Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care.
Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities, Relationships, and Responsibilites
Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life.
Tragic Choices: Disability, Triage, and Equity Amidst a Global Pandemic
In this paper, I make three arguments regarding Crisis Standards of Care developed during the COVID-19 pandemic. First, I argue against the consideration of third person quality of life judgments that deprioritize disabled or chronically ill people on a basis other than their survival, even if protocols use the language of health to justify maintaining the supposedly higher well-being of non-disabled people. Second, while it may be unavoidable that some disabled people are deprioritized by triage protocols that must consider the likelihood that someone will survive intensive treatment, Crisis Standards of Care should not consider the amount or duration of treatment someone may need to survive. Finally, I argue that, rather than parsing who should be denied treatment to maximize lives saved, professional bioethicists should have put our energy into reducing the need for such choices at all by resisting the systemic injustices that drive the need for triage.
Beasts of Burden: Animal and Disability Liberation
How much of what we understand of ourselves as “human” depends on our physical and mental abilities—how we move (or cannot move) in and interact with the world? And how much of our definition of “human” depends on its difference from “animal”?
Drawing on her own experiences as a disabled person, a disability activist, and an animal advocate, author Sunaura Taylor persuades us to think deeply, and sometimes uncomfortably, about what divides the human from the animal, the disabled from the nondisabled—and what it might mean to break down those divisions, to claim the animal and the vulnerable in ourselves, in a process she calls “cripping animal ethics.”
Beasts of Burden suggests that issues of disability and animal justice—which have heretofore primarily been presented in opposition—are in fact deeply entangled. Fusing philosophy, memoir, science, and the radical truths these disciplines can bring—whether about factory farming, disability oppression, or our assumptions of human superiority over animals—Taylor draws attention to new worlds of experience and empathy that can open up important avenues of solidarity across species and ability. Beasts of Burden is a wonderfully engaging and elegantly written work, both philosophical and personal, by a brilliant new voice.
Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All
The genome between socially constructed racial groups is 99.5%-99.9% identical; the 0.1%-0.5% variation between any two unrelated individuals is greatest between individuals in the same racial group; and there are no identifiable racial genomic clusters. Nevertheless, race continues to be used as a biological reality in health disparities research, medical guidelines, and standards of care reinforcing the notion that racial and ethnic minorities are inferior, while ignoring the health problems of Whites. This article discusses how the continued misuse of race in medicine and the identification of Whites as the control group, which reinforces this racial hierarchy, are examples of racism in medicine that harm all us. To address this problem, race should only be used as a factor in medicine when explicitly connected to racism or to fulfill diversity and inclusion efforts.
Intersectionality in Clinical Medicine: The Need for a Conceptual Framework
Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.
It’s Time for a Black Bioethics
There are some long-standing social issues that imperil Black Americans’ relationship with health and healthcare. These issues include racial disparities in health outcomes (Barr 2014), provider bias and racism lessening their access to quality care (Sabin et al. 2009), disproportionate police killings (DeGue, Fowler, and Calkins 2016), and white supremacy and racism which encourage poor health (Williams and Mohammed 2013). Bioethics, comprised of humanities, legal, science, and medical scholars committed to ethical reasoning is prima facie well suited to address these problems and influence solutions in the form of policy and education. Bioethics, however, so far has shown only a minimal commitment to Black racial justice.
Repatriation Reader: Who Owns American Indian Remains?
In the past decade the repatriation of Native American skeletal remains and funerary objects has become a lightning rod for radically opposing views about cultural patrimony and the relationship between Native communities and archaeologists. In this unprecedented volume, Native Americans and non-Native Americans within and beyond the academic community offer their views on repatriation and the ethical, political, legal, cultural, scholarly, and economic dimensions of this hotly debated issue. While historians and archaeologists debate continuing non-Native interests and obligations, Native American scholars speak to the key cultural issues embedded in their ancestral pasts. A variety of sometimes explosive case studies are considered, ranging from Kennewick Man to the repatriation of Zuni Ahayu:da. Also featured is a detailed discussion of the background, meaning, and applicability of the Native American Graves Protection and Repatriation Act, as well as the text of the act itself.
Marie’s Dictionary
This short documentary tells the story of Marie Wilcox, the last fluent speaker of the Wukchumni language, and the dictionary she created to keep her language alive. For Ms. Wilcox, the Wukchumni language has become her life. She has spent more than twenty years working on the dictionary and continues to refine and update the text. Through her hard work and dedication, she has created a document that will support the revitalization of the Wukchumni language for decades to come. Along with her daughter, Jennifer Malone, she travels to conferences throughout California and meets other tribes who struggle with language loss.
Ms. Wilcox’s tribe, the Wukchumni, is not recognized by the federal government. It is part of the broader Yokuts tribal group native to Central California. Before European contact, as many as 50,000 Yokuts lived in the region, but those numbers have steadily diminished. Today, it is estimated that fewer than 200 Wukchumni remain.
Indigenous Land Stewardship: Tending Nature
This “Tending Nature” special features multiple perspectives and voices from Indigenous communities across California who are striving to keep the practices of their heritage alive. From coming-of-age rituals, seasonal food harvests, basket weaving and jewelry making, the documentary shares how traditional practices can be protected and maintained as a way of life for future generations.