Aims and objectives. Participant narratives from a feminist and queer phe- nomenological study aim to broaden current understandings of trauma. Examin- ing structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. Background. Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have (...) an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. Design. Analysis of the qualitative data was guided by feminist and queer phe- nomenology. This was well suited to understanding queer women’s storied narra- tives of trauma, including disempowering processes of structural marginalisation. Methods. Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. Results. Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that recon- structs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. Conclusions. Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. Relevance to clinical practice. New trauma-informed assessment strategies recon- struct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re- experiencing the process of coming out as queer in opposition to the expectation of heterosexuality. (shrink)

Cesarean delivery rates have been steadily increasing worldwide. In response, many countries have introduced target goals to reduce rates. But a focus on target goals fails to address practices embedded in standards of care that encourage, rather than discourage, cesarean sections. Obstetrical standards of care normalize use of technology, creating an imperative to use technology during labor and birth. A technological imperative is implicated in rising cesarean rates if physicians or patients fear refusing use of technology. Reproductive autonomy is at (...) stake since a technological imperative undermines patients’ ability to choose cesareans or refuse use of technology increasing the likelihood of cesareans. To address practices driven by a technological imperative I outline three physician obligations that are attached to respecting patient autonomy. These moral obligations show that a focus on respect for autonomy may prove not only an ideal ethical response but also an achievable practical response to lowering cesarean rates. (shrink)

While gender and race often are considered socially constructed, this book argues that they are physiologically constituted through the biopsychosocial effects of sexism and racism. This means that to be fully successful, critical philosophy of race and feminist philosophy need to examine not only the financial, legal, political and other forms of racist and sexism oppression, but also their physiological operations. Examining a complex tangle of affects, emotions, knowledge, and privilege, The Physiology of Sexist and Racist Oppression develops an understanding (...) of the human body whose unconscious habits are biological. On this account, affect and emotion are thoroughly somatic, not something "mental" or extra-biological layered on top of the body. They also are interpersonal, social, and can be transactionally transmitted between people.Ranging from the stomach and the gut to the hips and the heart, from autoimmune diseases to epigenetic markers, Sullivan demonstrates the gastrointestinal effects of sexual abuse that disproportionately affect women, often manifesting as IBS, Crohn's disease, or similar functional disorders. She also explores the transgenerational effects of racism via epigenetic changes in African American women, who experience much higher pre-term birth rates than white women do, and she reveals the unjust benefits for heart health experienced by white people as a result of their racial privilege. Finally, developing the notion of a physiological therapy that doesn't prioritize bringing unconscious habits to conscious awareness, Sullivan closes with a double-barreled approach for both working for institutional change and transforming biologically unconscious habits. The Physiology of Sexist and Racist Oppression skillfully combines feminist and critical philosophy of race with the biological and health sciences. The result is a critical physiology of race and gender that offers new strategies for fighting male and white privilege. (shrink)

Max van Manen offers an extensive exploration of phenomenological traditions and methods for the human sciences. It is his first comprehensive statement of phenomenological thought and research in over a decade. Phenomenology of practice refers to the meaning and practice of phenomenology in professional contexts such as psychology, education, and health care, as well as to the practice of phenomenological methods in contexts of everyday living. Van Manen presents a detailed description of key phenomenological ideas as they have evolved over (...) the past century; he then thoughtfully works through the methodological issues of phenomenological reflection, empirical methods, and writing that a phenomenology of practice offers to the researcher. Van Manen’s comprehensive work will be of great interest to all concerned with the interrelationship between being and acting in human sciences research and in everyday life. (shrink)

It surely would lighten the tasks of feminism tremendously if we could cut to the quick of women's lives by focusing on some essential "woman- ness." However, though all women are women, no woman is only a woman. Those of us who have  ...

Abstract: This paper provides a phenomenological interpretation of technological and natural childbirth. By using Heidegger’s ontology of technology to think about childbirth I argue that these two types of contemporary childbirth present us with a false dilemma as both reflect the same norms Heidegger associates with modernity, namely order, control, and efficiency. The paper briefly explains Heidegger’s concept of the enframing as the essence of the technological age while focusing on how it helps us to avoid falling into a technophilic (...) or technophobic trap. Although the technophobic approach popularized by Lamaze gained some favor with feminists who saw the increased use of reproductive technology as an extension of patriarchal control over women’s bodies, I argue that this natural birthing technique incorporated order and control in ways that are similar to its technophilic counterpart. In order to move beyond what I call the reproductive enframing, it is necessary to recognize the false dilemma presented by the technological and natural alternatives. (shrink)

This paper presents a relational account of autonomy showing that a technological imperative impedes autonomy through undermining women’s capacity to resist use of technology in the context of labor and birth. A technological imperative encourages dependence on technology for reassurance whenever possible through creating a (i) separation of maternal and fetal interests; and (ii) perceived need to use technology whenever possible. In response I offer an account of how women might promote autonomy through cultivating self-trust and self-confidence. Autonomy is not (...) simply a matter of choosing freely and acting on our choices, it is also a matter of possessing the ability to resist social contexts undermining choice and action. An important implication of this view is that respecting autonomy requires more than simply respecting persons’ ability to make and act on choices. Respecting patient autonomy requires a recognition of patients’ need to resist factors impeding autonomy and support for that resistance. (shrink)

Written over a span of more than two decades, the essays by Iris Marion Young collected in this volume describe diverse aspects of women's lived body experience in modern Western societies. Drawing on the ideas of several twentieth century continental philosophers--including Simone de Beauvoir, Martin Heidegger, Luce Irigaray, Julia Kristeva, and Maurice Merleau-Ponty--Young constructs rigorous analytic categories for interpreting embodied subjectivity. The essays combine theoretical description of experience with normative evaluation of the unjust constraints on their freedom and opportunity that (...) continue to burden many women. The lead essay rethinks the purpose of the category of "gender" for feminist theory, after important debates have questioned its usefulness. Other essays include reflection on the meaning of being at home and the need for privacy in old age residences as well as essays that analyze aspects of the experience of women and girls that have received little attention even in feminist theory--such as the sexuality of breasts, or menstruation as punctuation in a woman's life story. Young describes the phenomenology of moving in a pregnant body and the tactile pleasures of clothing. While academically rigorous, the essays are also written with engaging style, incorporating vivid imagery and autobiographical narrative. On Female Body Experience raises issues and takes positions that speak to scholars and students in philosophy, sociology, geography, medicine, nursing, and education. (shrink)

This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including self-conception, self-worth, memory, and the (...) imagination. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

This volume breaks new ground by investigating the ethics of vulnerability. Drawing on various ethical traditions, the contributors explore the nature of vulnerability, the responsibilities owed to the vulnerable, and by whom.

This paper draws on findings from qualitative interviews with queer and trans patients and with physicians providing care to queer and trans patients in Halifax, Nova Scotia, Canada, to explore how routine practices of health care can perpetuate or challenge the marginalization of queers. One of the most common “measures” of improved cultural competence in health care practice is self-reported increases in confidence and comfort, though it seems unlikely that an increase in physician comfort levels with queer and trans patients (...) will necessarily mean better health care for queers. More attention to current felt discomfort in patient–provider encounters is required. Policies and practices that avoid discomfort at all costs are not always helpful for care, and experiences of shared discomfort in queer health contexts are not always harmful. (shrink)

The emergence of new forms of reproductive technology raise an increasingly complex array of social and ethical issues. Nevertheless, this paper focuses on commonplace reproductive technologies used during labor and birth such as ultrasound, fetal monitoring, episiotomy, epidurals, labor induction, amniotomy, and cesarean section. This paper maintains that social pressures increase women’s perceived need to such reproductive technologies and thus undermine women’s capacity to choose an elective cesarean or avoid an emergency cesarean. Routine, normalized use of technology interferes with the (...) possibility of choosing use of technology where best suited through misdirecting laboring women to use technological resources whenever possible. This normalized use of technology decreases risk tolerance and increases dependence on technology for reassurance, which bears significant implications for self-trust and self-confidence. My account encourages women’s cultivation of autonomy as a capacity interconnected with our own attitudes and those of other persons; and as a function of cultivating trust and confidence in one’s body. (shrink)

Chapter 4 demonstrates how white domination helps constitute the bodies of white people, focusing on white people’s stomachs and hearts in particular. Returning to the example of undergraduate student Brittney from the book’s Introduction, this chapter locates unconscious habits of white privilege in the clenching muscles of white people’s stomachs. It also argues that white people’s relatively good cardio health should be viewed a physiological effect of white privilege, rather than as a neutral or normal health condition. In the case (...) of both white stomachs and white hearts, a racialized knowledge grounded in white ignorance helps structure contemporary white physiology. (shrink)

In this article, the theme of introductory engagement is developed through the conversational interviews and participatory observations I carried out with perinatal nurses and birthing women in the context of a feminist phenomenological methodology. Positioned against the landscape of hierarchical health care practices embedded with power dynamics and disembodied practices, this research explored the ways in which perinatal nurses related to birthing women in the context of relational care. The focus of attention in this article is to describe the theme (...) of introductory engagement by way of a storied phenomenological text. (shrink)