Like and unlike: Late abortion in the case of wanted pregnancies, and miscarriage
Alison Reiheld

A recent article by Natalia Megas in The Guardian profiles three women who chose late abortions and who had very much wanted to be pregnant.  It is a moving exploration of the seriousness of abortion as a moral issue, and an important set of premises in why late abortion must remain legal and available. It also raises questions for me about whether the experience of late abortions of Yellow square bearing the words "A wanted pregnancy as much as a dreaded pregnancy can play differently than all one's previous imaginings. --Susie Orbach"wanted pregnancies shares elements of experiences of miscarriage, not just termination of unwanted pregnancies. But let’s start with real narratives from Megas’s article.

Early in the article, Dr. Jennifer Conti explains why women often must make such a decision:

Abortions that occur at this stage in pregnancy are often the result of tragic diagnoses and are exactly the scenarios wherein patients need their doctors, and not obstructive politicians… Asking a woman to carry a fatally flawed pregnancy to term is, at the very least, heartbreaking. I’ve often heard women say that they chose to end such pregnancies because of unselfish reasons: they couldn’t bear the thought of putting their fetus through even more pain or suffering.

One pregnant woman’s* fetus** had multiple congenital deformities which might cause the fetus to die during labor, caused complete or partial absence of the connection between the brain’s Continue reading

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Climate Change is a Medical Ethics Issue, and this graph shows why it’s real

Medical ethicists and public health specialists have argued for some time that climate change is  a health issue and a medical ethics issue. The four links in the previous sentences are a nice starting point if you want to bone up on some aspects of why this is the case.

This brings us to an April 19th, 2017, article from Climate Central that went viral on Twitter the past few days.  This article included a graph that shows, for each month since the year 1880, which months were hotter than usual, or colder than usual.  Since “than usual” is a shifting target as more and more data is recorded, continual trends of “warmer than usual” show increasing warming, not just steady temperatures.

And that is precisely what the graph shows: there hasn’t been a cooler-than-usual month in 628 months. Each row on the graph represents one year, divided into 12 horizontal blocks with one for each month.  If the month is warmer than usual, it is a shade of red: the darker, the warmer.  If the month is cooler than usual, it is a shade of blue: the darker, the cooler.

From 1880, when the chart begins, through 1915 or so, we see a mix of warmer and cooler months. Between 1915 and 1940 or so, we see a definite visual trend toward warmer months with decreasing numbers of cooler months.  And from 1940 on, there are very few cooler months. As we move from 1940 toward the present, the graph grows decidedly darker read.

The world is warming.  We may not be able to prevent it from warming further. But we must be asking ourselves what we can do to mitigate this damage, and to help those made vulnerable by it.

Several IJFAB blogs and peer-reviewed scholarly journal articles have addressed this in the past, as have some works published elsewhere but authored by members of the FAB community. You may find them useful for digging into this issue:


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Our own post-Easter resurrection: this Blog is fully operational

Many thanks to PJ Welsh and Ezgi Sertler for the technical work behind the scenes restoring IJFAB Blog to full functionality!

We are up and running.  Got a possible blog topic?  Contact the editor!

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Thank you for your patience

Hello, dear readers. As you may have noticed, IJFAB Blog has been down for a week and a half. While the blog is back up, we are working to fix access to our archive of blogs. You may notice that links to our excellent store of prior entries are currently non-functional.

Thank you for your patience as we work through these technical problems.

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TENTH ANNIVERSARY ISSUE OF IJFAB is an embarassment of riches

Our parent journal, International Journal of Feminist Approaches to Bioethics, is celebrating its 10th anniversary.  Lo those many years ago in Spring of 2008, our first issue, Doing Feminist Bioethics, was published. In the second issue, Lyerly, Little, and Faden’s article on including pregnant women in research hit the mass media with a bang and still keeps popping up in the news as a useful tool for the general public, health care providers, and researchers.

This Spring, we celebrate the 10th anniversary of IJFAB, vol 10 no 1with an issue that kicks off with an editorial from Mary Rawlinson, who helmed the ship for many years, on the very concept of feminist bioethics.

Check out this screenshot of the essays in this issue, and the breadth of topics.

But as usual, the essays aren’t all you’ll find there.

To access any of these just go directly to the Table of Contents for the issue.

Happy first decade, IJFAB. Thanks for the embarassment of riches. Here’s to many more.

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WAY BACK MACHINE Spring 2016 IJFAB vol 9 no 1: articles on queerness and reproductive ethics, “boutique” ultrasound, homebirth, GMOs, feminist practices of bioethical pedagogy, feminist palliation

If you missed last Spring’s issue of our parent journal, International Journal of Feminist Approaches to Bioethics, Spring of 2017 is a good time to jump in the Wayback Machine–before President Trump in the US and Brexit in the UK and the Colombian peace deal with FARC and any number of other global issues–and check out Spring of 2016. For ease of use, here’s the table of contents.  Continue reading

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The ABCs of the AHCA: A is for abortion, B is for backward, C is for costly
Rory Kraft

EDITOR’S NOTE: This piece’s posting was delayed by technical errors. However, the analysis of the American Health Care Act (AHCA) is still pressing and relevant. While the bill was pulled from a planned House vote in the US Congress on Friday 3/24/17 because Republicans (the GOP) did not have enough votes to pass it, House Republican leader Paul Ryan has vowed to try again after revisions to the AHCA. We do not know what they will be. Insofar as the elements critiqued by Rory Kraft remain in future versions, we still very much need this analysis. Indeed, Kraft analyzes some aspects of the proposal that did not receive a close viewing in news media, including the impact on access to abortion. At the end of Rory Kraft’s analysis, you will find a helpful list of other IJFAB Blog articles on health care and benefits reform in the US and other nations.


This argument was originally written for another venue, and thus is quirky in that it assumes a certain level of informality and is not written to be either persuasive or educational in the manners that op-eds often are.  It is also at the same time a bit defensive (“please don’t troll me!”) and expressive.  Quite simply, this is my attempt to capture for others my own reactions to the bills being called collectively the American Health Care Act.  I’ve cleaned it up a bit, but essentially here are my reactions as to how the relevant bills stood as of late Thursday 3/9/17.

Since the House leadership plan to repeal and replace the Affordable Care Act (ACA) was released late Monday March 6, I’ve had several people ask me what I think of the new plan.  This is my attempt to provide some insights.

First, like almost anyone who has looked at the ACA I have some problems with it.  The ACA is gargantuan in scope and has many side provisions which impact the functionality of it.  I can only assume that many of these were attempts to placate particular senators and/or congressmen who were wavering in their support of the bill.  The specifics of the bill are a mess while at the same time leaving big swaths to administrative regulatory language.   I say all this because I am concerned that some will take the following criticisms of the Budget Reconciliation act as a total endorsement of the ACA.

What do I think of these bills (the reconciliation language is split into two bills, perhaps in part to speed it through committees)?   Quite simply: they are horrible.

A is for Abortion, so I start with issues tied to that:

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Each English language user is about to meet their language’s new gender neutral singular pronoun, with the release of the new Associated Press Stylebook

For some time now, there has been a movement to address the English language’s need for a gender neutral singular pronoun. This need originates in the growing realization that using “he” to refer to a person whose gender you do not know is exceedingly troubling: in case studies and examples, then, all professionals become presumptively men.

In addition, people who do not fit into classic gender norms may not want to be shoved into them by “he” and “she” as English’s only singular pronouns.  And as Marilyn Frye noted in The Politics of Reality, English’s use of only gendered singular pronouns requires use to constantly engage in “sex-marking” (the determination of others’ sex before we can know how to refer to them, relate to them, shake hands, touch them, interpret body language, deploy body language, etc.). It also requires each of us to constantly announce our sex by using the techniques that fit into established gender norms.

This reinforces rigid gender norms for dress and comportment and the maintenance of our bodies (hairy, or hairless? makeup, or not? heels, or tennis shoes?) in order to clearly signal and clearly determine each person’s gender and sex. Thus, many feminists have proposed, the absence of a gender neutral pronoun is one of many social and linguistic features that shore up traditional rigid gender norms and their content.   Feminist science fiction has postulated a range of possibilities including some which have come into occasional usage, including “ze” for the pronoun and “zir” or “hir” for the possessive.  The recent scifi novel Ancillary Justice features a main character who simply cannot sex mark people accurately, and so uses “she” to refer to all other characters in the book.

Increasingly, though, it seems we no longer need novel pronouns.  Language users have naturally begun to adapt a word already in use.  Consider the claim “Someone left their phone in the bathroom. I hope they come back for it.” We already use “they” in casual usage to refer to someone whose gender is unknown   And  for some time now, the use of “they” as gender neutral singular pronoun has been gaining formal endorsements.  In January of 2016, the American Dialect Society adopted it as officially correct English, and the Washington Post had already integrated it into its style guide.  The next big leap occurred when the Associated Press Stylebook, which is widely used by many news organizations and blogs as a guide to language usage, embraced “they” for this purpose.  On Friday, March 24, 2017, the AP’s lead editor for the Stylebook, Paula Froke, had this to say:

We offer new advice for two reasons: recognition that spoken language uses they as singular, and we also recognize the need for a pronoun for people who don’t identify as a he or a she.

We also can use this wherever we need a gender neutral singular pronoun. Perhaps knowing that it is available will also lighten the burden of constant announcing and marking of sex and gender.

As  a side note, other revisions to the AP Stylebook that may be of interest to this blog’s readers include an explicit distinction between gender and sex. The entry on this reads “Gender refers to a person’s social identity while sex refers to biological characteristics… Not all people fall under one of two categories for sex or gender, according to leading medical organizations, so avoid references to both, either, or opposite sexes or genders as a way to encompass all people.”

With the imprimatur of a more universal style guide like the AP Stylebook, teachers and authors who had not yet adopted these usages in grading and writing may need to do so.

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Ebola Stigma and Lack of Access to Care in Liberia Cost the Life of an Ebola Fighter After Complications of Childbirth

Salome Karwah was recognized by Time magazine as an Ebola fighter during the 2015 Ebola outbreak. She died February 21 from complications of childbirth by C-section. Days after the procedure, she collapsed from a seizure and began foaming at the mouth.  Liberian healthcare providers refused to touch her or give her injections. Had she received care, she might still have died, but she might also have lived. You can read more here.

This image shows Salome Karwah, a woman with dark brown skin, standing in blue medical scrubs including a cap, and wearing a white apron. Behind her is a black tarped tent which may be a medical facility. In front of her are two white-skinned photographers, one holding a colorful pink umbrella to shade the person holding the camera. IMAGE CREDIT: Paul Moakley, TIME magazine.

Childbirth and its consequences are dangerous enough without adding stigmatized care to the picture.  Salome Karwah should not have died.  Stigma, whether from disease or social status, should never impede the provision of care. But were Liberian providers sure they had access to adequate training and protective gear, perhaps they would not have responded in this way. Health care in the developing world presents complicated ethical issues, no less complicated–and with difference factors–than in the developed world. Global bioethics, and developing world bioethics, is as much a part of what we bioethicists do as are our foci on developed world health care systems and the patient-physician relationship.

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Power, othering, and slurs in the clinic: undermining the capacity for care
Alison Reiheld

Over at the Feminist Midwife, we find a valuable post on WHY something that may seem prima facie wrong is, in fact, wrong.  In an entry called “Patients Are Not Bitches, and Thoughts Medical Othering,” Feminist Midwife considers a case she witnessed:

This image shows a woman with damp brown hair and pale skin standing next to a hospital bed with her arms on the bed and her head bent down. Her expression is one of concentrated effort. Her shoulders are bare, and in the foreground of the image we see a shoulder clad in the classic blue of set of scrubs. Medical equipment can be seen, out of focus, in the background of the image.

Recently, I overheard fellow providers refer to a laboring person as a bitch…. This actual event happened quite a while ago, but it’s taken me this long to separate my anger from the situation, to be able to calmly break apart all of the reasons why I felt that way. The exact circumstance was a room full of female Residents and one female midwife, referring to a patient who was disagreeing with a care plan and declining recommendations. Multiple providers in the room called the patient a bitch. They said it disparagingly toward the patient, and in comradery with each other.

The use of slurs or other demeaning speech to patients, families, or even providers is no new thing.  We do well to  give it thought, and to pay close attention to how it reinforces existing power structures. Feminist Midwife addresses this directly, with respect to gendered slurs such as “bitch”, in the blog entry linked above:

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‘Mom, I want to die, you can go in the Canada. I want to die in the snow, you can go, mom, in the Canada.’

This image is a screencap of a CBC video about refugees who cross into Canada from the US. It shows snow-covered ground, with dry brown winter grasses and train tracks poking through the snow. The text at the bottom of the screen says “Cold Crossing.”

Recent developments in American politics continue to exacerbate the migration on foot of refugees from the US to Canada. The Canadian Broadcasting Corporation has been covering this trend, and we at IJFAB Blog have also been watching. In a new CBC article yesterday, we read the words of a toddler who asked his mother to leave him to die in the snow so that she could go in to Canada. They were part of a group of refugees who walked for two hours from 2am to 4 am -20C weather. How many people are making these kinds of dangerous migrations, even in winter?

Canada Border Services Agency’s most recent numbers show 403 asylum seekers illegally crossed into Manitoba between April 2016 and the end of January 2017, many of them entering near the small border town of Emerson.

They come into Manitoba because nearby Minnesota is home to large immigrant populations from Somalia in particular.  This may be legal, and the refugees who find the U.S. to be inhospitable to their attempts to gain legal status may have rights within Canada based on U.N. agreements.

Cross through a snow-covered farmer’s field on foot in harsh winter conditions — like two Ghanaian refugees did in December, losing most of their fingers to frostbite — and the United Nations’ 1951 Convention Relating to the Status of Refugees kicks in.

In related news also breaking yesterday, the United Kingdom’s Home Office announced it would suspend admissions for child refugees with disabilities on the grounds that their needs for care would overburden the UK’s NHS, whose ability to provide care has suffered under repeated rounds of funding cuts.

IJFAB Blog will keep watching this issue of refugees and health as it develops in various nations.

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“You suffer. That is enough for me.”

Thanks to Gretchen Case for this image of the Pasteur Memorial at Cook County Hospital in Chicago.  It is a timely reminder as the context for global public health shifts, and many powerful nations (US, UK, France, and other European nations) that have been destinations of immigrants seeking freedom and better conditions begin to react against immigration. Physicians, nurses, and other health professionals across the world are likely to find themselves in the position of having to decide whether to turn away patients who are undocumented immigrants, or who are documented but cannot access the health system of the nation in which they reside. Do you think Pasteur had it right?

A bronze plaque bearing English text is surrounded by an ornate stone plinth. It reads “One doesn’t ask of one who suffers, what is your country and what is your religion? One merely says, you suffer. This is enough for me. You belong to me and I shall help you.” Below the text is the name Louis Pasteur.

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