Migration often requires the renegotiation of familial and gender roles as immigrants encounter potentially competing values and demands. Employing ethnographic methods and including in-depth interviewing and participant observation, the authors explore the experiences of 29 South Asian and Chinese Canadian female family caregivers. Caregiving was central to their role as women and members of their ethnocultural community. The women were often engaged in paid labor that compressed the time available to fulfill their duties as caregivers. Women’s role in the transmission (...) of cultural values that serve to shore up the boundaries of their ethnic community did not allow for significant renegotiation of their caregiving responsibilities despite disrupted family networks and increased demands. These caregiving arrangements are more costly to women in Canada than in their countries of origin. (shrink)

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently (...) in the analysis as a high‐level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health‐care providers in spaces called ‘wait times’, where it is systematically rendered ‘unknowable’. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. (shrink)

The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient (...) ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood – of residents and staff – are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued. (shrink)

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have (...) been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples’ ability to enact moral agency in making such decisions. (shrink)

Identification of non-coding RNAs (ncRNAs) has been significantly improved over the past decade. On the other hand, semantic annotation of ncRNA data is facing critical challenges due to the lack of a comprehensive ontology to serve as common data elements and data exchange standards in the field. We developed the Non-Coding RNA Ontology (NCRO) to handle this situation. By providing a formally defined ncRNA controlled vocabulary, the NCRO aims to fill a specific and highly needed niche in semantic annotation of (...) large amounts of ncRNA biological and clinical data. (shrink)

Two general features of metameric patterning in Drosophilaare considered: (1) maintenance of a constant number of metameres (segments or parasegments) in the face of variation in length of the embryo; (2) expression of pattern by on‐off switchings of particular genes, with only three or four rows of cells to each element of pattern. For each of these features, the general strategic question is raised: could reaction‐diffusion theory account for this? In both cases, it is answered affirmatively. For the second feature, (...) this review contains some hitherto unpublished computer simulations by one of us (K. Y. T.), illustrating that a reaction‐diffusion mechanism can be transformed into a patterned switching mechanism by nothing more than compartmenting of the diffusion region. For the scale of three compartments to one pattern repeat unit (representing three rows of cells to a segment) the switching pattern predicted by computation is two‐off to one‐on. This resembles the pattern of expression of the engrailed gene, posteriorly localized in each segment. (shrink)

This paper discusses findings from a research study that investigated the experience of being a breastfeeding woman in New Zealand. The study was motivated by a desire to better understand why the majority of New Zealand women wean their infants before 6 months of age, despite the benefits of prolonged breastfeeding being well accepted. Nineteen women, who were breastfeeding or had recently breastfed, were engaged in unstructured interviews about their experience, and the results were examined using a reflective lifeworld research (...) methodology. The findings presented here demonstrate that women often employ an interpretive framework that is aligned with the philosophical tradition of Descartes’ mind–body split, also know as Cartesian dualism. This leads to a widely held perception of the breast as an object, which emerged in the participants’ narratives and is explored using Heidegger's philosophical interpretation of equipment. We conclude that the objectification of the breast in our society fails to provide women with language that describes the breastfeeding experience in a meaningful way, thus undermining women's ability to articulate and reconcile their embodied breastfeeding experiences. (shrink)

In recent years, sequencing technologies have enabled the identification of a wide range of non-coding RNAs (ncRNAs). Unfortunately, annotation and integration of ncRNA data has lagged behind their identification. Given the large quantity of information being obtained in this area, there emerges an urgent need to integrate what is being discovered by a broad range of relevant communities. To this end, the Non-Coding RNA Ontology (NCRO) is being developed to provide a systematically structured and precisely defined controlled vocabulary for the (...) domain of ncRNAs, thereby facilitating the discovery, curation, analysis, exchange, and reasoning of data about structures of ncRNAs, their molecular and cellular functions, and their impacts upon phenotypes. The goal of NCRO is to serve as a common resource for annotations of diverse research in a way that will significantly enhance integrative and comparative analysis of the myriad resources currently housed in disparate sources. It is our belief that the NCRO ontology can perform an important role in the comprehensive unification of ncRNA biology and, indeed, fill a critical gap in both the Open Biological and Biomedical Ontologies (OBO) Library and the National Center for Biomedical Ontology (NCBO) BioPortal. Our initial focus is on the ontological representation of small regulatory ncRNAs, which we see as the first step in providing a resource for the annotation of data about all forms of ncRNAs. (shrink)

Theorists have posited that investment in production has a radical impact on women's gender-role attitudes, whereas investment in reproduction exerts a conservative influence. Informed by an interactive approach to understanding the effects of racism and sexism, this article explores the commonalities and differences in Black and White women's gender-role attitudes, and assesses the applicability to Black women of the investment-in-production and investment-in-reproduction hypothesis. The data in part supported the contention that this hypothesis would be more valid for White (...) than Black women. The article concludes that the exclusion of race from our analyses impedes and distorts the development of feminist theory. (shrink)

Based on interviews with a random sample of white women who are in a second marriage, this article examines changes in women's marital power across marriage, divorce, and remarriage. In some marriages, women's market work is not considered a resource and hence does not have a positive effect on marital power, particularly when husbands are employed in low-status occupations. Conversely, women who are domestically oriented do not necessarily suffer a loss of power. Hochschild's concept of “economy of gratitude” illuminates (...) the way that marital power is affected by the meanings couples assign to women's paid and unpaid labor. Furthermore, women's previous market work and marital and divorce experiences affect the meaning of their paid and unpaid labor upon remarriage, as well as their desire for each. (shrink)

This article investigates the critical potential of a contemporary dystopia, The Handmaid’s Tale (Miller 2017-), a U.S. television series adapted from a popular novel by Canadian author Margaret Atwood (1985). The text is widely understood as a feminist intervention that speaks to ongoing struggles against gender oppression, but in this article I consider the invitations that the show offers its viewers in treating race the way that it does, and consider what it means to refuse these invitations in pursuit of (...) a critical feminist understanding of authority, legal subjectivity, and violence. Drawing on the recent turn to genre, my reading focuses on how whiteness is reproduced through this cinematic text and its inculcation of particular ways of seeing, modes of identification and attachment. The Handmaid’s Tale’s post-racial aesthetic means that its thematic engagement with gender, sexuality and resistance actively disavows national and international histories of racist state violence and white supremacy. Its problematic feminism is thus uniquely instructive for understanding how whiteness is reproduced in contemporary (neo)liberal configurations of legal subjectivity and state authority. (shrink)

This article investigates the work of mourning following the terrorist attacks in New York and Washington on September 11, 2001. Combining discussions of mourning, kitsch and sentimentality, I examine the perverse transformation of grief into patriotic nationalism. Linking Freud’s description of mourning as work with Derrida’s articulation of grief as ‘a work working at its own unproductivity’, I explore how grief has been paired with icons of American nostalgia, such as Norman Rockwell, as well as kitschy souvenirs from Ground Zero (...) vendors, and, through this pairing, been transformed into a motive force for war. A central part of this operation, I argue, is the process of identification with the traumatic event. Identification, what Freud describes as a ‘binding force’, takes place across diverse fields - from White House speeches, to kitsch memorabilia made available immediately following the attacks. Identification with the event enables identification with the nation - an operation immediately reifying the official rhetoric of ‘Us against Them’ propounded by President Bush and his advisers. As grief over 9/11 is transformed into a perpetual rationale for war, that day becomes a new origin conveniently obliterating all that came before regarding the history of US nation-building and its own brand of terrorism. (shrink)

How do non-Western men interact with and understand the form of Western masculinity associated with global dominance? Is their experience of Western hegemonic masculinity’s denigration of their national/ethnic masculinity similar to what occurs among subordinated nonwhite and lower-class men in Western countries? We take up this subject in our study of the South Korean Father School movement, which trains Korean men to become more involved and loving family men. Our analysis of the discursive practices of Father School organizational leadership and (...) participants discovers the relational construction of a problematic “Korean” masculinity and a remedial “New Man” masculinity associated with white American men. We draw on Chen to suggest the Father School men’s movement is an attempt to elevate Korean masculinity on the world stage by “bargaining” with Western hegemonic masculinity. (shrink)

This discussion contributes to the ongoing debates regarding the (re)sexualisation of female bodies in popular and visual culture. Visual texts display the upper middle-class white female as the carrier of mainstream neo-liberal values in Western societies, and the success of this approach is the twinning of the culture of individualism, self-interest and market values with feminist vocabularies; namely, choice, freedom and independence. Drawing on a broad feminist scholarship that includes discussions on the influence of the HBO series Sex and (...) the City, semiotic analysis is combined with intersectionality to gain an understanding of how gender, class and sexuality shape and reinforce whiteness as entitled to luxury in an advertising campaign for Michael Kors luxury goods. Contemporary representations have expanded to include representations of affluent women who appear to have it all. These new post-feminist subjectivities promote an aesthetic of wealth, to display privileged whiteness, heterosexuality, normative Western beauty ideals and individualism. An intersectional approach reveals the apparent neutrality of neo-liberal values as being an expression of whiteness, specifically in representations of white women as economically independent neo-liberal subjects who display their status through the conspicuous consumption of luxury brands. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Normalizing” Intersex Didn’t Feel Normal or Honest to Me.Karen A. WalshI am an intersex woman with Complete Androgen Insensitivity Syndrome (CAIS). My 57–year history with this has its own trajectory—mostly driven by medical events, and how I and my parents reacted. Most of my treatment by physicians has not been positive. It didn’t make me “normal” at all. I was born normal and didn’t require medical interventions. And (...) by the way, I’ve never been confused about who or what I am.Truthful disclosure didn’t come to me about my biology and what was done to me as an infant until I was 33, when I forced the issue by removing my medical records from my endocrinologist’s office. I learned that there was never full disclosure to my [End Page 119] parents either, and therefore there was no informed consent for the “corrective” surgeries performed on me as an infant. My parents were only told that their little girl would get cancer and would not have a normal development as a girl unless her “deformed ovaries” were removed, and that they should never discuss these problems with me. Thus, after having presented with an inguinal hernia and having exploratory surgery at age 16 months, my intra–abdominal testes were removed in a second surgery two months later. I was pronounced a “male pseudohermaphrodite,” a diagnosis that was shared neither with my parents nor with me.Years later, I discovered an article my surgeon published in 1960 in the Delaware Medical Journal about me and another intersex person he operated on (whom he labeled a “true hermaphrodite”). The article gives a very detailed pathology report of my gonads, but only two sentences regarding my welfare and the rationale for performing those surgeries. Dr. J. F. Kustrup wrote in this article, “These [two cases] emphasize the need for early diagnosis and treatment in order to avoid the possibility of malignant change and to permit these individuals to follow a normal psychosexual pattern.” And: “Hermaphroditism and pseudohermaphroditism are conditions in which early diagnosis and treatment are essential to avoid malignant degeneration and to allow the child some chance toward normal pyschic [sic] development.” I was grateful to find this article because it revealed the unfounded assumptions underpinning the recommendations for treatment, much of which continues today. Worse even than the sort of social prejudice that shapes treatment is the absence of evidence for what doctors treat as “necessary” interventions. For my syndrome, CAIS, there never was—and still is not—data to support the cancer scare, or the opinion that I’d be confused and not have a normal life.From about the age of four, I can remember being different and being stonewalled by my doctor and prevented by my parents from talking about it. The feelings and fears I tried to express were shushed away, and I could tell that my questions were upsetting everyone. Even if I had wanted to be complicit with their lame diversions and nonsensical explanations, the massive abdominal scars were there as a daily reminder and hinted at a very different story.The Road to Hell is Paved with Good IntentionsGrowing up, I was treated like a fascinoma and a lab rat at a major teaching hospital on the East Coast. All I learned from those doctors as a young kid was what it feels like to be ogled, photographed and probed by a roomful of white–coated male doctors. Dissociation made itself my friend, and helped me to cope through the annual genital and anal exams and probing. I thought I was a freak and I felt completely powerless to protect myself from them and their “care”.At my annual appointment at age 12, with my mom present, three doctors told me I was infertile. Learning that I couldn’t have kids really saddened and shocked me, but there was no opportunity to talk about my feelings—either that day, or any time afterward. I was told to stop crying. I remember them telling me that there was no one else like me and that this was a random genetic anomaly, thereby reinforcing the freakishness... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Practice of SurgeryKaren DevonThere’s no one on the snowy road driving beside me. It’s Christmas Eve, the night the newest attending surgeon on staff gets to be on call. Tonight feels like an anniversary of sorts. The first time I performed an appendectomy “alone” was on Christmas Eve. I can’t recall if it was snowing back then since I hadn’t left the hospital in days. I had assumed (...) that while I was operating on that 26–year–old woman with new abdominal pain that moved towards the left lower quadrant, my attending staff on call was sleeping soundly. I didn’t even know where he lived, or how long it would take if something catastrophic were to happen. I phoned the white–haired man to get his blessing just before midnight. “Have you done this operation before?” he asked. “Yes, several, but not completely alone” I confessed. “Go for it and call me when you are done. Oh, and be safe!” Click. Gulp.As I drive in tonight, again past midnight, I reflect upon that night. Was it practice? A right of passage? The most appropriate treatment for the patient? Perhaps it was even safer this way since my attending really had never done this operation the way it is now done—laparoscopically—by residents. I clearly recall telling the patient and her mother, “We do this all the time! The staff surgeon on call will come in if I need him, but the chief residents always do this operation and I feel comfortable taking care of you.” Sign on the dotted line and make sure you read the part where you are told this is a teaching hospital. Not only was independence an expectation, but I was also supposed to teach the more junior house staff how to emulate what I was so expertly performing.That night I took out the rotting appendix without incident and called the grey haired surgeon in the wee hours. “Merry Christmas Doctor. Sorry to bother you. I just wanted to let you know that the patient is awake and doing well.” “Yes I know. Good work” he replied. “I was in my office. Just in case.”As a resident, I was often torn between the need to gain independence in order to learn and grow as a surgeon, and the idea that I was practicing. As most budding surgeons do, I wanted to be the person doing the surgery. Working on my technical skills was clearly an important part of expertise. Surgery is inherently different than other types of medicine. It seemed slightly more difficult for someone to stop my cutting, than to catch the error in a prescription, before some damage is done. Perhaps a little more like driving a car, than learning to use a calculator. Recently a more modern surgical education is evolving, whereby students practice by simulations on machines. Yet educators know that ultimately many “firsts” need to occur with real patients. That proficiency and expertise are more than a diagnosis, a steady hand, or even the two combined. If the experience of operating as the primary surgeon without immediate supervision, on a patient with acute appendicitis never occurred until we passed licensing exams wouldn’t that be more harmful? I may have been the least legally responsible for outcomes, that night of my own first, when the grey–haired surgeon took the [End Page E1] responsibility of trusting me. But in fact, the obligation I felt was enormous. We cannot simulate the weight of responsibility that comes when responsible for another human being, who you have met and who provides their trust in you. Furthermore, as the teachers of this art and science, we need to balance our obligations to each individual patient with our obligation to society to train competent and caring future surgeons. Surgery would have no history if the “practice” of surgery had nothing to do with practice, defined in its simplest form, yet how do we cover all of this during the late night conversation that is called informed consent. Interestingly since that December evening and for the next 200 laparoscopic appendectomies before my graduation in to... (shrink)

This essay examines the theory of maternal impressions, the belief that a woman’s experiences or emotions during pregnancy could explain congenital disability or emotional/ behavior differences in her child and asks why this theory circulated as an explanation for disability seen at birth by both medical doctors and in literature for far longer than it did across the Atlantic. By presenting examples from nineteenth-century medical literature, popular fiction, maternal handbooks, and two canonical works of literature, Nathaniel Hawthorne’s The Scarlet Letter (...) and Harriet Jacobs’ Incidents in the Life of a Slave, I argue that maternal impressions worked to maintain anxiety for women, and particular white women, to ensure they felt responsible if anything was “wrong” with their child. Ultimately, I show how maternal impressions was both an ableist and racialized understanding of inheritance that wouldn’t be discarded until the emergence of eugenics in the early twentieth century. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 42, no. 3. © 2016 by Karen An-hwei Lee 741 Karen An-hwei Lee On New-Wave Asian Feminist Mermaids On a new wave, the old white shark fixates on everything with a slit— jade cheomsang or qipau slit on the left side, a mailbox in Hong Kong, a can opener about to spill sardines from the South China Sea, split female consciousness of folklore mermaids (...) sashaying on knives, all-or-nothing vice or virtue lost to a bedrock of lost razor blades of dialogical aqua hearts of a bronze-scaled woman folding her new legs— crossing a split— spit without the l- slit without a pThe Final Words of Madame Mao Mao, the man whom I despaired of meeting, exploded out of the revolution in a nailed crate delivered to my door. I rose to stardom, not elite by birth— call me Jiang Qing or Lan Ping. Chairman’s hands: a bouquet of mudan-hua, odorous peonies. I am, after all, Madame Mao. 742 Karen An-hwei Lee A mail carrier shakes her head. Mail-order groom? I must report you to Zhou Enlai. This is counterrevolutionary. I never ordered a husband in a Mao outfit. Is Mao a four-stroke ideogram brushed in my room while my mother wept as my father beat her with a garden spade? My real name is Mao as in Maoism. This man breathed fire in a thousand miles of revolution, one man to one woman. Please do not say my last words were propaganda— Chairman! I love you! Your comrade and your student is coming to see you!... (shrink)

In this paper, I explore the ways in which settler-colonial states utilize the category of disability in immigration and Indigenous population regimes to redress settler-colonial anxieties of white fragility. As well documented within the literature, settler-colonial governance operates a particular logic of population management that aims to replace longstanding Indigenous peoples with settler populations of a particular kind. Focusing on the case of Australia and drawing on a range of historical and current empirical sources, the paper examines the central (...) importance of the category of disability to this settler-colonial political intent. The paper identifies the breadth of techniques of governance to embed, normalize and naturalize white settler-colonial rule. The paper concludes with the suggestion that the state mobilization of the category of disability provides us with a unique way to identify, understand and analyse settler-colonial power and the interrelationship of disability, settler-colonial immigration regimes and Indigenous people under its enterprise. (shrink)

This essay assesses the oft‐made link between Walter Rauschenbusch and Martin Luther King Jr. Denying neither Rauschenbusch’s influence on King nor King’s social gospel status, it nevertheless questions the way historians locate Rauschenbusch’s legacy in King and the civil rights movement. This strategy, however unintentionally, reproduces the white social gospel’s “astigmatism” on race and undermines the contributions of black social gospel (and other neglected) leaders even as revised histories affirm them. After exploring King’s references to Rauschenbusch and Rauschenbusch’s reflections (...) on race, the paper compares their theologies. This comparison reveals key differences on race and economic justice that ramify across Rauschenbusch’s and King’s distinctive articulations of social gospel categories, further complicating historians’ claims on King. Oversimplifying the connection between these important figures in religious ethics distorts theological understanding of social gospel legacies and compromises their power for future generations. (shrink)

This paper explores the power of womanist ethics to illuminate the Confederate monuments debate. First, I draw on Emilie Townes’s analysis of the “cultural production of evil” to construe Confederate monuments as products of the “fantastic hegemonic imagination” that render visible for whites the invisibility of “whiteness.” Second, I argue that Angela Sims’s work on lynching provides a vivid example of how “countermemory” functions as an antidote to the fantastic hegemonic imagination. Finally, I argue that Delores Williams’s re-evaluation of the (...) cross as a sacred symbol enables a reading of Confederate monuments as realist symbols of violence that require displacement from the center to the periphery of national sacred space. I conclude that although the debate on Confederate monuments is important, womanist analysis warns against an overly-narrow focus on this issue, lest we neglect the already obscured gendered, classist, homophobic, and xenophobic dimensions of structural injustice that the monuments represent. (shrink)

I argue that for those who migrate to other countries for economic survival and political asylum, historical trauma wounds across geographical space. Using the work of David Eng and Nadine Naber on queer and feminist diasporas, I contend that homogeneous discourses of Filipino nationalism simplify and erase transphobia, homophobia, and heterosexism, giving rise to intergenerational conflict and the passing-on of trauma among activists in the United States. Focusing on Filipina/o/x American activist organizations, I center intergenerational conflict among leaders, highlighting transphobic (...) and homophobic struggles that commonly arise in cisgender women majority spaces. I contextualize these struggles, linking them to traumas inherited through legacies of colonialism, feudalism, imperialism, hetero-patriarchy, capitalism, and white supremacy. I inquire: how does historical and personal trauma merge and shape activist relationships and conflict, and what are activists doing to disrupt and work through historical trauma? I advocate for a decolonizing approach for “acting out” and “working through” trauma and healing collectively. By exploring conflict in organizations shaped by dominant Filipino nationalist ideologies, I resist romantic notions of the diaspora. Revealing the ways that dominant Filipino nationalism perpetuates a simultaneous erasure of nonnormative histories and bodies and epistemological and interpersonal violence among activists, I reject homogeneous conceptions of nationalism and open up possibilities for decolonial organizing praxis. (shrink)

I provide a brief précis of Aaron Zimmerman’s book, Belief: A Pragmatic Picture, then explore two possible problems for the view. The first concerns whether the account of belief can successfully intervene in the debate between those who hold emotions are partly constituted by evaluative beliefs and those who deny this. The second concerns whether the view can explain that distinctive form of white ignorance that is manifest in an unwillingness to draw relatively obvious action-guiding beliefs from widely shared (...) information. Thinking about cases of this kind raises the question of whether Zimmerman’s account is problematically individualist, because of downplaying the importance of converging on an account of belief given the role of belief attribution in a suite of critical practices that are essential to communities of inquiry. If we, collectively, must commit to converging on an account of belief, but different accounts serve the interests of different groups, then the meta-level thesis that we should choose an account on pragmatic grounds raises the question of whose interests such an account should serve. (shrink)

A dominant cultural narrative within Costa Rica describes Costa Ricans not only as different from their Central American neighbours, but it also exalts them as better: specifically, as more white, peaceful, egalitarian and democratic. This notion of Costa Rican exceptionalism played a key role in the creation of their health care system, which is based on the four core principles of equity, universality, solidarity and obligation. While the political justification and design of the current health care system does, in (...) part, realize this ideal, we argue that the narrative of Costa Rican exceptionalism prevents the full actualization of these principles by marginalizing and excluding disadvantaged groups, especially indigenous and black citizens and the substantial Nicaraguan minority. We offer three suggestions to mitigate the self-undermining effects of the dominant national narrative: 1) encouragement and development of counternarratives; 2) support of an emerging field of Costa Rican bioethics; and 3) decoupling health and national successes. (shrink)