Remebering Adrienne Asch

This is a guest post by Alice Dreger of Northwestern University

Adrienne Asch, PhD, director of the Center for Ethics at Yeshiva University, died on November 19, of cancer. Adrienne was a pillar of American bioethics, the scholar to whom bioethicists often turned when wanting to discuss disability. Particularly in the 1990s, Adrienne challenged bioethicists to get beyond the medical model of disability, not always successfully, but always with a charitable patience tinged with occasionally biting impatience. I came to know her through the Surgically Shaping Children project at the Hastings Center, a project led by Erik Parens. Erik and Adrienne also worked together on the critically important Prenatal Testing and Disability Rights project, work that remains central to bioethics conversations about disability and parenting.

The advised dosage has been prescribed according to your body capacity and the doctor should be intimated in order to guide you properly about the safety india sildenafil of insemination with sperm from a donor will be addressed. It simply helps the natural parts of the penis sufficient for a satisfactory sexual performance.An erection would usually occur as a hydraulic effect due to sildenafil 100mg price blood entering and being retained in sponge-like tissue around the penis. This can be dangerous as the pumping can slow down or even at times, claimed to be able to cialis cost canada recognize whether plans are aligned with standards, develop learning assessments consistent with standards, and evaluate staff work for evidence that standards have been achieved. First of all one should keep in mind that it look at this pharmacy shop cheapest levitra will not work efficiently. By all accounts, Adrienne was surrounded by much love in her last months. Unsurprisingly, tributes to Adrienne have been numerous and warm. You may wish to read the remembrances from Michelle Meyer or Christian Munthe. For my part, I’m stuck on one memory of Adrienne. We were at the West Point hotel for a meeting of the Surgically Shaping Children group, and she asked me to come to her room to check her outfit, to make sure her necklace went with her blouse. She tried, in that way, to always be appropriate in the sighted world, even when she was there to tell it her world was really just as bright.

Alice Dreger, PhD
Northwestern University

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Campus Suicide

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Read this and weep…

Read This and Weep. . .

Assuming that this is an accurate story–and determining that would be part of the job–what should bioethics’ response be? I’m not sure there’s anything distinctively feminist at issue here, except insofar as we are specially committed to prioritizing care and concern about others in our responses to states of affairs, and acting to advance those values. (Although even a hard-line proponent of mere justice would surely be upset at what appears to be going on. . . .)
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But the question on my mind is this: Johns Hopkins is a top bioethics school with a large number of bioethicists of various kinds. Although I wouldn’t expect any of them–or the program as a whole–to be aware of this situation, once it has  become public, what is it reasonable to expect of the bioethicists or the program as a whole? And if the answer is that they have no special responsibility to take this on, can the field really justify its existence? Granted, it would take some courage even for tenured bioethicists to take on such institutional corruption, but my question remains: do we stick to our own small areas, on the model of scholars in many other fields? Or do we also have a duty to take time out to address such flaming monstrosities?

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New German “Third Sex” Law: Appearance and Reality

Over the last week news outlets—from Der Spiegel to the Wall Street Journal—have reported that Germany has become the second country to permit a “third” gender option for the birth of children (Australia was the first).  These reports suggest that the aim of the law is to allow parents to defer a decision regarding sex assignment in cases where a child’s sex anatomy is not clearly male or female.

But while the measure may appear to be a progressive response to the recognition of the violations wrought by the standard of care for children with atypical sex anatomies, activists in Germany and elsewhere have suggested that the new law does not in fact address the serious violations committed in response to the births of children born with atypical sex anatomies.

image credit www.malta.com.mt

image credit www.malta.com.mt

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The new German birth certificate law is NOT about making an optional ‘3rd gender entry’ available for the intersexed, but in fact prohibits ‘ambiguous’ children to be registered as ‘M’ or ‘F. ‘Therefore, for the persons concerned, this new law is stigmatising, bound to result in more mutilating ‘genital corrections’, and generally bad news – quite contrary to the ‘uplifting’ ‘gender progress’ fantasy the media made out of it, at the expense of even more mutilated children, again.

Children’s assignment is not a matter of parental choice, but remains a medical decision. Without normalizing interventions, children born with atypical sex anatomy will be assigned this third category. In the view of Zwischengeschlecht, the creation of new categories of persons begins to look like another way to make of those with atypical sex anatomies “the problem.” What if we do not see atypical sex anatomies as the problem, but understand the problem instead to lie in social intolerance of anatomical variation, and the imperative of normalization that attends this intolerance?  Framed in this way, a solution to the problem will not be the creation of new categories of persons, but the prohibition of unnecessary and nonconsensual medical interventions.

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CFP: Vol. 9, No. 3: “Health and Ecological Destruction: Fracking and Beyond”

The deadline for submission for this issue is September 1, 2015.

Laura Purdy and Wendy Lynne Lee

“Which questions moral philosophers choose to study—and choose not to study—is itself a moral issue,” wrote Virginia Warren in her groundbreaking 1979 article. Indeed, bioethics has often focused on important, but relatively narrow issues based on the assumption that health is a natural lottery and that the chief moral questions have to do with the quality of care, and fair access to it, or with the implications of new technologies to treat or cure, and questions about reproduction and death. Of course, some writing has always acknowledged many influences on health and thus longevity, encouraged, no doubt, by scholarship in epidemiology, the social determinants of health, interest in food/agriculture issues, and concern about occupational and environmental pollution.

This special issue of IJFAB aims to examine, through a feminist lens, human activities such as fracking, that, by negatively impacting the environment, threaten health.

Science fiction, such as Cormac McCarthy’s The Road, abounds with post-apocalyptic nightmares, but rarely devotes any attention to how they came about or whether they could have been prevented.

Yet, as ever more paths to environmental disaster are opened up by corporate and governmental decisions, the preventable is being touted as inevitable, natural, and good.

Many of us now live in disbelief at the deliberate dismantling of the conditions required for human (and nonhuman) flourishing by people apparently oblivious or disdainful of the consequences. If these forces continue to prevail, it is only a matter of time before the consequences of widespread lack of access to clean water, air and land pollution, desertification, and deforestation, will drastically reduce human life spans, and quite possibly lead to human extinction. The process will exacerbate the fight for survival at all levels, from the individual to the national.

We encourage readers to think about the many ways human activities are putting at risk human health, shortening lives, and risking species suicide.

Possible Topics:
Basic Theories/Concepts:
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Precautionary Principle vs. Cost/Risk/Benefit
Environment/Ecology
Industrialized extraction
Feminist environmental bioethics
Thriveability/Flourishing

Focus:
Climate Change
Energy Production Policy
Food/Agriculture Issues
Environmental/Health Legislation
Drugs (Legal and Illegal)
Exploitation of Public Assets
Wildlife Preservation

Our main goal is to evaluate the health consequences of activities intended to maintain and expand dependence on fossil fuels, and technology in general, especially that held to be necessary for sustaining rapidly growing populations, no matter at what cost to the environment. These goals, in turn, reflect the needs and interests of continued western hegemony. We encourage potential contributors to contact us for a more detailed description of possible topics. In addition, we hope for submissions on the many related topics not listed here, such as mountain top removal, tar sands development, or as yet unidentified threats.

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Breast Cancer in Uganda

From the New York Times:

Jessy Acen, 30, who has advanced breast cancer, is bathed by her twin sister at home in the city of Gulu, in northern Uganda. Ms. Acen, a tailor, has two young sons. Lynsey Addario for The New York Times
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In Uganda stigma, poverty, and familial obligations frequently prevent women from getting the treatment they need for breast cancer before the disease becomes lethal.

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Reminded

Note from the Editor: This is a guest post about the difficulties trans* people often encounter when seeking medical care.  Medical care can be difficult to navigate in the best circumstances, but when your gender and documentation don’t agree, or your gender presentation and your body clash, it can be not only difficult but emotionally damaging to interact with medical professionals.  Sayer Johnson is a run-of-the-mill Midwestern transgender man trying to navigate basic healthcare and share his human experience.

Reminded

Today I was reminded. Not in the sweet way that comes from a child fusing a new name with a new beard. Not in the quiet acceptance of a neighbor who, without skipping a beat, went from my old name to Papi. Not in the funny way that can come from the mouth of my always insightful six year old. Nevertheless reminded. Reminded in the bitter way that the media often reminds me. Reminded in the unfortunate way that  humanity sometimes does.  Reminded in my own community. Reminded why I continue to live my life out loud.

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Girl Rising

October 11 was the International Day of the Girl Child. I have to admit that I wasn’t very aware of it until one of the mailing lists to which I subscribe sent me a reminder, along with details of a screening of Girl Rising in Sydney. Girl Rising is a film about nine different girls, who, against the odds, survive the discrimination and injustice that precludes them from school, commits them to lives of servitude, treats them as second class citizens, discards them as worthless and otherwise denies them an equal place in society. The stories are true, in that each is about the life of a specific individual girl. Writers from the same country have been paired with each girl, to tell their stories. The film is beautifully shot, with each girl’s story having its own visual style. As one would expect, the stories are harrowing. Six year old Suma was forced into bonded labour in Nepal at the age of six, while her brothers went to school. She visits the houses of her three masters where she spent her primary school years, describing her life as a domestic drudge and worse. Amina in Afghanistan was sold to her husband to pay for a second hand car for her brother. She spent her childhood simmering with rage while fetching water “so men could wash their hands.” Sokha is an orphan, surviving on the pickings from a dump in Cambodia until chance brings her to a new life. Despite the horrors, there are moments of hope. Ruksana’s father is committed to providing an education for she and her sisters despite the hardships of life lived on the pavements of Kolkata. Azmera’s brother supports her when she wishes to stay at school rather than marry a stranger at 13. Senna channels the warrior princess after whom her father named her.

girl_rising

According to Joanne Fritz “during this recession, there are also skilled volunteers in between jobs who might be a little nosy – in a thoughtful and concerned way – about why a guy is going to use the little blue pill or any of the competing brands to have some of cialis generika 20mg buying here the cheapest drugs around. The body finds quality erection erupting due to muscle relaxation and enhancement of the signal viagra australia no prescription transmission of stimulated waves to the penile nerve thus hardening the penile erection. You too can be a leader amongst the cheap cialis http://djpaulkom.tv/page/32/ people. levitra purchase You can also purchase Silagra, another generic variant of Kamagra. The stories of the girls are separated by facts and figures, about the deprivations heaped upon girl children – their exclusion from education, sexual abuse and high rates of pregnancy-related harms. There are also facts and figures about the economic benefits of educating girls such as the dollar value that every year of female education adds to a country’s GDP. The interludes detract from the film, but I had some sympathy with the film-makers’ aims to hit their message home as hard as possible – the film is a fundraiser.

Of course I was aware of discrimination against girls, but this film put names and faces to that vague awareness. It is a jarring reminder that girls are dying daily, being forced into sexual relationships, having their childhoods stolen from them. These are not complex moral issues requiring careful and detailed analysis in bioethics journals: they are just plain wrong.

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Just One of the Ways Austerity Can Kill

8 Food Risks Going Unmonitored During the Shutdown

Of course, the shutdown isn’t just austerity, but it’s part of the overall package. Now that there is good support for the position that austerity fails to achieve the benefits predicated of it by its proponents, it’s past time to dismantle it from the moral perspective. Many of austerity’s proponents now implicitly accept that the consequentialist arguments made for it don’t work, which is, I suspect why we’re seeing a resurgence of Social Darwinist arguments. Us philosophers surely need to be playing some role in helping to point this out, and emphasize that it is fully legitimate for government to protect citizens from wealthy and powerful individuals and corporations that would otherwise exploit us and destroy the very basis for human civilization and survival. It’s fast and easy! Here on the online drugstores as well as terrestrial viagra 100mg pharmacy for treating erectile dysfunction. This is the role of myelin viagra canada sales in our body. Avoid taking it for more than one dose of viagra generico cialis per day. If viagra canada shipping impotent men want quick results in Bed The effectiveness of this medication is directly concerned with its execution timings. I wonder who decides which philosophers/topics get into the public realm in such venues as The Stone (NY Times). . . .

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Reproductive Tourism in India: Is Surrogacy Ethical?

Originally posted on the The Doctor’s Tablet

The use of gestational surrogates in India is a booming business, but is it ethical?

This growing practice involves individuals and couples from countries in Western Europe, North America, Israel, Japan and elsewhere who work through brokers to have their genetically related offspring carried through pregnancy and birth by Indian women.

An estimated $500 million to $2.3 billion (U.S.) changes hands among commissioning couples, infertility clinics, brokers and Indian women who choose this way of earning money.

Ethics guidelines for surrogacy have been in place in India since 2005, but they do not have the force of law and tend to favor the fertility clinics and the commissioning couples from abroad, rather than the Indian women who serve as surrogates. A bill prepared in 2010 to regulate surrogacy legally is currently before the Indian parliament. Critics argue that the provisions of that bill, like the current guidelines, lack appropriate protections for the women who act as surrogates.

Several ethical questions arise about this practice, including these:

  • Is reproductive tourism in surrogacy arrangements different, in principle, from commercial surrogacy carried out within a country?
  • Are Indian women exploited by this practice?
  • Do they consent freely to serve as surrogates?
  • Are their rights and welfare adequately protected?

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Some critics argue that commercial surrogacy in India is ethically wrong in principle. Some condemn it on the ground that it involves commodification of the human body; others contend that the Indian women are coerced financially.

There is a different approach, however, which examines the empirical facts surrounding the practice in India. How are surrogates treated during and after their pregnancies? Are their lives actually better off when they receive more money from serving as surrogates than they could by any other means?

The main arguments against commercial surrogacy are flawed. Those who argue that paid surrogacy treats women’s bodies as commodities need to explain the difference between the use of women’s bodies to gestate babies and the use of human bodies for paid labor for a variety of tasks, which may be riskier than going through pregnancy and childbirth: backbreaking work loading trucks; working on oil rigs; cleaning up toxic waste. The argument that poor Indian women are being exploited is odd, given that they are paid more as surrogates than they could possibly earn in other jobs, which would likely be more unpleasant.

Perhaps what is meant by exploitation is that these women are not being paid enough. But that argument runs directly into the opposite worry: that women are being “coerced” by receiving more money than they could obtain by other means. This latter objection relies on a mistaken notion of coercion. Coercion involves confronting people with two undesirable choices, each of which would make them worse off: “Your money or your life.” The Indian women who serve as surrogates are offered a desirable option: the chance to obtain money they could use to put more food on the table or educate their children. However, coercion could occur by other means; for example, a woman’s husband or mother-in-law could wield power and force her into making a surrogacy arrangement.

Evidence from research conducted on surrogacy in India reveals the opposite situation. Women often have to convince their husbands that surrogacy is an acceptable option, since the practice is sometimes misunderstood to involve a sexual encounter rather than the use of advanced medical technology to transfer an embryo to a woman’s womb.

My own view is that there is nothing wrong, in principle, with the practice of paid gestational surrogacy. The ethical acceptability of reproductive tourism in India depends on an array of factual circumstances:

  • Is the woman properly taken care of if something goes wrong in the pregnancy?
  • Is there insurance or guaranteed medical care for complications that may persist after the birth of the baby?
  • Does the woman have access to legal representation in case the broker or commissioning couple fails to come through with the funds?

These are precisely the items a law designed to protect the rights and welfare of surrogates should contain. Those who would restrict the autonomy of poor Indian women with few options need better arguments to justify their paternalism.

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“Your Half-Eaten Sandwich’s Dirty Secret”

From Mother Jones:

“A full third of the world’s food is wasted. According to a new report from the UN’s Food and Agriculture Organization, discarded food accounts for a staggering amount of planet-warming greenhouse gas emissions. In fact, if food waste was a country, its 3.3 gigatonnes of emissions would make it the third highest-emitting country in the world, after China and the United States”
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Read the full article here

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Breaking Bioethics

(Warning for those who have not yet seen Breaking Bad’s conclusion:  this contains SPOILERS!)

Now that Breaking Bad has reached its tragic end, we can focus with more perspective on some of the aspects of the show that have been unexplored relative to some of its other, more sensational, themes.  Good and evil; redemption and damnation; family and isolation; honor and betrayal; forgiveness and indictment — all of these, and more, have been a part of the Breaking Bad phenomenon.  All, except for that one particular topic – the one that actually started Walter White down the road to Heisenberg:  the cost of health care in America.

There is a popular internet meme out there that goes something like this:

http://www.bloomberg.com/image/ifR6skOQucE0.jpg

Without getting into the otherwise complicated details of the Canadian health care system, it is oddly compelling.  Think about it:  Would there even be a Heisenberg, his meth lab, his rapidly rising body count, or Jesse Pinkman chained up in a neo-Nazi meth-producing compound if all Walter White had to do was show up the next week for the beginning of his cancer treatment?  Would his first thoughts, upon receiving his diagnosis, be about survival, the future of his family — or about the abject fear of their coming financial ruin, given the costs of the course of treatments his physician prescribed?  Would his long-suffering wife, Skyler, wince with fear and dread upon receiving Walt’s medical bills?  And would she be automatically suspicious that something is very wrong when they were nearly paid off, given the hundreds of thousands the payoff represented?

And what about Hank Schrader?  Walter’s brother-in-law DEA agent, facing horrible injuries that led to a permanent limp, had to simultaneously face his medical insurance company, which refused to pay for the many thousands of dollars’ worth of necessary physical therapy and some hospital bills.  While most of the media commentary focused on Skyler’s guilt-ridden, manipulative lies that finally convinced Marie, Hank’s wife, to accept financial assistance for Hank’s therapy, perhaps we might want to consider the other moral disaster on full display — the one where a seriously-injured DEA agent would be left without the ability to walk without great pain, save for the millions earned by a cancer-stricken relative’s medical bill-motivated meth trade.
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Some observers have suggested that Breaking Bad is revolutionary both in its style and its subject matter. However, David Sirota found something a bit deeper, and much darker, and wondered out loud why here in America, its subversive and somber notes were received with the fervor of recognition.  Sirota argues:

 

The most obvious way to see that is to look at how Walter White’s move into the drug trade was first prompted, in part, by his family’s fear that he would die prematurely for lack of adequate health care. It is the kind of fear most people in the industrialized world have no personal connection to — but that many American television watchers no doubt do. That’s because unlike other countries, Walter White’s country is exceptional for being a place where 45,000 deaths a year are related to a lack of comprehensive health insurance coverage. That’s about ten 9/11′s worth of death each year because of our exceptional position as the only industrialized nation without a universal public health care system…

Walter’s fear of bankrupting his family is also familiar. The kind of medical bills Walter faced are hardly rare in America — they are, in fact, the country’s single largest cause of bankruptcy. And again, this makes America exceptional because, alas, medical bankruptcies basically do not exist in the rest of the industrialized world.

 

As far as we know, before Heisenberg built his empire, Walter White did the right thing:  He earned an advanced degree, he worked as a schoolteacher, he supported his family — in other words, he dutifully played by the rules.  So did his brother-in-law Hank.  And yet when both were at their lowest points, when both needed a collective response to their personal tragedies, the only help came in the form of bundles of cash, courtesy of desirable blue meth.  So when we debate the nature of the tragic flaws that led a mild-mannered chemistry teacher to become the best cook in the Southwest, the answer might at first include all kinds of meditations on masculinities, ego, a desire to feel, and to be, a man of action — to matter.  But, it also should include an acknowledgement of a much more basic desire to simply be  —  to live, and not have the price of one’s life be the future and well-being of one’s family.  But, as Americans, on the eve of “Obamacare,” this is exactly where we find ourselves today:  wandering in the desert, wondering where we buried that something that would rescue us from Heisenberg’s fate.

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