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Bioethics Blogs

Ethics & Society Newsfeed: March 10, 2017

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White House Slammed by Federal Ethics Chief for Not Disciplining Kellyanne Conway
U.S. government’s official ethics watchdog blasted White House for not taking disciplinary action against senior counselor Kellyanne Conway for promoting Ivanka Trump’s products on TV

Trump’s Ethics Order Seen as Boost for Shadow Lobbying
President Trump’s speech to the joint session of Congress on Tuesday explains executive order to ban lobbying for five years for officials who leave office – addresses the ethics of “draining the swamp”

George W. Bush’s ethics lawyer says Jeff Sessions’ denial of Russia talks ‘a good way to go to jail’
Alleged ethics violations Jeff Sessions may have made when he claimed under oath that he “did not have communications with the Russians”

ACLU lawyer files ethics complaint against Sessions over Russia testimony: report
An American Civil Liberties Union (ACLU) lawyer, Christopher Anders, formally filed an ethics complaint against Attorney General Jeff Sessions over his testimony to the Senate Judiciary Committee denying any contact with Russian officials

Trump’s team nixed ethics course for White House staff
White House staff has received no ethics training under the Trump transition team and now presidency

Medical Ethics

House Republicans would let employers demand workers’ genetic test results
Bill moving through Congress would allow companies to require employees to undergo genetic testing or risk paying a penalty of thousands of dollars; employers see that genetic and other health information

Prisoners with serious mental health problems face urgent treatment delays
Prisoners in the UK are supposed to receive mental health services after being referred to such a unit within 14 days and new official numbers have indicated that regulations are not being followed

New pregnancy testing technique needs limits say ethics body
Press release from the Nuffield Council on Bioethics explores the ethics of Non-Invasive Prenatal Testing (NIPT) and explains why they are calling for a moratorium on the use of the new technology

Ethical Implications of User Perceptions of Wearable Devices
Wearable devices can save time at medical appointments and may even save lives – ethical implications of having large amounts of personal information stored in devices that are shared with third parties

When Evidence Says No, But Doctors Say Yes
Medical costs increasing and patient benefits are declining  – ethical conundrum of why medical professionals continue to prescribe unnecessary treatment, and calls for responsible regulation

States Wrestle With Legalizing Payments For Gestational Surrogates
Legislators proposed a bill that would regulate gestational surrogacy — potentially adding legal oversight to fertility clinics that facilitate these pregnancies

Environmental Ethics

EPA environmental justice leader resigns, amid White House plans to dismantle program
Key environmental justice leader at the Environmental Protection Agency has resigned, saying recent budget proposal to defund work would harm the people who most rely on the EPA

Why Won’t American Business Push for Action on Climate?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Human-Pig Chimeras: The Potential and Concerns Of Hybrid Human-Animal Organs

One of the great advances in modern medicine has been the success of organ transplantation. Whilst complications still arise from its use, the refinement of drugs designed to reduce organ rejection alongside other improvements, mean that the procedure is often lifesaving.

As is frequently the case however, there is a caveat to this “wonder-cure”, namely, that far more people require organs than there are organs available. This global shortage has given rise to a host of complex ethical challenges. Several of these issues have already been explored here, including the implementation of ‘opt-in’ organ donation systems and the appropriateness of receiving organs on the basis of ability to pay1, 2, 3.

The development of chimeric human-pig embryos announced in the journal Cell last week may therefore be hailed as the much-needed answer to this problem of organ shortages. With over 120,000 people on the national transplant list in the US alone and 22 people on that list dying each day, any opportunity to increase the numbers of transplantable organs has an obvious appeal4. However, this development is far from a perfect solution.

Chimeric embryos are early life forms that are composed from 2 or more different sets of genetic material. In this case therefore, one set of genetic material is from a pig and the second from a human. These chimeras were initially made in the laboratory, before being transplanted into surrogate sows. In the study, only a fraction of the total embryos transplanted (just over 10%) showed successful development, surviving for 3-4 weeks5.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

A social scientist’s guide to the Final Rule

On 18 January 2017, sixteen federal agencies announced revisions to the Federal Policy for the Protection of Human Subjects. As I noted earlier, this marks a huge victory for historians, who have spent the last 20 years working to end the inappropriate interference of IRBs with oral history research.

In addition, the final rule includes several provisions of note to scholars in the humanities and social sciences. Here are some of them; I don’t claim it is a complete list.

No biospecimens overhaul; less controversy

The final rule “does not adopt the proposal to require that research involving nonidentified biospecimens be subject to the Common Rule, and that consent would need to be obtained in order to conduct such research.” This was the target of the greatest criticism from groups like the National Academies of Sciences, Engineering, and Medicine and SACHRP. So while this change has little direct bearing on the work of social scientists and scholars in the humanities, it will likely reduce the controversy surrounding the regulatory reform as a whole.

The abandonment of the biospecimens proposal could also reduce opposition to reform by conservatives. The House Freedom Caucus opposed a new Common Rule on the grounds that it would cost $13.334 billion over 10 years. This figure seems to have been drawn from the NPRM’s quantified costs of $13.342 billion (using a 3 percent discount rate), and ignored the NPRM’s quantified benefits of $2.6 billion. If all the Freedom Caucus cares about is money, it may like the final rule a lot more.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

We Can’t End the HIV Crisis Unless We Get Serious About Sexual Health in Prisons

If the US wants to take the crisis of HIV in African American communities seriously, researchers and HIV advocates say they must treat prisoners with the same time-tested health practices that are used on the outside, which includes making condoms and PreP available and ensuring HIV-positive incarcerated people continue receiving their HIV treatment. With comments from our Leonard Rubenstein

Bioethics Blogs

In the Journals – December 2016, Part I by Livia Garofalo

Here is the first part of our December article roundup. Three journals have special issues this month (abstracts in the post below):

Enjoy reading (and what’s left of the holidays)!

American Anthropologist

The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic

Betsey Behr Brada

One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of “humanitarianism” itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals’ capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person “humanitarian” without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana’s national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions.

Scripting Dissent: US Abortion Laws, State Power, and the Politics of Scripted Speech

Mara Buchbinder

Abortion laws offer a point of entry for “the state” to intervene in intimate clinical matters. In this article, I explore the various uses of scripts and scripting in state-mandated abortion counseling following the implementation of North Carolina’s (2011) Woman’s “Right to Know” Act. The law mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. Drawing on interviews with abortion providers in North Carolina, I analyze how the meaning of scripting shifts across different clinical and bureaucratic contexts and show that abortion providers perceived themselves to be scripted by “the state” even though their words were not explicitly chosen by lawmakers. Thus, rather than viewing the law merely as a product of North Carolina legislative activity, I argue that abortion providers also help to create the law, and its social and moral power, by interpreting and enacting it. However, abortion providers also revealed creative strategies for “scripting dissent” from the law—that is, rejecting, challenging, or otherwise subverting the state’s ideological message. This demonstrates that the linguistic force of the script stretches beyond its textual meaning to encompass the way it is performed within a particular context and how it is sometimes used for unexpected ends.

Between Electricity and Spirit: Paranormal Investigation and the Creation of Doubt in England

Michele Hanks

In contemporary England, amateur paranormal investigators actively seek empirical evidence of the paranormal. These investigators are self-fashioned experts who aim to balance scientific and spiritual perspectives in hopes of researching the existence of ghosts from an objective perspective. Despite actively seeking out ghosts and amassing firsthand paranormal experiences, investigators remain deeply doubtful about the nature of their evidence and the existence of the paranormal. Here, I explore the production and experience of doubt by examining paranormal investigators’ struggles to define and quantify the paranormal. Competing ideas about the substance or nature of ghosts lie at the heart of this struggle. Paranormal investigators agree that collecting and analyzing electromagnetic energy offers the most promising pathway for establishing empirical evidence of the paranormal. However, there is analytic uncertainty regarding the meaning of electromagnetic energy: it might indicate a spiritual or natural presence. Here, I argue that these two competing frames of interpretation engender and sustain states of doubt among investigators; however, paradoxically, these very states of doubt allow them to maintain and sustain embodied encounters with the very paranormal forces they doubt.


The hybrid bioeconomy of umbilical cord blood banking: Re-examining the narrative of opposition between public and private services

Christine Hauskeller and Lorenzo Beltrame

Umbilical cord blood (UCB) is an important source for stem cells used in clinical treatments. For this purpose, UCB has to be collected at birth and stored in biobanks. The discourse about UCB biobanking practices commonly holds that it occurs in two opposite economies, the public sector and a competing private one. They correspond with moral economies of gift-giving in a redistributive economy versus private ownership of cord blood in a market economy. Our analysis of UCB banking in Europe shows that this opposition narrative is both empirically and analytically unsatisfactory. Using the analytic concepts of entanglement (Callon) and biomedical platforms (Keating and Cambrosio), we demonstrate how the network of actors, objects, interests and practices in biobanking creates different kinds of value and shared issues across public and private services. Our case study illustrates how the interrelation between technical, ethical, economic and logistical considerations plays out and generates a field of practices where redistributive and market economies coexist, are co-dependent and hybridize each other. The narrative of opposition therefore can inform STS studies regarding the normative values written into the public facing side of biobanking, but bioeconomic analyses benefit from building on concepts that enable the examination of the complex interrelations between the wider network of heterogeneous elements on which UCB banking relies.

How to fix a broken heart: Cardiac disease and the ‘multiverse’ of stem cell research in Canada 

Annette Leibing, Virginie Tournay, Rachel Aisengart Menezes, and Rafaela Zorzanelli

This article focuses on Canadian stem cell researchers working on therapeutic applications of autologous stem cells for heart disease. Building on the concept of ‘multiverse’ – coined by William James and then further developed by Ernst Bloch – we are interested in the simultaneity of the certain and uncertain, sometimes contradictory arguments articulated by these scientists. In the first part of the article we illustrate some of the factors that provide certainty for researchers and clinicians. The second part analyzes the ways in which uncertain elements become integrated into a discourse of certainty. What we would like to show, using the concept of multiverse, is that a relatively new bio-technology such as stem cell treatments generally relies on both certain and uncertain reasoning. However, uncertainty has to give way to a platform of partial certainty, if crucial action is to be taken on issues as diverse as treatments and grant applications. The principle mechanisms we found that can make this kind of transformation possible target future developments (what we call ‘if only arguments’), including past encouraging results in need of further research.

Placental economies: Care, anticipation and vital matters in the placenta stem cell lab in Korea

Jieun Lee

Thinking with the vital materiality of placentas as it is evinced in a placental stem cell research lab in Korea, this article explores the relations and practices of care that are essential to the circulation of biological matters as infrastructure of tissue economies. I attend to the flows of care that sustain tissue economies with the notion of ‘placental economies’. Shifting attention from donor subjects and tissue objects to practices and relations of care as an infrastructure for the circulation of tissues, I explore how the vitality of biological matters is an achievement made and sustained through the relations and practices of care that animate the placenta in different forms. On the basis of an ethnographic fieldwork conducted in Korea, this article focuses on two different forms of care (lab workers’ care of cells, and pregnant women’s care of fetuses) that enable the (re)production and circulation of placenta-derived stem cells possible. I argue that the flows of tissues and vitality are indeed the flows of care, as an anticipatory as well as responsive practices, without which the vitality cannot exist in its current form. Furthermore, I suggest that relations and practices of care are a kind of infrastructure of promissory biotechnological enterprises.

You can go your own way: State regulation of oocyte donation in California and New York 

Erin Heidt-Forsythe

State regulation of oocyte donation in the context of human embryonic stem cell (hESC) research has increased since California’s landmark passage of Proposition 71 and the establishment of the first state-funded stem cell agency, the California Institute for Regenerative Medicine (CIRM). Scholarship has largely focused on California’s regulation of stem cell research as a patchwork of private sector and state regulations, reflecting major debates about the social contract for science. Given California’s political exceptionalism, how does examining alternative state histories, political structures, and institutions at the state level illuminate the ways that bio-innovation is being regulated in a federal regulatory vacuum? Examining state management of oocyte donation in the context of hESC research, this article considers New York and California as comparative sites of stem cell science regulation, which enriches our understanding of how regulation of stem cell science arises out of an engagement with representative politics and the private sector in the United States. Employing a process tracing of policy development in New York and California, this article highlights alternative democratic pathways to the management of oocyte donation in research contexts: given differences in direct democratic action, legislative representation, executive leadership, and publicly funded state stem cell research institutions, distinct regulatory outcomes occur with important bioethical implications for publics and participants in stem cell science at the state level.

Changing cells: An analysis of the concept of plasticity in the context of cellular differentiation

Alison Kraft and Beatrix P. Rubin

This paper analyses the changing conceptualisation of cellular differentiation during the twentieth century. This involved a move away from a view of this process as irreversible to an understanding of it as contingent. We examine the import of this shift for the transformation of stem cell biology, including the therapeutic promise attributed to this field, and how it came to challenge historical conceptions of both the cell and stem cell. We take as our starting point the 2012 Nobel Prize for Physiology and Medicine awarded jointly to John Gurdon and Shinya Yamanaka. In the view of the Nobel Committee, their work delineates a paradigm shift in the understanding of cellular differentiation, one that incorporates the concept of ‘plasticity’. We explore the emergence, uses and meanings of this concept within this specific biological context, examining and emphasising its role as an epistemological tool. In this setting, ‘plasticity’ was introduced by cell biologist Helen Blau in the course of research undertaken in the 1980s into the genetics of cell differentiation. We argue that Blau’s experimental and theoretical contributions were seminal to a reconceptualisation of this process and provide a crucial link between the work of Gurdon and Yamanaka. Overall, the paper highlights the contested process of conceptual change within the biomedical sciences. It also draws attention to the dynamic and reciprocal relationship between conceptual and technical change, exemplified here in the changing conceptions of cell differentiation following from the analysis of gene expression using new cell fusion and cloning techniques. More broadly, the paper also affords a window onto the shifting priorities, goals and values within late twentieth-century biomedical research.

Body & Society

Special Issue: The New Biologies: Epigenetics, the Microbiome and Immunities

Antibiotic Resistance and the Biology of History

Hannah Landecker

Beginning in the 1940s, mass production of antibiotics involved the industrial-scale growth of microorganisms to harvest their metabolic products. Unfortunately, the use of antibiotics selects for resistance at answering scale. The turn to the study of antibiotic resistance in microbiology and medicine is examined, focusing on the realization that individual therapies targeted at single pathogens in individual bodies are environmental events affecting bacterial evolution far beyond bodies. In turning to biological manifestations of antibiotic use, sciences fathom material outcomes of their own previous concepts. Archival work with stored soil and clinical samples produces a record described here as ‘the biology of history’: the physical registration of human history in bacterial life. This account thus foregrounds the importance of understanding both the materiality of history and the historicity of matter in theories and concepts of life today.

Epigenetics and Obesity: The Reproduction of Habitus through Intracellular and Social Environments

Megan Warin, Vivienne Moore, Michael Davies, and Stanley Ulijaszek

Bourdieu suggested that the habitus contains the ‘genetic information’ which both allows and disposes successive generations to reproduce the world they inherit from their parents’ generation. While his writings on habitus are concerned with embodied dispositions, biological processes are not a feature of the practical reason of habitus. Recent critiques of the separate worlds of biology and culture, and the rise in epigenetics, provide new opportunities for expanding theoretical concepts like habitus. Using obesity science as a case study we attempt to conceptualise the enfolding of biological and social processes (via a Deleuzian metaphor) to develop a concept of biohabitus – reconfiguring how social and biological environments interact across the life course, and may be transmitted and transformed intergenerationally. In conclusion we suggest that the enfolding and reproduction of social life that Bourdieu articulated as habitus is a useful theoretical frame that can be enhanced to critically develop epigenetic understandings of obesity, and vice versa.

Fetal–Maternal Intra-action: Politics of New Placental Biologies 

Rebecca Scott Yoshizawa

Extensively employed in reproductive science, the term fetal–maternal interface describes how maternal and fetal tissues interact in the womb to produce the transient placenta, purporting a theory of pregnancy where ‘mother’, ‘fetus’, and ‘placenta’ are already-separate entities. However, considerable scientific evidence supports a different theory, which is also elaborated in feminist and new materialist literatures. Informed by interviews with placenta scientists as well as secondary sources on placental immunology and the developmental origins of health and disease, I explore evidence not of interfacing during pregnancy, but of intra-action, or the mutual emergence of entities in simultaneous practices of differentiation and connection. I argue that attending to evidence that can be figured as intra-action enables us to recognize, account for, and attend to diffuse responsibilities for fetal–maternal outcomes that extend beyond mothers to the biosocial milieus of pregnancy. In reimaging the intra-action of placentas, a new understanding of what constitutes a ‘healthy pregnancy’ becomes possible.

The Politics of Immunity: Reading Cohen through Canguilhem and New Materialism

Michelle Jamieson

The issue of what is proper to nature, or life itself, is central to critical accounts of biomedicine and its complex interrelations with social, political and economic forces. These engagements, namely biopolitical accounts of medical practices and ethical-political critiques of biomedical discourse, grapple with the indistinction between the political and biological that biomedicine enacts. Making a significant contribution to both literatures, Ed Cohen’s A Body Worth Defending argues that the emergence of the concept of biological immunity signals the entry of politics into life itself and, as such, constitutes a concrete example of biopolitics. This article examines Cohen’s account of how the political becomes biological, and the view of life it assumes. Seeking to open up the question of biology, it draws on the work of Georges Canguilhem, and New Materialist accounts of matter–meaning entanglement, to offer a reading of knowledge and life, or politics and biology, as ontologically entangled.

Immunity, Biopolitics and Pandemics: Public and Individual Responses to the Threat to Life

Mark Davis, Paul Flowers, Davina Lohm, Emily Waller, and Niamh Stephenson

This article examines discourse on immunity in general public engagements with pandemic influenza in light of critical theory on immuno-politics and bodily integrity. Interview and focus group discussions on influenza with members of the general public reveal that, despite endorsement of government advice on how to avoid infection, influenza is seen as, ultimately, unavoidable. In place of prevention, members of the general public speak of immunity as the means of coping with influenza infection. Such talk on corporeal life under microbial threat is informed by self/not-self, network and ‘choice’ immunity, and therefore makes considerable allowance for cosmopolitan traffic with others, microbes, ‘dirt’ and immune-boosting consumer products. The immuno-political orientation of members of the general public, therefore, appears to trend towards a productive cosmopolitanism that contrasts with more orthodox bioscientific and governmental approaches to pandemic influenza. We reflect on the implications of the immuno-cosmopolitanism of everyday life for the advent of global public health emergency and for biopolitical rule in general.

The MRSA Epidemic and/as Fluid Biopolitics

Joshua I Newman, Rachel Shields, and Christopher M McLeod

This article offers a series of critical theorizations on the biopolitical dimensions of methicillin-resistant Staphylococcus aureus (MRSA), with specific attention to what has recently been referred to in the United States as the ‘MRSA Epidemic’. In particular, we reflect on the proliferation of biomedical discourses around the ‘spread’, and the pathogenic potentialities, of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We turn to the work of Roberto Esposito and Jean-Luc Nancy to better make sense of how, during this immunological crisis, the individualized fleshy and fluid body is articulated to dimensions of community and corporeal proximity; the body is thus conceived in popular biopolitical framings as a site of transmission, inoculation, and isolation – as a living ecological and pathological vessel. We give emphasis to the spatial relations of flesh, namely in how biomedical ‘experts’ have sought to (bio-)technologize spaces of heightened communal bodily contact (such as playgrounds or gymnasia).

Culture, Medicine and Psychiatry

A Transcultural Model of the Centrality of “Thinking a Lot” in Psychopathologies Across the Globe and the Process of Localization: A Cambodian Refugee Example

Devon E. Hinton, David H. Barlow, Ria Reis, and Joop de Jong

We present a general model of why “thinking a lot” is a key presentation of distress in many cultures and examine how “thinking a lot” plays out in the Cambodian cultural context. We argue that the complaint of “thinking a lot” indicates the presence of a certain causal network of psychopathology that is found across cultures, but that this causal network is localized in profound ways. We show, using a Cambodian example, that examining “thinking a lot” in a cultural context is a key way of investigating the local bio-cultural ontology of psychopathology. Among Cambodian refugees, a typical episode of “thinking a lot” begins with ruminative-type negative cognitions, in particular worry and depressive thoughts. Next these negative cognitions may induce mental symptoms (e.g., poor concentration, forgetfulness, and “zoning out”) and somatic symptoms (e.g., migraine headache, migraine-like blurry vision such as scintillating scotomas, dizziness, palpitations). Subsequently the very fact of “thinking a lot” and the induced symptoms may give rise to multiple catastrophic cognitions. Soon, as distress escalates, in a kind of looping, other negative cognitions such as trauma memories may be triggered. All these processes are highly shaped by the Cambodian socio-cultural context. The article shows that Cambodian trauma survivors have a locally specific illness reality that centers on dynamic episodes of “thinking a lot,” or on what might be called the “thinking a lot” causal network.

When Care is a “Systematic Route of Torture”: Conceptualizing the Violence of Medical Negligence in Resource-Poor Settings 

Carina Heckert

Descriptions of patient mistreatment fill ethnographic accounts of healthcare in resource-poor settings. Often, anthropologists point to structural factors and the ways that the global political economy produces substandard care. This approach makes it difficult to hold parties accountable when there is blatant disregard for human life on the part of individuals providing care. In this article, I draw on the illness narrative of Magaly Chacón, the first HIV positive individual in Bolivia to file charges of medical negligence after failing to receive care to prevent mother-to-child transmission. Magaly’s narrative demonstrates how structural conditions are often used to explain away poor patient outcomes, shifting attention away from and normalizing the symbolic violence that also perpetuates substandard care of marginalized patients. I use Magaly’s accusations to interrogate how defining acts of mistreatment as medical negligence can be a productive exercise, even when it is difficult to disentangle structural constraints from blatant acts of negligence. Defining who is negligent in resource-poor settings is not easy, as Magaly’s case demonstrates. However, Magaly’s case also demonstrates that accusations of negligence themselves can demand accountability and force changes within the local structures that contribute to the systematic mistreatment of marginalized patients.

Utilization of Standardized Mental Health Assessments in Anthropological Research: Possibilities and Pitfalls

Emily Mendenhall, Kristin Yarris, and Brandon A. Kohrt

In the past decade anthropologists working the boundary of culture, medicine, and psychiatry have drawn from ethnographic and epidemiological methods to interdigitate data and provide more depth in understanding critical health problems. But rarely do these studies incorporate psychiatric inventories with ethnographic analysis. This article shows how triangulation of research methods strengthens scholars’ ability (1) to draw conclusions from smaller data sets and facilitate comparisons of what suffering means across contexts; (2) to unpack the complexities of ethnographic and narrative data by way of interdigitating narratives with standardized evaluations of psychological distress; and (3) to enhance the translatability of narrative data to interventionists and to make anthropological research more accessible to policymakers. The crux of this argument is based on two discrete case studies, one community sample of Nicaraguan grandmothers in urban Nicaragua, and another clinic-based study of Mexican immigrant women in urban United States, which represent different populations, methodologies, and instruments. Yet, both authors critically examine narrative data and then use the Center for Epidemiologic Studies Depression Scale to further unpack meaning of psychological suffering by analyzing symptomatology. Such integrative methodologies illustrate how incorporating results from standardized mental health assessments can corroborate meaning-making in anthropology while advancing anthropological contributions to mental health treatment and policy.

Letting the Air Out: Aire as an Empty Signifier in Oaxacan Understandings of Illness

Toomas Gross

“Air (aire, also aigre) in the body” is a frequent explanation of illness according to the traditional medical beliefs in Mexico. Anthropologists have generally scrutinized aire in the context of other common folk illnesses treated by traditional healers (curanderas). However, drawing on my research in the communities of Northern Oaxaca I suggest that aire occupies a more distinct position in the folk medical cosmology than it has usually been credited with. This distinction rests on the notion’s exceptional ambivalence and openness to multiple interpretations. “Air” is recurred to as the cause of illness mainly in situations where every other explanation, either “traditional” or “biomedical,” seems to be inadequate. The physical properties of air—its transparency, invisibility, apparent immateriality, near omnipresence, and virtual “nothingness”—render it a suitable explanation of the last resort. Local understandings of what aire “is” are often vague and elusive, and in many respects the term functions in folk medical discourse as an “empty signifier.”

Emplotting Hikikomori: Japanese Parents’ Narratives of Social Withdrawal

Ellen Rubinstein

Hikikomori, often glossed as “social withdrawal,” emerged as a sociomedical condition among Japanese youth at the end of the twentieth century, and it continues to fascinate and concern the public. Explanatory frameworks for hikikomori abound, with different stakeholders attributing it to individual psychopathology, poor parenting, and/or a lack of social support structures. This article takes an interpretive approach to hikikomori by exploring parents’ narrative constructions of hikikomori children in support group meetings and in-depth interviews. I argue that some parents were able to find hope in hikikomori by ‘emplotting’ their children’s experiences into a larger narrative about onset, withdrawal, and recovery, which helped them remain invested in the present by maintaining a sense of possibility about the future. Contrary to literature that examines hikikomori as an epidemic of isolated individuals, I demonstrate how parents play a key role in hikikomori through meaning-making activities that have the potential to shape their children’s experiences of withdrawal.

The War on Drugs That Wasn’t: Wasted Whiteness, “Dirty Doctors,” and Race in Media Coverage of Prescription Opioid Misuse

Julie Netherland and Helena B. Hansen

The past decade in the U.S. has been marked by a media fascination with the white prescription opioid cum heroin user. In this paper, we contrast media coverage of white non-medical opioid users with that of black and brown heroin users to show how divergent representations lead to different public and policy responses. A content analysis of 100 popular press articles from 2001 and 2011 in which half describe heroin users and half describe prescription opioid users revealed a consistent contrast between criminalized urban black and Latino heroin injectors with sympathetic portrayals of suburban white prescription opioid users. Media coverage of the suburban and rural opioid “epidemic” of the 2000s helped draw a symbolic, and then legal, distinction between (urban) heroin addiction and (suburban and rural) prescription opioid addiction that is reminiscent of the legal distinction between crack cocaine and powder cocaine of the 1980s and 1990s. This distinction reinforces the racialized deployment of the War on Drugs and is sustained by the lack of explicit discussion of race in the service of “color blind ideology.” We suggest potential correctives to these racially divergent patterns, in the form of socially responsible media practices and of clinical engagement with public policy.

Remembering Collective Violence: Broadening the Notion of Traumatic Memory in Post-Conflict Rehabilitation

Ruth Kevers, Peter Rober, Ilse Derluyn and Lucia De Haene

In the aftermath of war and armed conflict, individuals and communities face the challenge of dealing with recollections of violence and atrocity. This article aims to contribute to a better understanding of processes of remembering and forgetting histories of violence in post-conflict communities and to reflect on related implications for trauma rehabilitation in post-conflict settings. Starting from the observation that memory operates at the core of PTSD symptomatology, we more closely explore how this notion of traumatic memory is conceptualized within PTSD-centered research and interventions. Subsequently, we aim to broaden this understanding of traumatic memory and post-trauma care by connecting to findings from social memory studies and transcultural trauma research. Drawing on an analysis of scholarly literature, this analysis develops into a perspective on memory that moves beyond a symptomatic framing toward an understanding of memory that emphasizes its relational, political, moral, and cultural nature. Post-conflict memory is presented as inextricably embedded in communal relations, involving ongoing trade-offs between individual and collective responses to trauma and a complex negotiation of speech and silence. In a concluding discussion, we develop implications of this broadened understanding for post-conflict trauma-focused rehabilitation.

East Asian Science, Technology, & Society

Population Control and Reproductive Politics in Cold War Asia

Biopolitical Knowledge in the Making: Population Politics and Fertility Studies in Early Cold War Taiwan

Yu-Ling Huang

Like many developing countries in the 1950s and 1960s, Taiwan experienced a social process of constructing and controlling population that relied on demography and fertility studies as essential governing tools. This article investigates population politics and biopolitical knowledge production in postwar Taiwan through synthesizing three bodies of literature that have just begun to comment on one another: histories of postwar population control, analyses of the technoscientific turn in Cold War history, and forensics into the production of social-scientific knowledge via science-study approaches. Along with the complexities of Asian biopolitics, three main social elements affecting the production of biopolitical knowledge at the time are discussed: (a) the historical backstage on which the Cold War and the civil war met, (b) the acting group of Taiwanese and US agencies and individuals who took part in the process, and (c) the three types of fertility studies and the data from them that ultimately expanded the focus of the process of population control from the population in general to the reproductive behavior of women. The complexities of Asia biopolitics are also discussed.

Between the West and Asia: “Humanistic” Japanese Family Planning in the Cold War (open access)

Aya Homei

This article studies the formation of Japanese ventures in family planning deployed in various villages in Asia from the 1960s onward in the name of development aid. By critically examining how Asia became the priority area for Japan’s international cooperation in family planning and by analyzing how the adjective humanistic was used to underscore the originality of Japan’s family planning program overseas, the article shows that visions of Japanese actors were directly informed by Japan’s delicate position in Cold War geopolitics, between the imagined West represented by the United States and “underdeveloped” Asia, at a time when Japan was striving to (re)establish its position in world politics and economics. Additionally, by highlighting subjectivities and intra-Asian networks centered on Japanese actors, the article also aims to destabilize the current historiography on population control, which has hitherto focused either on Western actors in the transnational population control movement or on non-Western “acceptors” subjected to the population control programs.


Special Issue: Anthropology and Psychoanalysis

From Filial Piety to Forgiveness: Managing Ambivalent Feelings in a Beijing House-Church

Susanne Bregnbæk

This article is based on fieldwork in a Chinese Protestant house-church in Beijing—more specifically, it focuses on a form of group therapy, which took place in the vicinity of the church. It combines two phenomena usually studied separately, namely the popularity of Chinese underground churches and China’s so-called “psycho-boom.” Drawing on attachment theory, I focus on the psychic conflicts that draw certain people, in this case a young woman, Lin, to this kind of therapeutic/ritual context. Filial piety, the moral value that children should respect and honor their parents, who have sacrificed so much for them, remains a strong social norm in Chinese society. I argue that forbidden feelings such as anger directed at parents found expression in this Chinese house-church. The ritual and therapeutic context can be understood as a cultural defense mechanism, which celebrates an inversion of dominant societal norms.

Silence as a Response to Everyday Violence: Understanding Domination and Distress Through the Lens of Fantasy

Tine M. Gammeltoft

Across the world, existing research indicates that many women respond with silence to marital abuse. This article offers an ethnographic investigation of the social and psychic forces behind Vietnamese women’s silencing of violence and a theoretical exploration of how the psychoanalytic concept of fantasy—understood as unconscious or subconscious mental processes—may contribute to the analysis of everyday violence and psychic distress. Distinguishing between what I term deliberate and subconscious silence, I explore the role that fantasy plays when Vietnamese women silently endure intimate partner violence. Closer ethnographic attention to the fantasy-constructions that sustain day-to-day lives can, I argue, strengthen the capacity of anthropology to comprehend how systems of everyday violence are upheld and rendered socially invisible.

Unthinkable Solitude: Successful Aging in Denmark Through the Lacanian Real

Henrik Hvenegaard Mikkelsen

As states across the world develop strategies for administering their aging populations, different assumptions and anxieties regarding the condition of old age and how they haunt people are disclosed, across national-cultural settings. Within recent years, loneliness has been identified as one of the key threats to the well-being of the elderly in the Danish welfare society, and the tendency to view solitary seniors in terms of “loneliness” and “social isolation”—along with the attempts to reintegrate these solitary seniors into society—reveals how solitude is being tied to detrimental states of existence. Based on an ethnographic fieldwork among healthcare workers and solitary elderly men in the rural area of southern Sealand, Denmark, this article lays out the Danish configuration of what has been called the paradigm of “successful aging.” However, not only is the attention to loneliness among Danish eldercare professionals a sign of an inherent fear; at the same time, I will argue, it reveals an inherent inability to conceptualize “solitude” as other than “loneliness.” By employing the concept of the Real—the enigmatic realm within Lacanian psychoanalysis that represents the limit of language—the aim of this article is to uncover how the current discourse on successful aging renders solitude “unthinkable.”

Ambivalent Attachment — Melancholia and Political Activism in Contemporary Palestine

Lotte Buch Segal

This article argues that over the course of the past three decades a mood change has occurred in terms of how Palestinians relate to the ideal of an independent Palestinian state. During the first Intifada, from 1987 to 1993,1 which constitutes the golden age of Palestinian resistance towards Israel’s occupation, the Palestinian resistance movement was characterized by a passionate belief in the possibility of a revolutionary transformation. Due to the consistent stalemate and even worsening of the conflict that have followed in the wake of the Second Intifada, from 2000 to 2003, this passionate belief in the realization of a Palestinian state has been replaced by ambivalence toward that ideal. Based on insights from my intermittent fieldwork with families of Palestinian political prisoners from 2004 to 2011, this article suggests that the contemporary ambivalence surrounding the revolutionary project can be meaningfully analyzed using Freud’s notion of melancholia. In Freud, melancholia accounts for the relation between a feeling of indeterminate loss and ambivalent attachment. The notion of melancholia thereby provides anthropology with a concept that can be used to name and explore the frayed attachment to the ideal of a Palestinian state in the context of an ongoing colonial occupation. The passionate politics of the First Intifada enabled a fusing of Palestinian personhood with the overall political project into a subject characterized by active resistance. In contrast, the ambivalent attachment that marks the link between self and state project in the Palestinian territories after the Second Intifada leads to a mood of melancholia. By analyzing the attachment to the political project as an indeterminate loss in the melancholic’s ego, I argue that the Palestinian political project is part of the self and keeps its adherents in a repetitive temporal fold from which they are unable to escape, because they are obliged and compelled to keep fighting for a state that does not seem to materialize. Conceptually, melancholia has the capacity to elucidate the emotional and deeply intersubjective toll it takes to live and aspire to an ideal that seems further from realization by the hour. 

Public Anxieties and Projective Identification: Therapeutic Encounters Between Danish Clairvoyants and Their Clients

Vibeke Steffen

The capacity to receive occult messages and look into the future is claimed by individuals in most societies and probably always has been. In Denmark, clairvoyance is a popular service offered at the alternative market for counseling and healing. During my fieldwork among Danish spiritualist mediums in 2007–08, I was often puzzled by the way in which clairvoyants and clients seemed to share the same kinds of problems. This observation steered my interests toward understanding how personal sensations and feelings are exchanged in therapeutic encounters and raised questions about who is doing what to whom. Drawing on Jung’s concept of the wounded healer to highlight the clairvoyant’s role as a channel for societal anxieties and Melanie Klein’s concept of projective identification as a framework for understanding the defense mechanisms at stake in object relations, I argue that psychoanalysis may add an important critical dimension to the anthropology of therapeutic encounters.

Psychoanalysis and Ethnography

Douglas Hollan

In this commentary, I discuss some of the theoretical and methodological issues the contributions to this special issue raise collectively, namely: how do we as anthropologists pick and choose among the many diverse psychoanalytic concepts available to us, especially when these concepts may come embedded in very different, and sometimes contradictory, theoretical assumptions about human behavior? Once we find a psychoanalytic concept that is useful for ethnographic work, can we or should we attempt to relate it to more experience near ethnopsychological terms and assumptions, ones that might seem more understandable and intuitive from a local point of view? How intimately should we know people, biographically or developmentally, before we attempt to apply psychoanalytic concepts to their behavior? And, given that George Devereux is cited as one of the inspirations for this special issue, what role can or should an awareness of countertransference play in ethnographic work, and what are the limits, if any, of psychoanalytic interpretation in an ethnographic context?

Journal of the Royal Anthropological Institute 

Embodied narratives of disaster: the expression of bodily experience in Aceh, Indonesia

Annemarie Samuels

The devastating Indian Ocean tsunami of 26 December 2004 caused massive destruction to coastal Aceh, Indonesia, and left countless numbers of people dead or wounded. This article focuses on the embodied narratives of three Acehnese women who survived the disaster and, like many others in Aceh, told their stories ‘through’ their bodies. A detailed ethnographic account of their narratives reveals how the body stretches temporally between the ‘narrated event’ and the ‘narrative event’, both through the representation of the body in narratives and through the embodied performance of narratives. Moving beyond meaning-centred analyses of narratives, I argue that the central accomplishment of these narratives is that they convey poignant bodily experiences to others and thereby create a shared, post-disaster, world. Ultimately, through these embodied narratives of disaster people remake their world, with others, in the wake of its ‘unmaking’.

Necrosociality: isolated death and unclaimed cremains in Japan

Jieun Kim

Inquiring into concerns surrounding death and the afterlife in an underclass enclave in Japan, this article proposes that the politics of survival involves engaging with the enduring relationship between the living and the dead, referred to as ‘necrosociality’. Based on fieldwork carried out in Yokohama, it explores how ‘isolated death’ (kodokushi) and ‘disconnected spirits’ (muenbotoke) have become major concerns in homeless activism and support, giving rise to various necrosocial innovations and practices. The emergent necrosociality in Yokohama conjures up an alternative logic of care that connects people based on the general premise of inevitable decay and decline rather than familial ties and intimate memories. This article suggests that the concept of necrosociality provides a useful framework for analysing how social relations are negotiated, reaffirmed, or negated through bodily remains and graves, effectively shaping the modes of being and care among the living.

Medical Anthropology Quarterly

Special Focus Section: Comorbidity

Ectoparasitic Syndemics: Polymicrobial Tick-borne Disease Interactions in a Changing Anthropogenic Landscape

Merrill Singer and Nicola Bulled

Based on an assessment of the available research, this article uses syndemic theory to suggest the role of adverse bio–social interactions in increasing the total disease burden of tick-borne infections in local populations. Given the worldwide distribution of ticks, capacity for coinfection, the anthropogenic role in environmental changes that facilitate tick dissemination and contact, evidence of syndemic interaction in tick-borne diseases, and growing impact of ticks on global health, tick-borne syndemics reveal fundamental ways in which human beings are not simply agents of environmental change but objects of that change as well.

Beyond Comorbidity: A Critical Perspective of Syndemic Depression and Diabetes in Cross-cultural Contexts

Emily Mendenhall

This article examines the comorbidity concept in medical anthropology. I argue that the dearth of articles on comorbidity in medical anthropology may result from the rise of syndemic theory. Syndemics recognize how social realities shape individual illness experiences as well as distribution of diseases across populations. I discuss synergistic interactions foundational to the syndemics construct through my research of depression and diabetes comorbidity in vulnerable populations from urban United States, India, and South Africa. I argue that social and economic factors that cluster with depression and diabetes alone and together exemplify the biosocial processes that are at the heart of syndemics. In doing so, I illustrate how social, cultural, and economic factors shape individual-level experiences of co-occurring diseases despite similar population-level trends. Finally, I discuss the relevance of syndemics for the fields of medicine and public health while cautioning what must not be lost in translation across disciplines.

“Just One Thing after Another”: Recursive Cascades and Chronic Conditions

Lenore Manderson and Narelle Warren

Chronic conditions and their resultant difficulties in daily living frequently occur with other health problems, sometimes due to interactions or complications at a biological level, or as a result of common pathogens or risk factors. On other occasions, they develop independently. Drawing on research conducted with Australian women that began in the mid-2000s and is still ongoing, we highlight how chronic structural factors shape the risk factors of “chronic” conditions, influencing health seeking, continuity of care, and health outcomes. Institutional, economic, and other circumstantial factors pertain and impact health trajectories as much in highly industrialized as in resource poor settings. In illustrating how poverty and social exclusion create the preconditions of multiple chronic health problems, and how chronic health problems increase such disadvantages for individuals and their households, we introduce the idea of “recursive cascades” to capture the often inevitable trajectory of increasing ill health and growing empoverishment.

Transactions in Suffering: Mothers, Daughters, and Chronic Disease Comorbidities in New Delhi, India 

Lesley Jo Weaver

The biomedical definition of comorbidity belies the complexity of its lived experience. This article draws on case studies of women with diabetes and various comorbidities in New Delhi, India, to explore intergenerational transactions surrounding suffering in contexts of comorbidity. The analysis synthesizes sociological theories of chronic disease work, psychological theories of caregiver burnout, and anthropological approaches to suffering and legitimacy to explore how, when, and by whom women’s comorbid sources of suffering become routinized in everyday life. The analysis demonstrates, first, that comorbid suffering is not simply a matter of the addition of a second source of suffering to an existing one; rather, it comprises complex interactions between suffering, disability, family dynamics, and quality of life. Second, it illustrates several social routes through which comorbid suffering can fade into the background of everyday life, even when it is severe. Close attention to how suffering works in cases of comorbidity will be important as comorbid conditions become increasingly commonplace around the world.

Culture and Comorbidity: Intimate Partner Violence as a Common Risk Factor for Maternal Mental Illness and Reproductive Health Problems among Former Child Soldiers in Nepal

Brandon A. Kohrt and Christine Bourey

Our objective was to elucidate how culture influences internal (psychological), external (social), institutional (structural), and health care (medical) processes, which, taken together, create differential risk of comorbidity across contexts. To develop a conceptual model, we conducted qualitative research with 13 female child soldiers in Nepal. Participants gave open-ended responses to intimate partner violence (IPV) vignettes (marital rape, emotional abuse, violence during pregnancy). Twelve participants (92%) endorsed personal responses (remaining silent, enduring violence, forgiving the husband). Twelve participants endorsed communication with one’s husband. Only four participants (31%) sought family support, and three contacted police. Ultimately, 12 participants left the relationship, but the majority (nine) only left after the final IPV experience, which was preceded by prolonged psychological suffering and pregnancy endangerment. In conclusion, comorbidity risks are increased in cultural context that rely on individual or couples-only behavior, lack external social engagement, have weak law and justice institutions, and have limited health services.

Comorbidity: Reconsidering the Unit of Analysis

Mark Nichter 

In this short essay, I wish to briefly discuss smoking, polypharmacy, the human biome and multispecies relations, and biomedicalization as a means of stretching the common ways we think about comorbidity. My intent is to expand our thinking about comorbidity and multimorbidity beyond the individual as a unit of analysis, to reframe comorbidity in relation to trajectories of risk, and to address comorbid states of our own making when the treatment of one health problem results in the experience of additional health problems. I do so as a corrective to what I see as an overly narrow focus on comorbidity as co-occurring illnesses within a single individual, and as a complement to critical medical anthropological assessments of synergistic comorbid conditions (syndemics) occurring in structurally vulnerable populations living in environments of risk exposed to macro and micro pathogenic agents.


Disordered Eating/Eating Disorder: Hidden Perils of the Nation’s Fight against Fat 

Susan Greenhalgh

The nation’s fight against fat has not reduced obesity, but it has had other worrying effects. Mental health researchers have raised the possibility that the intense pressures to lose weight have heightened the risks of developing eating disorders, especially among the young. Medical anthropology can help connect the dots between the war on fat and disordered eating, identifying specific mechanisms, pathways, and contextual forces that may lie beyond the scope of biomedical and psychiatric research. This article develops a biocitizenship approach that focuses on the pathologization of heaviness, the necessity of having a thin, fit body to belonging to the category of worthy citizen, and the work of pervasive fat-talk in defining who can belong. Ethnographic narratives from California illuminate the dynamics in individual lives, while lending powerful support to the idea that the battle against fat is worsening disordered eating and eating disorders among vulnerable young people.

Locating Purity within Corruption Rumors: Narratives of HPV Vaccination Refusal in a Peri-urban Community of Southern Romania 

Cristina A. Pop

This article locates the symbolic construction of “corrupted purity”—as a key assertion in Romanian parents’ HPV vaccination refusal narratives—within a multiplicity of entangled rumors concerning reproduction and the state. Romania’s unsuccessful HPV vaccination campaign is not unique. However, the shifting discourses around purity and corruption—through which some parents conveyed anxieties about their daughters being targeted for the vaccine—place a particular twist on the Romanian case of resisting the HPV vaccination. Parental discourses took the form of clusters of rumors about state medicine’s failure to provide adequate reproductive health care, additive-laden foods, and exposure to radioactive contamination. In these rumors, corruption becomes literally embodied, through ingestion, consumption, contact, or inoculation. Parental discourses about what is being injected into their daughters’ pristine bodies express their uncertainty around navigating the unsettled post-socialist medical landscape.

Enveloped Lives: Practicing Health and Care in Lithuania 

Rima Praspaliauskiene

This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient–doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes.

Medicine Anthropology Theory

The moral life of epinephrine in the United States

 Danya Glabau

This paper follows the ‘moral life’ of epinephrine auto-injectors, devices that people with food allergies and their caretakers use to administer emergency medication to stop serious allergic reactions, in the United States. These devices are potent signifiers of the seemingly precarious nature of life with food allergies. I follow auto-injectors from their social birth as a commodity object, through how they structure doctor-patient interactions and parenting, to the ways that parents and illness advocates talk about their life-saving properties. At every step of the way, their significance is influenced by the political-economic context of health care in the United States, which places significant burdens of financial cost and responsibility for deciding what constitutes ‘good’ care upon individual patients and caretakers. The moral life of epinephrine serves as a model for thinking about how medical devices take on meaning that is at once practical, moral, and economic as they circulate through manufacturing and distribution channels and into the lives and social worlds of users. 

Am I fine? Exploring everyday life ambiguities and potentialities of embodied sensations in a Danish middle-class community

Sara Marie Hebsgaard Offersen, Mette Bech Risør, Peter Vedsted, Rikke Sand Andersen

Woven into the fabric of human existence is the possibility of death and suffering from disease. This essential vulnerability calls forth processes of meaning making, of grappling with uncertainty and morality. In this article we explore the uncertainty and ambiguity that exists in the space between bodily sensations and symptoms of illness. Bodily sensations have the potential to become symptoms of disease or to be absorbed into ordinariness, prompting the question: how do we ascribe meaning to sensations? In the context of middle-class everyday life in Denmark, we show how different potentialities of ambiguous sensations are weighed against each other on a culturally and morally contingent continuum between normal and not normal, uncovering the complex interplay between the body, everyday life, and pervasive biomedical discourses focusing on health promotion, symptom awareness, and care seeking.

Milk, meaning, and morality. Following the trajectory of donated breast milk from donor to baby

Miriam Waltz and Fiona C. Ross

Donated human milk’s status comes into question as it leaves the mother-child relationship and is reconfigured through practices and discursive structures that seek to stabilise it as a specific kind of object. Based on research conducted in Cape Town, South Africa, we examine the crucial role of technologies in aiding the milk’s transformation as milk moves from donors’ homes into the clinical setting where it is received by preterm, low-birth weight newborns. We show that the milk shifts back and forth between being a bodily fluid, food, and medicine in the course of this trajectory. Different techniques foreground milk’s diverse properties as a set of moral decisions converges around saving, securing, and sustaining life, and materialising relationships.

Medical Humanities

Whereto speculative bioethics? Technological visions and future simulations in a science fictional culture

Ari Schick

This article critically examines the development and current state of speculative bioethics (bioethics discourse concerned with future technologies) as reflecting an intensifying science fictionality, a cognitive/perceptual mode in which the imagined future begins to exert increasing degrees of influence on the present, culminating in a collapse of distance between the two. Future technologies thereby come to be viewed as generating practical ethical issues that need to be addressed well in advance of their arrival. Although this appears to be a prudent effort, it actually bypasses the present as a site of moral agency and locates ethics within a simulation of the imagined future. A constructive form of speculative bioethics must be able to critically assess visions of technological futures if it is to function as an ethics that is of and for the present.

Towards a structure of feeling: abjection and allegories of disease in science fiction ‘mutation’ films

Frances Pheasant-Kelly

This article considers differences between the representation of mutation in science fiction films from the 1950s and the present, and identifies distinctive changes over this time period, both in relation to the narrative causes of genetic disruption and in the aesthetics of its visual display. Discerning an increasingly abject quality to science fiction mutations from the 1970s onwards—as a progressive tendency to view the physically opened body, one that has a seemingly fluid interior–exterior reversal, or one that is almost beyond recognition as humanoid—the article connects a propensity for disgust to the corresponding socio-cultural and political zeitgeist. Specifically, it suggests that such imagery is tied to a more expansive ‘structure of feeling’, proposed by Raymond Williams and emergent since the 1970s, but gathering momentum in later decades, that reflects an ‘opening up’ of society in all its visual, socio-cultural and political configurations. Expressly, it parallels a change from a repressive, patriarchal society that constructed medicine as infallible and male doctors as omnipotent to one that is generally more liberated, transparent and equitable. Engaging theoretically with the concept of a ‘structure of feeling’, and critically with scientific, cinematic and cultural discourses, two post-1970s’ ‘mutation’ films, The Fly (1986) and District 9 (2009), are considered in relation to their pre-1970s’ predecessors, and their aesthetics related to the perceptions and articulations of the medical profession at their respective historic moments, locating such instances within a broader medico-political canvas.

‘Limbitless Solutions’: the Prosthetic Arm, Iron Man and the Science Fiction of Technoscience

Susan Smith

Early last year, a non-profit organisation called ‘Limbitless Solutions’ modelled a 3D printed prosthetic arm on a fighting suit that features in the popular superhero film series, Iron Man (2008–2013). In addition, ‘Limbitless Solutions’ resourcefully deployed the fictional character and inventor of the Iron Man suit, weapons specialist and philanthropist, Tony Stark, played by Robert Downey Jr, in a celebrity/superhero endorsed promotional short film, showing ‘Tony’, the ‘real Iron Man’, gifting the futuristic military styled ‘gauntlet’ to Alex, a 7-year-old boy with a partially developed right arm. Engaging with scholarly work on the science fiction of technoscience, prostheses and the posthuman, and disability and DIY assistive technology, I analyse ‘Limbitless Solutions’ use of science fiction in a high-profile media event that problematically portrays an impaired child ‘in need’ of ‘repair’ and subsequently ‘fixed’ by technology. Overall, the aim is to integrate science fiction tropes, such as the wounded hero, the fighting suit and prosthetic arm, with disability studies, to highlight the sustained challenges that emerging theories of disability and technology face as contemporary economic, political and ideological forces endorse and promote militarised images of cyborg assimilation over human variation and physical difference.

Doctors in space (ships): biomedical uncertainties and medical authority in imagined futures (open access)

Lesley Henderson and Simon Carter

There has been considerable interest in images of medicine in popular science fiction and in representations of doctors in television fiction. Surprisingly little attention has been paid to doctors administering space medicine in science fiction. This article redresses this gap. We analyse the evolving figure of ‘the doctor’ in different popular science fiction television series. Building upon debates within Medical Sociology, Cultural Studies and Media Studies we argue that the figure of ‘the doctor’ is discursively deployed to act as the moral compass at the centre of the programme narrative. Our analysis highlights that the qualities, norms and ethics represented by doctors in space (ships) are intertwined with issues of gender equality, speciesism and posthuman ethics. We explore the signifying practices and political articulations that are played out through these cultural imaginaries. For example, the ways in which ‘the simple country doctor’ is deployed to help establish hegemonic formations concerning potentially destabilising technoscientific futures involving alternative sexualities, or military dystopia. Doctors mostly function to provide the ethical point of narrative stability within a world in flux, referencing a nostalgia for the traditional, attentive, humanistic family physician. The science fiction doctor facilitates the personalisation of technological change and thus becomes a useful conduit through which societal fears and anxieties concerning medicine, bioethics and morality in a ‘post 9/11’ world can be expressed and explored.

Bioethics Blogs

BioethicsTV: Pure Genius Proudly Ignores the Rules

by Craig Klugman, Ph.D.

“We’re Bunker Hill, since when do we follow the rules” sums up the attitude of this poor-performing medical drama that kicks ethics, law, and regulation to the curb on a weekly basis. Fictional Dr. Zoe Brockett uttered the above statement. In this fall finale episode, she breaks confidentiality, UNOS rules, and autonomous informed consent.

This episode (season 1; episode 8 – 12/15/2016) sees a patient with a rare blood type in need of a kidney transplant or face certain death in weeks. Her daughter, a world-class ballerina who was just offered her lifetime dream—a position with the Paris Opera Ballet—is willing to donate but is not a match. The hospital designs a new algorithm outside of UNOS to create an 8-pair transplant chain of international scope. The caveat is that the pairs will not learn of each other until after the surgeries and one pair will never be known. After all 8 pairs are flown to Northern California, we discover that mom’s donor is 1-month pregnant and thus cannot donate. However, if the daughter will still be a donor then the other 7 recipients can get their transplants.

The daughter chooses to withdraw, knowing that her mother will not get a kidney and in the recovery period she will not only lose her chance at the dream job, but she also won’t be able to be helpful during her mother’s dying. Another patient is concerned about the international representation in the donor pool, wanting only to get a kidney from a white person. The parents of a 10-year-old boy say that they will pay the daughter to stay in the chain, something that is clearly illegal in the U.S. and that is explained to them.

Chief of Staff Dr. Wallace understands the daughter’s reluctance and tells her there is no pressure and no obligation. However, Brockett feels a need to save the chain at all costs. Despite the ban on knowing donors and recipients, Brockett brings the daughter into the room of the 10-year-old boy who would have received her kidney. Brockett says that she is not coercing the daughter but wants her to see who won’t be getting a kidney based on her decision. In the closing shots of the scene, the little boy asks the daughter if she is a donor or a recipient because he’s a recipient. She hesitates but after this emotional assault says that she is a donor.

Brockett’s actions violate UNOS rules and the stated hospital policy. Wallace later “reams” Brockett, as she phrases it, but she defends herself by saying that she “saved the chain.” She says to Wallace, “I didn’t coerce her [the daughter]” and he responds that she most certainly “manipulated the donor.” Coercion is intimidating a person to perform an act through psychological or physical force or pressure. An agreement made under coercion is not ethically nor legally valid because the person was not free to make an autonomous choice. According to the Oxford English Dictionary, manipulation is “The action or an act of managing or directing a person, etc., especially in a skillful manner; the exercise of subtle, underhand, or devious influence or control over a person, organization, etc.; interference, tampering.” While the show might be making a distinction between two terms, in spirit they are the same thing in regards to forcibly pushing a patient to make a decision that she or he would not have made on his/her own.

Brockett’s punishment is being taken off of the transplant surgery on which she was scheduled to assist. Wallace tells her she was lucky not to have been fired. Realistically, she should have been fired and reported to the licensing board. By giving her a lesser penalty, she may repeat her actions in the future, causing harm to future patients.

The bigoted recipient is basically ignored. Once his wife is in her donation surgery he is told that since the chain is unbroken, if he wants to refuse the kidney being donated to him by a minority individual, he can but he would be the only person who suffers: The chain is maintained. He agrees and swallows his hatred.

The secretive pair turns out to involve a donor who is a prisoner for violent crimes. He declines meeting his recipient because he feels that he does not deserve to be thanked after all of the bad things he has done. As he states, one good deed does not make up for his past nor make him a good person. Such a sentiment comes directly from Aristotle who stated that a deed is moral if it fulfills three qualities, one of which is a consistent and established character. Dr. Verlaine tells the donor that may be true, but one act can help a person on a road to changing and making amends.

The deeper conversation from having this particular donor is that in general, prisoners cannot donate organs in the U.S. Much has been written on prohibitions against death row inmates donating, but far less from those serving life or shorter sentences. Certainly donating cannot lead to a reduction in sentence, rewards, better treatment by guards or warden, or earlier probation since this would be the equivalent of paying for an organ (getting a good in return for donating) and would also be highly coercive (get out early if you donate a kidney). Prisoners are considered a vulnerable population and their ability to freely consent can be (but is not necessarily) compromised. In addition, prisoners have a higher rate of hepatitis and HIV than the general population and thus are considered to be a higher risk pool for transplant. . However, in 2013, Utah became the first state to create a prisoner organ donor registry (joining Maricopa County, Arizona; New Jersey and Florida allow prisoners to donate if they were on the registry before incarceration or If the family decides to donate posthumously).

The moral theme of this show is that the ends justify the means. The daughter donates and all 7 recipients receive their new lives. They are all shown hugging and jumping and dancing at the end of the episode. There is no mention of a lifetime of anti-rejection drugs or any negative aspects of being a donor or a recipient. Even Brockett who coerced the daughter finds redemption when she is able to complete development of an artificial kidney that is surgically implanted into the mother to give her one additional year of life. Although we are told the device is experimental, nothing is said of a new device permit or FDA oversight. We are shown a 3-D printed model as proof the device works, but no animal testing is done. And the pregnant woman who could not donate signs a contract pledging to donate her kidney after she has given birth. Of course, she lives out of the U.S. and if she violated the contract, who is going to arrest her, extradite her, and forcibly remove her kidney? No one.

This show that flaunts its unethical, illegal actions has five more episodes in the bank. While it has not been cancelled, it has not been renewed either and no additional episodes have been ordered. Unlike Brockett, hopefully the show will bear the full consequences of its tragic actions.

Bioethics News

Organ Traffickers Lock Up People to Harvest Their Kidneys. Here Are the Politics Behind the Organ Trade.

December 8, 2016

(The Washington Post) – The organ trade typically takes place in developing countries whose hospitals are advanced enough to offer transplant services. It originated in India in the 1980s; in the following years, Pakistan, the Philippines, Egypt and China (where the organs were alleged to have come from executed prisoners) became hubs of commercial transplants. Such illegal transplants are also known to have been done in Turkey, Kosovo, South Africa and other sites. The patients typically come from the rich countries of East Asia (e.g., Japan and Taiwan), the rich countries of the Middle East (e.g., Saudi Arabia and Israel), as well as the United States and Western Europe.

Bioethics News

Signed Out of Prison But Not Signed Up for Insurance, Inmates Fall Prey to Ills

December 6, 2016

(Kaiser Health News) – Most of the state prison systems in the 31 states that expanded Medicaid have either not created large-scale enrollment programs or operate spotty programs that leave large numbers of exiting inmates — many of whom are chronically ill — without insurance. Local jails processing millions of prisoners a year, many severely mentally ill, are doing an even poorer job of getting health coverage for ex-inmates, by many accounts. Jail enrollment is especially challenging because the average stay is less than a month and prisoners are often released unexpectedly.

Bioethics Blogs

Neuroscience hasn’t been weaponized – it’s been a tool of war from the start

A discipline neither good nor evil. Saturday Evening Post/Harris A. Ewing

What could once only be imagined in science fiction is now increasingly coming to fruition: Drones can be flown by human brains’ thoughts. Pharmaceuticals can help soldiers forget traumatic experiences or produce feelings of trust to encourage confession in interrogation. DARPA-funded research is working on everything from implanting brain chips to “neural dust” in an effort to alleviate the effects of traumatic experience in war. Invisible microwave beams produced by military contractors and tested on U.S. prisoners can produce the sensation of burning at a distance.

What all these techniques and technologies have in common is that they’re recent neuroscientific breakthroughs propelled by military research within a broader context of rapid neuroscientific development, driven by massive government-funded projects in both America and the European Union. Even while much about the brain remains mysterious, this research has contributed to the rapid and startling development of neuroscientific technology.

And while we might marvel at these developments, it is also undeniably true that this state of affairs raises significant ethical questions. What is the proper role – if any – of neuroscience in national defense or war efforts? My research addresses these questions in the broader context of looking at how international relations, and specifically warfare, are shaped by scientific and medical expertise and technology.

An Air Force video about military research on the human brain.

Weaponization of a peaceable science?

To understand the relationship between science and war, academic bioethicists, journalists and policy advisors alike typically rely on the framework of “dual use.” Starting from the assumption that the purpose of science is to improve human life, this perspective nevertheless admits that many technologies used in peacetime or to help enhance human capacities can also be harnessed to a second use: harming and degrading human capacities as part of a military arsenal. This framework calls attention to the potential misappropriation of sciences and technologies. By acknowledging potential misuses, it aims to help guide policy to limit such possibilities through practical tools such as weapons conventions.

Key to this framework is the concept of “weaponization.” The dual use idea assumes that we should be concerned with how a once “peaceful” science or technology came to be developed and used in war or national security applications. This process is termed the “weaponization of neuroscience.”

The dual use framework and the weaponization concept may offer some immediate potential practical utility. But, as I have written more extensively elsewhere, they’re based on a massively misguided notion both of the history of neuroscience and of what is at stake practically and politically.

Neuroscience’s roots are both civilian and military

The dual use framework and weaponization concept assume stark war/peace and military/civilian divides. But in fact, the discipline of neuroscience grew equally and simultaneously out of institutions we typically consider civilian and military.

The Walter Reed Army Institute of Research building, site of much early neuroscience work.
National Museum of Health and Medicine, CC BY

Modern neuroscience was established in the post-WWII period. Like many disciplines developed and funded in that era (such as physics, nuclear medicine and others), the discipline was established through military funding in both “civilian” institutions such as MIT and Harvard and military research institutes such as the Walter Reed Army Institute of Research. That Institute’s Department of Neuropsychiatry originated the idea that researchers should study brain anatomy and physiology at the same time as psychology or psychiatry. Neuroscience was funded and shaped to meet the needs of warfare and national security imperatives.

This state of affairs was nothing new: Modern warfare and medical and scientific innovation have long been symbiotic, including the “invention” of American clinical neurology through the American Civil War. It’s not possible to say that neuroscience has been “weaponized,” because this presumes a naturally peaceful and nonmilitary origin story that is simply historically inaccurate.

Simultaneously used for good and ill

Also, the dual use framework and the concept of weaponization assume a distinct divide between help and harm. People using these concepts are primarily concerned with harmful applications of neuroscience – those that degrade human capacities. Without a doubt, these are of deep concern. Few would deny that we should pay close attention, for instance, to the use of neuropharmaceuticals to degrade the combat capabilities of enemies or produce interrogation susceptibility, or related developments.

But the stark divide between help and harm elides the fact that many technologies can do both simultaneously.

One example is the current DARPA-funded development of brain-machine interfaces. These technologies seek to connect the brain directly to machine technologies in order to control them remotely. Of course this may be a boon for veterans and soldiers in need of better prosthetic devices. But these are the very same technologies (and sometimes the same experimental subjects) that are being used to pilot drones for potential use in warfare.

‘Virtual Iraq’ exposure therapy can help veterans – and prepare them to return to the battlefield.
Defense Dept. photo by John J. Kruzel, CC BY

By way of a second example, consider military medical and rehabilitative practices. These are assumed to be on the “help” rather than “harm” side of the split. Think, for instance, of increasing diagnosis of (mild) traumatic brain injuries in military settings. Treatment of these injuries may do great good in the clinical setting for individuals who receive this care. But these therapies are also part of a system of military medicine aimed at producing war readiness and potential redeployment of soldiers. The good health of soldiers (help) is integral to warfare (harm), suggesting that the help/harm divide is not so stark as the dual use framework assumes.

For all these reasons, it’s not possible to say that neuroscience has been “militarized” or “weaponized.” The dual use framework ignores how embedded neuroscience has always been with war and national defense. In doing so, it leads us to underestimate the political task at hand, both in relation to war and in relation to science. On the side of war, it elides the ethical questions we need to be asking, not only about weaponization, but also about the supposedly benign practices of diagnosis, cure and enhancement. On the side of science, it obscures questions about what research gets funded and praised, and about the opportunity costs of allowing military imperatives to drive scientific inquiry.

The Conversation

Alison Howell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

Bioethics Blogs

BioethicsTV (November 2016): Informed consent, HIV organ transplants, Forgiveness, Assisted Suicide, Treating Prisoners, Undue Influence in Consent, and Failure to Vaccinate

by Craig Klugman, Ph.D.

Grey’s Anatomy (Season 13, Episode 9). A building collapses when a landlord has failed to make necessary repairs a year after an earthquake. The landlord mistakes a resident for a priest and confesses that his neglect was the cause of the tragedy that has led to much morbidity and mortality. The resident wonders if he has to preserve confidentiality like a priest or if information told to a doctor is different. A fellow resident tells him that since it’s not medically related, he has no obligation to maintain this particular confidence. Later, after surgerty the landlord tells the resident that he knows there was never a priest, but he simply needs someone to forgive him. The question then is whether the physician can offer a patient forgiveness for causing mass casualties to others. Of course, a physician must treat every patient the same irrespective of anything the patient may or may not have done in life. Thus the serial killer is treated the same as the cop. Health care professionals must make no moral judgments about choosing who to treat and how. But what if a patient admits criminal neglect? If the physician is a mental health professional, then the therapeutic privilege of confidentiality may protect the patient’s secret (unless there is an admission of fraud or abuse). But to your surgeon or anesthesiologist there is no such promise of confidentiality. In fact, the non-therapist physician may be obligated to report knowledge of the crime.

Chicago Med (Season 2, Episode 7-11/3) The main story line consists of a female patient who presents with altered mental status. Turns out she has a heart infection that is causing micro strokes that have affected her cognition. Cardiac surgery fellow Rose takes her for surgery but not before Charles, the psychiatrist, stops him, asking how the patient was consented. Rose responds that he explained everything to her and she signed. Charles says he only sees scrawl and that she’s not capacitated to consent. Later Rose shows up with signatures from two attendings saying the surgery was necessary and most be done imminently, which is a stretch. Charles calls him on this to the administrator stating that it violates not only ethics but also the law. However, after watching her first love die, the administrator says that Rose should go ahead and tells ## that he can file a complaint. At the end, the patient is better and has no memory of meeting the psychiatrist or anything that happened before her surgery. Rose sees this good outcome as his proof that he did the right thing. Charles is not so sure, thinking that there was no informed consent for this surgery. The reality is that the two doctor rule only applies to imminent threats—a patient likely to die within about 2 hours. This case was urgent, but not that imminent. Why didn’t they call for an ethics consult? Because this show established ethics as merely policing doctors, looking for wrong doing in its premiere episode. Certainly a family member or surrogate could have been found or an emergency court order could have been sought. In this show as in most television dramas, the ends justifies the means even when it violates ethics and law.

Chicago Med (Season 2, Episode 8-11/10). A brother has end stage kidney disease and heart disease. He needs a kidney transplant, as he can no longer receive dialysis. Given his complicated health situation, he is unlikely to receive an organ off the UNOS list. His brother is a strong match but is gay and HIV positive, two facts that he has not shared with his sick brother who is homophobic. Such a transplant is illegal because the patient would become infected and the immune suppressant drugs would make the disease very difficult to treat. Dr. Halstead also states that such a transplant would be unethical because it would be harming the patient. However, the patient is willing to take the risk because the his current life span is days.. The doctors end up providing a syringe to the patient and explain that an HIV infected organ can only go to a patient already infected with HIV. The doctors say that they cannot infect him, but his brother could, and they walk out. While this storyline is not resolved, the implication is that the brothers will go through with it. The mere suggestion, nevermind making the means available is not only a violation of a physician’s fiduciary responsibility and nonmaleficence but is also illegal. Of course the viewer is supposed to see the physicians as noble, doing everything possible for their patients. The reality is these physicians should lose their licenses.

Code Black (Season 2, Episode 5 – 11/2). In this episode a mother brings in a troupe of campers with “poison ivy.” The grandmother soon faints with similar symptoms. The diagnosis is measles because the mother chose not to vaccinate her child. Her mother was susceptible because she last had the immunization decades earlier. The mother says she did her research on the internet and made the decision to protect her children from autism and other conditions. A first year resident offers her a lecture that the internet material is not scientific but the diseases the vaccinations protect against are very real. Indeed, there have been outbreaks of measles in public places (most notable DisneyLand). For some diseases, such as measles there has been such an epidemic of parents avoiding vaccines that herd immunity has been lost, meaning that vulnerable people who may have low immune systems (like the grandmother) or who cannot have immunizations for medical reasons are at greater risk. The resident was correct and even though his method of delivery was aggressive, he is correct that not a single legitimate study has shown a risk of autism from vaccines. The mother at that moment did not need a lecture, but compassion. A lecture, however, should have been delivered after the immediate danger was past. As a t-shirt my husband has says, “Your Google search is not the same as my MD.” At the end, grandma comes through fine and the daughter has an appointment to vaccinate her kids.

Code Black (Season 2, Episode 6). A young woman is brought to the ER suffering from metastic cancer that has infiltrated into her brain. She has frequent seizures and loses the ability to speak on occasion (though she can communicate by writing). The 22-year-old woman wants to die and has asked Dr. Campbell (surgeon and ER chief) to help her die under California’s new End of Life Option Act. When she regains the ability to speak, she says that she wants his help and the ten days between first and second asking under the law have passed (the real law requires 15 days between oral requests plus a third, written request). Campbell refuses to help her, saying that the job of a doctor is to save life, not end it. The patient’s mother also is against an assisted suicide, urging her daughter to try more chemo and fight on. The mother soon learns that her daughter is an adult and gets to make her own decisions now. Dr. Willis (semi-permanently visiting military trauma surgeon), however, feels compassion for the patient, especially since his own mother died of ALS and wanted to have the option to end her life sooner. He provides the patient with a large pill (in reality, it’s a lot of pills, not a single big one) and a bottle of wine. The patient’s mother holds her hand and finally crawls into bed with her, holding her child as the drugs kill her.

 Code Black (Season 2, Episode 7). After a prison fight, a number of prisoners are sent to the ER. The doctors have to work hard to save a patient after a guard was killed. A surgical resident asks why they worked so hard to save a murderer. Rorish’s response is the correct one, “Because he’s a patient.” I say correct because patients should be treated as human beings irrespective of what they may have done in the world. In fact, in the United States, prisoners are the only population with a Constitutional right to health care (according to the Supreme Court).

Code Black (Season 2, Episode 8 – 11/23). A cult is brought to the ER after attempted mass suicide in an attempt to live forever in a virtual world. Led by their prophet, each cult member states that he or she does not want any medical treatment and refuses all attempts at medical intervention. Willis wants to treat them anway, saying that they lack capacity to consent or to refuse treatment. A psychologist says that they cannot treat the patients since each patient clearly stated a refusal of treatment. Willis is the final arbiter, deciding that they would treat all the patients despite what their words. The notion of undue influence may come into play here. This is a notion that a person is so influenced by another person that agreements made by the first person should be set aside. In other words, another person is such a coercive force that a person is unable to make a truly autonomous choice. In this case, the leader of the cult who leads his followers in a call and response refusal of treatment is such a coercive influence, that the patients are not actually legally or ethically able to refuse life sustaining treatment (in this case treatment needed as a result of their attempt to poison themselves).

Pure Genius (Season 1, Episode 4 – 11/17); The genius administrator of this futuristic hospital, who has no medical training, continues to dictate medical practice—telling his chief of surgery that he must repair a torn knee meniscus using a robotic surgery tool “because it’s cool” even if not medically indicated. Of course, like most medical shows where the ends justify the means, this unwarranted technique discovers a cancerous mass. The genius suggests that they pre-program a robot to automatically perform multiple complex surgeries at the same time, doing what a surgeon cannot do. However, it certainly is not more than a team of surgeons could do or a single surgeon could do over multiple surgeries (since each surgery is a distinct part of the body). The chief expresses his concern by saying, “Just because a patient is going to die, doesn’t mean you turn them into a guinea pig. This is a human being we’re talking about here.” The genius responds, “We have no other recourse.” And in the hubris of this show, the attempt is successful. I take issue with a surgeon who consistently tells his boss “no” when it comes to crazy procedure ideas and then always does them, even though they are medically not indicated. Every procedure done on this show is experimental and yet there is little conversation with patients about the risks or benefits and no conversations about FDA trials. The idea is that to truly innovate, medicine has to look less like a safety-conscious, conservative enterprise and more like a tech start-up. The difference is that in a start up failure means something doesn’t work and money is lost. But in medicine, if there’s failure a person could die or be permanently injured. Such a hospital in real life would be shut down very quickly. Also consider that this is a hospital where money is no object—no one ever asks what the cost is, or what the long term cost to a patient will be, or even whether creating an entire new technology to save a single life is the best use of resources. Or perhaps this show is what happens when corporate interests practice medicine—ignoring safety, ignoring the law and ethics, and ignoring that patients are vulnerable people who need help not to be used to further other goals (profit, fame, stock price, etc.).

Pure Genius (Season 1, Episode 5 – 11/24). A patient with facial disfigurement is set to receive an experimental treatment of printing skin directly onto her wounds. The only problem is that the FDA has just banned the use of bioprinted body parts. As usual chief of surgery Wallace says that if the FDA has a ban, then you don’t do it. Tech genius and hospital owner Bell plans to woo the FDA (the representative happens to be Wallace’s wife). The FDA nails the problem with a genius running a hospital, “He thinks he can get whatever he wants.” Wallace uses emotion to sway his wife’s opinion by introducing her to the patient and the patient’s daughter. The wife caves and grants a one-time, first in human permit. Coercion? Conflict of interest? No mention is raised. The ends justify the means in this show.