one group of people relative to a problem that afflicts another, it is worth asking why. Such questions are not asked to imply that no one should get help, nor to imply that the current group should not be helped. Rather, we ask them to urge that in the future all persons get help and to understand the social forces that result in such disparities.

When it comes to treating addiction as a public health problem, the disparities in question are health disparities. PBS NewsHour in the US recently ran a short piece on the disparities in how crack cocaine abuse was treated when it largely affected African-American communities, and how opioid abuse is being treated now that it is heavily affecting white communities. As the introduction to this piece says.

Faced with a rising national wave of opioid addiction and its consequences, families, law enforcement and political leaders around the nation are linking arms to save souls. But 30 years ago, it was a different story. Ekow Yankah, a Cardozo School of Law professor, reflects on how race affects our national response to drug abuse.

Historically, drug abuse in the US has been criminalized. Now, we see a much-needed flourishing of drug courts which specifically are empowered to offer rehabilitation and treatment instead of jail time. As the Kaiser Family Foundation has noted in this handy chart with data from the Centers for Disease Control, most deaths from opioid overdose are now amongst white Americans (in the US, whiteness often is taken to include hispanic/latinx persons, though this chart separates them out).

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What bearing does this have on why the public health and political responses to drug use in these two communities has been so different? Check out the PBS NewsHour video for more (transcript is available at the link).

April 15 Deadline is coming up for submissions to FAB Congress/World Congress of Bioethics in India

Posted on April 10, 2018 by EditorApril 10, 2018

Editor’s Note: If you have work in feminist bioethics, broadly construed, please submit to FAB Congress, meeting in conjunction with the World Congress of Bioethics later this year in India. These opportunities to be with the global bioethics community and do our kind of feminist work together only come once every two years. Vikki Entwistle, one of the organizers, has a few words for you all as the April 15 deadline approaches!

FAB 2018 – looking forward to our World Congress

The International Network on Feminist Approaches to Bioethics (FAB) will hold its 12th World Congress (FAB 2018) at St John’s College, Bangalore, India, from December 3rd to 5th 2018.

This image shows a map of India with St. John’s Medical College in Bangalore, India, highlighted.

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The FAB 2018 theme is ‘Confronting Inequality in Health and Health Care: Global Challenges, Feminist Responses’. We are looking forward to rich discussions on this and other themes in feminist bioethics. Our World Congress has a strong tradition of embracing contributions from a wide range of disciplines, including philosophy, social sciences, critical cultural studies (e.g. gender and sexuality studies, disability studies, race studies, etc.), law, public health, and others. We also welcome early career researchers alongside established scholars and activists.

There are still a few days to go to the abstract closing date (15 April 2018). You can find the call for papers and the simple Abstract and Cover Sheet forms for submission here: http://ijme.in/nbc-20140321/index.php/14th-wcb-india/index/pages/view/call-for-papers

FAB is affiliated with the International Association of Bioethics. The final event of FAB 2018 will be a plenary session run jointly with the 14th World Congress of Bioethics. You can find more information about both meetings at: http://ijme.in/nbc-20140321/index.php/14th-wcb-india/index/pages/view/home-page

Seek each other out: Nothing About Us Without Us, Autism Awareness Month, and the centering of autistic persons

Posted on April 6, 2018 by Alison ReiheldApril 6, 2018

April is Autism Awareness Month in the U.S. All too often, the rhetoric around autism is shaped by the needs and voices of the caregivers and families of people who are autistic. Goodness knows the perspectives of caregivers and families are indeed important. As many feminist bioethicists have noted, including the incomparable Eva Kittay in her book Love’s Labor and her essay “Love’s Labor Revisited“, they are too often overlooked for both caregivers in general. As I myself have argued, we unjustly continue to overlook societal obligations to those who engage in unpaid medical caregiving for persons with illness or disability.

But attending to the needs of caregivers and families must not mean centering their needs over and against the needs of the persons for whom they provide care. All too often, those who are physically or neurologically different from the majority have little or no say in the policies and decisions and rhetoric that governs their lives. It’s not for no reason that the abiding slogan of the disability rights movement, adopted by many minority groups, is “Nothing about us without us.” Indeed, this is the slogan used specifically by the Autistic Self-Advocacy Network.

If this issue is of interest to you, consider this essay by an autistic person of what it means to handle Autism Awareness month the way it is usually handled. K. Tilden Frost, over at GeekMom, writes:

In a month that is theoretically about raising awareness of issues that affect me, my kids, and my community, I am invisible. There are very real issues affecting the autistic community: abusive therapies and “cures,” culture-wide sympathy with caregiver murders, and the total lack of acknowledgment that autistic kids eventually become autistic adults and have specific and individual support needs, to give some of the many, many examples.

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Weight-loss surgery for teens: a disturbing trend

Posted on April 3, 2018 by Catherine WomackApril 3, 2018

We bloggers and readers been writing and talking amongst ourselves lately about children, weight, fat shaming, and concerns about policing and medicalizing kids’ bodies. Once you start down this path, it’s really hard to stop. And where does this lead? To increased health and fitness, an end to worries about body appearance and function and social acceptability? Not if you read the studies.

The recent news (and blog posts like this, this, and this) about Weight Watchers targeting children with their new teen diet programs has been a hot topic around here. I wrote here about what I don’t like about diets for children even when they’re informed by extensive research. In short, I don’t like weight loss programs that set up kids with possibly unattainable goals that also may not be necessary for them to live healthy and long lives.

But in the realm of kid weight problem concerns, nothing worries me like the increasing push to use both weight-loss drugs and bariatric surgery on children.

Let me repeat this last part: bariatric surgery on children.

What?

No, really, this is a thing now. Here’s Columbia University’s Center for Metabolic and Weight Loss Surgery’s take on age minimums:

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In case you missed it, ACOG’s guidelines on reproductive sterilization were updated last year

Posted on March 23, 2018 by EditorMarch 23, 2018

Feminist bioethics is, of course, about more than reproductive ethics. But it is also about reproductive bioethics. One of the big issues with reproductive bioethics from a feminist perspective is the tension between who is dissuaded from or prevented from accessing sterilization or other forms of contraception, and who is encouraged to use or coerced into accepting sterilization or other forms of contraception. IJFAB Blog contributor Alison Reiheld has addressed this in the past with respect to some European countries’ policies of mandatory sterilization for transgender people seeking a legal change of gender, and contributor Anna Gotlib has considered coercive sterilization practices in modern US prisons more than once.

In case you missed it, the revisions in April of 2017 to the American College of Obstetrics and Gynecology’s (ACOG) guidance on sterilization procedures for women addressed this tension between preventing some people from getting sterilized and targeting others for sterilization.

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ABSTRACT: Sterilization is the most common method of contraception among married couples, with nearly twice as many couples choosing female partner sterilization over male sterilization. Although sterilization is among the most straightforward surgical procedures an obstetrician–gynecologist performs, it is enormously complex when considered from a historical, sociological, or ethical perspective. Sterilization practices have embodied a problematic tension, in which some women who desired fertility were sterilized without their knowledge or consent, and other women who wanted sterilization to limit their family size lacked access to it. An ethical approach to the provision of sterilization must, therefore, promote access for women who wish to use sterilization as a method of contraception, but at the same time safeguard against coercive or otherwise unjust uses. This Committee Opinion reviews ethical issues related to the sterilization of women and outlines an approach to providing permanent sterilization within a reproductive justice framework that recognizes that all women have a right to pursue and to prevent pregnancy.

For more on this topic elsewhere on the internet, check out the superb documentary No Mas Bebes on the sterilization of latinas without proper informed consent, this 2017 article on the difficulty of accessing sterilization in Canada for young women who do not ever want to become pregnant, and this 2012 article on the same issue in the US. One need only Google “forced sterilization international” to see a raft of articles on the how the issue manifests in Brazil, with the Roma in Europe, and with disabled and HIV+ women around the world.

Intimacy Without Reciprocity: How Researchers Working With Transgender Humans Can Do Better

Posted on March 16, 2018 by Sayer JohnsonMarch 16, 2018

Editor’s Note: This blog comes to us from Sayer Johnson, who blogged for IJFAB Blog in the past on the issue of how clinicians respond to trans patients. Here, Mr. Johnson reaches a frustrated breaking point with the way that researchers wanting to work with trans persons behave in the process of recruiting their research participants. The alert reader will note echoes of important research ethics work on community participant research, especially that done with indigenous communities and with other ethnic minorities and with the disability community (“nothing about us without us” is a good slogan for any researcher to keep in mind). This is just as relevant for working with transgender persons. Yet as Mr. Johnson illustrates, the message isn’t getting through, and the lessons research ethics has already learned are not being implemented well and pervasively.

Mr. Sayer Johnson, social worker, Papi and husband, lifelong activist, and co-founder and Executive Director of the Metro Trans Umbrella Group. He worked with MTUG and the University of Missouri St. Louis to create and sustain an annual conference on the needs of the transgender community and has just released a documentary called TransGeek. He is the founder of the Queer Trans Flat, which provides housing in St. Louis for queer trans humans who have had difficulty finding stable housing. He is working to create power for trans persons in the St. Louis area.

Get ready. This is an early morning rant on being inundated with asks for lab rats AKA research participants. Researchers often start by contacting local advocacy organizations like us (the Metro Trans Umbrella Group, or MTUG, which serves trans humans in the St. Louis Metro Area). Fine. But the way it’s done is a big ethical problem.

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New issue is out! And don’t miss the University of Toronto Press Blog based on an article from the new issue of IJFAB

Posted on March 12, 2018 by EditorMarch 7, 2018

The new issue of IJFAB is out with some spectacular articles on topics ranging from childbirth to epistemic injustice to patient noncompliance to Saudi Arabian bioethics. Scroll down to the bottom for the table of contents!

The UT Press Blog also has a short blog, “When Concepts Function Badly: Distorted Thinking and our Understanding of Combat Trauma” by Mary Catherine McDonald, to whet your appetite for the new issue which I have copied here in full and in italics.

In her wonderful essay, “Philosophical Plumbing” – in which Mary Midgley compares philosophy with, well, plumbing – Midgley writes, “when the concepts that we are living by function badly, they do not usually drop audibly through the ceiling or swamp the kitchen floor. They just quietly distort and obstruct our thinking.” It’s a haunting idea – that conceptual mistakes can be so invisibly insidious and corrosive. When we think about things like oppression, we often focus primarily on the victims of that oppression, as we should. But we also need to pay attention to the fact that oppressive structures do not only impact individuals – they infect our ideas, and by extension everything that is touched by those ideas.

Something that I struggle with when teaching the philosophy of gender is getting my students to understand the ways in which structures designed to oppress women or other minority groups eventually impact all of us. Though women are certainly oppressed by the stereotyping, fragmentation, and objectification of patriarchal society, the damage does not end here. The oppressive structures of power also influence the concepts within that patriarchal society, giving birth to all sorts of other flawed ideas. Because we are still so focused on who is oppressed and who is to blame for that oppression, we miss the way in which gendered norms infect all areas of our lives.

How are the concepts that we are living by functioning badly? And how might we fix them? To continue the plumbing analogy, we first must find the source of the leak. It is in this spirit that I began thinking about the history of combat trauma, and the ways in which our ideas of trauma in general have their roots in pernicious concepts about gender and weakness. If our current classification of PTSD begins with hysteria – a diagnosis deeply rooted in misogyny – how might this impact the way that we understand the phenomenon?

In the paper, I explore the ways in which we have used the oppressive structures at work within our understanding of PTSD to systematically undermine those who suffer from it. To silence them, negate their experience, and prolong their suffering. It’s not the gender of the soldiers at issue here – it is the way that gender informs our understanding of combat trauma. How do conceptions of femininity (in a pejorative sense) and weakness get imported from history into clinical and societal understandings of trauma today? Finally, what might happen when we free our understanding of combat trauma from these insidious concepts? We come to see it as it really is: an adaptive response to an overwhelming experience that is rooted in an impulse to survive, a response borne of strength, not weakness.

Mary Catherine McDonald’s full IJFAB article, “Hysterical Girls: Combat Trauma as a Feminist Issue”, is available open access by clicking on the linked title in this sentence.

You can find the full table of contents for the new issue online here. It has clickable links to the articles. But if you love a good look-see as much as I do, here are the other articles in the issue:

ESSAYS

Childbirth is Not an Emergency: Informed Consent in Labor and Delivery by Allison B. Wolf and Sonya Charles
Appropriations of Informed Consent: Abortion, Medical Decision Making, and Antiabortion Rhetoric by Heather Lakey
Self-Governed Agency: A Feminist Approach to Patient Noncompliance by Ruth Tallman
Should Pregnancy Be Considered a (Temporary) Disability? by Devora Shapiro
From ‘She Would Say That, Wouldn’t She?” to “Does She Take Sugar?” Epistemic Injustice and Disability by Jackie Leach Scully
Beyond Sacredness: Why Saudi Arabian Bioethics Must Be Feminist by Ruaim A. Muaygil

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Click on through to the table of contents in the above link for these essays, reviews of books on sexuality and reproduction and disability, and more.

Larry Nassar, Sexual Assault by a Physician, and an Army of Women: IJFAB editors’ take from within the MSU community

Posted on March 8, 2018 by Robyn BluhmMarch 9, 2018

Written by Robyn Bluhm of MSU with input from, and speaking for, the other MSU-affiliated IJFAB folks: two Editors of the International Journal of Feminist Bioethics (Jamie Nelson and Hilde Lindemann) and the Editor of the IJFAB Blog (Alison Reiheld).

IJFAB is currently hosted at Michigan State University (MSU). Three of the Journal’s editors and the editor of the blog have close connections with the university (one Professor Emerita, two current faculty members, and one Ph.D. alumna). We therefore feel that we should comment on recently disclosed events at the university. Many readers will already be aware that hundreds of children and young women were sexually abused by Larry Nassar, a doctor affiliated with MSU as a faculty member who practiced at MSU’s sports medicine clinic. Nassar used his authority as a physician to molest his patients while telling them that his actions were a medical treatment.

Larry Nassar alone is responsible for his actions. However, the responsibility for the creation of the institutional systems, professional regulations, and social structures that enabled his crimes is widespread. MSU is currently under investigation to determine the extent to which Nassar’s crimes were known by his colleagues and by university administration. There is some evidence that complaints were made about his behavior dating back over 20 years.

A person whose face is not visible holds a sign, which occupies most of the image. Written on it in big black marker is “Nassar Enablers. WE’RE COMING FOR YOU.” A chiron at the bottom says “Hundreds of MSU Students Rally to Support Nassar Abuse Survivors” and bears the logo of a local Detroit, MI TV news station.
IMAGE CREDIT: wxyz.com

Bioethics, frankly, has little to tell us about Nassar’s actions; we don’t need ethical analysis to tell us that what he did was horrible beyond words. But bioethics, and feminist bioethics in particular, may help us to understand how he was enabled to do so. For example, it has been suggested that

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Objection! Sustained

Posted on March 7, 2018 by M Sara RosenthalMarch 7, 2018

Editor’s Note: This blog entry by special guest author Dr. M. Sara Rosenthal is part of our miniseries on conscientious objection including the Editor’s introduction and blog entries by Ruth Groenhout, Karey Harwood, and Laura Guidry-Grimes on this subject.

This month, the Trump Administration introduced a mechanism through HHS for healthcare providers to object to performing procedures they find morally distressing or objectionable based on their religion to “ease the way for doctors, nurses or other medical professionals to opt out of providing services that violate their moral or religious beliefs.” For more information see:

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HHS will soon create the Conscience and Religious Freedom Division — an entire division devoted to conscientious objection. The vast majority of bioethicists find this announcement to be cause for concern because it introduces further barriers to healthcare for many groups already disenfranchised or vulnerable. But it also violates what bioethicists see as clear duties of care inherent in the medical profession. (See: https://www.reuters.com/article/us-usa-healthcare-religion/u-s-government-to-shield-health-workers-under-religious-freedom-idUSKBN1F7262)

I have mixed feelings about this new division, which may become a cautionary tale for the Trump Administration. Moral diversity and “moral objection” swings many directions, and by creating an official conscientious objection division, the Trump Administration must now allow for a wide range of moral protections for practitioners. In some ways, this could provide unanticipated protections for the very groups the Administration seeks to deride.

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