Interview by Klasien Horstman on gender and genetics. 'Unlike many gender theorists, I do not view the body as socially constructed; nor do I share postmodern and deconstructionist disquiet at the notion of a unified subject. Frankly, I think these constructions get in the way of political action and are bad for women’s rights.' -/- .

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance of concepts widely (...) disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

Interview on the commodified body with Donna Dickenson by Alana Cattapan.

This article, arising from a comparative European Commission project, analyses different national perspectives on bioethics issues.

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers strong counter-arguments to (...) this view that enable us to think in terms of universal standards. (shrink)

New developments in biotechnology radically alter our relationship with our bodies. Body tissues can now be used for commercial purposes, while external objects, such as pacemakers, can become part of the body. Property in the Body: Feminist Perspectives transcends the everyday responses to such developments, suggesting that what we most fear is the feminisation of the body. We fear our bodies are becoming objects of property, turning us into things rather than persons. This book evaluates how well-grounded this fear is, (...) and suggests innovative models of regulating what has been called 'the new Gold Rush' in human tissue. This is an up-to-date and wide-ranging synthesis of market developments in body tissue, bringing together bioethics, feminist theory and lessons from countries that have resisted commercialisation of the body, in a theoretically sophisticated and practically significant approach. (shrink)

Most opponents of somatic cell nuclear transfer and embryonic stem cell technologies base their arguments on the twin assertions that the embryo is either a human being or a potential human being, and that it is wrong to destroy a human being or potential human being in order to produce stem cell lines. Proponents’ justifications of stem cell research are more varied, but not enough to escape the charge of obsession with the status of the embryo. What unites the two (...) warring sides in ‘the stem cell wars’ is that women are equally invisible to both: ‘the lady vanishes.’ Yet the most legitimate property in the body is that which women possess in their reproductive tissue and the products of their reproductive labour. By drawing on the accepted characterisation in the common law of property as a bundle of rights, and on a Hegelian model of contract as mutual recognition, we can lessen the impact of the tendency to regard women and their ova as merely receptacles and women’s reproductive labour as unimportant. (shrink)

Abstract Gender and Ethics Committees: Where’s the Different Voice? -/- Prominent international and national ethics commissions such as the UNESCO Bioethics Commission rarely achieve anything remotely resembling gender equality, although local research and clinical ethics committees are somewhat more egalitarian. Under-representation of women is particularly troubling when the subject matter of modern bioethics so disproportionately concerns women’s bodies, and when such committees claim to derive ‘universal’ standards. Are women missing from many ethics committees because of relatively straightforward, if discriminatory, demographic (...) factors? Or are the methods of analysis and styles of ethics to which these bodies are committed somehow ‘anti-female’? It has been argued, for example, that there is a ‘different voice’ in ethical reasoning, not confined to women but more representative of female experience. Similarly, some feminist writers, such as Evelyn Fox Keller and Donna Haraway, have asked difficult epistemological questions about the dominant ‘masculine paradigm’ in science. Perhaps the dominant paradigm in ethics committee deliberation is similarly gendered? This article provides a preliminary survey of women’s representation on ethics committees in Eastern and Western Europe, a critical analysis of the supposed ‘masculinism’ of the principlist approach, and a case example in which a ‘different voice’ did indeed make a difference. (shrink)

The spread of liberal individualism to the family is often portrayed as deeply inimical to the welfare of children and young people. In this view, the family is the bastion of the private and the antithesis of the contractual, rights-oriented model that underpins public life. This chapter examines that proposition critically.

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, that of the (...) common good as a goal in medicine. (shrink)

The present article proposes to study Condillac’s analysis of Spinoza’s Ethics, against the background of the more general criticism that the French abbot makes of the seventeenth-century logique de système. From the Essai sur l’origine des connaissances humaines to the Traité des systèmes to the later texts, Condillac’s theory and critique of systems are crossed by two components: on the one hand, the search for the sensory origin of ideas, that Condillac radicalizes in his Traité des sensations into a theory (...) of knowledge as a ‘transformed sensation’. On the other hand, an operative logic of signs, which from the Essai to the works subsequent to the Traité des sensations translates sensibility into a knowledge, or a ‘well-made language’, whose logic is calculation. My objective is to clarify how the new ‘systematic spirit’, repeatedly invoked by the abbot, departs from the ‘bad metaphysics’ that he claims to liquidate. The comparison with the Spinozist system will be illuminating: in his treatise on the metaphysical systems of the seventeenth century Condillac proposes a critical analysis of the ‘geometrical spirit’; in his latest work, La langue des calculs, he proposes a new logic to which he assigns the task of bringing together the abstract and the concrete, beyond the ruins of classical metaphysics. The ‘systematic spirit’ and ‘spirit of system’ will be revealed, in spite of Condillac’s efforts, as being much closer to what it appears at first sight. (shrink)

Critical examination of the concept of property in the body, with particular relevance to Stephen Munzer's work on umbilical cord blood.

Correction of major error in review of Bioethics: All That Matters.

This book contributes to the feminist reconstruction of political theory. Although many feminist authors have pointed out the ways in which women have been property, they have been less successful in suggesting how women might become the subjects rather than the objects of property-holding. This book synthesises political theory from liberal, Marxist, Kantian and Hegelian traditions, applying these ideas to history and social policy.

In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural and gender issues; (...) rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)

Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

'An alarming and illuminating book. The story of how we have allowed private corporations to patent genes, to stockpile human tissue, and in short to make profits out of what many people feel ought to be common goods is a shocking one. No one with any interest at all in medicine and society and how they interact should miss this book, and it should be required reading for every medical student,'--Philip Pullman.

It is well known that there is a shortage of human ova for in vitro fertilization (IVF) purposes, but little attention has been paid to the way in which the demand for ova in stem-cell technologies is likely to exacerbate that shortfall and create a trade in human eggs. Because the 'Dolly' technology relies on enucleated ova in large quantities, allowing for considerable wastage, there is a serious threat that commercial and research demands for human eggs will grow exponentially from (...) the combination of these two pressures. In the absence of legal regulation in the United Kingdom, and in the context of a globalized trade in human organs, we face a 'Wild West' situation in genetic and biotechnological research that involves human ova. (shrink)

For a long time discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. However, a narrow focus on medical resources prevents us from seeing that there are many cases-- perhaps the majority-- in which less dramatic but equally important issues of rationing occur. The allocation of nurses' time is one such issue.

The results of a recent survey of Nigerian women might give pause to opponents of female genital mutilation (FGM). One could well argue that if these Nigerian women themselves favour FGM, then it is ironically paternalistic to oppose it. Should Western feminists actually support FGM if it is what women in the South want? I argue in this commentary that such an argument rests on shaky statistical, psychological, medical, political and philosophical grounds. We should go on opposing female genital mutilation (...) with all our power. (shrink)

There has been a troublesome anomaly in the UK between cash payment to men for sperm donation and the effective assumption that women will pay to donate eggs. Some commentators, including Donald Evans in this journal, have argued that the anomaly should be resolved by treating women on the same terms as men. But this argument ignores important difficulties about property in the body, particularly in relation to gametes. There are good reasons for thinking that the contract model and payment (...) for gametes are both inappropriate, and that a model based on altruism should be applied to both sexes. (shrink)

The feminist movement may seek democratization on a global scale, but women are still hampered by a democratic deficit in terms of economic and political power. On the other hand, global feminist networks and new expanded forms of non-territorial political space do appear to be increasing democratic participation for women.

In the specific case of geography, the real world consists on the one hand of physical geographic features (bona fide objects) and on the other hand of various fiat objects, for example legal and administrative objects, including parcels of real estate, areas of given soil types, census tracts, and so on. It contains in addition the beliefs and actions of human beings directed towards these objects (for example, the actions of those who work in land registries or in census bureaux), (...) and the relations between these beliefs and actions and their targets. The document is a Report of the Specialist Meeting held under the auspices of the Varenius Project. (shrink)

Speculative enhancement technologies are premised on the notion that I have a duty to be the best Me I can possibly be. This article takes a sceptical look at that claim.

How can we allocate scarce health care resources justly? In particular, are markets the most efficient way to deliver health services? Much blood, sweat and ink has been shed over this issue, but rarely has either faction challenged the unspoken assumption behind the claim made by advocates of markets: that efficiency advances the interests of both individuals and society. Whether markets actually do increase efficiency is arguably a matter for economists, but the deeper ethical question is whether efficiency is the (...) correct criterion, in terms of social justice and individual needs. (shrink)

Does advocating women's reproductive rights require us to believe that women own property in their bodies? In this chapter I conclude that it does not. Although the concept of owning our own bodies — ‘whose body is it anyway?’ — has polemical and political utility, it is incoherent in philosophy and law. Rather than conflate the entirely plausible concept of women’s reproductive rights and the implausible notion of property in the body, we should keep them separate, so that the weakness (...) of the second concept does not contaminate the purity of the first. (shrink)

Guidelines on embryo storage prioritise 'respect for the embryo' above the wishes of the women whose labour and tissue have gone into creating the embryo in the first place, effectively making women and the female body disappear. In this article I draw a parallel between this phenomenon relating to embryo storage and other instances of a similar phenomenon that I have called 'the lady vanishes', particularly in stem cell and 'mitochondrial transfer' research. I suggest that a modified property regime could (...) protect women's interests in embryo storage, making a parallel with the Yearworth case, in which it was recognised that men had limited but actionable interests in their stored sperm.. (shrink)

How can intellectuals who oppose the illegitimate war in Iraq come to similar terms with the U.S. neoconservatives, and their unrepentant British collaborators, who have stranded us in it? In the Tempest, Shakespeare’s most political play, comedy though it is meant to be, intellectuals are warned not to consider themselves guiltless. But how can those who marched against the war, or who tried to speak truth to power in other ways, be guilty of its misuses? Surely this is too harsh (...) a view of the role of the public intellectual. What choice did Prospero really have? He was exiled, hapless, stranded. What choice do intellectuals who are against the war have? We, too, are powerless. Aren’t we? (shrink)

The soaring promises made by personalized genetic medicine advocates are probably loftier than those in any other medical or scientific realm today. Are they justified?

The growth of personalised medicine threatens the communal approach that has brought our biggest health gains.

Payment for eggs used in stem cell research puts women at unacceptable risk and encourages exploitative commodification of the female body. Thanks to the development of induced pluripotent stem cells, however, we no longer face a choice between good science and good ethics.

Children and young people under 18 years old should no longer be regarded as incompetent to give or withhold consent in decisions involving their health care, Recent research suggests a functional test of cognitive and emotional maturity, rather than a strict age cut-off point. However, it is often difficult to implement these recommendations in practice, not least because the law is, if anything, increasingly 'hard-line' about children's autonomy.

Review of Margit Shildrick, Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)Ethics.

What does it mean to respect autonomy and encourage meaningful consent to treatment in the case of patients who have dementia or are otherwise incompetent? This question has been thrown into sharp relief by the Law Lords' decision in R.v Bournewood Community and Mental Health NHS Trust, ex parte L.

This chapter critically examines two frequently found assumptions in the debate about trafficking for prostitution: 1. That the sale of sexual services is like the sale of any other good or service; 2. That by and large women involved in trafficking for prostitution freely consent to sell such services.

In this article I evaluate a resurrected French resistance movement--to biotechnological commodification. The official French view that ‘the body is the person’ has been dismissed as a ‘taboo’ by the French political scientist Dominique Memmi . Yet France has indeed resisted the models of globalised commodification adopted in US bioechnology, as, for example, when the government blocked a research collaboration between the American firm Millennium Pharmaceuticals and a leading genomics laboratory, le Centre d’Etude du Polymorphisme Humain, on the grounds the (...) ‘French DNA’ should not be given away. -/- This example, however, itself suggests why the ‘new French Resistance’ is not altogether liberating. The absolutist conception of all bodies as belonging to the French state—indeed, as constituting the body politic —is so potentially invasive that a counter-ideology of inviolability of the body is maintained assiduously. This inviolability is defended particularly strongly against commercialisation, but only at the moment when tissue is taken from the individual subject, who is not to be paid or compensated-- although commercial enterprises who subsequently use the tissue are not similarly constrained. -/- . (shrink)

Reproductive ageing has effects on individual and public health, now and in generations to come. This volume of presentations from a conference at the Royal College of Obstetricians and Gynaecologists brings together a diverse but timely set of contributions.. in ny chapter I specifically examine the responsibilities of the College to women outside normal reproductive age.

Until very recently the question of who owns embryonic or fetal tissue was of limited importance to clinicians, but advances in stem cell research have made such tissue commercially valuable. This chapter examines the legal and ethical basis of claims to property in embryonic or fetal tissue, taking a critical stance.

With the highest profile seller of $99 genetic tests under fire, will public trust in personalised medicine suffer?

This article, based on a case study, examines issues of confidentiality and family impact in a diagnosis of Huntington's disease. Genetic-based illness transcends individualistic models of patient autonomy because it also involves other family members, requiring a new approach to patient confidentiality.

Whilst India has been debating how to regulate 'surrogacy' the UK has undergone a major consultation on increasing the amount of 'expenses'paid to egg 'donors', while France has recently finished debating its entire package of bioethics regulation and the role of its Biomedicine Agency. Although it is often claimed that there is no alternative to the neo-liberal, market-based approach in regulating (or not) reproductive medicine--the ideology prevalent in both India and the UK--advocates of that position ignore the alternative model offered (...) by France's tighter regulation, as well as its overarching concern with protecting the vulnerable and ensuring social justice. Whilst the concepts underpinning the French model of regulation also have their provenance in Western political philosophy and not in the developed world, they embody a very different attitude and suggest that there is indeed an alternative to letting the market decide. However, even in France that alternative is highly contested. (shrink)

The debate about direct-to-consumer genetic testing has centred on whether consumers are the best judges of their own clinical care. Inthis article, I also examine whether the science of personalized medicine is really as advanced as its proponents claim, and how the availability of genetic markers affects decisions on who gets and does not get medical treatment.

The rise of personalised medicine can be seen as an extension of individualism and as a threat to the common good.

How heavily should ethical considerations weigh in allowing or disallowing genetic patents? The concept of 'ordre public' can be useful in offsetting a simple utilitarian view.

What should we do about children and young people who want to be tested for incurable, adult onset, genetic disorders? In particular, what should a general practitioner do if he or she believes the young person is competent to decide, but the regional genetics unit refuses to test anyone under 18? In this article I discuss such a case (drawn from actual practice, but anonymised), and consider the arguments for and against allowing the young person to be tested in terms (...) of good practice, case and statute law, empirical evidence, and ethics. (shrink)

This contribution aims to present the different philosophical interpretations of Descartes and Cartesian philosophies in the 17th century within the Revue Internationale de Philosophie. Studies on Descartes and Cartesian philosophies profoundly influenced the scientific orientations of the Revue by promoting the encounter between historical-philosophical and epistemological research. By reconstructing a century of Cartesian interpretations in the Revue, from the 1930s to the present day, the contribution examines the link between the universality of philosophical ideas and the analysis of texts, between (...) the history of ideas and the history of philosophical systems. (shrink)

Three-parent IVF is proceeding towards partial legalisation in the UK, but is this process too hasty?

Whether intentional suppression of an unpleasant or unwanted memory reduces the ability to recall that memory subsequently is a contested issue in contemporary memory research. Building on findings that similar processes are recruited when individuals remember the past and imagine the future, we measured the effects of thought suppression on memory for imagined future scenarios. Thought suppression reduced the ability to recall emotionally negative scenarios, but not those that were emotionally positive. This finding suggests that intentionally avoiding thoughts about emotionally (...) negative episodes may inhibit representations of those memories, progressively reducing their availability to recall. (shrink)

Should we do whatever science lets us do? This short introduction in the 'All That Matters' series shows how developments in biotechnology, such as genetics, stem cell research and artificial reproduction, arouse both our greatest hopes and our greatest fears. Many people invest the new biotechnology with all the aspirations and faith once accorded to religious salvation. But does everyone benefit equally from scientific progress? This book argues that although we've entered new scientific territory, there is no need to jettison (...) our existing moral sense. By discussing a range of real-life cases, it equips readers to make up their own minds on these important questions. Good science and good ethics needn't be contradictory. (shrink)