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Added by: Chris Blake-TurnerAbstract:
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.Peter, Elizabeth, Liaschenko, Joan. Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities, Relationships, and Responsibilites2013, The Journal of Bioethical Inquiry. 10: 337–345.-
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Added by: Chris Blake-TurnerAbstract:
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.Comment (from this Blueprint): Moral distress is, roughly, when a healthcare worker is institutionally constrained to act against their best moral judgement. A typical example is a nurse being prevented from giving care they deem morally required because they are hierarchically constrained by the orders of a physician. Moral distress has been much discussed in nursing ethics, but is almost entirely absent from broader bioethics syllabi and conversations. This paper examines moral distress through a lens of feminist care ethics. In doing so, it draws lessons that apply very broadly throughout professional ethics.
Stramondo, Joseph A.. Tragic Choices: Disability, Triage, and Equity Amidst a Global Pandemic2021, The Journal of Philosophy of Disability. 1: 201–210.-
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Added by: Chris Blake-TurnerAbstract:
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.Comment (from this Blueprint): Stramondo critiques triage protocols that were put into place, or at least proposed, during the COVID-19 pandemic. Stramondo argues that protocols that prioritize quality of life involve ableist commitments. While chance-of-survival protocols might do better here, he argues that they are also vulnerable to creeping ableism. Stramondo’s paper is valuable not only for its perspective on triage protocols, but also for highlighting some crucial theoretical contributions by philosophers of disability and by bioethicists. Stramondo also argues not to cede too much ground to fatalism in thinking about triage protocols; bioethicists should also, and perhaps primarily, resist the framing of triage as inevitable, rather than a product of various privileged interests.
Yearby, Ruqaiijah. Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All2021, The American Journal of Bioethics. 21(2): 19–27.-
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Added by: Chris Blake-TurnerAbstract:
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.Comment (from this Blueprint): Yearby argues that appeals to racial categories—social, but especially biological—in medicine harm people from all races, including those from dominant racial groups, like Whites. Yearby first gives evidence for the claim that there is no biological reality to race. She then argues that the continued use of racial categorization in medicine—for instance, as a basis for different standards of care—leads to worse outcomes for all. For example, because Whites are often the de facto standard group in healthcare, their worse health outcomes are sometimes overlooked. Yearby ends by making suggestions for improving the categorization of people in healthcare.
Wilson, Yolonda, et al.. Intersectionality in Clinical Medicine: The Need for a Conceptual Framework2019, The American Journal of Bioethics. 19(2): 8–19.-
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Added by: Chris Blake-TurnerAbstract:
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.Comment (from this Blueprint): Wilson et al. argue that intersectionality is an important concept in clinical practice. They clarify the concept and distinguish their call for intersectionality from nearby claims. For instance, they argue that intersectionality goes beyond mere cultural competence that healthcare providers are already trained in, at least to some degree. Their paper is anchored around two fictionalized case studies, which they use to make vivid and explain their central claims. They end by responding to objections, including the very idea of intersectionality itself.
Ray, Keisha. It’s Time for a Black Bioethics2021, The American Journal of Bioethics. 21(2): 38–40.-
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Added by: Chris Blake-TurnerAbstract:
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.Comment (from this Blueprint): In this short, seminal piece, Keisha Ray argues that bioethics needs to address issues of health and well-being of Black individuals. She applies Beauchamp and Childress’s famous four principles of bioethics to a particular issue: the disproportionate maternal mortality rate of Black women in the United States. Ray argues bioethics must incorporate the lens of Black bioethics, if the discipline is to remain relevant.
Dickie, Bonnie. Hollow Water2000, NFB. 48 min. Canada.-
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Added by: Sonja Dobroski and Quentin PharrAbstract:
This documentary profiles the tiny Ojibway community of Hollow Water on the shores of Lake Winnipeg as they deal with an epidemic of sexual abuse in their midst. The offenders have left a legacy of denial and pain, addiction and suicide. The Manitoba justice system was unsuccessful in ending the cycle of abuse, so the community of Hollow Water took matters into their own hands. The offenders were brought home to face justice in a community healing and sentencing circle. Based on traditional practices, this unique model of justice reunites families and heals both victims and offenders. The film is a powerful tribute to one community's ability to heal and create change.Comment:
available in this Blueprint
Waziyatawin. What Does Justice Look Like?: The Struggle for Liberation in Dakota Homeland2008, Living Justice Press.-
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Added by: Sonja Dobroski and Quentin PharrPublisher’s Note:
During the past 150 years, the majority of Minnesotans have not acknowledged the immense and ongoing harms suffered by the Dakota People ever since their homelands were invaded over 200 years ago. Many Dakota people say that the wounds incurred have never healed, and it is clear that the injustices: genocide, ethnic cleansing, mass executions, death marches, broken treaties, and land theft; have not been made right. The Dakota People paid and continue to pay the ultimate price for Minnesota's statehood.This book explores how we can embark on a path of transformation on the way to respectful coexistence with those whose ancestral homeland this is. Doing justice is central to this process. Without justice, many Dakota say, healing and transformation on both sides cannot occur, and good, authentic relations cannot develop between our Peoples. Written by Wahpetunwan Dakota scholar and activist Waziyatawin of Pezihutazizi Otunwe, What Does Justice Look Like? offers an opportunity now and for future generations to learn the long-untold history and what it has meant for the Dakota People. On that basis, the book offers the further opportunity to explore what we can do between us as Peoples to reverse the patterns of genocide and oppression, and instead to do justice with a depth of good faith, commitment, and action that would be genuinely new for Native and non-Native relations.Comment:
available in this Blueprint
Maracle, Lee. I Am Woman: A Native Perspective on Sociology and Feminism2002, Press Gang Publishers, Canada.-
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Added by: Sonja Dobroski and Quentin PharrPublisher’s Note:
I Am Woman represents my personal struggle with womanhood, culture, traditional spiritual beliefs and political sovereignty, written during a time when that struggle was not over. My original intention was to empower Native women to take to heart their own personal struggle for Native feminist being. The changes made in this second edition of the text do not alter my original intention. It remains my attempt to present a Native woman's sociological perspective on the impacts of colonialism on us, as women, and on my self personally.Comment:
available in this Blueprint
1991, Frameline. 20 min. USA.-
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Added by: Sonja Dobroski and Quentin PharrAbstract:
An overview of historical and contemporary Native American concepts of gender, sexuality and sexual orientation. This documentary explores the berdache tradition in Native American culture, in which individuals who embody feminine and masculine qualities act as a conduit between the physical and spiritual world, and because of this are placed in positions of power within the community.Comment:
available in this Blueprint
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Ashley, Florence. Gatekeeping Hormone Replacement Therapy for Transgender Patients is Dehumanising
2019, The Journal of Medical Ethics. 45: 480-482.
Comment (from this Blueprint): Ashley draws on their own experiences as a trans person, as well as that of the trans community more broadly, to argue against assessment and referral requirements for hormone-replacement therapy (HRT). Ashley argues instead for an informed consent model, on which providers of HRT are not gatekeepers of transness, but facilitators of thoughtful decision-making.