Since the emergence of in-vitro fertilization, a specific set of technologies has been developed to address the problem of the ‘biological clock’. The medical extension of fertility time is accompanied by promissory narratives to help women synchronize conflicting biological and social temporalities. This possibility also has a transgressive potential by blurring one of the biological landmarks – the menopause – by which reproductive lives are organized and governed. These new ways of managing, measuring and controlling reproductive time have renewed debates (...) on the age limits of motherhood and the moral legitimacy of medical intervention into age-related fertility decline. Building on Amir’s feminist concept of biotemporality, this paper questions what happens when the ontological foundations of age-limited motherhood are disrupted by technologies which allow fertility to be extended. It discusses the reconfigurations of the ontological boundaries of the facts of life in the light of literature on reproductive technologies and temporality. Through the Swiss experience, the paper shows how medical experts are drawn into negotiating the ontological boundaries of age-limited motherhood along the binaries of the normal/pathological and the biological/social. Questioning the purpose of medical interventions in what are seen as facts of life, they produce different configurations of moral reasoning where what is natural undergoes shifts which both reinforce the normative order and subvert it. (shrink)

This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from each (...) guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources. (shrink)

The paper encircles the subjectivity of drug taking as one form of contemporary practice in which fundamental theoretical issues are dealt with. In particular, following Mariana Valverde's genealogy of alcohol regulation (Valverde, 1998), the question of the free will, and the paradox of the simultaneous being and non-being of the autonomous subject, are viewed as present in various approaches to drugs. The current neo-pragmatist wave substitutes low-key practical notions of habits for a dichotomy of free will or determinism. The concept (...) of objectification promises to overcome that dichotomy by externalizing it; in terms of this concept, we can distinguish the abstract-imagined 'fix' from a genuinely transforming realization, and suggest that ours is the age of the fix, of instrumental commodities that change us in ways we do not intend. But, it is claimed, an inescapable issue of the self-dissolution of the subject remains; perhaps in the definitive shape of a suicide, or in the minor shapes of fixes such as a tactics of feigned surrender, New Age Higher Powers, or imagined communities. Determined to realize the idea of a benevolent surrender of the subject, the paper ends in an attempt to contribute to the coming to an understanding of herself and with herself of a person who finds herself at the troublesome intersection of Narcotics Anonymous and a social work development network of Copenhagen City called Wild Learning. (shrink)

Part of the normalization of assisted reproductive technologies is the premise that the children born from in vitro fertilization are no different from their counterparts conceived spontaneously. However, interest in peri-conception health and new epigenetic understandings of biological plasticity has led to some questioning the presumed irrelevance of conception in vitro, and when doing so, describing IVF children as “apparently healthy.” Taking “apparently” and “healthy” seriously, this article explores how modes of attention—ways of naming and framing embryo potentiality—shape understandings of (...) health and normality. I contend that understanding the politics of potentiality, and how they may emerge in a postgenomic age, requires an unpacking of various modes of attention and framing. Ethnographic findings from South Africa’s fertility clinics and emerging literature on epigenetic variation in IVF conception demonstrate how, under a genetic mode of attention, IVF clinics views “abnormality” as fated, unviable, and discardable. Exploring the possibility of answering the postgenomic questions to IVF reveals structural challenges to knowing long-term health implications. Incipient attempts within the fertility clinic at managing these questions shows various strategic techniques, such as leveraging epigenetics to marketable ends and shifts to individual responsibility. (shrink)