Book reviewed in this article: No Longer Patient: Feminist Ethics & Health Care. By Susan Sherwin Feminist Perspectives in Medical Ethics. Edited by Helen Bequaert Holmes and Laura M. Purdy.

An ethnographic field study about the informed consent process in investigational drug trials for seriously ill persons with hepatitis C suggests that nurses and physicians referred to these trials as giving treatment, even though they involved placebos. Interview data and informed consent documents contained frequent references to the term `treatment trial' or `treatment'. Although these findings were unexpected and not the original focus of our study, we consider them in the light of an extensive literature on the `therapeutic misconception' that (...) has been described among physicians and patients with AIDS and other serious illnesses. We also suggest that certain organizational and professional characteristics of nursing and medicine reinforce this tendency to refer to the trials as treatment. Implications for further research are provided. (shrink)

Recent developments of three-dimensional printing of biomaterials in medicine have been portrayed as demonstrating the potential to transform some medical treatments, including providing new responses to organ damage or organ failure. However, beyond the hype and before 3D bioprinted organs are ready to be transplanted into humans, several important ethical concerns and regulatory questions need to be addressed. This article starts by raising general ethical concerns associated with the use of bioprinting in medicine, then it focuses on more particular ethical (...) issues related to experimental testing on humans, and the lack of current international regulatory directives to guide these experiments. Accordingly, this article considers whether there is a limit as to what should be bioprinted in medicine; examines key risks of significant harm associated with testing 3D bioprinting for humans; investigates the clinical trial paradigm used to test 3D bioprinting; analyses ethical questions of irreversibility, loss of treatment opportunity and replicability; explores the current lack of a specific framework for the regulation and testing of 3D bioprinting treatments. (shrink)

Recent studies of early development in a number of ivertebrate and vertebrate species have suggested that growth factors and their receptors may play important roles in differentiation as well as cell proliferation. In the mouse embryo, the expression of the receptors for insulin and insulin‐like growth factors I and II (IGF‐I and ‐II) are temporally regulated. The ontogeny of receptor and ligand expression within the insulin and IGF gene family suggests that the very earliest stages of mammalian embryogenesis may be (...) subject to regulation by autocrine and paracrine factors from maternal and embryonic sources. (shrink)

Bioethics, Volume 36, Issue 1, Page 25-41, January 2022.

There has been a surge in mass media reports extolling the potential for using three-dimensional printing of biomaterials to treat a wide range of clinical conditions. Given that mass media is recognized as one of the most important sources of health and medical information for the general public, especially prospective patients, we report and discuss the ethical consequences of coverage of 3D bioprinting in the media. First, we illustrate how positive mass media narratives of a similar biofabricated technology, namely the (...) Macchiarini scaffold tracheas, which was involved in lethal experimental human trials, influenced potential patient perceptions. Second, we report and analyze the positively biased and enthusiastic portrayal of 3D bioprinting in mass media. Third, we examine the lack of regulation and absence of discussion about risks associated with bioprinting technology. Fourth, we explore how media misunderstanding is dangerously misleading the narrative about the technology. (shrink)

In their article published in Nanoethics, “Ethical, Legal and Social Aspects of Brain-Implants Using Nano-Scale Materials and Techniques”, Berger et al. suggest that there may be a prima facie moral obligation to improve neuro implants with nanotechnology given their possible therapeutic advantages for patients [Nanoethics, 2:241–249]. Although we agree with Berger et al. that developments in nanomedicine hold the potential to render brain implant technologies less invasive and to better target neural stimulation to respond to brain impairments in the near (...) future, we argue against presenting the development of nanobionic clinical devices in terms of a moral obligation to conduct this research. In the first part of the paper, we consider what a duty to pursue new technologies might mean, and in the second we explore some of the negative consequences of defending such development as a moral obligation based on potential benefit. We argue that promoting the advances available to brain implants through developments in nanotechnology and bionics could contribute to medical rhetoric that indirectly increases the risk of exposing patients to harm when participating in clinical trials. We argue that rather than there being a moral obligation to improve nanobionics implants because of their potential benefit, the pursuit of improved neuro implants must be balanced against the prima facie obligations to protect patients against harm and to promote and protect patient autonomy. (shrink)

Fewer than half of medical interventions are supported by scientific evidence. These essays examine the hopes that the new push for comparative effectiveness research will improve medical care, the fears that it could harm the doctor‐patient relationship, and the experiences of states and countries that already put it into practice.

We’d like to do a little hypnosis on you. Imagine that you’re ensconced in your own family room, your study, or your queen-sized bed. Settling back, you pick up the remote, flick on the TV, and naturally you turn to PBS. This is what you hear:Host 1: Good evening. Welcome to Masterpiece Theatre. Because Alistair Cooke is away on assignment in Alaska, we’ve agreed to host the show tonight, and that’s both a pleasure and a privilege because our program this (...) evening marks the beginning of a fascinating new series, a first on television: Masterpiece Theatre will present you with a docudrama entitled “Masterpiece Theatre.”Host 2: Like “The First Churchills,” this show analyzes the situation of real-life people—tonight, people in the academy. Names have not been changed to protect either the innocent or the guilty, but all the situations are fictive and at times words that may never have been spoken are put into the mouths of people who did not speak them. Other lines, however, are direct quotations from various written sources, although none of the characters, as we depict them, should be confused with any “actual” persons, whether or not those persons would scribe to the idea of their own reality. Like “Upstairs/Downstairs,” this program will introduce you to a spectrum of characters from many walks of life. What’s different about tonight’s episode, though, is that all these characters have passionate opinions about the show itself. Why, the very idea of Masterpiece Theatre drives some of them to Guerrilla Theatre, others to Theatre of the Absurd. Yes, you’ve always already guessed it: we focus tonight on a drama involving what we used to call humanists—now for some a dirty word—and most of our characters are in deep trouble. Sandra M. Gilbert, professor of English at the University of California, Davis, and Susan Gubar, professor of English at Indiana University, are coauthors of No Man’s Land: The Place of the Woman Writer in the Twentieth Century, Volume 1: The War of the Words and Volume II: Sexchanges , the first installments of a three-part sequel to their Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination . They have also coedited The Norton Anthology of Literature by Women: The Tradition in English. (shrink)

That the pattern into which Lentricchia seeks to assimilate Stevens is politically charged becomes clearest when we turn to the following oddly incomprehensible statement: “In the literary culture that Stevens would create, the ‘phallic’ would not have been the curse word of some recent feminist criticism but the name of a limited, because male, respect for literature” . At the point where he makes this assertion, Lentricchia has been persuasively demonstrating that Stevens was “encouraged … to fantasize the potential social (...) authority of the literary as phallic authority” . But suddenly the critic’s measured discourse is disrupted by obviously personal feelings about the “curse word of some recent feminist criticism” and by a dazzlingly illogical definition of “respect for literature.” Such a disruption suggests that, in making his apparently objective argument about Stevens, Lentricchia has some other not so hidden agenda—and, of course, his peculiar decision to link his discussion of Stevens with an attack on The Madwoman in the Attic further supports this conclusion. What most strikingly reinforces the point, however, is the hysterical—or perhaps, with some recent feminist linguists, we should say “testerical”—rhetoric in which he couches his assault on our work.14 14. The term “testeria,” for male “hysteria,” is proposed by Juli Loesch in “Testeria and Penisolence—A Scourge to Humankind,” Aphra: The Feminist Literary Magazine, 4, 1 : 43-45; quoted in Casey Miller and Kate Swift, Words and Women: New Language in New Times , pp. 60-61. Sandra M. Gilbert, professor of English at Princeton University, and Susan Gubar, professor of English at Indiana University, are coauthors of No Man’s Land: The Place of the Woman Writer in the Twentieth Century, Volume I: The War of the Words , the first installment of a three-part sequel to their Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination . They have also coedited The Norton Anthology of Literature by Women: The Tradition in English. (shrink)

Some years ago, Deborah Blum, a Pulitzer Prize–winning science journalist, nailed the divide between scientists who conduct research on animals in the hope of advancing medical knowledge and people who object to that work for being immoral and inhumane. They are “like two different nations, nations locked in a long, bitter, seemingly intractable political standoff,” she wrote in her 1994 book, The Monkey Wars. The two sides certainly have been like nations locked in a long, bitter standoff. That standoff has (...) seemed intractable. But when Blum talked to people on both sides, she found glimmers of hope—a few individuals willing to listen to one another and find common ground. “When they can be freely heard,” she concluded, “then we will have progressed to another place, beyond this time of hostilities.” Today, while we are not yet beyond hostilities, we have progressed to another place. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page inside_front_cover-inside_front_cover, January/February 2022.

For more than eleven years, I worked with Dan Callahan as an editor, a liaison with journalists, and a sounding board for ideas. To Dan, every new writing project was a thrill, whether it was for the New Republic or a blog. He consumed a wide range of professional and scholarly literature, followed the news with the eye of a reporter, and called experts when he wanted to learn more about something he had read. The result was a volcanic bubbling (...) of story ideas. If he didn't turn them into articles or books, I sometimes had the feeling that he might burst. (shrink)

Bioethics in the blogosphere. There is important news, and then there is important news that grabs hold of people and gets them thinking and talking: “Did you see the piece on . . . ?” “What do you think?” “What would you do?” That kind of news often has to do with bioethics. The desire to capture diverse perspectives on bioethical issues of the day led The Hastings Center to launch Bioethics Forum nearly five years ago. Greg Kaebnick, editor of (...) the Hastings Center Report, conceived of it as an online adjunct to the Report. Commentaries that would take at least a month to work their way through the Report’s production cycle could be posted immediately on Bioethics Forum. And the Forum might broaden our .. (shrink)

At a time of fake news, hacks, leaks, and unverified reports, many people are unsure whom to believe. How can we communicate in ways that make individuals question their assumptions and learn? My colleagues at The Hastings Center and many journalists and scientists are grappling with this question and have, independently, reached the same first step: recognize that facts can't be fully understood without probing their connection to values. “Explaining the basics is important, of course, but we also need to (...) diversify our approach to the coverage of science—particularly as it intersects with the matrix of cultural, religious, social, and political values of our readers,” said an article in Undark, an online magazine of science journalism. An editorial in Nature called for scientists to engage directly with citizens in debates over climate change and genome editing, noting that “the ethical issues can be critically dependent on the science, for example, in understanding where the boundaries between non-heritable and heritable genome modifications might be.” We're here to help. (shrink)

We first got to know TEDMED, a partner of TED (known for its entertaining talks on important ideas), in November 2011, when Jay Walker, its ebullient curator and chairman, visited The Hastings Center to discuss our common interests. What took place was an energizing conversation with Hastings Center staff and several members of the center's board of directors about some of the most intractable health care problems. Jay sketched his vision of marshaling creative and motivated leaders from business, public policy, (...) and medicine to address them. He imagined these people drawing on their areas of expertise to make unforeseen connections—perhaps some insight from business would spark a new idea for combatting childhood obesity or eliminating medical errors. They would use their influence to put the best ideas into practice. Soon after, Walker's colleagues were back in touch with a plan for launching his movement: The Great Challenges of Health and Medicine program. (shrink)

Genetic research powered by social media has the potential for great benefit: to quickly and inexpensively gather the massive amounts of data that are essential for understanding the genetic basis of diseases. But what are the ethical soft spots or gaps? I invite readers to write commentaries on this question for the blog of the Hastings Center Report.

To get an idea of how personalized medicine could reshape patient care in the years ahead, one need only look at how it is beginning to reshape the care of patients with cancer. Cancer is where personalized medicine has gained its firmest foothold. The longstanding scattershot practice of prescribing the same drugs to virtually all patients with a particular type of cancer is giving way to a more selective approach in which genetic tests are run on tumor samples to identify (...) which patients are likely to benefit from which drugs, or to tell whether they need drugs at all. This shift holds the prospect of improving cancer care and the stewardship of costly cancer care resources. It has had its successes and failures .. (shrink)

Research on how genetics contribute to human behavior and achievement raises many bioethical questions. What are we to make, for example, of a study published last year that found that students with genetic variants associated with educational attainment (years of education) took more advanced math classes in ninth grade? Does this finding have implications for education practice? Should it? How so? Questions like these serve as reminders that genetic science has long been misused to draw conclusions about individuals and groups (...) of people, conclusions laced with racism and other biases. As research on human genomics ramps up, now is the time to ramp up science communication about what these studies do and, importantly, do not show. A new feature on The Hastings Center's website does just that. (shrink)

What is, what was the human? This book argues that the making of the human as it is now understood implies a renogotiation of the relationship between the self and the world. The development of Renaissance technologies of difference such as mapping, colonialism and anatomy paradoxically also illuminated the similarities between human and non-human. This collection considers the borders between humans and their imagined others: animals, women, native subjects, machines. It examines border creatures (hermaphrodites, wildmen, and cyborgs) and border practices (...) (science, surveying, and pornography). (shrink)

Book reviewed in this article: No Longer Patient: Feminist Ethics & Health Care. By Susan Sherwin Feminist Perspectives in Medical Ethics. Edited by Helen Bequaert Holmes and Laura M. Purdy.

It is hardly necessary to rent I Spit on Your Grave or Tool Box Murders for your VCR in order to find images of sexuality contaminated by depersonalization or violence. As far back as Rabelais’ Gargantua, for example, Panurge proposes to build a wall around Paris out of the pleasure-twats of women [which] are much cheaper than stones”: “the largest … in front” would be followed by “the medium-sized, and last of all, the least and smallest,” all interlaced with “many (...) horney joy-dinguses” so that fortification would be impregnable, except for the “ordure and excretions” of the flies it would doubtlessly attract.1 Two centuries later, one of Rabelais’ compatriots, the Marquis de Lade, described the rage of a sexually initiated daughter against a woman who refuses to consider her “pleasure-twat” “cheaper than stones.” The Sadeian heroine first sodomizes her puritanical mother with an artificial penis, then has her infected with syphilis, and finally performs infibulations to prevent the infected semen from leaking out: “Quickly, quickly, fetch me needle and threat! … Spread your thighs, Mama, so I can stitch you together.”2One century later in England, the author of My Secret Life explained that, when in a state of sexual excitement, “he is ready to fuck anything,” from his sister to his grandmother, from a ten-year-old, to a woman of sixty, for a standing prick has no conscience.” To this credo, he adds the admonition, “Woe be to the female whom he gets a chance at, if she does not want him, for he will have her if he can.”3 The sexually aroused man in the contemporary American film Looking for Mr. Goodbar curses the woman who does not want him as much as she wants a room of her own and the freedom to choose a succession of male lovers. After he resentfully determines to have her when he gets the chance , he rapes her and finally knifes her to death, exclaiming “That’s what you want, bitch, right? That’s what you want.”However these individual works are labeled, such passages remind us of the long history of pornography, a gender-specific genre produced primarily by and for men but focused obsessively on the female figure. In their depictions of female sexuality, narratives from Gargantua to La Philosophie dans le boudoir, My Secret Life, and Looking for Mr. Goodbar explain why definitions of the pornographic have recently moved away from “obscenity,” a term that generally refers to the sexually stimulating effects of a picture, a novel, or a film on the male reader/observer, and toward “dehumanization,” a word that is used to evoke the objectification of women. As Irene Diamond has demonstrated, during the past decade the generally held assumption that pornography is about male sexuality has been qualified by those who argue that “the ‘what’ of pornography is not sex but power and violence, and the ‘who’ of concern are no longer male consumers and artists but women.”4 1. François Rabelais, Gargantua and Pantagruel, trans. Jacques Le Clercq , bk. 2, chap. 15. I have used this translation because it is employed in Helene Iswolsky’s translation of Mikhail Bakhtin’s Rabelais and His World . With no analysis of gender, Bakhtin’s exclusive focus on the grotesque wipes out the significance of Rabelais’ sexual imagery.2. Marquis de Sade, quoted in a brilliant reading of this text by Angela Carter, The Sadeian Woman and the Ideology of Pornography , p. 127; all further references to this work , abbreviated SW, will be included in the text.3. My Secret Life , p. 361.4. Irene Diamond, “Pornography and Repression: A Reconsideration,” in Women: Sex and Sexuality, ed. Catharine Stimpson and Ethel Spector Person , p. 132. Susan Gubar is professor of English and women’s studies at Indiana University, Bloomington. Together with Sandra M. Gilbert, she has coauthored The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination and co-edited both Shakespeare’s Sisters: Feminist Essays on Women Poets and the Norton Anthology of Literature by Women: The Tradition in English. This fall they will publish the first volume of a three-volume work, No Man’s Land: The Place of the Woman Writer in the Twentieth Century. Her previous contribution to Critical Inquiry is “ ‘The Blank Page’ and the Issues of Female Creativity”. (shrink)

Woman is not simply an object, however. If we think in terms of the production of culture, she is an art object: she is the ivory carving or mud replica, an icon or doll, but she is not the sculptor. Lest this seem fanciful, we should remember that until very recently women have been barred from art schools as students yet have always been acceptable as models. Both Laura and Beatrice were turned into characters by the poems they inspired. A (...) poet as sensitive as Chaucer to this reification of the female allowed Criseyde to recognize and lament her own dilemma: "Allas, of me, unto the worldless ende,/Shall neyther ben ywritten nor ysonge/No good word; for these bokes wol me shende" . Like the words written about her, she fears she will be "rolled on many a tongue!"6· 6. I am indebted for this view of Criseyde to Marcelle Thiebaux's "Foucault's Fantasia for Feminists: The Woman Reading" .Susan Gubar, associate professor of English at Indiana University, is coauthor of The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination and coeditor of Shakespeare's Sisters: Feminist Essays on Women Poets, both with Sandra M. Gilbert. They are currently working on No Man's Land: Feminism and Modernism, the sequel to their book. (shrink)

There is a striking difference, however, between the ways female and male modernists define and describe literal or figurative costumes. Balancing self against mask, true garment against false costume, Yeats articulates a perception of himself and his place in society that most other male modernists share, even those who experiment more radically with costume as metaphor. But female modernists like Woolf, together with their post-modernist heirs, imagine costumes of the mind with much greater irony and ambiguity, in part because women's (...) clothing is more closely connected with the pressures and oppressions of gender and in part because women have far more to gain from the identification of costume with self or gender. Because clothing powerfully defines sex roles, both overt and covert fantasies of transvestism are often associated with the intensified clothes consciousness expressed by these writers. But although such imagery is crucially important in works by Joyce, Lawrence, and Eliot on the one hand, and in works by Barnes, Woolf, and H. D. on the other, it functions very differently for male modernists from the way it operates for female modernists.Sandra M. Gilbert, professor of English at the University of California at Davis, is the author of Acts of Attention: The Poems of D.H. Lawrence and In the Fourth World; the coauthor, with Susan Gubar, of The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination, and its sequel, No Man's Land: The Woman Writer and the Twentieth-Century Literary Imagination. (shrink)

A definition of [George] Eliot as renunciatory culture-mother may seem an odd preface to a discussion of Silas Marner since, of all her novels, this richly constructed work is the one in which the empty pack of daughterhood appears fullest, the honey of femininity most unpunished. I want to argue, however, that this “legendary tale,” whose status as a schoolroom classic makes it almost as much a textbook as a novel, examines the relationship between woman’s fate and the structure of (...) society in order to explicate the meaning of the empty pack of daughterhood. More specifically, this story of an adoptive father, an orphan daughter, and a dead mother broods on events that are actually or symbolically situated on the margins or boundaries of society, where culture must enter into a dialectical struggle with nature, in order to show how the young female human animal is converted into the human daughter, wife, and mother. Finally, then, this fictionalized “daughteronomy” becomes a female myth of origin narrated by a severe literary mother uses the vehicle of a half-allegorical family romance to urge acquiescence in the law of the Father.If Silas Marner is not obviously a story about the empty pack of daughterhood, it is plainly, of course, a “legendary tale” about a wanderer with a heavy yet empty pack. In fact, it is through the image of the packman that the story, in Eliot’s own words, “came across my other plans by a sudden inspiration”—and, clearly, her vision of this burdened outsider is a re-vision of the Romantic wanderer who haunts the borders of society, seeking a local habitation and a name.11 I would argue further, though, that Eliot’s depiction of Silas Marner’s alienation begins to explain Ruby Redinger’s sense that the author of this “fluid and metaphoric” story “is” both Eppie, the redemptive daughter, and Silas, the redeemed father. For in examining the outcast weaver’s marginality, this novelist of the “hidden life” examines also her own female disinheritance and marginality.12 11. Eliot to Blackwood, 12 Jan. 1861, quoted in Ruby V. Redinger, George Eliot: The Emergent Self , p. 436. As Susan Garber has suggested to me, the resonant image of the “packman” may be associated with the figure of Bob Jakin in The Mill on the Floss , the itinerant pack-bearing peddler who brings Maggie Tulliver a number of books, the most crucial of which is Tomas à Kempis’ treatise on Christian renunciation .12. Rediner, George Eliot, p. 439; Eliot, “Finale,” Middlemarch, p. 896. Sandra M. Gilbert, now professor of English at the University of California, Davis, will join the Department of English at Princeton University in fall 1985. Her most recent works include a collection of poems, Emily’s Bread , and, coedited with Susan Gubar, The Norton Anthology of Literature by Women: The Tradition in English . In addition, she is at work on Mother Rites: Studies in Literature and Maternity, a project from which “Life’s Empty Pack” is drawn, and, with Susan Gubar, on No Man’s Land: The Place of the Woman Writer in the Twentieth Century, a sequel to their collaborative Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination . “Costumes of the Mind: Transvestitism as Metaphor in Modern Literature” appeared in the Winter 1980 issue of Critical Inquiry. (shrink)