Published: Medical Ethics Education: An Interdisciplinary & Social Theoretical Perspective

My book 'Medical Ethics Education: An Interdisciplinary and Social Theoretical Perspective' has been published. The publishers website is here, it is on Amazon here and on my page here. If your library has access you can probably read it online and, if you really like it, by a 'My Copy' for about half price. The publisher has made Chapter 2 (Sociological Perspectives on Medical Education) freely available [.pdf here]. This chapter is mostly about the social theory of Pierre Bourdieu. Maybe they think it is the best one or maybe they think Chapter 1 (Some Relevant Concepts) is one of the main selling points! Either way, I'd love to hear what people think of it. 

Embryo Sex Selection and the Idealization of the Family

In a recently published report Dr Eve Garrard and Professor Steve Wilkinson argue that there is nothing unethical about embryological sex selection. Indeed, in the name of choice and allowing parents to fulfill their desires for male or female offspring, they argue that such selection should be available to those who want or, at least, those who can afford it. Their views go beyond permitting ‘family-balancing’ i.e. allowing those with 5 boys to finally have the girl they, or at least one of them, has always wanted. The author’s views support those who only desire a child or children of a particular sex. Whilst the report has much to recommend it - many of the arguments and much of the discussion they offer is clear, informative and fulfills what they call their fundamental aim, to be illuminating - there is something missing from the analysis. 

The report, and its discussion, proceeds in largely asocial terms meaning that the family and parenthood are implicitly considered natural kinds. Thus the desire for a ‘balanced’ family or to parent a girl rather than a boy is constructed as an authentic desire. It is therefore construed as a legitimate and innocuous personal preference in the fulfillment of a - perhaps even the or the only - universal human purpose. However when they quote mothers who have a deep-seated desire to parent a girl it is clear that what they want is a particular, and gendered, relationship. Such relationships are fundamentally social and contain a normative dimension. This is not the formal normativity of an ethical rule but the cultural normativity of a gender role and of gendered relationships. Furthermore roles such as motherhood, fatherhood and being a daughter or a son are fundamentally relational, they exist between individuals. They are a function of society and are not the property of the individual in grand (cultural) isolation. 

3-Parent Embryos and the Politics of Scientific Description

Following a report by the Human Fertilisation and Embryological Authority (HFEA), the chief medical officer for England, Dame Sally Davies, recently announced the UK government’s support for mitochondrial transfer. This procedure, developed by scientists at the University of Newcastle, can be used to prevent mitochondrial genetic diseases being passed on. Since the invention of the technique the media have been reporting on this possibility as involving the creation of ‘3-parent’ or, in the case of the Guardian, ‘3-person’ embryos. 

Whilst this phrase certainly describes something about the science of the procedure it also codes for a certain sort of moral reaction. One only has to reflect on the recent social history of the family - of marriage and divorce - to realize the role this unit, a unit Pierre  Bourdieu called a real-ised social fiction, plays in the moral landscape of contemporary culture. Whilst we may have come to accept the idea of the single (or is it lone or solo?) parent and the step (or is it blended?) family the idea of creating embryos with three biological parents – or is that from three biological persons? – still appears to have the power to provoke. 

Will an Opt-Out Organ Donor Register Make a Real Difference?

Today (2/6/13) the devolved parliament of Wales will debate moving to an opt-out organ donor register. It is highly likely to vote in favour of the measure. If so there will follow a two year program of publicity before the measure is finally introduced. it appears that various initiatives surrounding organ donation, many recommended in a 2008 report by the UK's Independent Organ Donation Taskforce, have seen a rise in postmortem donation rates across the UK. I would expect this programme of publicity to provoke a further increase not only in donation rates but also in the number of individuals who register their wish to be a postmortem organ donor. 

When surveyed, the majority of UK citizens report a willingness to be a postmortem organ donor [.pdf]. Unfortunately this percentage is not reflected in the number of citizen’s who sign the existing organ donor register. This fact is used to justify both asking the family of an unregistered potential donor for their views and for moving to an opt-out system of registration. However any opt-out system of registration adopted in the UK will be a so-called ‘soft’ opt-out system. Whilst an opt-out register will permit the registration of positive and negative views the family of any potential donors who has not registered a view will be consulted and, in practice, will have a large, and possibly determinate, say in the matter. 

Appreciating the politics of psychiatry (Cross posted from the Guardian)

Shortly after the publication of the DMS-5 I wrote the following for the Guardian's 'Political Science' blog. The original is here and a .pdf copy can be found here

Appreciating the Politics of Psychiatry: Concerns over the DSM are part of a bigger issue concerning the power of the psychological and neurological sciences.

The relationship of psychiatry to the prevailing political context has always been troubling. In authoritarian environments, such as the USSR, psychiatry has been used as a relatively blunt tool of political repression. This can be paralleled with contemporary concerns about corporate influence. The worry is that a capitalist or overly marketised environment prepares the ground for the diagnostic criteria of psychiatric illnesses to be influenced by the available treatments ie by the available psycho-pharmacological drugs.

Although his suggestion that mental illness is a myth is overly polemical Thomas Szasz offered a more nuanced critique, one that exposed the subtle relationship between social norms, small "p" politics, and psychiatric knowledge. Some of the concerns raised by Szasz and other "anti-psychiatrists" can be discerned in recent debate, prompted by the publication of DSM-5, about whether or not mental illness is "really real".

The task of securing the etiology of mental illness is an important one, but it is not the case that the only "real" illnesses are those with biological causes. Those addicted to gambling are no less addicted than those addicted to heroin. Addiction is not simply a function of an individual's neurobiology but of their psychology, history and social environment. The emotional, affective, cultural and social dimensions cannot be eliminated from mental illnesses, even those illnesses thought to have a strong biological basis. This perspective is reinforced when we consider the fact that the ongoing success of any treatment is inseparable from the social realities within which individuals live.

This entanglement between the biological, psychological and sociological dimensions of human life is the basis for the field of biopolitics. Whilst this term is increasingly influential in a range of academic endeavors, it has only just begun to make serious cultural inroads. This is somewhat ironic as the basic insight of biopolitics is that academic and, in particular, scientific understandings of what it is to be human exert a deep influence on the ways in which we can understand ourselves and, therefore, on the nature of our existence as socio-cultural beings.

For example Foucault held that the existence of human sexuality was not so much discovered as invented. Initially homosexuality was conceived as a proto-psychiatric and pathological category but with it came its antonym. The concept of heterosexuality, the norm from which homosexuality deviates, was also brought into existence. The consequences have been enormous, not least in producing the idea that sexuality is a central aspect of not only humanity but also individual human beings and their identity. Recent discussion of asexuality only provides further support for this view.

In a relatively short historical time sex between people of the same gender has gone from sinful act, to a pathological sexuality, to one form of human sexuality. To recognise the role of psychiatry in the production and transformation of sexuality is to recognise the moral and political significance of the discipline and the knowledge it has to offer. We might then reflect on the moral and political significance of transforming the cultural problems of "overeating" and "grief" when we label them "binge-eating disorder" and "major depressive disorder" respectively.

We might also reflect on the current trend for neurological explanations of everything. Some bioethicists have recently argued for the utility of so-called "love drugs". These drugs are psychoactive compounds that may, one day, allow us to reinforce aspects of our romantic lives. They might allow us to support a foundering marriage or to weaken romantic feelings we no longer wish to have.

Aside from the dualism inherent in this picture, which suggests a distinction between our emotional attachments, feelings and desires and our logical and rational intentions and decision-making, such fictional social-scientific imaginings may themselves make important contributions to the possibility of their own success. The very fact of imagining ourselves to be beings whose emotional lives can be subjected to material and psychopharmacological control is an important factor in making the possibility a cultural reality. At minimum the existence of such drugs will radically alter the social morality of our romantic relationships.

There is an increasing recognition of the way in which science and scientific knowledge influences culture. This influence is noticeable precisely because we are not simply biological beings, and precisely because our biology cannot be separated from our culture. However we should be wary of replacing our cultural self-understanding with that offered by "the human sciences". When taken up as cultural self-understanding, the knowledge offered by science and, in particular, the psy-sciences must be considered as having political consequences and, indeed, as being inherently political in the first place.

Just as the idea of sexuality has made a deep contribution to the way in which we understand ourselves, both individually and collectively, the psy-, neuro and human sciences offer frameworks within which we can conceptualise and reconceptualise ourselves. They function to reorientate and reinterpret collective and individual problems of cultural concern. Thus when Nikolas Rose talks of "Inventing Our Selves" and Ian Hacking writes about "Making up people" or lectures on "Making up Autism" they are rejecting the idea that the science of human beings and of human being can tell us what is and is not "really real" precisely because they are implicated in the outcomes of their endeavors.

Where the natural sciences have objects – atoms, electromagnetic waves, molecules, cells and organisms – the science of human beings has subject-objects. Human beings conduct those sciences that take "human being" as the object of their attention. They are ways of understanding ourselves and, since we are reflexive beings, they cannot but impact upon us as the subjects of their investigation. This does not prevent the human sciences from being rigorous but it does alter the basis on which they are conducted; it alters the ethical and political orientation we ought to adopt towards the knowledge they produce.

We must be wary of uncritically accepting knowledge offered by the human, psy-, and neuro- sciences because, as amply demonstrated by the uses to which it is put by speculative bioethics and allied projects such as post- and trans- humanism, within it we find the power for a transformation of what it is to be human. The human sciences and, for that matter, bioethics are not ethically neutral and we should recognise that the knowledge they offer is part of the politics of life itself.