Obstructing access to gender affirming care in Missouri: the Missouri Attorney General’s “emergency order” goes into effect today, and it’s not about informed consent or protecting kids
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Posted on by April 27, 2023
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UPDATE: A number of advocacy groups have sued to prevent the rule from going into effect, including the ACLU (American Civil Liberties Union) and Southampton Community Healthcare in St. Louis. The petition says “The Rule targets gender-affirming care with unprecedented and unique restrictions so onerous that it effectively prohibits the provision of this necessary, safe, and effective care for many, if not most, transgender people in Missouri.” The suit sought a stay on the order. After this blog post was written, St. Louis County Circuit Court Judge Ellen Ribaudo issued the stay of enforcement that would allow the court time to “review the briefing sufficiently.” Judge Ribaudo anticipated doing so by May 1. This changes the timeline on implementation. It does not change the substance of this blog entry.

I have been thinking more about Missouri Attorney General Andrew Bailey’s emergency order restricting access to gender affirming care. The order was scheduled to go into effect today, Thursday April 27 2023. While initially touted by Bailey as “protecting” kids, in fact it affects both minors and adults, and puts serious obstacles in the path of anyone seeking gender affirming care. Since Bailey made it clear adults will also be affected, he has been framing the emergency order as “protecting consumers” and supporting “informed consent” by making sure that “all patients” realize that these treatments are “experimental.” Bailey has in fact said, ““I am standing up to make sure that patients have the information they need to make informed health care decisions.” If this were true, medical ethicists would have to take note, and might even be manipulated into supporting such rules. However, it’s not. Experts from numerous medical associations have pushed back on the claim that these are experimental treatments, instead noting that they are considered standard of care with decades of evidence for effectiveness and are not experimental. And the St. Louis Department of Health has issued a statement condemning the order on these and further grounds (St. Louis is where most gender affirming care in Missouri, especially for trans youth, takes place). Other medical experts and health care institutions have noted that access to gender affirming care improves mental health for trans youth and adults, and reduces suicidality by as much as 73%, thus, making it harder to access gender affirming care is the opposite of protecting trans youth and trans adults. The order isn’t about informed consent, and it isn’t about protecting kids. Let’s explore this further.

Here are the criteria for accessing gender affirming care in the state of Missouri as of today, criteria that probably don’t affect people already receiving care but definitely affect trans youth and adults who are just establishing gender affirming care in Missouri. This handy summary of the criteria is taken from an article in the Springfield News-Leader by Susan Szuch:

  • Assess at least annually whether the patient has gender dysphoria;
  • Disclose a list of information potential negative side effects and information about gender dysphoria;
  • Perform a full psychological/psychiatric assessment, including at least 15 hourly sessions over the span of at least 18 months, to identify whether the patient has any other mental health comorbidities;
  • Treat and resolve existing mental health comorbidities;
  • Track all adverse effects from any course of covered gender-affirming procedures for at least 15 years from the start of the intervention;
  • Obtain and keep on file informed written consent;
  • Ensure that the patient has a comprehensive screening to determine whether or not they have autism;
  • Ensure at least annually that the patient’s gender identity is not the result of a “social contagion;”
  • Ensure at least annually that minor patients are screened for “social media addiction or compulsion”

All of the criteria are quite troublesome in terms of putting in place nearly insurmountable barriers to accessing care. But the two that I want to single out are:

  1. that all other mental health conditions be not only treated but resolved before gender affirming care can begin, and
  2. that the person be assessed for social contagion and prove that their gender identity is not being influenced by others.
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FAB Gab Episode 31 – Jane Dryden on the Microbiome and the Imperative of Normalcy

Posted on by April 25, 2023
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In this episode of FAB Gab, Jane Dryden talks about her recently-published paper about the way that microbiome research reflects and reinforces the imperative of normalcy in health and medicine. Through the two cases of obesity and of autism, Dryden argues that healthism and ablism are combined in the way that researchers and popular writers talk about the ‘promise to cure’ in microbiome research.

Here’s a sneak peak from the conversation:

…With autism, there’s a lot of studies that do show a correlation between being autistic and having and having various forms of gut issues. Like they’re just really common. The exact prevalence varies a lot depending on the study. But this correlation kind of comes up again and again. And so you can pretty reasonably ask, you know, would it be helpful if we found sort of useful, useful treatments for this? But the focus is so often on the behaviors. So for example, autistic people frequently stim, right? So kind of repetitive movements and motions and so forth that are aimed at sort of self soothing, and, you know, just interacting with the environment. And the, and so one of the measures of well, did this microbiome therapy work is, well, was there less stimming? And did the person make more eye contact? It’s like, Well, are we worried about this? Or are we worried about whether their stomachs feel okay?

Jane Dryden in conversation on FAB Gab

You can check out this episode on Spotify or Apple Podcasts. Don’t forget to subscribe so that you never miss an episode!

FAB Gab is hosted and produced by Kathryn MacKay.

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Mifepristone Round-Up

Posted on by April 22, 2023
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On April 21, the US Supreme Court rejected lower court decisions restricting or altogether banning abortion medication Mifepristone and, by extension, the regulatory power of the FDA. The case is now in the hands of the 5th Circuit Court of Appeals, which will begin hearing oral arguments on May 17.

For more details and responses, see the range of sources below.
NPR presents a timeline starting with Texas Judge Matthew Kacsmaryk’s order through yesterday’s response from the Supreme Court.

DemocracyNow! turns to law professor and reproductive justice Michelle Goodwin and abortion provider Julie Burkhart for analysis of Kacsmaryk’s suspension of Mifepristone and the state of abortion care in the US. See also Dr. Goodwin’s book, Policing the Womb: Invisible Women and the Criminalization of Motherhood and guest essay in The New York Times, along with Burkhart’s Salon article.

Meanwhile, Hannah Levintova at Mother Jones presents a long-form investigation of Mifeprex’s private equity investors who stand to profit from the pill’s protection. See also Madison Pauly’s analysis of the resurgence of the Comstock Act for Mother Jones.

Kiarash Aramesh writes for The Hastings Center’s Bioethics Forum that the struggle over Mifepristone and abortion care in the U.S. more generally indicates an accelerating slide into theocracy.

Reach out to the IJFABBlog editors with pitches for feminist bioethical analyses of the struggle for medication abortion.

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An APA Pacific Meeting With(out) Anita Silvers
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Posted on by April 20, 2023
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Anita Silvers is depicted. She is sitting in her powerchair, which has snazzy black and red detailing. She has pale skin, long blonde hair that is greying, is wearing white slacks and a black turtleneck, and wearing large beaded silver jewelry including necklaces and a turqoise ring. She has a blanket across the back of her chair colorfully decorated in geometric patterns common in North American indigenous peoples' blankets. She is gazing at and touching a ceramic sculpture of a mesoamerican person wearing an infant on their back. A ceramic pot rests on the floor next to the left wheel of her chair.
Anita Silvers is depicted. She is sitting in her powerchair, which has snazzy black and red detailing. She has pale skin, long blonde hair that is greying, is wearing white slacks and a black turtleneck, and wearing large beaded silver jewelry including necklaces and a turqoise ring. She has a blanket across the back of her chair colorfully decorated in geometric patterns common in North American indigenous peoples’ blankets. She is gazing at and touching a ceramic sculpture of a mesoamerican person wearing an infant on their back. A ceramic pot rests on the floor next to the left wheel of her chair.

A couple weeks ago was my first American Philosophical Association (APA) Pacific Division meeting where I didn’t get to see my dear mentor and friend, Dr. Anita Silvers (1940-2019), the fearless Secretary-Treasurer for the APA for 26 years. Anita was a philosophy professor at San Francisco State University for over 50 years and department chair for 15 of those years. A “towering figure” in feminist and disability bioethics, to use Dr. Adam Cureton’s fitting description, Anita served on the IJFAB Advisory Board, and long argued for a feminist ethics that bases morality on dependency or vulnerability to challenge the moral priority of uniform over disparate treatment. I first met this revered “authority on disability rights” in 2002 at an APA meeting, where I sought Anita’s advice on my growing research interest in disability bioethics. Anita’s mentor instinct immediately kicked in – she encouraged me to participate in the upcoming NEH seminar, “Justice, Equality, and the Challenge of Disability,” which was to be co-directed by Anita and Dr. Eva Kittay. I am forever grateful for the rich summer seminar and Anita’s subsequent mentoring that sowed the seeds for much of my work in disability bioethics and feminist bioethics. Some of my collaborative (or more like mentored) work with Anita also enriched my thinking on the use of remote AI health monitoring for older adults and people with disabilities.

While I miss Anita and our conversations deeply, and was always impressed with her ability to choose the best restaurants in whatever cities we found ourselves, her legacy was on full display at the APA Special Memorial Session and Reception organized by Anita’s long-time collaborator and dear friend, Dr. Leslie Pickering Francis, completed with chocolates sprinkled across the St. Francis Room and champagne brunch in Anita’s honor. (I have fond memories of helping Anita hide Easter eggs for the Sunday brunch at that same venue, where children of APA attendees would excitedly search for the special treats.)

The full panel sits at a long table in the front of a conference room. There are two light-skinned women and two light-skinned men at the table, all paying attention to a speaker who is standing at a podium next to them gesturing animatedly with her hand. Behind them is an ornate wood-paneled wall and carved fireplace with mantle, as well as a mirror reflecting the warm yellow light of chandeliers.
The full panel sits at a long table in the front of a conference room. There are two light-skinned women (Teresa Blankmeyer-Burke and Eva Kittay) and two light-skinned men (Adam Cureton and Dominic McIvers Lopes) at the table, all paying attention to Dr. Leslie Pickering Francis, the speaker, who is standing at a podium next to them to the right of the panelist table, gesturing animatedly with her hand. Behind them is an ornate wood-paneled wall and carved fireplace with mantle, as well as a mirror reflecting the warm yellow light of chandeliers.
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Books, books, everywhere…

Posted on by April 13, 2023
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The International Journal of Feminist Approaches to Bioethics welcomes enquiries regarding book reviews. Our process is supportive, so if you’re a student or a more seasoned academic please do consider getting in touch if there is something on your radar that you think will be of interest to an IJFAB audience.

Some that have caught our attention that we would love to see reviewers for are:

“Abolish the Family” by Sophie Lewis (Abolish the Family – Verso (versobooks.com))

Sara Ahmed’s latest “The Feminist Killjoy Handbook” (The Feminist Killjoy Handbook by Sara Ahmed | Seal Press)

“Black Health” by Keisha Ray (Black Health – Paperback – Keisha Ray – Oxford University Press (oup.com))

“Crip Genealogies” edited by Mel Y. Chen, Alison Kafer, Eunjung Chen, and Julie Avril Minich (Duke University Press – Crip Genealogies (dukeupress.edu))

Amber Knight’s and Joshua Miller’s “Prental Genetic Testing, Abortion and Disability Justice” (Prenatal Genetic Testing, Abortion, and Disability Justice – Amber Knight; Joshua Miller – Oxford University Press (oup.com))

If any of these are of interest or there are others you’d like to suggest please get in touch with our Book Review Editor, Emma Tumilty (emtumilt@utmb.edu). You can read what she thinks makes a good book review here.

Happy Reading!

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New study on hormonal birth control risks

Posted on by March 30, 2023
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A new study from Oxford University finds that the slightly elevated risk of breast cancer due to use of hormonal birth control pills extends across all forms of hormonal birth control. While earlier findings showing a similar increased risk were based in the study of combination pills containing both estrogen and progestin–the kind of pill dominant in the 1990s–these more recent results take into account progestin-only “mini pills” and intrauterine devices (IUDs), showing that elevated risk remains consistent across all forms of hormonal birth control. Although the absolute elevation of risk is small (+.15% for women under 40 and +.5% for women under 50 years old), the results are significant given that the population of hormonal birth control users in their 20s and 30s have a lower background risk for the disease, and that progestin-only therapies were previously assumed to carry less risk than combination pills. The results are interesting, moreover, given the significant differences in functioning between hormonal birth control therapies.

Mini pills and IUD

Source: “Study finds same small rise in breast cancer risk in many forms of hormonal birth control,” STATNews (statnews.com)

These findings raise familiar feminist bioethical questions concerning our relative lack of knowledge about hormonal birth control and the predominant focus on modes of contraception that intervene in the reproductive capacities of people with uteruses rather than exploring alternative methods like the “male pill.” Of course, the risks with hormonal birth control methods should be considered alongside their demonstrated benefits. Gillian Reeves, director of cancer epidemiology at Oxford and researcher on the recent study underscored to StatNews that, especially in the context of elevated maternal morality rates in the United States, hormonal birth control is still less risky than childbirth.

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Feminist Approaches to Bioethics Works-In-Progress Session

Posted on by March 28, 2023
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On Monday, April 3rd at 12pm Pacific/3pm Eastern (find your local time zone here) the American Society for Bioethics and Humanities (ASBH) affinity group on Feminist Approaches to Bioethics is hosting a virtual works-in-progress session for scholars to get feedback on news works in feminist approaches to bioethics. Anyone working on feminist approaches to bioethics broadly construed is welcome to join, learn about emerging work in feminist bioethics, and provide feedback. No need to be a member of ASBH or the FAB Affinity Group. Registration link here to join.

April 3rd via Zoom: Virtual Works-in-Progress Session Hosted by the ASBH Feminist Approaches to Bioethics (FAB) affinity group

2 New Works In Progress

Hannah Carpenter from The University of Texas Medical Branch will present on “Affording Access to Contraception” arguing that although the US Affordable Care Act has generally improved access and affordability of contraception, in the context of limited abortion access greater contraception access is imperative, including full coverage of contraception without restrictions in order to achieve reproductive autonomy.

Darcy Metcalfe from the University of Findlay will present on “Race-ing the Future’: Ending the Use of Racial Categories in Biotechnology,” a project that aims to end the use of racialized categories in the research, funding, and marketing of genetic biotechnologies in order for new and burgeoning genetic technologies to be free of the racialized harms of medical history.

Come learn about these project, provide collaborative and constructive feedback, and network with others working within feminist approaches to bioethics.

Register Here for April 3rd Event

Complete this link to attend the virtual works-in-progress session on April 3rd at 3pm Eastern Daylight Time.

The FAB Affinity Group

The ASBH Feminist Approaches to Bioethics Affinity Group (FAB) is currently co-chaired by Georgina Campelia (Department of Bioethics and Humanities, UW Medicine) and Elizabeth Lanphier (Ethics Center, Cincinnati Children’s Hospital Medical Center) and is seeking new leadership to co-chair the affinity group for a three year term from 2024 through 2026.

Reach out to Georgina or Elizabeth with any questions about the group and its activities including periodic virtual workshops, panels, and networking sessions in addition to the in-person meeting at the annual ASBH conference each October.

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FAB Gab Episode 30: Karen Davis on women’s pain and breaking through isolation

Posted on by March 21, 2023
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This month, on FAB Gab, Karen Davis speaks about her paper in the new Spring 2023 issue of IJFAB, which is about women’s experiences of pain and how dialogue with sympathetic others can break isolation. Karen’s work stems from her own experience with chronic pain and her background in philosophical hermeneutics.

Here’s a quote from the discussion:

[Gadamer’s] idea is self mastery, that like the physicians role is just to help you to control your own self in a way that you already can. And, you know, the image of the midwife is meaningful to philosophers in many ways. But that, that felt like a certain kind of abandonment to me, that wasn’t what I needed, in sort of a recovery or healing relationship. It wasn’t that midwife guidance, it was something a little different, that it wasn’t something within me that needed to be brought out. It was actually my connections with the world that needed to be reinstated, or reinvigorated. Right, that the pain had sort of cut me off.

Karen Davis, in discussion on FAB Gab

Check out this episode, and all other episodes of FAB Gab, on Spotify, Apple Podcasts, or Radio Public. You can subscribe so that you never miss an episode!

FAB Gab is hosted and produced by Kathryn MacKay.

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“Effectively the biggest prison in the world”

Posted on by March 10, 2023
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This is how Zahra Nader a freelance journalist describes Afghanistan under current Taliban rule to Amy Goodman on Democracy Now this week. In a week that saw many protests across the world tied to International Women’s Day, a small group of women in Afghanistan bravely sat outside the University they are now barred from entering to protest their exclusion from higher education.

The Taliban, who have now been in power for a little under two years, have been described as creating the most repressive country for women in the world by the U.N. Women are effectively trapped in their homes under new rules of movement, work, and education. This to the detriment of women and the country as a whole which is consequently suffering a humanitarian and economic crisis.

Source: Afghan Girls’ Education: ‘I Don’t Think I Have a Future’ | Human Rights Watch (hrw.org)

Access to education is also under threat in Iran where 1000 girls have been poisoned attending school. This follows large scale protests and arrests that began in September 2022 after the death of Mahsa Amini at the hands of the morality police. While international attention may have waned, resistance in Iran has continued with ongoing acts of defiance in the face of the repressive regime and subsequent arrests of journalists, athletes, people who dare dance in the street.

Shirin Ebadi, the first Iranian to win the Nobel Peace Prize, said:

“It’s not just about hope and ideas but action”

Action gains greater power through collective force. Feminists have always understood that solidarity is strength. All of us wherever we may be can do something. Find what actions you can take, they will vary by person and place, to stand together with those facing utter hopelessness.

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Online workshop on epistemic injustice in psychiatry and mental health

Posted on by February 23, 2023
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Just passing on this announcement relevant to folks working in feminist bioethics:

The Canada Research Chair on Epistemic Injustice and Agency is pleased to host an online workshop on Epistemic Injustice and Agency in Psychiatry and Mental Health, on 10 March 2023.

La Chaire de recherche du Canada sur l’injustice et l’agentivité épistémiques est heureuse d’organiser un atelier en ligne sur le thème Injustice et agentivité épistémiques en psychiatrie et en santé mentale, le 10 mars 2023.

Program – Programme:

https://crc-iae.com/events/?lang=en

Registration – Inscription:

https://forms.gle/47Zt4pDkJ8pnsjhD6

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FAB Gab Episode 29: Maya Goldenberg on Vaccine Hesitancy, pre- and mid-pandemic

Posted on by January 26, 2023
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The latest episode of FAB Gab is out now, and this time, Prof. Maya Goldenberg discusses her ‘author meets critics’ feature in the last issue of IJFAB. Goldenberg and two critics, Miriam Solomon and Inmaculada de Melo-Martin, discussed Goldenberg’s recent book, Vaccine Hesitancy: Public Trust, Expertise, and the War on Science (2021).

Goldberg and critics discuss vaccine hesitancy in the context of childhood vaccination, which is the book’s focus, as well as what might be extrapolated and applied to the public discussions around COVID-19 vaccines.

You can subscribe to FAB Gab on Spotify and Apple Podcasts, or listen to new episodes here!

FAB Gab is hosted and produced by Kathryn MacKay

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Urgent Care and Systemic Damage: Health Issues in the Wake of the earthquake affecting Syria and Turkey
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Posted on by February 14, 2023
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Hi, folks. IJFAB Blog Editors, here, with a quick roundup of links about the health and ethical issues that arise in the wake of any natural disaster, and specifically last week’s earthquake affecting Syria and Turkey. The death toll is presently well over 33,000, and expected to continue climbing as we see increased exposure to winter storms from lack of warm shelter, combined with disruption of social supports and access to health care, along with continued efforts for search and rescue and identification of the deceased. Pre-existing problems are worsened in such situations.

The Guardian has been doing some excellent English-language reporting. This link stopped updating on February 12, but has handy bullet points on major issues from Guardian reporting, and provides a timeline of events. It also discusses some of the reasons that the death toll will continue to rise, and the health and safety issues facing those who survived the event. https://www.theguardian.com/world/live/2023/feb/12/turkey-syria-earthquake-latest-news-updates-death-toll

This link, from Doctors Without Borders / Medecins Sans Frontieres (MSF), addresses their rescue and health efforts: https://www.doctorswithoutborders.org/latest/msf-responds-overwhelming-medical-needs-following-earthquakes-turkey-and-syria. Go to the link for details, but here’s their bullet-point summary of the situation on the ground as they are involved.

  • MSF-supported hospitals in northwestern Syria have seen more than 3,500 injured patients.
  • MSF has donated emergency kits, trauma kits, medical supplies, and blankets to 30 hospitals and health facilities in Idlib and Aleppo governorates.
  • We are running mobile clinics in five reception centers in Idlib governorate for people displaced by the earthquake and we will ramp up these services in the coming days.
  • We have sent our ambulances and dispatched extra medical staff—including surgeons—to hard-hit health care facilities in northwestern Syria
  • Teams are distributing blankets, hygiene kits, food items, and more supplies to families in Aleppo and Idlib governorates
  • Emergency teams are assessing the needs in southern Türkiye and stand ready to provide assistance

Al Jazeera reports on a well-known feature of natural disasters: not only do they introduce new health risks, but they can worsen pre-existing ones, especially when it comes to epidemics. Whether we’re talking about respiratory viruses that spread more virulently in packed warming centers and camps for displaced persons, or water-borne illnesses that worsen as water treatment and sewage systems are damaged by natural disaster, exacerbation of pre-existing health issues is common during and after natural disasters. The pre-existing health issue highlighted in the link at the beginning of this paragraph? Cholera.

Across war-torn Syria, where the UN has estimated that 5.3 million people have been left homeless by the disaster, “there was a perfect storm brewing before the earthquake – of increasing food insecurity, collapsing healthcare systems, the lack of access to safe water and poor sanitation”, said Eva Hines, chief of communications for the United Nations Children’s Fund (UNICEF) in the Syrian capital, Damascus.

“More than half of people in Syria depend on unsafe alternative water sources when it comes to their water needs. And that, of course, increases vulnerability to fast-spreading waterborne diseases such as cholera,” Hines told Al Jazeera.

To this editor’s surprise, Women’s Health magazine had a decent little article on why women are often at the pointy end of natural disasters. One issue is one we have seen throughout social upheavals that increase social stress and/or trap people at home, unable to move in society as they usually do: increases in domestic violence that fall overwhelmingly on women. In addition, already-heavy caregiving loads for children and elderly family members, as well as spouses, still tend to be borne disproportionately by women. These increase dramatically as food, clean water, and warm shelter become harder to find, and as family members may be injured or become ill.

While this editor cannot find good articles on mental health issues with respect to this particular earthquake, we can expect these to develop in coming months as survivors deal with loss, trauma, and even guilt. Mental health services are woefully inadequate in most of the world. And are common in the wake of natural disasters.

These are just some of the public health and individual health access issues that are present now in Syria and Turkey.

Another thing to consider is the role that social systems play in preventing or reducing death tolls, injuries, and illness. When we’re talking about earth quakes and flooding, this includes whether governments hold construction companies to good building standards. Yet, in Turkey, this has not happened. In fact, Turkish government leaders have proudly forgiven the fines and penalties of construction companies for not building to code. Here are a few links on this issue:

Natural disasters present not only emergent care needs and longer-term care needs for both physical and mental health, but also worsen existing health crises and highlight systemic problems (building codes; disproportionate caregiving loads; domestic violence) that could be otherwise.

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