Thank you for your patience

Hello, dear readers. As you may have noticed, IJFAB Blog has been down for a week and a half. While the blog is back up, we are working to fix access to our archive of blogs. You may notice that links to our excellent store of prior entries are currently non-functional.


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Thank you for your patience as we work through these technical problems.

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TENTH ANNIVERSARY ISSUE OF IJFAB is an embarassment of riches
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Our parent journal, International Journal of Feminist Approaches to Bioethics, is celebrating its 10th anniversary.  Lo those many years ago in Spring of 2008, our first issue, Doing Feminist Bioethics, was published. In the second issue, Lyerly, Little, and Faden’s article on including pregnant women in research hit the mass media with a bang and still keeps popping up in the news as a useful tool for the general public, health care providers, and researchers.

This Spring, we celebrate the 10th anniversary of IJFAB, vol 10 no 1with an issue that kicks off with an editorial from Mary Rawlinson, who helmed the ship for many years, on the very concept of feminist bioethics.

Check out this screenshot of the essays in this issue, and the breadth of topics.

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To access any of these just go directly to the Table of Contents for the issue.

Happy first decade, IJFAB. Thanks for the embarassment of riches. Here’s to many more.

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WAY BACK MACHINE Spring 2016 IJFAB vol 9 no 1: articles on queerness and reproductive ethics, “boutique” ultrasound, homebirth, GMOs, feminist practices of bioethical pedagogy, feminist palliation

If you missed last Spring’s issue of our parent journal, International Journal of Feminist Approaches to Bioethics, Spring of 2017 is a good time to jump in the Wayback Machine–before President Trump in the US and Brexit in the UK and the Colombian peace deal with FARC and any number of other global issues–and check out Spring of 2016. For ease of use, here’s the table of contents.  Continue reading

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The ABCs of the AHCA: A is for abortion, B is for backward, C is for costly
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EDITOR’S NOTE: This piece’s posting was delayed by technical errors. However, the analysis of the American Health Care Act (AHCA) is still pressing and relevant. While the bill was pulled from a planned House vote in the US Congress on Friday 3/24/17 because Republicans (the GOP) did not have enough votes to pass it, House Republican leader Paul Ryan has vowed to try again after revisions to the AHCA. We do not know what they will be. Insofar as the elements critiqued by Rory Kraft remain in future versions, we still very much need this analysis. Indeed, Kraft analyzes some aspects of the proposal that did not receive a close viewing in news media, including the impact on access to abortion. At the end of Rory Kraft’s analysis, you will find a helpful list of other IJFAB Blog articles on health care and benefits reform in the US and other nations.

AUTHOR’S PREFACE:

This argument was originally written for another venue, and thus is quirky in that it assumes a certain level of informality and is not written to be either persuasive or educational in the manners that op-eds often are.  It is also at the same time a bit defensive (“please don’t troll me!”) and expressive.  Quite simply, this is my attempt to capture for others my own reactions to the bills being called collectively the American Health Care Act.  I’ve cleaned it up a bit, but essentially here are my reactions as to how the relevant bills stood as of late Thursday 3/9/17.

Since the House leadership plan to repeal and replace the Affordable Care Act (ACA) was released late Monday March 6, I’ve had several people ask me what I think of the new plan.  This is my attempt to provide some insights.

First, like almost anyone who has looked at the ACA I have some problems with it.  The ACA is gargantuan in scope and has many side provisions which impact the functionality of it.  I can only assume that many of these were attempts to placate particular senators and/or congressmen who were wavering in their support of the bill.  The specifics of the bill are a mess while at the same time leaving big swaths to administrative regulatory language.   I say all this because I am concerned that some will take the following criticisms of the Budget Reconciliation act as a total endorsement of the ACA.

What do I think of these bills (the reconciliation language is split into two bills, perhaps in part to speed it through committees)?   Quite simply: they are horrible.

A is for Abortion, so I start with issues tied to that:

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Each English language user is about to meet their language’s new gender neutral singular pronoun, with the release of the new Associated Press Stylebook
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For some time now, there has been a movement to address the English language’s need for a gender neutral singular pronoun. This need originates in the growing realization that using “he” to refer to a person whose gender you do not know is exceedingly troubling: in case studies and examples, then, all professionals become presumptively men.

In addition, people who do not fit into classic gender norms may not want to be shoved into them by “he” and “she” as English’s only singular pronouns.  And as Marilyn Frye noted in The Politics of Reality, English’s use of only gendered singular pronouns requires use to constantly engage in “sex-marking” (the determination of others’ sex before we can know how to refer to them, relate to them, shake hands, touch them, interpret body language, deploy body language, etc.). It also requires each of us to constantly announce our sex by using the techniques that fit into established gender norms.

This reinforces rigid gender norms for dress and comportment and the maintenance of our bodies (hairy, or hairless? makeup, or not? heels, or tennis shoes?) in order to clearly signal and clearly determine each person’s gender and sex. Thus, many feminists have proposed, the absence of a gender neutral pronoun is one of many social and linguistic features that shore up traditional rigid gender norms and their content.   Feminist science fiction has postulated a range of possibilities including some which have come into occasional usage, including “ze” for the pronoun and “zir” or “hir” for the possessive.  The recent scifi novel Ancillary Justice features a main character who simply cannot sex mark people accurately, and so uses “she” to refer to all other characters in the book.

Increasingly, though, it seems we no longer need novel pronouns.  Language users have naturally begun to adapt a word already in use.  Consider the claim “Someone left their phone in the bathroom. I hope they come back for it.” We already use “they” in casual usage to refer to someone whose gender is unknown   And  for some time now, the use of “they” as gender neutral singular pronoun has been gaining formal endorsements.  In January of 2016, the American Dialect Society adopted it as officially correct English, and the Washington Post had already integrated it into its style guide.  The next big leap occurred when the Associated Press Stylebook, which is widely used by many news organizations and blogs as a guide to language usage, embraced “they” for this purpose.  On Friday, March 24, 2017, the AP’s lead editor for the Stylebook, Paula Froke, had this to say:
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We offer new advice for two reasons: recognition that spoken language uses they as singular, and we also recognize the need for a pronoun for people who don’t identify as a he or a she.

We also can use this wherever we need a gender neutral singular pronoun. Perhaps knowing that it is available will also lighten the burden of constant announcing and marking of sex and gender.

As  a side note, other revisions to the AP Stylebook that may be of interest to this blog’s readers include an explicit distinction between gender and sex. The entry on this reads “Gender refers to a person’s social identity while sex refers to biological characteristics… Not all people fall under one of two categories for sex or gender, according to leading medical organizations, so avoid references to both, either, or opposite sexes or genders as a way to encompass all people.”

With the imprimatur of a more universal style guide like the AP Stylebook, teachers and authors who had not yet adopted these usages in grading and writing may need to do so.

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Ebola Stigma and Lack of Access to Care in Liberia Cost the Life of an Ebola Fighter After Complications of Childbirth
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Salome Karwah was recognized by Time magazine as an Ebola fighter during the 2015 Ebola outbreak. She died February 21 from complications of childbirth by C-section. Days after the procedure, she collapsed from a seizure and began foaming at the mouth.  Liberian healthcare providers refused to touch her or give her injections. Had she received care, she might still have died, but she might also have lived. You can read more here.

This image shows Salome Karwah, a woman with dark brown skin, standing in blue medical scrubs including a cap, and wearing a white apron. Behind her is a black tarped tent which may be a medical facility. In front of her are two white-skinned photographers, one holding a colorful pink umbrella to shade the person holding the camera. IMAGE CREDIT: Paul Moakley, TIME magazine.


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Childbirth and its consequences are dangerous enough without adding stigmatized care to the picture.  Salome Karwah should not have died.  Stigma, whether from disease or social status, should never impede the provision of care. But were Liberian providers sure they had access to adequate training and protective gear, perhaps they would not have responded in this way. Health care in the developing world presents complicated ethical issues, no less complicated–and with difference factors–than in the developed world. Global bioethics, and developing world bioethics, is as much a part of what we bioethicists do as are our foci on developed world health care systems and the patient-physician relationship.

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Power, othering, and slurs in the clinic: undermining the capacity for care
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Over at the Feminist Midwife, we find a valuable post on WHY something that may seem prima facie wrong is, in fact, wrong.  In an entry called “Patients Are Not Bitches, and Thoughts Medical Othering,” Feminist Midwife considers a case she witnessed:

This image shows a woman with damp brown hair and pale skin standing next to a hospital bed with her arms on the bed and her head bent down. Her expression is one of concentrated effort. Her shoulders are bare, and in the foreground of the image we see a shoulder clad in the classic blue of set of scrubs. Medical equipment can be seen, out of focus, in the background of the image.

Recently, I overheard fellow providers refer to a laboring person as a bitch…. This actual event happened quite a while ago, but it’s taken me this long to separate my anger from the situation, to be able to calmly break apart all of the reasons why I felt that way. The exact circumstance was a room full of female Residents and one female midwife, referring to a patient who was disagreeing with a care plan and declining recommendations. Multiple providers in the room called the patient a bitch. They said it disparagingly toward the patient, and in comradery with each other.

The use of slurs or other demeaning speech to patients, families, or even providers is no new thing.  We do well to  give it thought, and to pay close attention to how it reinforces existing power structures. Feminist Midwife addresses this directly, with respect to gendered slurs such as “bitch”, in the blog entry linked above:

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‘Mom, I want to die, you can go in the Canada. I want to die in the snow, you can go, mom, in the Canada.’
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This image is a screencap of a CBC video about refugees who cross into Canada from the US. It shows snow-covered ground, with dry brown winter grasses and train tracks poking through the snow. The text at the bottom of the screen says “Cold Crossing.”

Recent developments in American politics continue to exacerbate the migration on foot of refugees from the US to Canada. The Canadian Broadcasting Corporation has been covering this trend, and we at IJFAB Blog have also been watching. In a new CBC article yesterday, we read the words of a toddler who asked his mother to leave him to die in the snow so that she could go in to Canada. They were part of a group of refugees who walked for two hours from 2am to 4 am -20C weather. How many people are making these kinds of dangerous migrations, even in winter?

Canada Border Services Agency’s most recent numbers show 403 asylum seekers illegally crossed into Manitoba between April 2016 and the end of January 2017, many of them entering near the small border town of Emerson.

They come into Manitoba because nearby Minnesota is home to large immigrant populations from Somalia in particular.  This may be legal, and the refugees who find the U.S. to be inhospitable to their attempts to gain legal status may have rights within Canada based on U.N. agreements.
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Cross through a snow-covered farmer’s field on foot in harsh winter conditions — like two Ghanaian refugees did in December, losing most of their fingers to frostbite — and the United Nations’ 1951 Convention Relating to the Status of Refugees kicks in.

In related news also breaking yesterday, the United Kingdom’s Home Office announced it would suspend admissions for child refugees with disabilities on the grounds that their needs for care would overburden the UK’s NHS, whose ability to provide care has suffered under repeated rounds of funding cuts.

IJFAB Blog will keep watching this issue of refugees and health as it develops in various nations.

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“You suffer. That is enough for me.”
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Thanks to Gretchen Case for this image of the Pasteur Memorial at Cook County Hospital in Chicago.  It is a timely reminder as the context for global public health shifts, and many powerful nations (US, UK, France, and other European nations) that have been destinations of immigrants seeking freedom and better conditions begin to react against immigration. Physicians, nurses, and other health professionals across the world are likely to find themselves in the position of having to decide whether to turn away patients who are undocumented immigrants, or who are documented but cannot access the health system of the nation in which they reside. Do you think Pasteur had it right?

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International Efforts to Mitigate the effects of Trump’s Expanded Mexico City Policy
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Just a quick update on Trump’s expanded Mexico City Policy AKA the “global gag rule”, which we previously addressed.  The Netherlands are leading an effort to implement a fund which would replace funding stripped from organizations under the expanded U.S. policy.  The aim is to allow the continued functioning of health organizations that might lose U.S. foreign aid from U.S.A.I.D. because they discuss abortion with patients, provide abortions, or advocate the use of abortion as a solution to any women’s health problems.

On Friday, The Guardian announced  that Canada may be contributing to this Dutch-led fund. The Dutch have already committed US$10 million  to the fund and are hoping to solicit more contributions from other nations. At least 20 countries are expected to contributions if negotiations go as planned.  Canada confirmed they will be increasing their support for global reproductive health whether or not they do so by giving money to the Dutch-led fund.  Said Canadian Minister of International Development Marie-Claude Bibeau:
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Yes, we will support the [Dutch] effort… Will it be directly through the fund or indirectly, this is not clear yet. But, I assured my colleague, the Minister from the Netherlands, that we will increase our funding to sexual and reproductive health and rights. This is definitely a very important priority for our government.

Keep your attention on this situation as it develops.

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It’s Only Words: On Refugees and Liminality
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I sit in front of my computer in New York, contemplating how I am going to speak to groups of people about refugees, narratives, and moral luck in two days’ time.  It is not that I am overly worried about what I am going to say, what arguments I will use, or what philosophical claims I might make  —  I have been doing this for a while now.  What is tearing at me is how I will do this without internally collapsing, without alienating my audience, without weeping openly and uncontrollably.

I am usually not the kind of person who does this  —  I can (mostly) hold it together, even if the subject matter is rough-going.  So why am I so worried this time?

The obvious answer, right?  Trump and his nightmarish reign, only days-old, has thus far unleashed at least the promise of innumerable horrors to come:  the elimination of the ACA, the gutting of any environmental protection programs, the racism, the LGBTQ hatred, the anti-science, anti-truth, -anti-reality, anti-….The anti-immigrant and refugee policies.  The unabashed, public, seething hatred of those who are here, or who want to come here largely out of desperation, and sometimes without the proper documentation.  This is what my talk is about  —  it is about the consequences of the words that paint the immigrant and the refugee as “other.”  It is about why we must be so careful with these words  —  both in saying them ourselves, and in allowing those in power to wield them, to weaponize them.  It is about how these words create moral and political realities that shape identities, destinies  —  lives  —  of others.

So what does liminality have to do with anything?  Simply, everything:  To be a refugee is, in many ways, to be in a state of non-belonging, non-citizenship….sometimes, non-personhood.  It is, as Hannah Arendt noted, a state of not being recognized, not even having a right to have rights.  And it does a number on one’s sense of self, on one’s confidence, on one’s notions about one’s place in the world, and one’s rights to make claims  —  it is the periphery of the periphery.  To borrow a fitting film title, it is “the howling plains of nowhere.”

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But as difficult as my experiences were, they pale in comparison to the Syrians and others currently trying to flee circumstances that are not just unbearable socially, economically, physically, but are an existential threat.  And while they try to save their lives, they are openly, publicly storied as other, as dangerous, as subhuman by those with the largest megaphones, on some of the biggest stages in the world.  Nigel Farage of Brexit fame, Trump, Le Pen, Putin  —  the list goes on.  Add to this the audiences that all-too-eagerly grant uptake to the dehumanization, the othering, of the refugee….you get the idea.  And now, we can see the consequences:  American plans barring people from particular regions of the world, people of particular faiths, and others from entering the United States.  Le Pen’s statements about suspending all immigration to France.  Putin’s well-known pan-Slavic nationalism.  And on and on….

So we have to talk about it.  Publicly and loudly.  Even if our voices sometimes catch.

Editor’s Note: This issue has been so in flux over the last few months, after years of Syrian refugees seeking entry to European and North American nations, that we recently had another blog entry on the subject.  Check out Kate McKay’s “A Door Slams in the Night” for another part of the picture.

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Not Business As Usual: President Trump reinstates Mexico City Policy with a substantive addition
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On January 23, 2017, U.S. President Donald Trump reinstated Reagan’s so-called Mexico City Policy, also known as the “global gag rule.”  In the process, he also added text that makes a substantive change going farther than any U.S. national-level anti-abortion policy has ever gone before. This Editor wishes to point out that this is not simply business as usual.

Here is the full text  of Trump’s Presidential Memorandum, in case it disappears from the White House website or later archives, in both text and a screenshot taken January 26, 2017, with a short analysis afterwards:

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