It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems.
Global health and national borders: the ethics of foreign aid in a time of financial crisis.
BACKGROUND: The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. METHODS: We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. RESULTS: Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. CONCLUSIONS: Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action.
Disability, Enhancement and the Harm-Benefit Continuum
Suppose that you are soon to be a parent and you learn that there are some simple measures that you can take to make sure that your child will be healthy. In particular, suppose that by following the doctor’s advice, you can prevent your child from having a disability, you can make your child immune from a number of dangerous diseases and you can even enhance its future intelligence. All that is required for this to happen is that you (or your partner) comply with lifestyle and dietary requirements. Do you and your partner have any moral reasons (or moral obligations) to follow the doctor’s advice? Would it make a difference if, instead of following some simple dietary requirements, you consented to genetic engineering to make sure that your child was free from disabilities, healthy and with above average intelligence? In this paper we develop a framework for dealing with these questions and we suggest some directions the answers might take.
Involuntary experiments in former colonies: The case for a moratorium
Abstract: There is a rich literature on the use of medical trials as a model for designing and evaluating the outcomes of social policy interventions in former colonies. Yet social experimentalists have not engaged in a correspondingly vibrant discussion of medical ethics. A systematic review of social experiments shows that few studies explicitly discuss informed consent, or the serious constraints on securing informed consent from impoverished or child participants, particularly in the context of cluster randomization. The silence on informed consent, and in some cases active denial thereof, suggests that it is often considered less important than other elements of experimental design. This matters since involuntary experimentation on vulnerable people violates their personhood, increases the risk of unintended harm, and establishes continuities with colonial experimentation. There is a need to develop more effective mechanisms for regulating social experiments in former colonies. In the interim, scholars in the South have a responsibility to call for a moratorium on experiments.
No Longer Patient: Feminist Ethics and Health Care
Introduction: This book attempts to deepen common understandings of what considerations are relevant in discussions of bioethics. It is meant to offer a clearer picture of what morally acceptable health care might look like. I argue that a feminist understanding of the social realities of our world is necessary if we are to recognize and develop an adequate analysis of the ethical issues that arise in the context of health care.
The professional responsibilities of medicine
Publisher’s Note: The Blackwell Guide to Medical Ethics is a guide to the complex literature written on the increasingly dense topic of ethics in relation to the new technologies of medicine. Examines the key ethical issues and debates which have resulted from the rapid advances in biomedical technology Brings together the leading scholars from a wide range of disciplines, including philosophy, medicine, theology and law, to discuss these issues Tackles such topics as ending life, patient choice, selling body parts, resourcing and confidentiality Organized with a coherent structure that differentiates between the decisions of individuals and those of social policy
That Makes It Worse
Abstract: Essays on excusing conditions and their correlates, mitigating conditions, usually begin with the assumption that there is general agreement on what the standard excuses are, and on where they are inapplicable. This assumption is justified; criminal law and the history of discussions of excuses have produced accord, though now and then doubts are expressed about particulars. Essays on excuses typically aim not so much to convince one that such-and-such are the general types of excuses but, rather, to show how they work and what their operation reveals about the nature of voluntary acts, full responsibility, etc.
Individual Complicity: The Tortured Patient
Abstract: Medical complicity in torture is prohibited by international law and codes of professional ethics. But in the many countries in which torture is common, doctors frequently are expected to assist unethical acts that they are unable to prevent. Sometimes these doctors face a dilemma: they are asked to provide diagnoses or treatments that respond to genuine health needs but that also make further torture more likely or more effective. The duty to avoid complicity in torture then comes into conflict with the doctor’s duty to care for patients. Sometimes the right thing for a doctor to do requires complicity in torture. Whether this is the case depends on: the expected consequences of the doctor’s actions; the wishes of the patient; and the extent of the doctor’s complicity with wrongdoing. Medical associations can support physicians who face this dilemma while maintaining a commitment to clear principles denouncing torture.
Should the Baby Live? The Problem of Handicapped Infants
Publisher’s Note: Few subjects have generated so many newspaper headlines and such heated controversy as the treatment, or non-treatment, of handicapped newborns. In 1982, the case of Baby Doe, a child born with Down’s syndrome, stirred up a national debate in the United States, while in Britain a year earlier, Dr. Leonard Arthur stood trial for his decision to allow a baby with Down’s syndrome to die. Government intervention and these recent legal battles accentuate the need for a reassessment of the complex issues involved. This volume–by two authorities on medical ethics–presents a philosophical analysis of the subject based on particular case studies. Addressing the doctrine of the absolute sanctity of life, Singer and Kuhse examine some actual cases where decisions have been reached; consider the criteria for making these decisions; investigate the differences between killing and letting die; compare Western attitudes and practices with those of other cultures; and conclude by proposing a decision-making framework that offers a rational alternative to the polemics and confusion generated by this highly controversial topic.
The Sanctity-of-Life Doctrine in Medicine: A Critique
Publisher’s Note: According to the “sanctity-of-life” view, all human lives are equally valuable and inviolable, and it would be wrong to base life-and-death medical decisions on the quality of the patient’s life. Examining the ideas and assumptions behind the sanctity-of-life view, Kuhse argues against the traditional view that allowing someone to die is morally different from killing, and shows that quality-of-life judgments are ubiquitous. Refuting the sanctity-of-life view, she provides a sketch of a quality-of-life ethics based on the belief that there is a profound difference between merely being alive and life being in the patient’s interest.