About Alison Reiheld

Alison Reiheld is Professor of Philosophy at Southern Illinois University - Edwardsville and co-President (with Perry Zurn) of the Association for Feminist Ethics and Social Theory (FEAST).

“Society: Don’t blame the mothers”

A new piece in Nature raises important points for scientists working in fetal epigenetics to consider when writing up and communicating their work. The authors urge consideration of how the results will be used to target the behavior of pregnant … Continue reading

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“Australia queries ‘moral responsibility’ over abandoned Down’s baby”

A complication of transnational surrogacy: what happens when the contracting couple/parent(s) decide after birth that they do not want the child? In this case, one of two twins carried by a surrogate was born with Down syndrome. His “healthy” sister … Continue reading

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This July 4th, Here’s Hoping For More Freedom To Access American Healthcare Options

International readers will, I hope, both forgive and find value in this Amerocentric reflection on health care and freedom as America celebrates its Independence Day this July 4th (and the day after, and the day after that). It bears reflecting … Continue reading

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The Pendulum Swings? Spain faces a return to an era of very restricted access to abortion

  In 1985, Spain passed laws restricting a woman’s right to abortion, the so-called “Organic Law” governing reproductive health and abortion. Under this law, abortion was legal in only three cases: serious risk to physical or mental health of the … Continue reading

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Aiming at Body Size: How Medicalizing Obesity Changes the Very Notion of What it is to be Healthy

Something is changing the bodies of Americans.  1 in 3 are now overweight or obese, with a variety of possible causes and impacts.  But how important is this, medically? And what ought physicians to do about it? Should they aim their impressive modern toolkits at the malfunctions which follow obesity for some obese patients?  Or at obesity and body size, itself?  Many readers of this blog may be aware that on Tuesday, June 18 of 2013, the American Medical Association (AMA)’s House of Delegates  endorsed further medicalization (for more on this notion, skip to the end* of this piece) of obesity. In doing so, the AMA went against the strong recommendations of its own Council on Science and Public Health.   Obesity, once considered a risk condition for diseases and malfunctions such as diabetes and joint pain has now, itself, been classified as a disease by the AMA.  Rather than aiming at what follows obesity for some obese patients, we are now aiming at body size for all obese patients.

Holley Mangold, Olympic athlete, member of the 2012 U.S. Weightlifting team. Her personal record in the combined snatch and clean-and-jerk is 562.2 pounds. With obesity defined as a disease, she is by definition unhealthy. Photo credit: Scripps Howard News Service. Holley Mangold, Olympic athlete, member of the 2012 U.S. Weightlifting team. Her personal record in the combined snatch and clean-and-jerk is 562.2 pounds. With obesity defined as a disease, she is by definition unhealthy. Photo credit: Scripps Howard News Service.

As the AMA acknowledged in its resolution, the organization is by no means the first to make this classification: “The World Health Organization, Food and Drug Administration (FDA), National Institutes of Health (NIH), the American Association of Clinical Endocrinologists, and Internal Revenue Service recognize obesity as a disease.”  Indeed, the American Association of Clinical Endocrinologists and the American College of Cardiology pushed hard to have the AMA recognize obesity as a disease even after the Council on Science and Public Health recommended against it.

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Eating as Shameful: Food, Gender, Daily Life, and Media Messages

Why do women feel such shame about being seen to indulge, whether or not they are fat? Why do others take such glee in shaming them? Why does this extend even to non-indulgent foods?

I was recently at a social gathering of adults over the age of 25, the vast majority of whom hold PhDs and were academics. At this gathering, a male attendee speaking to a group of about seven people began to mock a pair of fat women he used to encounter who would walk together down the sidewalk briskly and clearly for exercise, and whom he would occasionally see end their walk at a fast food restaurant. He commented about the irony of this, and how much space they took up on the sidewalk which required him to get off the sidewalk to let them pass—as though this would not have been the case with two smaller women walking side by side—and connected this with their eating habits and fatness. Despite gentle pushback from myself and one other woman at the gathering, he doubled down on their rudeness and his shaming of them for eating at the fast food place despite the fact that he had no knowledge of their health other than their body size, no knowledge of what they ordered or ate at the fast food place, and was using them as an object of fun in an “amusing” party story. The raconteur fully expected everyone in his audience to share his attitude. And in many audiences, everyone would have.

This sort of shaming of fat people for eating is common. A “normal” sized man eating a hamburger with juices dripping down his chin and an expression of ecstasy may well be perceived as enjoying his food, but a larger man doing the same thing is likely to be perceived as a glutton.

But it goes far beyond shaming of fat people. Even skinny people, especially women, are often made to feel shame for what they eat. Just consider the standard stock photo of women eating salad joyfully. Or this image of model Barbara Palvin with food near her mouth, presented on a “thinspo” (thinsporation) blog critiquing Palvin for gaining weight (though not enough that her thighs actually touch). The phrase which introduces it is from the blog’s author, and is the way she herself introduced this image.

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The same blog also attacks Kate Upton for her curvy figure. For those who don’t follow such things, Upton was Sports Illustrated’s 2012 Swimsuit Issue Covergirl.  On a page called “Kate Upton is Well-Marbled”, Upton is routinely called a “cow” and the author bemoans what the fashion industry is coming to when Upton is representing the profession:

Look, I’ll admit – I love In’n’Out as much as the next gurl, but it’s not supposed to be an everyday thing, Kate! And we can be sure that Kate is the rare model who poses with food – and then actually devours it.

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When Drug Use Isn’t Just About Anti-Drug Laws: Criminalizing Pregnancy Behavior

U.S. states have long had the power to override a pregnant woman’s medical autonomy in specific kinds of instances in order to prevent harm to her fetus. Means for doing so have included court orders to compel C-section or to … Continue reading

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Constraints on Medical Autonomy for Pregnant Women

I have written on diminished autonomy for pregnant women before for IJFAB blog in my piece,  Not All Objectification Is Sexual: The Return of the Fetal Container.   That piece, like Minkoff and Lyerly’s excellent 2010 piece in Hastings Center Report, dealt broadly with the choices which pregnant women are or are not constrained from making during their pregnancy, allegedly by state-imposed duties to their fetuses.  There is another aspect of constrained medical autonomy for pregnant women, however, and it has to do with the priorities of some physicians (and patients) with respect to how risk and other concerns are viewed.

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Denying the Patient In Front Of You: Recent Studies of Transgender Patients’ Experiences in the ER Confirms Prior Results about Poor Treatment of Transgender Persons in Clinical Settings

Two studies which have recently hit the press reinforce a problem I have been considering for some time, namely the difficulties which transgender persons face in getting care. Herein, I will give an overview of these difficulties, the new studies, what they reveal about causes of provider’s behavior with respect to trans persons, and some brief recommendations for how providers can do better.

Transgender health advocates Sabrina Suico of the Couples Health Intervention Project and Brionna of the Mariposa project both work with services dedicated to improving the lives of transgender or gender-variant people of color. Image Credit: Aubrie Abeno, via mintpressnews.comTransgender health advocates Sabrina Suico of the Couples Health Intervention Project and Brionna of the Mariposa project both work with services dedicated to improving the lives of transgender or gender-variant people of color. Image Credit: Aubrie Abeno, via mintpressnews.com

In 2012, I presented a paper at the American Society for Bioethics and Humanities, “She Walked Out of the Room And Never Came Back…”, in which I discussed the case of a patient who had been denied care by health care personnel while visiting the ER for a broken limb before finally being seen by another provider. The first provider walked out in a huff after the transgender patient’s trans status became clear as the patient’s anatomy was revealed during a diagnostic procedure. After leaving the patient alone, in pain, with no idea whether to leave and go to another facility or wait, another provider came into the room and professionally and compassionately provided the necessary medical care. This, I found, was not uncommon. Approximately 1 in 5 transgender patients have put off preventive medical care due to experiencing, or fear of experiencing, discriminatory behavior directed at the patient by clinical staff. According to some figures, this rises above 1 in 4 (28%), and transgender persons report being denied care across every demographic but worst for transgender women, who were assigned male sex at birth, than for transgender men who were assigned female sex at birth. The fact that transgender persons experience difficulties with access to health care should come as no surprise. In 2011, the Institute of Medicine released a report which addressed the many ways in which poor access to basic medical care for transgender individuals is “due largely to social stigma” and “fear of discrimination in health care settings” as well as lack of employer-provided health insurance due to employment discrimination.

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Presumed Incompetent: Treatment of Persons in Long-Term and In-Patient Psychiatric Care Facilities

Over at Feministing, Katie has a pretty solid analysis of the recent case of a woman in an independent living facility who was unambiguously raped by a male employee. After reporting the rape, to which the perpetrator confessed, the survivor … Continue reading

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True Romance: got consent?

This Valentine’s Day, folks across the country will be either ignoring the romantic vibes altogether, deriding the holiday, praising the single life, celebrating an ongoing romance, or trying to start a new one. For folks seeking out companionship, relationships can … Continue reading

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Callous analogies: a blogger reflects on the implications of abortion policy for her own treatment decisions regarding her severely premature infants

The rhetoric surrounding late abortions and so-called “fourth trimester abortions” (in which the fetus is alive after an attempted abortion) touches perilously on the ethical issues surrounding care for very premature infants. The author of this blog entry at a … Continue reading

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