IJFAB: International Journal of Feminist Approaches to Bioethics

In Medical Entanglements: Rethinking Feminist Debates About Healthcare, Kristina Gupta (2020) adopts a feminist social constructionist approach to medicine (10) and utilizes feminist science studies, queer studies, disability studies and intersectional approaches to analyze three controversial medical interventions: transition-related care, sexuopharmaceuticals and weight-reduction interventions (11–15). Her motivation for writing the book originated from her experience thinking about drug treatments for “female” (i.e., cisgendered women’s) sexual dissatisfaction. Those arguing on behalf of drug treatments for sexual dissatisfaction maintained that women have the right to experience sexual pleasure and ought to have pharmaceutical options to pursue these ends. Those opposed claimed that drug companies developed these drugs to increase profits while ignoring the social causes of women’s sexual dissatisfaction (1). Upon considering the positions for and against these drugs, Gupta realized that there is no “correct” position to take in the debate. She explains that in our current sociopolitical reality, medical interventions have been primarily developed to promote normalization that supports oppressive systematic structures (2). However, she acknowledges that normalization can be a survival strategy and can alleviate individual suffering. Additionally, she recognizes that there are situations in which these medical interventions will be appropriated for subversive, nonnormative, and queer ends (3).

Before delving into her discussions on these medical interventions, Gupta provides a brief overview of feminist critiques of medicine, including how medicine has benefited marginalized persons and intersectional feminist critiques of [End Page 161] contemporary and historical Western biomedicine approaches (21). She outlines ways in which Western biomedicine has reinforced racism, ableism, sexism, heterosexism, and colonialism (23–25). In what follows, Gupta devotes a chapter to each of the above-mentioned medical interventions. She approaches the discussed medical interventions critically but ultimately adopts the same conclusion for all three: Although these medical interventions reinforce normative and oppressive standards, they are nevertheless valuable as they reduce suffering and promote individual flourishing. Additionally, she argues that there must be a radical transformation of the systemic structures that uphold and reinforce sexist, racist, ableist, and classist tendencies present in current approaches to these medical interventions.

In her third chapter, Gupta begins her discussion on the ethics and the politics of transition-related care. Her goal in this chapter is to conceptualize ways in which trans healthcare can be less sexist, heterosexist, classist, racist, and ableist (41). Gupta begins this chapter with a case study of a transwoman, Oneal Ron Morris, who provided unlicensed silicone injections both to transgender and cisgender women. Morris was convicted of manslaughter in 2017 after the death of one of her clients. Prior to this, in 2011, Morris also faced jail time for practicing medicine without a license, after one of her clients suffered severe complications. Despite the risk, transgender women still sought out medical procedures from Morris. Gupta argues that the demand for these illicit procedures, despite the known risks, “highlights the current failures of the medical system to meet the needs of transgender people in an affirming way” and reveals the complicated relationship between gender normalization and gender-related medical interventions (42). Following this, Gupta moves into a discussion of critiques of medical approaches to trans related healthcare, focusing on how normative standards imposed by society (including parts of the trans community) and medical practitioners reinforce the gender binary and put pressure on trans persons to “perfectly” transition (53–56). Despite the tendency of gender- affirming surgeries to reinforce the gender binary, Gupta argues that gender affirming surgeries are valuable in that they are effective at alleviating suffering that trans people may experience (57–58). Gupta argues that instead of focusing on how these surgeries may reinforce the gender binary, what ought to be focused on is ensuring that trans people do not feel coerced by society or the medical community to medically transition (58). She then urges us to recognize and validate the multiple ways persons can be trans (58–59). Finally, she encourages us to challenge the gatekeeping function of the medical community in trans healthcare, which would...