The Battered Woman Syndrome, like the Cycle Theory of Violence, helps to illuminate the situation of the person victimized by domestic violence. However, it may also contribute to the violence of the battering situation. In this paper, I explore some of the implications of the Battered Woman Syndrome for domestic violence cases wherein an abused woman kills her abuser. I begin by delineating some of the circumstances of a domestic violence situation. I then (...) discuss the particular moral issue of subjectivity or moral personhood involved in instances wherein a woman victimized by domestic violence responds by killing her batterer. Finally, I argue that the Battered Woman Syndrome and similar alternatives to or qualifications of self-defense are problematic because they strip a woman of her moral subjectivity. I conclude with a brief articulation of a proposal for reform of the criminal justice system specifically aimed at cases wherein there has been a long history of abuse or violence. This reform is unique because it does not rely on a separate standard of reasonableness particular to battered women, but arises out of consideration of the moral implications of legal proceedings involving domestic violence. (shrink)

This article explores how the acceptance of the battered woman syndrome as the explanation for why abusive relationships continue can be understood as a cultural compromise. The syndrome's portrayal of battered women as passive victims resulted in an exclusive definition of who “counts” as a victim. It further emphasized many abused women's weaknesses rather than their resourcefulness and overlooked the plights of a great variety of women in need of help. More important, it placed emphasis (...) on individualized solutions for domestic violence rather than addressing structural inequalities in American society. These issues ultimately led to a critique by other advocates of the battered woman syndrome as an inadequate and flawed explanation for domestic violence. Yet despite its weaknesses, the syndrome allowed advocates the chance to appeal to the larger public and, ultimately, begin the process of alleviating structural inequalities. (shrink)

Donald Alexander Downs, More Than Victims: Battered Women, the Syndrome Society, and the Law Chicago: University of Chicago Press, 1996. Pp. xi + 309.

This paper evaluates the existing research on Stand Your Ground (SYG) laws in terms of the extent to which it has accounted for gender. In particular, we address (a) what the available evidence suggests are the gender-based impacts of SYG laws and (b) where, how, and why considerations of gender may be missing in available studies.

This article attemps to provide a good defense for battered women who kill their sleeping husbands, particularly in cases where it is judged that she was mistaken in her assumption of the need to exercise self-defense. Proceeding from the distinction between the imputation of an act to an actor and the imputation of blame to an actor for criminally prohibited conduct , the article moves on to a discussion of the relevance of mistakes as to justifying circumstances under the (...) criminal law. Although some attention is given to the theoretically sound solution to the problem raised by the unknowingly justified actor, primary emphasis is placed on the putatively justified actor. The argument is advanced that the false assumption of justifying circumstances negates the imputation of wrongful conduct to an actor, rather than negating the imputation of blame to him for his wrongful conduct. Accordingly, criminal liability can only attach to an individual acting in putative self-defense, for example, if that individual was negligent for making the mistake . The standard for judging negligence in the United States is that of the so-called "reasonable person". A great deal of discussion in the U.S. scholarly literature has been revolving around the question of whether an "objective" or "subjective" standard of reasonableness should be employed when determining whether an individual acted reasonable and thus non-negligently. This article argues for a "subjective" standard for the criminal law, as opposed to an "objective" standard, which is claimed to have more relevance for tort law . Finally, the claim is made that a battered woman who kills her sleeping husband should be given the benefit of the self-defense justification under the U.S. law approach to self-defense. If the woman is mistaken as to the need to exercise self-defense, then wrongful conduct should be imputed to her only on the basis of whether her mistake was subjectively unreasonable and thus negligent . Der Aufsatz liefert Argumente dafür, daß eine "battered woman" für die Tötung ihres schlafenden Ehemannes strafrechtlich nicht zur Verantwortung gezogen werden kann, und zwar insbesondere dann nicht, wenn sie irrig Umstände annimmt, die, wenn sie vorlägen, die Handlung der Frau unter Notwehrgesichtspunkten rechtfertigen würden. Die Unterscheidung zwischen der Zurechnung eines Vorgangs als Handlung und der Zurechnung einer rechtswidrigen Tat zur Schuld wird vorangeschickt . Dann wird die strafrechtliche Relevanz von Irrtümern über rechtfertigende Umstände besprochen. Zwar wird die theoretisch richtige Lösung auch solcher Fälle diskutiert, bei denen der Täter rechtfertigende Umstände verkennt. Doch wird die Betonung auf die Fälle der Putativnotwehr gelegt, wobei die These vertreten wird, daß die irrige Annahme von rechtfertigenden Umständen die Zurechnung des Vorgangs als Totschlagshandlung und nicht erst die Zurechnung zur Schuld ausschließt. Daraus läßt sich entnehmen, daß der Täter, der in Putativnotwehr handelt, strafrechtlich nur dann verantwortlich ist, wenn sein Irrtum auf Fahrlässigkeit beruht . In den U.S.A. wird die Frage, ob jemand fahrlässig gehandelt hat oder nicht, danach beantwortet, ob eine "reasonable person" in der gegebenen Situation genauso wie der Täter gehandelt hätte. Zur Zeit findet eine lebhafte Diskussion darüber statt, ob dieser Maßstab "objektiv" oder "subjektiv" aufzufassen sei. Anders ausgedrückt: Es wird die Frage gestellt, ob die Geschworenen die Annahmen eines Durchschnittsmenschen oder aber die eines Menschen mit den persönlichen Merkmalen und Erfahrungen des Angeklagten in ihren Überlegungen darüber heranziehen sollten, ob dieser hypothetische Mensch einem Irrtum wie dem des Angeklagten erlegen wäre. Der Aufsatz spricht sich, was strafrechtliche Urteile angeht, für den "subjektiven" und gegen den "objektiven" Maßstab aus, der statt dessen für die deliktsrechtlichen Urteile der angemessenere zu sein scheint . Die Ergebnisse dieser Argumentationen werden dann auf den Fall der "battered woman" angewandt. Es wird gezeigt, daß die geschundene Frau, die ihren schlafenden Ehemann tötet, nach dem U.S. Model Penal Code unter Notwehrgesichtspunkten gerechtfertigt sein kann. Sollte es im Einzelfall so sein, daß die Frau sich über die Erforderlichkeit der Notwehrhandlung geirrt hat, dann kann ihr die Handlung nur dann zugerechnet werden, wenn der Irrtum im "subjektiven" Sinne fahrlässig gewesen ist. (shrink)

Domestic violence is a pervasive problem in our society that has only recently come to be acknowledged in public discussion. Though many see it as a social and political problem grounded in unequal gender roles, this level of analysis fails to explain adequately why many battered women return to their abusers despite intense suffering and the certainty of more physical violence. The Illusion of Love challenges the prevailing model, which views the victim of abuse as a normal woman (...) who is unable to escape from her batterer due to the effects of terror and psychological collapse. Instead, David Celani offers a new answer--that women who are battered have a fundamental attraction to partners who are abusive. Based on his years of clinical experience treating battered women, Celani applies object relations theory and case examples from his own practice to show that many women--and indeed some men--are unconsciously drawn to abusive partners because of personality disorders caused by childhood abuse and neglect. He argues that any effective treatment for battered women must help unravel futile and self-defeating patterns, such as ones that spring from fears of abandonment and fascination with men who produce exaggerated promises of love followed by extreme rejecting behaviors. _The Illusion of Love_ examines the personalities of abusers as well, many of whom suffer from narcissism, a disorder that is also often associated with childhood abuse and neglect. Narcissistic men lash out violently in an attempt to control their own fears or abandonment and to compensate for unsatisfied emotional needs. Celani concludes that domestic violence is often the tragic result of a union between individuals with complementary personality disorders. His findings fly in the face of the politically correct refusal to examine the behavior of the victim of abuse, a strategy that has led to a severe misunderstanding of the dynamics of the battering scenario. _The Illusion of Love_ calls for primary prevention of neglectful parenting to stem the tide of abuse in the future, offering tangible hope for the treatment of victims of abuse as they attempt to extricate themselves from unhealthy, damaging relationships. (shrink)

This paper discusses the responsibility of general practitioners who are consulted by women who have been physically injured by the men with whom they live. The paper draws on a study of 50 women who were interviewed at a refuge for battered women, and considers the help which they received, or did not receive, from their general practitioners. Such women are likely to face many difficulties: it is perhaps the essence of their problem that, because it is potentially the (...) concern of so many people, it can so easily become the concern of nobody--except of the woman herself. (shrink)

This paper investigates the gendered and racialized discourse on Polycystic Ovary Syndrome in India. A complex metabolic, endocrinal and reproductive disorder, PCOS is one of the most common endocrinopathies in women of reproductive age today. Due to an unclear etiology, there is no single clinical definition for PCOS, contributing to a sense of confusion around the syndrome. India has one of the highest rates of PCOS in the world. Medical and social discourses on PCOS suggest the high rates (...) are due to the failures of Westernized lifestyle and diet in women from developing countries. Taking the example of India, I argue that the lack of a clear etiology creates a discursive vacuum and that PCOS in itself is not a gendered and racialized syndrome, but the discourse on it is. Through the figure of the “new Indian woman,” I address the socio-political anxieties of nationalism projected onto the female body and suggest that the discourse on PCOS in India is in reaction to a rising nationalist rhetoric. As a syndrome that presents through “masculine” symptoms, PCOS acts a unique entryway into the intersectional issues of gender, race, sexuality, class and national identities. An analysis of the Indian setting might shed light on PCOS discourses that are increasingly relevant globally. (shrink)

Abortion continues to be a moral and ethical dilemma in medicine. While abortions in general have always faced social stigmas, the abortion of fetuses with Down’s syndrome in particular remains the subject of debate across the globe. In India, under the Medical Termination of Pregnancy Act, abortion is legal under prescribed circumstances only till 20 weeks of gestation. Laws for abortion after 20 week of gestation are ill defined. In a recent ruling of the Supreme Court in India, a (...) woman was denied the right to abortion of her 26 week old fetus. With this ruling, India has joined the rest of the world in the debate surrounding abortion laws and the ethics of abortion. (shrink)

The mystery does not always end when the crime has been solved. Indeed, the most insolvable problems of crime and punishment are not so much who committed the crime, but how to see that justice is done. Now, in this illuminating volume, one of America's great legal thinkers, Norval Morris, addresses some of the most perplexing and controversial questions of justice in a highly singular fashion--by examining them in fictional form, in what he calls "parables of the law." The protagonist (...) of these stories, the figure who must see that justice is done, is Eric Blair, a name familiar to most readers: it's the real name of George Orwell. In fact, Morris has set his tales in the time and place of Orwell's famous essay, "Shooting an Elephant," in Moulmein, Burma, in the 1920s. What might seem a curious strategy at first glance--borrowing Orwell's persona to narrate these tales--is actually a brilliant stroke. For in Eric Blair we have an ideal narrator to highlight the complexities of justice: an untrained police lieutenant and junior magistrate, uncertain of judgement--and all the more likely to anguish over judgement, and to examine every facet of a case before deciding. And in 1920s Moulmein we have a neutral time and space in which to consider--free of our own political, religious, or social prejudices--a set of contemporary legal and moral questions that rarely find so calm an arena. And these stories certainly address some highly charged issues--capital punishment, insanity as a murder defense, the "battered wife syndrome" as a murder defense, child custody, "parental neglect" due to religious conviction--to name a few. In each tale, Norval Morris excels at placing Blair at the center of a controversy that has no easy answer, and that he and he alone must decide. In the title story, for instance, a retarded boy, whose only understanding of sex comes from the brothel in which he works, accidentally murders a young girl while raping her, his only defense being "Please sir, I paid her." Blair can see that the boy doesn't realize that he has committed a crime, but both the Burmese and the European community of Moulmein demand the boy's execution. Does capital punishment make sense in such an instance? Does it ever make sense? To broaden our understanding of these intricate cases, Morris concludes each story with a perceptive and often provocative commentary on each issue. After "Brothel Boy," for instance, Morris points out that no reputable study has ever shown capital punishment to be an effective deterrent to future murders, and more surprisingly, that paroled murderers commit proportionately fewer homicides than paroled felons who used a firearm in the commission of their crime. Norval Morris is one of America's foremost experts on crime and punishment, and the stories collected here represent the culmination of a lifetime of thought on the major criminal law debates of our time. A reader of these tales will come away with a deeper understanding of these debates and with a profound respect for the intricacies of justice and the complexity of the law. (shrink)

This analysis of the National Survey of Families and Households confirmed earlier findings: Much of the violence between married partners occurred in couples in which both partners were reported as perpetrators, and women as well as men committed violent acts in married couples. However, the NSFH data indicated that the probabilities of injury for male and female respondents differed significantly, with wives more likely to be injured than husbands. The NSFH differentiated between violent acts and injurious outcomes and provided an (...) empirical rebuttal of the “battered husband syndrome.” At the same time, the NSFH reproduced many of the problems of quantitative surveys as they are currently used to measure the incidence and consequences of intimate violence. The article discusses the major problems with both the content and the context of currently employed survey methodology, as exemplified by the NSFH. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Explode and Die!A Fat Woman’s Perspective on Prenatal Care and the Fat Panic EpidemicJennifer HansenClassifying obesity as a disease provides more ammunition for the “war on obesity.” I gather that this is supposed to be a good thing. The problem is that obesity isn’t a germ or a crime; it’s a word applied to a particular kind of body—and thus to the person inhabiting it.From a fat person’s (...) perspective, the “war on obesity” is a war on fat people. It’s a license to bully, shame, and ostracize fat people and deny us employment, medical care, and even ordinary family life because we don’t look right. Fat people, proclaimed by medical authority to be the enemy and identifiable on sight as outsiders, are made into targets for all kinds of free–floating anger. For example, I am apparently sucking away people’s tax dollars via my fat, and it’s also my fault that men expecting to fantasize about every woman they see on the street encounter my distasteful fatness instead. But no matter how many times we get told that we are wrong just for existing, we go on existing, in public even. How dare we? The answer, obviously, is to keep at us. If we would just admit that we have no right to exist, then we would all either vanish or become socially acceptably thin, and then the whole world would be unicorns and butterflies and everyone would be rich and nobody would get old. Or something like that. If obesity is a disease, then phrenology is a science.Of course, we get a lot of well–meaning flak along with the bullying; after all, concentrating on weight loss can only be good for us, because fat people are always about to explode and die. This assumption has definitely affected my relationship with the only medical practice I can reach that’s in my network. During the 20–plus years since I became visibly obese, I have gotten used to the constant drone of “You’re fat, you’re fat, you’re about to explode and die, we don’t care about what you actually came in for because it’s vitally important that we bug you yet again about your pants size,” but some things can still shock me. For example, during all three of my pregnancies, I never had a result that was even borderline for gestational diabetes (GD). And yet, some time after my last baby was born, someone wrote “HISTORY OF GESTATIONAL DIABETES” in my file. I first heard about it during my annual checkup, when the doctor referred to it when talking about my increased risk of Type 2 diabetes due to age (unavoidable), my first–ever non–whitecoat–syndrome borderline blood pressure (BP) reading (taken with a standard cuff, gee how could it possibly have been inaccurate), and GD (gosh, I felt so safe and supported at this fine reality–based practice). And of course my weight.Whoever wrote that felt free to make things up because I’m fat. To repeat, somebody with access to my file at my only source for affordable health care felt free to write things in it that were completely contradicted by the facts just a few sheets below. There’s no need to fact–check your assumptions when you can tell by looking at her that she’s F–A–T, and everybody knows what they are. They’ll explode and die, every last one of them. Better medicate them now before they inevitably break down!Speaking of which, there’s a particular OB at the practice who I’ll call Doctor Eeyore. At every appointment, Doctor Eeyore would take measurements, stare, and say, “Hmm … tch.” If I asked him to tell me what he had found, he would say, “Too big,” or, “Too small,” or indicate some other inadequacy in his glum, word–miserly way. He only bothered to produce complete sentences when he enthusiastically told me that I would die if I didn’t give birth with an IV in place to administer the life–saving drugs for my inevitable cardiac event... (shrink)

This article suggests increased attention to how medical discourses of gastrointestinal (GI) disorder and distress are fraught with social assumptions and consequences by examining nineteenth-century and contemporary medical texts focused on chronic constipation and Irritable Bowel Syndrome (IBS). I suggest that these medical discourses present what I call the “gastrointestinal woman,” who is characterized as having unjustified anxiety and is to blame for her condition. My approach to understanding, and ultimately revising, the representation of the gastrointestinal woman (...) is shaped by disability studies scholarship, which encourages intervention in problematic medical discourses and more active shaping of discourses of chronic pain and illness by those who have these conditions. (shrink)

In coming decades, fetal medicine may become a routine part of reproductive care. The measures pregnant women now take to protect fetal health are largely generic, like restricting their diets and using supplements. Relatively few interventions are based on specific conditions revealed by ultrasound or genetic testing. A recent finding, though, may herald a dramatic rise in “personalized” fetal medicine: certain drugs already approved by the Food and Drug Administration can apparently boost neural growth in fetuses with Down syndrome, (...) improving cognitive functioning in the future child. Many more condition‐specific findings are likely in the near future. But as commentators have frequently observed about prenatal testing, technologies that appear to increase reproductive options also complicate and constrain them. (shrink)

Recent theoretical analyses of domestic violence have posited the complicity of medical communities in erasing and obfuscating the cause of injuries. Although medical cultures have engaged in progressive initiatives to address and treat domestic violence, these medical and clinical models can render domestic violence invisible by framing the battered woman as evidentiary object. By analyzing this invisibility of domestic violence through the concept of public secrecy, in this article I consider Kiki Smith's 1982 installation piece Life Wants to (...) Live. Using medical technologies, Smith's installation offers the viewer a vision of domestic violence that recognizes its inherently problematic invisibility and emphasizes the importance of lived, bodily experience. (shrink)

This paper will examine the way in which premenstrual symptomatology has been represented and regulated by psychology and psychiatry. It questions the “truths” about women's premenstrual experiences that circulate in scientific discourse, namely the fictions framed as facts that serve to regulate femininity, reproduction, and what it is to be “woman.” Hegemonic truths that define Premenstrual Dysphoric Disorder (PMDD) and its nosological predecessor Premenstrual Syndrome (PMS) are examined to illustrate how regimes of objectified knowledge and practices of “assemblage” (...) come to regulate individual women through a process of subjectification. Five interconnected “truths” are presented as objects of scrutiny: PMDD is a thing that can be objectively defined and measured; PMDD is a pathology to be eradicated; PMDD is caused and can be treated by one factor; PMDD is a bodily phenomenon; PMDD causes women's problems or symptoms. I examine the way in which these hegemonic truths function in framing the reproductive body as a cause of disorder or distress that leads women to interpret premenstrual experiences within a pathological framework deserving medical or psychological treatment. Finally, I offer an alternative framework drawing on Eastern models of selfhood that provides a more empowering model of women's premenstrual experiences. (shrink)

Does a woman's being repeatedly battered by her husband excuse her killing him while he was asleep? This and similar questions are often dealt with by asking a more general question, “Should we accept abuse excuses? ” These questions engender a lot of heat, but little light, in the media and other public forums, and even in the writings of many theorists. They have been discussed as if there is a typical abuse excuse we can examine in order (...) to examine abuse excuses in general. Similarly, the question of whether we should accept abuse excuses has often been discussed as if it is simple and straightforward. But there is no one typical abuse excuse, and the question of whether to accept such excuses is neither simple nor straightforward. There are many different abuse excuses, many different circumstances in which they are deployed, and many different sorts of concerns motivating their use. In this, abuse excuses are just like other, well-accepted excuses, such as self-defense. (shrink)

Human immunodeficiency viruses (HIV) and acquired immunodeficiency syndrome (AIDS), COVID-19 and Ebola have exposed the magnitude of care-related tasks on women. Most often, because of the gendered nature of domestic and reproductive roles, women are expected to assume unpaid care-related, nurturing and domestic work. Despite the valuable duties, women are economically poor and othered. These unpaid care duties are exacerbated by pandemics and ratified even further by religion. For instance, in Nomiya Church (NC), the first African independent church in (...) Kenya, women’s experience narratives and biblical texts such as the story of the Proverbs 31 virtuous woman are used to glorify unpaid charitable work for women. Women’s virtuous personality, hard work and character are upheld in Christian spaces, thus obstructing sound work theologies. This article employed African Women’s theological lens in view of pointing out repressing and transformative tenets in charitable theologies of work for social and gender justice. While applying womanhood hermeneutics in the passage, the article points to valued behavioural postures of hard work in responding to God’s stewardship mandate. An affirmation of fair reward and accumulation of property is embraced as a familial complementary role, especially in pandemic contexts. The article amplifies the accumulation of property as a human right and the mandate of stewardship for all earth communities. Hence, charity work is a stewardship framework that all earth communities must engage in for replenishment and sustenance for all.Contribution: The article challenges literal biblical interpretations that glorify charity work. It advances a stewardship framework in understanding unpaid and charity work that all earth communities must engage in to replenish and sustain all creation. The framework affirms the dignity of all human persons through a transformational understanding of the theology of work as enabled by the African theological hermeneutics. (shrink)

Reproduced with the kind permission of the author. Currently available in the collection I Looked Alive . © 2010 The Brooklyn Rail/Black Square Editions | ISBN 978-1934029-07-7 Originally published 2003 Four Walls Eight Windows. continent. 1.1 (2011): 43-51. Introduction Ben Segal What interests me is instigated language, language dishabituated from its ordinary doings, language startled by itself. I don't know where that sort of interest locates me, or leaves me, but a lot of the books I see in the stores (...) seem to lack language entirely. Gary Lutz (2006). This issue of continent.'s fiction section features a reprint of “This Is Nice of You” from the first edition of Gary Lutz's collection I Looked Alive . That book was originally released by Four Walls Eight Windows in 2003 and has since been reissued in 2010 by The Brooklyn Rail/Black Square Editions. Calamari Press has also reissued Lutz's Stories in the Worst Way (originally published by Knopf, largely forgotten and dismissed, and then re-issued by the too-short-lived 3rd Bed). “This Is Nice of You” was edited for the re-issue of I Looked Alive and, as the original book is out of print, the earlier version of the story has been hard to come by for some time. This initial version is a bit longer than the new version—Lutz is a master of tightening down his texts to their most linguistically intensified cores—but it is in no way sloppy. It is a great privilege for continent. to be able to make available rare texts of (first) aesthetic and (second) scholarly value. For those readers unfamiliar with Gary Lutz, I believe this story will serve as a worthy introduction. Like Raymond Carver, Diane Williams, Christine Schutt, and so many other important twentieth century and contemporary short story writers, Lutz studied with and was edited by Gordon Lish. This connection is apparent in his attention to sound and the sentence as compositional unit, but Lutz's is a unique voice. “This Is Nice of You” bears Lutz's trademark torqued and turning syntax, his sexed-but-nameless characters, his rendering of the human body and its emissions as utterly discomfiting. Lutz's preoccupations with the mundane raise ordinariness, via startling language and observation, to grandiosity and grotesquery. In the fall of 2008, Lutz delivered a lecture entitled “The Sentence is a Lonely Place” to writing students at Columbia University. The lecture was later printed in The Believer (and is linked below). In it, he spoke about the importance of the sentence as a compositional unit, as even the distinguishing formal characteristic of prose. Specifically, Lutz explained that, from Lish, he had developed a "poetics of the sentence." Accordingly, Lutz constructs his stories at the level of the sentence, paying extreme attention to the material of words- their letters and their sounds- and the way they abut one another and interact on this material level even before they are employed in the service of traditional aims of fiction like meaning or story. Lutz often uses a(n almost constraint-related) technique called consecution. Letters or sounds from one word are carried forward into the following, producing drama and movement in the language itself at a level entirely apart from that of plot. For example, you can see how the 't's in the first sentence of “This Is Nice of You” repeat fast and hard through met and then soften into the 'th's of brothers and they. This close attention to the specific material and characteristic conditions of prose means that Gary Lutz's work always involves both a happening in language and of language. “This Is Nice of You” has a richness and depth that is hidden not in symbolism or obscure reference but on the surface of the page, in the language of every sentence. FURTHER READING Lutz, Gary. “ The Sentence Is a Lonely Place. ” The Believer January, 2009. Web. Short stories and excerpts at Web del Sol . Web. Taylor, Justin. “ An Interview with Gary Lutz .” Bookslut. July, 2006. Web. THIS IS NICE OF YOU [156] [1] I was a man dropping already well through my forties, filthy with myself, when, taking a turn at the toilets one afternoon, I met two brothers-they said they were brothers-who swore they had a sister, a schoolteacher, an officer of instruction at the county college, a whirlwind midlife turmoil of everything already put to ruin, who had gone off from a new marriage in an old car, an upkept and ennobling sedan, but had returned now to the apartment and [157] was living there alone with the little runoff there was from the marriage-some outcurved appliances, apparently, and low-posted furniture promoting its own mystery but becoming figurable in certain concentrations of TV light-and, above all, a telephone (on a pedestal, they insisted), the handpiece of which she gripped in lieu of exercise, or in fury, and I thus let out my little, reliable cry that I was in fact a student of the telephone, that it was a debasing apparatus in the main, with its meager economy of bells and tones, and the intimacy of the mouthpiece that sent your breath, tiny aftervapors of it, back toward your lips, so that regardless of the party accepting the outgoing products of your voice, you were, at most, in a further, rivaling exchange with yourself alone, and this is what must have brought the two of them around, the men who proclaimed brotherhood with the woman, because they offered me her phone number, put it at my disposal on a piece of paper one of them had already committed it to, a tearing from a menu, and the looks the men were now giving me had deletions in them, already, of my exact, beanpole shape and size. So off I went to a pay phone, the nearest canopied one I could find. The woman answered after the second ring and said she needed a lift right that very moment into the little, unlevel city close by. She was idling in the doorway of the building when I pulled up in front, and I helped her into the car, then got back in myself. I had always had a way of not having to look at people that nonetheless brought them to me in full, and so I still am certain of the susceptive and impressible comp-[158]lexion, the shimmer on the mouth, a lipstick of low brilliance, a difficulty around the eyes, the hair short and rayed out exclamation ally, skin bagged up over the elbow bone, conflict even in how her arms stayed at her sides—in sum, a spinal loveliness for me, an off-blonde quantity with shadowed, thumbworn hollows that put me out of as much as I might have ever known of women before. I set the two of us into the narrow traffic, and I remember telling her, by way of explaining the little burden which I had shifted, by now, from the shelf of the dashboard and onto my lap, that when you lived in filth, as I then did, a daily newspaper came to count for a lot, although instead of the thick-supplemented local paper I bought a trimmer one from a backlying town—not, of course, for any affluences of native data it carried, but as an article of house ware: a rough immaculacy in four lank sections, a set of fresh, hygienic surfaces to come between the table, say, and whatever I had going for me at the table, if the table was where I was going forward—because what else so cheap comes so clean and far-spreading? The woman told me that her own trouble with paper was that through a modest hole, no larger than a quarter, that had been drilled a foot or so above the floor (the standard height, she had reasoned, of legitimate electrical outlets), and by means of which her faculty office had at last gained communication with the roomier but unoccupied office next door, more and more often shot a single sheet of paper, plain copier paper she had rolled just barely into a tube, [159] so that after landing on the floor of the neighboring office the paper would preserve little if any of the curl, and there would be nothing written or typed on it, of course, and it was always a blank sheet that had been ageing on her desk for some time and had already been moved around, or advanced, from station to station on the desktop, coming into further creaselets and crimps and other infirmities—paper, in short, still too bare and unfraught to be thrown responsibly and forgettably away, and yet too seasoned and beset with irritations of the surface (a molelike blemish, say, or what looked like a tiny hair, an eyelash, sunk into it, or frecklings, or notational pressings of a fingernail), too wrought, in sum, for the paper to be appointed to any secure curricular purpose. Her office, she claimed, was in fact full of such paper, much-handled and singularized sheets of it by the loose, functionless hundred. I had to get it across to the woman that I myself no longer had an office, or any other place to divide me reliably from everybody else, and that for much of the daylight I thus appeared to be among people because I kept putting myself where people came together into even closer-fitting assortments, the viewing areas and showrooms and rotundas and such: I took in the lean-to look of the women, the tongues coming and going in what the men kept thinking of to say—whole families of low knees for me to bark my shins against during the crowded and involving way out. At home afterward, in the one room where my life was packed down, I would keep my nose stuck in the safehold of the phone [160] book, where the names of people suffered reduction to mere episodes of the alphabet and underwent humbling declensions down every column (Lail, Lain, Laine, Lainerd), and he names of streets, of the towns and townships, got docked in crude, heedless abbreviations (the vowels almost always the first to get poked out), and I would run my eyes over the telephone numbers themselves, each sequence of digits another fallible run of the infinite. I thus corrected my feelings for people and assembled myself emotionally into whatever else I had at hand—the obligating arms of the clothes hangers, usually, or the keen-angled understructure, the guardian legginess, of the ironing board. The woman said that in her case, though, it was more a matter of making slow circuits of the classroom where she had to put across the Emporial Sciences, retail theory and methods, to heat-giving and suggestive young women, some of them world cruelties already. There was the cooing of empty stomachs in the hour just before lunch, and the braying and fizzle of loaded stomachs in the low hours of the afternoon. She would recite her notes in a voice barely loyal to anyone octave, a tiny alluvium of slaver hardening at the corners of her mouth on the days she gave the glassy lozenges a slow, warming suck, and she would take lowering notice of how whatever she said succumbed at once to freak spellings and razzing paraphrase in the big, dividered notebooks; and because in midafternoon light the world looked as thorough, as filled in, as it was ever going to get, a better way to set about ruining her eyes was to review how hair had [161] established itself on the arms of the young women, because almost every arm had brought across itself a welcome and diversifying shadow. On one girl it would be a fine, driftless haze afloat above the white of the arm, never seeming to touch down on the skin itself. (An atmosphere, at most, of chestnut brown.) On another, it was as if copper wire, the narrowmost lengthlets of it, had been stuck into the fleshy batter of the thick, freckled forearms. On a third: a field of it–wheat-colored, thin-spun. On a fourth; a differencing, darkish updrift that shaded off as it approached the inner bend of the elbow, then re-emerged at the base of the upper arm as whiskery fringe. On others it was a brassy or rust-colored frizz, or it was as coarse as cornsilk, or it looked fussed on, as if the arm had been slowly stroked with charcoal. But here the woman broke off, or I may well have made an interruption of my own—I think I must have asked whether she was hungry, and she said if I was, and so on one of the lesser streets I parked the car and led her down into a belowstairs eating house I still remembered. Sandwiches were presently lowered in front of us. I watched her remove the festooned toothpick from hers and then play her fingers over the toasted planes before she took a fond first bite. "This is nice of you," she said. I must have looked at her in the way I then had of getting people to speak so they would not seem to be dwelling any longer on my features, because if on the well-set face the mouth and eyes are said to seem frozen in elegant orbit about the til) of the nose, then mine was a face that behold-[162]ers, regarders, could not help trying to round off with greater success, to goad the particulars of it back into the arcs they had wandered away from—the mouth, for instance, having been pursed and pinched suchwise that it seemed resident more on one side of the face than the other—and there were other signs of original strife to be busied with (slapdash eyebrows unbunched, it appeared, from reserves of hair elsewhere on my person; a showing of adult acne, a shrivelly little relevance of it, confined to the declivity of my nose); and so to be polite, the woman thus sank her gaze into her sandwich, and told me, in a voice lowered accordingly, that, one late-childhood summer, she had devoted herself to collecting postage stamps: it was a tongue-involving sideline to early-arriving puberty, and she liked having to lick the pale, gummed hinges instead of the sticky backs of the stamps themselves before entering everything into the hosting album; and once, during some foul weather between her and a brother (the older, thrown-over one, who had already made a habit of fooling the underside of his arm across the top of hers and calling her "pussified"), she reached for the shoe box in which she had let duplicate stamps accumulate—Spanish ones, mostly, of a fading orange—and sent the box slooshing through the lower air so that the stamps showered onto the brother's bare legs with a full, delicate harm. The woman was now touching up the surface of her iced tea with tiny activities, initiatives, of the longspun spoon. I myself was good at getting my touch onto things, although in a way that seemed to mix up the motive atoms inside [163] them, but I was satisfied that for the moment my sandwich, the unbitten-at half of it, was displayable and fit and local to my plate. The woman went on to say that, as a child, she had been bundled off, many an afternoon, to the slope-ceilinged quarters of a bachelor uncle who, when speaking of anybody not immediately present, could not bring himself to use the person's name but instead would say "an acquaintance of mine in ..." and then mention the name of some lapsed homeland, or little-loved rural orchestra, or backset building about to come down; and it was never a riddle, this device of his (not once could the girl have been expected to identify any of the subjects), and no matter how often and aloud he insisted that particularizing persons any further—bringing even a first name down upon anyone of them—would have been indecent, he claimed, much like doing things to people while they slept, the girl accepted all of the uncle's prim and extravagant evasion for what he surely must have intended it to be: a neat, protective trick to space the world out a little further in her favor, to scatter the population so that wherever her hand might at last come down, it would have to be on herself alone. And here I could sense that the woman wanted from my mouth an account of as much as I myself might have ever managed of attachment, so I told her I had once owned a house (a rising, really, of much-fingered, handwrought architecture that amounted to a little family of rooms above garages: a boxlike building with a rattly thorax of downspouts [164] and drainpipes and an unfolded but full-toned fire escape), and I had had for a time a boarder, a student, a high-colored, loose-packed representative of declining girlhood, hung with necklaces and barrettes, a girl of precise but shifting leanings and inclinations; and the afternoon she had come round to ask after the room, I stood in the entranceway, handshaken and asweat, and from what would later be my memory of the girl, I made off with, first, how every pore of her nose seemed to be sheltering within itself a tiny dark seedlet, a grain of something immediately, enormously valuable. And an almost lipless mouth (just a slit, practically), the teeth inside looking wet, watered-it was my life's chore, at that instant, to keep from sending the back of my thumb blotterlike across the line of them (I was later to learn she drank everything cold and through the narrowest of straws). And her hair: it was tea-colored hair she had, long and reachful, an unstopped downcome of it. Tall for a girl, but she managed to stay out of much of her height and put herself across as somebody backward, or behind. I must have told the girl, as best I could, that I of course had a wife, a full-faced, imperishable partner, though for the moment she was gone otherwhere in the marriage, and here the woman, my present companion, my tablemate, whose feet were now parked, in parallel, on the grade of my upper leg, interrupted to say that her husband, too, had been such a liar, and what could I bring up by way of reply other than that a lie is a truth struck through with other, further truth, or that a lie is the present multiplied by the past or that a lie [165] is an outcry of borrowed hope? The woman gave me an allowed look of disgust, her eyes lowered but still popular with me, and on I went with what had now become the girl of my story. For there had been a great, gainful carpet in the room I put the girl into, a matty expanse of coarse, grabby piles, an engrossing affair that took things into itself and held them tight, misered them, and I of course insisted that the girl not bother herself with its upkeep, that I enjoyed weekly access to a prestigious, upstanding vacuum cleaner; but no sooner was the girl out of the house each morning than I would withdraw from my room, where time was unportionable, and loose myself into the ticktock impertinence of the girl's room and get down on my knees, and, going after the carpet first with my fingers, then with a forceps, and finally by unspooling lengths of clear package-sealing tape and pressing them against the tufts in neat rectangles to catch what I might have missed, I brought vast tracts of the carpet to depletion, recovering not simply the girlinesses, the girleries, one would expect (buttons, straight pins, downed jewelry), but flirtier personalia in the form, say, of a stray confetto brought into the world when a page had been wrung with out caution from a spiral-bound notebook, or some pleated paper shells of the chocolates she required, or one of the bargain antihistamines she took to get her naps going, or a trash-bag tie ragged enough to show the kinked line of the wire within (this I would get wound around my finger), or a cough drop enwrapped like a bonbon (I would undo the [166] wings of the wrapper and have to decide whether to suck the drop all down or begin chewing it midway)—I became the following, the public, that these things, these off-faIlings, had come to have; but mostly there was hair, afloat above the uppermost pushings of the fabric of the carpet an almost continuous haziness of loose hairs of all lengths and sources, and I would have to set them out on a fresh sheet of paper and assort them according to the regions of the body they had taken their departure from, and in no time I had nest-like filiations of broken filaments and smaller involvements of the hairs that made me think of hooks, of barbs, of treble clefs, and each pile required a separate envelope, to be filed in a separate shoe box for every sector of the body until, I hoped, the boxes themselves would no longer be enough and I would have raised something semblable, brought up something equal in volume to the comprehensive girl herself. And her wastebasket! For every bit of rubbish, every dreariment she tossed into the thing, I would, in secret, deposit a reciprocal discard of my own, matching a spotted, confessory tissue of hers with a lurid throwaway after my own heart–the cardboard substructions of a fresh parcel of underwear, maybe, or tearings from pantyhose I now and again pressed against a span of my forearm to work onto it the complications of female shading I otherwise made do, choosily, without. I thus built the two of us up together in her trash! One afternoon-it was another of those lifeful, unsam-[167]pled days on which the world humors us each a little differently to keep us nicely on our last legs—I discovered in the wastebasket an inch-deep textbook of hers, a paperback with a celery-colored cover that had come partly unglued, and this dilapidation I paired off, naturally, with a name-your baby guide to whose pages, during my recurrent turnings of them, in bed or at table, I had contributed dried produces of my person, a chemical splendor entirely mine. This coupling sent a sudden spigoty thrill from me that forced an unbuckling and an unzipping and a cleanup with a handkerchief I then ventured responsively into the wastebasket as well. It was in the bathroom afterward that I found a suds-clouded puddle on the unlevel floor of the tub, a little undrained remainder, rimmed with offscum, of the girl's prolonged early-morning soak, and this was as much as I needed to get on my hands; I pressed them flat against the wet porcelain, then flapped them around in the air, and that was when I noticed it—in the amphitheater of the toilet bowl, an orange-yellow tint, or value, to the waters. When the girl arrived home that evening, I told her, of course, that I had discovered fresh, unforeseen trouble within the tank of thelet (a misalignment of the trip lever, a waywardness of the float ball, a ulation of the lift wires, kinks and defects, really, throughout the entire system) and that in fine it was an apparatus now operable only by means of advanced and strenuous equilibrial manipulations that it would be unseemly, inhospitable, of me to pre-[168]sume to burd to burden her with–so that from here on out, following any leak or evacuation she need merely lower the lid and then, before quitting the room, ring the handbell that had been placed on the would seeeverythinghing else. But the bell never rang, not even once, and from my window the next morning I watched the girl carry from the house a little plastic bag distended balloonishly, much like those bags you will remember having seen in the hands of children bearing homeward their solitary carnival-prize goldfish. In fact, I never ran across the likes of the girl again. The man who came to collect her things-not the father, apparently, but an advocate, an upholder-l found to be dull-eared and lax in his speech, and the better part of his face seemed to have already begun making tiny, rotational departures from whatever it was that the eyes, themselves impressively mobile, were just that moment having to take in. (Was there a lamp in the house that was not that night slopping its wattage over everything?) I guess I was waiting for the man to take a laggard, last-minute interest in me, and by now I was pushing everything out into the paired first person–it was, I said, “Our night shot,” and I began including the two of us in whatever it might be doing out, the expected sprinkles and such—but he was no friendship buff, and he paid no heed to my telling him that the only dress of hers I'd ever twidged myself into even part of the way had been the simplest of them all, a large-buttoned wonder of depthless blue, and then only on the principle that one naturally fits whatever one has into whatever somebody else [169] had first, or how else would the world keep getting any taller with people? The man just went about the removal of the girl's things without having to be reminded too noticeably, I guess, of how every dick hangs by a thread. My listener, though, had by this time brought about some becoming slowings of her arm—it was an arm inclinable to langorous diagonals and magicianly swoops through the air above the tabletop—but it no longer was involving itself with her plate, so I suggested we shove off, I made payment for the food, and on our way to the car, and then in the car as I took to following her pointings, the directional tilts of her head, she said that you naturally kept putting more and more of yourself into another person, at first wondering how much she can take, how much of you is accumulable and how much she can hold, and you're letting things out, disbursing yourself, and you've soon got things set up in her, and room is being made for even more of you, and if you bring this off with enough people, even two or three, what you've got is at first a comfort, because you can pass yourself along and move a little more widely through the world and leave it to these others to man your grievances, your disappointments; and what brought this to mind, the woman said, was a term of financial hardship she had contrived for herself a few years back, an unpaid leave of absence from scrupling letter grades onto quiz papers (propped-up As, and upended Bs made to look, rather, like fannies; all As and Bs, no Cs or anything lower, the difference between an A and a B having less to do with the accuracy of whatever facts might [170] have been impounded in provided for an answer than with anything recallable about the way the enrollee ad conformed her body to the confining perpendiculars of her chair and the navel-level writing surface that projected from it, or the way there might one day have been an unignorable blush on the instep of a once-moseying foot, disburdened of its shoe, that had got itself trapped in the grillwork of that cagelike involvement, intended for books, that was welded to, or otherwise schemed into, the underworks of the chair)—this had been a duration, in short, of controlled difficulty when the misexpenditure of even a twenty-dollar bill had set her thrilling, gloating, over everything she would miss out on, and one afternoon she had made an engagement for a haircut, just a trim, and very early in the session the haircutter, a woman ill-defined in the face but otherwise full of conspicuities of emotion, set down the prevailing scissors and pressed the flat of a lukewarm hand against the woman's cheek, held it there for a good minute or longer, while the other hand eventually found its way into a drawer, a shallow treasury of slender specialty scissors, one pair of which the cutter withdrew and began routing deductively through the woman's hair, the other hand staying put on the cheek, longer and longer, and the woman went home and for afterward the bathtub was now a more likely destination than any of the upright furniture, and it got easier to fill the tub with further clarifying volumes than to clear space on the difficult heights of the sofa, and she was hardly claiming to have become a cleaner [171] person in result—she in fact would often discover, voyaging about her body, a browned, fractionary detail of a larger crepe of toilet tissue that must have got itself stuck in some assy crevice and was impossible to get plucked out of the revolving suds—she was saying only that she spent more and more of her time thus immersed, ill off in water, and the haircutter had surely had a hand in it, the woman was doing some of the cutter's life now, coming into some of its wrong, because you sometimes have to look to somebody else's life to get dimensions set back even part of the way around your own, and it should not have to be any less your own life when it comes from somebody else, and you could surely fudge a society out of anyone available person and get this person doubling for the many, so that in the little run of things perpetuable from one person to the next, every loose moment stood to become a complete, active finality. But by now this was a new day, with only an hour or so off it already, and the place the woman had made me bring us to, the man's place, with a promise that the man was elsewhere—this was on a little offshoot of a street, a stewy efficiency apartment the color had long ago gone out of; and when, once in bed, still clothed, I found among the sheets and blankets a spoiling pair of the man's underpants, one of the leg openings of which was puckered into an avid, sloppy mouth, I held myself accountable for redisposing the fabric until I got a befitting featurelessness back onto it; but all the while, I am sure I had to make myself go over again in my mind that if the body is the porter of as many organs of affec-[172]tion as there might one day turn out to be, then the idea was to let the thing carry you to where you would otherwise never have any reason to arrive, because I listened for the unmelodiof the the thede ofthe woman's zipper, and then the woman made me put myself out of my own clothes, the attritional corduroys and overshirt, and got herself up at last onto the topic not of the man whose apartment it was (because his story was scarcely the story of how the boy who decides he is half a girl no sooner starts to worry about where the other half might than he gets careless with where he rests his eyes, or what he gives even the feeblest of fingerholds to, and anything, even a crumbly triangle of pie offered on a saucer instead of on a pie plate proper, comes in easy, ready, wronging answer), but of her husband, and how, no more than a couple of months into the marriage, he had begun snugging away in his undershorts a little source of chanc, reliable frictions to nudge him onward through the workday—anything company-keeping that could be counted on not to slide out of the elasticky leg holes: a half-dollar packet of chocolate tittles, maybe, that was barely noticeable in the baggy surround of the widecut trousers so popular at the time. For by now the woman had at last brought what is usually called the other mouth to within only inches of my lips, but it is not a mouth, obviously, although I let myself go along with the goodwill behind the comparison, the way I will remain loyal to anything deliberately and faithfully misunderstood, and I fussed my tongue against the vital trifles hung inside of her, as much of the curtailed finery as I could find, [173] and gave the whole insimplicity of it a slow-circling, examinational lick, until I was taking a sudden tepid downwash on the tongue. It was a familiar, latrine in dribble that must have tasted, no doubt, like trouble just starting out.p [1] Editor's Note: Original pagination from first edition print denoted with bracketed page numbers. (shrink)

Congenitally infertile woman such as those with Turner syndrome or Mayer Rokitansky-Kuster-Hauser syndrome have available the technologies of oocyte harvestation, cryropreservation, in-vitro fertilization, and gestational surrogacy in order to have genetically related offspring. Since congenital infertility results in a variety of experiences that impacts on nearly every aspect of a person’s life, in the future it is possible that these women might desire a congenitally infertile child through the use of preimplantation genetic diagnosis so as to share (...) this common bond. While infertility results in a relatively normal quality of life, it is morally wrong to necessitate the future use of infertility services with its variable success rate on a child. Also, whereas the woman has fundamental reproductive autonomy, she lacks the substantive autonomy regarding the specific characteristics of her child. Finally, the infertile community does exhibit a strong presence, but it lacks characteristics that define it as a culture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Lesbian Desire in the Lyrics of SapphoSarah MaceJane McIntosh Snyder. Lesbian Desire in the Lyrics of Sappho. New York: Columbia University Press, 1997. xi 1 261 pp. Cloth, price not stated.Snyder’s aim in Lesbian Desire in the Lyrics of Sappho is to make Sappho’s poetry “come alive for the modern reader” (ix), which is to say, for the Greekless reader. To this end, the author bases her discussions (...) of Sappho’s poems on her own translations accompanied by transliterations of the Greek text. She also explains the system of inflection in Greek and Sappho’s lyric meters, discusses the meanings of Greek words, and lucidly summarizes some of the principal textual difficulties. The result is a far from unsophisticated introduction to Sappho’s poems and the complex issues of their interpretation. For the non-Greekless reader, Snyder reproduces Voigt’s text (with her own translations in parallel) in an appendix (163–218). Her notes (219–37) are scholarly but not pedantic and refer to most of the important recent and older scholarship on Sappho.Snyder’s translations of Sappho are good: quite literal, simple, and elegant. Although it is possible to take issue with a few renderings here and there, it would be caviling to cite examples here; I should note, however, that she has [End Page 636] a tendency to translate supplements (found, e.g., in Campbell) which do not appear in Voigt’s text, and has been somewhat inconsistent about bracketing supplements in her own translations (particularly, e.g., in 17 V). The transliterations would probably have served their purpose just as effectively if used only for illustrative purposes rather than throughout the text; presumably Greekless readers will not be able to connect sense and sound except where their attention is drawn to a particular phrase or verse. The first appendix, “A Guide to the Transliteration,” could have been improved by a pronunciation guide; nowhere does the author note distinctions between long and short alpha, iota, and upsilon.Snyder’s approach to interpreting Sappho’s lyrics is twofold. The author points out that her method “is inevitably that of the classical philologist” and that she is “heavily influenced by the assumptions of New Criticism and the tradition of close textual analysis” (ix). She intentionally steers clear of the subject of Sappho’s historical and social context (1), believing that “Sappho’s text—even in its battered state—has the power to stand alone, with the benefit of very little ancient social context to help explain the author’s purpose or intention” (79). At the same time Snyder identifies herself as a “feminist scholar” whose approach has been “significantly colored by the questions raised through the influence of women’s studies, gay and lesbian studies, and postmodernism” (ix). Thus she wishes “to read what is left of [Sappho’s] songs for what they can say to women (and men who are willing to abandon a masculinist frame of reference) who hear her words today” (1).Chapter 1, “Sappho and Aphrodite,” focuses on the Hymn to Aphrodite (1 V). After a close reading of the poem, with attention to Sappho’s themes and techniques of composition, Snyder advances the view that it “subverts the traditional system of female subordination by creating a female authorial self that is of key importance in this song” (16); the powerful goddess featured here also contrasts with “the helpless, girlish whiner of the Iliad” (10). She concludes that the poem “offers us a clear paradigm for a woman-centered perspective on the universe, one in which the goddess and the relationships between women take center stage” (24). This movement from close, text-based readings to more general assertions sets the pattern for chapters 1–4. In a discussion of 2 V Snyder asserts that the temple and grove are “encoded as female space” (19) but does not demonstrate how the description differs substantively from other passages describing idyllic settings in archaic lyric (e.g., Ibycus 286 PMG). The chapter concludes with a summary treatment of other fragments involving Eros or Aphrodite.Chapter 2, “The Construction of Desire,” focuses on 31 V. Properly dismissing interpretations based on “the disease... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:538 Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. Doreen J. Mattingly The Limited Power of Female Appointments: Abortion and Domestic Violence Policy in the Carter Administration In 1977 in the United States, Second Wave feminists were poised to make a meaningful impact on federal policy. Jimmy Carter’s successful 1976 presidential campaign had included an open wooing of feminist support : he had created a “51.3 (...) Percent” committee to address women’s issues and he had told feminist audiences that he “wanted to be known as the President who achieved equal rights for women, just as President Johnson had won civil rights legislation for blacks.”1 Once elected, Carter appointed an unprecedented number of feminist women to high office, many of whom were committed to addressing the concerns of marginalized women and advancing policy on issues such as sexual violence and reproductive rights. These appointees were linked to a dense feminist organizational presence in Washington that was unprecedented in its size and diversity. Not surprisingly, many feminists had high expectations for the new administration. 1. Cynthia Harrison, “Creating a National Feminist Agenda: Coalition Building in the 1970s,” in Feminist Coalitions: Historical Perspectives on Second-Wave Feminism in the United States, ed. Stephanie Gilmore (Urbana: University of Illinois Press, 2008), 30. See also John Dumbrell, The Carter Presidency: A Re-evaluation (New York: Manchester University Press, 1993); and Sara Evans, Tidal Wave: How Women Changed America at Century’s End (New York: Free Press, 2003). Doreen J. Mattingly 539 Despite these promising conditions, feminists made little headway on policy during the Carter administration (1977–1981). Federal funding for abortion was eliminated; no permanent offices that would have advocated for women’s issues were created; and bills supporting domestic violence shelters, support for “displaced homemakers,” and quotas for female-owned businesses were defeated or extremely diluted. In addition, no additional states ratified the Equal Rights Amendment (ERA) and several states rescinded earlier ratification votes. Some of these failures can be attributed to the general loss of feminist momentum and the emergence of a conservative backlash in the late 1970s. Anti-ERA organizing fueled the rise of a conservative “family values” movement that would shape social policies for more than a generation, and neoliberal economic conservatives were challenging the welfare-state programs that feminists sought to expand. But in Washington, there was an addition challenge —the unreliable support of Carter himself. Despite his promises, Carter felt that by appointing women he had met his commitment to feminists and did little to support feminist policy goals that went beyond eliminating discrimination. This paper makes an important contribution to the history of feminist action by looking in detail at the efforts of Jimmy Carter’s feminist appointees to influence policy. In particular, it discusses the actions of the most visible feminist in the White House, Margaret “Midge” Costanza. Carter named Costanza director of the Office of Public Liaison, a department that was created to manage relations between the White House and citizens’ groups. Her position as the first woman to serve as Assistant to the President, in concert with her gregarious nature and strong support for women’s issues, made Costanza a very visible symbol of affirmative action for Carter. Yet Costanza, like many other high-level feminist appointees, met opposition within the White House when she tried to advance women’s issues. Her persistent advocacy contributed to her marginalization within the White House. Just twenty months into the administration she resigned in frustration.2 This paper begins with a discussion of the unique circumstances surrounding Carter’s feminist appointees, followed by a detailed exploration 2. For Costanza’s complete story, see Doreen J. Mattingly, A Feminist in the White House: Midge Costanza, the Carter Years, and America’s Culture Wars (New York: Oxford University Press, 2016). 540 Doreen J. Mattingly oftwomeetingsheldbyCostanzainJuly1977.Thefirstwasanimpromptu meeting of roughly forty prochoice Carter appointees, all deeply troubled by a statement made by Carter in support of the Hyde Amendment banning federal funds for abortion. The same month, Costanza hosted a groundbreaking White House meeting about battered women, in which high-level bureaucrats heard testimonials from domestic violence victims and shelter advocates. While both meetings broke new... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Search of FaithKate RowlandSometimes I’m jealous of my patients’ faith. As a former happily religious person I miss the benefits I used to get from an active faith. I know that some of my patients must struggle with their faith, and I know the struggle probably affects their well–being. For those who simply believe or those who simply don’t believe, it’s easy. And for those who do believe, (...) there can be so much serenity and so much reward.As a doctor, I spend a lot of time reading science, weighing evidence, and making recommendations. Religion has been a respite from this. Faith, for me, has never been a series of decisions based on the best available evidence. I could analyze it as much as I wanted, peel its layers apart, question it, but in the end, it was just faith, not a hypothesis. It has always been something that I believe (or don’t), and practicing my faith had always been a relatively pleasant decision of figuring out what kind of community I want to share in.My faith life has been in shambles for the past several years. I feel distant from and unwelcome in the church where I was raised, and I haven’t found anywhere else to land. I cannot decide how to raise my own small children. I want them to have grounding in God, but I can’t decide how much I believe in God anymore, and I am fixated on the idea that I don’t want to be hypocritical or lie to [End Page 210] them. I don’t want them to see me worshipping in a way that is not really authentic to me.My husband is agnostic—literally—on the issue. He is open to introducing a loving, kind, forgiving God, but unsure about a God incarnate. We both worry about the identity with a particular religion usurping the actual relationship with God: I am [religion], therefore I believe [this], therefore my God does [this] or is [this].And so all of these fears and doubts have led us to live with no religion, and no outward faith. Our children attend a parochial nursery school run by a religion other than one where we were raised, and they have an apparently happy but neutral opinion of religion and God. They understand ceremonies. At age four, they have a more active faith life than I do, since they attend weekly services at school. But then, they have fewer choices than I do. They do what the teachers tell them. They would do what I told them to do, if I could ever decide what I believed in.I spend so many hours a week with my patients that they have become my main source of demonstration of active, living faith. I know that they share mostly good parts with me. I see so much of the good because I mostly see patients who get to choose how to practice their own religions; they don’t feel oppressed by religious or culturo–religious demands or expectations. It’s interesting that I see the positive sides of their faith, not the struggle, because I otherwise see a lot of the struggling parts of their lives. I see the flinty, edgy woman, the patient who has spent more time in the hospital in the past month than I have, the woman who is sick of her low platelet count that keeps her from living a normal life. And every day she has some message of faith: she tells our medical team what Bible passage is keeping her strong, she tells us how God watches over her when we tell her that her counts are better, she tells us to have a blessed day. Sometimes she curses at the hospital or her condition or at her medications, sometimes at us. So far her faith is unshaken.I take care of a woman who has burning mouth syndrome, a chronic condition that causes her lips, her tongue, and her palate to feel as though they are on fire. Eating makes it worse, drinking makes it worse, breathing makes it worse... (shrink)

Since the birth of the first test-tube baby, Louise Brown, in 1977, we have seen truly remarkable advances in biotechnology. We can now screen the fetus for Down Syndrome, Spina Bifida, and a wide range of genetic disorders. We can rearrange genes in DNA chains and redirect the evolution of species. We can record an individual's genetic fingerprint. And we can potentially insert genes into human DNA that will produce physical warning signs of cancer, allowing early detection. In fact, (...) biotechnology has progressed to such a point that virtually any kind of genetic manipulation, if not already possible, is just around the corner. But these breakthroughs also raise serious ethical and moral dilemmas that we are only now beginning to confront. In Wonderwoman and Superman, noted medical ethicist John Harris offers the first thorough analysis of the moral dilemmas created by the revolution in molecular biology. Covering a wide array of recent innovations, Harris discusses, for example, the moral decisions involved and the consequences of creating egg and embryo banks. Who should be allowed to use such resources? Should recipients be screened? Should such banks be open for public or private use? And does it cheapen life to make embryos available for sale? In another chapter, Harris examines the question of conceiving children chiefly for organ donation, focusing on the recent case of a woman who wanted to have a second child to provide a bone marrow donor for her first child sick with leukemia (she intended to abort the fetus if its bone marrow did not genetically match that of her living child). In this case, the medical staff had to decide whether they should perform in-vitro fertilization, knowing that the mother did not satisfy the clinic's criteria (there was no father), and also knowing the potential for abortion. Discussing the ethics of the mother's choice and the clinic's choice, Harris asks whether it is morally correct to create a child as an organ donor, whether the future child would suffer, whether it is worth any suffering to be born, and who has the right to weigh the various factors (both moral and physiological) involved in making these decisions. Delving into a multitude of issues such as when life begins, when suffering is needless, and whether we should play God, Wonderwoman and Superman provides not only a thought-provoking inquiry into the potential and actual ethical dilemmas created by the many advances in biotechnology, but challenges us to learn to choose responsibly and to face the moral implications of the choices that confront us. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 42, no. 3. © 2016 by Feminist Studies, Inc. 689 Elizabeth Jean Hornbeck Who’s Afraid of the Big Bad Wolf?: Domestic Violence in The Shining At first glance, Stanley Kubrick’s 1980 film The Shining seems to be a straightforward Gothic horror film. It starts with the Torrance family— Jack, Wendy, and Danny—moving from their Boulder, Colorado, apartment into the Overlook Hotel, where Jack (Jack Nicholson) has accepted (...) a job as the winter caretaker. By the film’s climax, an axe-wielding Jack says to his terrified wife and son (Shelley Duvall and Danny Lloyd), through the door to the bathroom where they are hiding, “Little pigs, little pigs, let me come in. Not by the hair on your chinny chin chin? Then I’ll huff and I’ll puff and I’ll blow your house in!”1 Jack assumes the role of the Big Bad Wolf, the nightmarish, predatory beast of fairy tales. These lines, along with Nicholson’s exaggerated performance as a crazed killer, parody the Gothic horror genre and slasher films and even children ’s fairy tales in what is, at its core, a story about domestic violence. In both Kubrick’s film and Stephen King’s 1977 novel, from which the film was adapted, the Gothic genre becomes a vehicle for a serious tale about violence within the family. The “discovery” of child abuse in the 1960s, “the creation of the wife-beating problem” in the 1970s, and 1. The Shining, directed by Stanley Kubrick (1980; Warner Home Video, 2007), DVD. The line is from the fairytale of The Three Little Pigs. Geoffrey Cocks discusses the sources and ramifications of the fairytale in The Wolf at the Door: Stanley Kubrick, History and the Holocaust (New York: Peter Lang Publishing, Inc., 2004), 33–38. 690 Elizabeth Jean Hornbeck the feminist movement allowed viewers to perceive domestic violence with a new level of understanding.2 It is my contention that The Shining comments on domestic violence in a way that has been mostly overlooked by critics. While most analyses of both the novel and the film have come from literary and cinema studies perspectives, I offer a sociological approach focused on the profound effect of changing social mores on cultural production. I draw also on feminist and queer theorizing of audience identification, gender, and erotic pleasure in horror films to explain the significant contributions made by King, Kubrick, Duvall, and screenwriter Diane Johnson to the film’s intervention in US public discourse about domestic violence.3 The first scholar who argued that Kubrick’s film is essentially a domestic abuse narrative was James Hala, who based his analysis on a close reading of critical reviews of the film and a discussion of the performances, with no reference to its social, political, or historical context.4 But it is important to note that both the novel and the film came at the end of a decade when the recognition of domestic violence as a social problem was still relatively new. Sociologists and the medical and legal professions did not take “wife beating” seriously until the mid-1970s, when the women’s movement brought public attention to spousal abuse.5 2. Kathleen J. Tierney, “The Battered Women Movement and the Creation of the Wife Beating Problem,” Social Problems 29, no. 3 (1982): 207–20; Stephen J. Pfohl, “The ‘Discovery’ of Child Abuse,” Social Problems 24, no. 3 (1977): 310–23. 3. The theoretical works that I have drawn on most heavily are Carol J. Clover, Men, Women, and Chain Saws: Gender in the Modern Horror Film (Princeton, NJ: Princeton University Press, 1992); and David Greven, Representations of Femininity in American Genre Cinema: The Woman’s Film, Film Noir, and Modern Horror (New York: Palgrave Macmillan, 2011). 4. James Hala, “Kubrick’s The Shining: The Specters and the Critics,” in The Shining Reader, ed. Anthony Magistrale (Mercer Island, WA: Starmont House, 1990), 203–16. 5. In 1976, a national survey reported that “at least 1.8 million American women are severely beaten in their own homes every year.” Murray A. Straus, et al., Behind Closed Doors: Violence in the American Family, as cited in “‘The Burning Bed’: TV... (shrink)

This essay is based on a close reading of two poems written by ChatGPT. One is about preimplantation genetic testing; the other is about Down syndrome. Examining these AI-generated poems along with several human-composed texts, the author—the father of a young woman with Down syndrome—explores a number of related topics, including the difference between human- and machine-written poetry; ableist bias in large language models; the future of people with intellectual disabilities, in a world of machine intelligence; and (...) the value of writing by people with disabilities. The author does not reject the use of ChatGPT or preimplantation genetic diagnosis, but argues that for them to be compatible with human flourishing, we need to consider the way they are sold to us, the need for regulation, and the assumptions they embed. (shrink)

In this article I investigate the ways in which phenomenology could guide our views on the rights and/or wrongs of abortion. To my knowledge very few phenomenologists have directed their attention toward this issue, although quite a few have strived to better understand and articulate the strongly related themes of pregnancy and birth, most often in the context of feminist philosophy. After introducing the ethical and political contemporary debate concerning abortion, I introduce phenomenology in the context of medicine and the (...) way phenomenologists have understood the human body to be lived and experienced by its owner. I then turn to the issue of pregnancy and discuss how the embryo or foetus could appear for us, particularly from the perspective of the pregnant woman, and what such showing up may mean from an ethical perspective. The way medical technology has changed the experience of pregnancy—for the pregnant woman as well as for the father and/or other close ones—is discussed, particularly the implementation of early obstetric ultra-sound screening and blood tests for Down’s syndrome and other medical defects. I conclude the article by suggesting that phenomenology can help us to negotiate an upper time limit for legal abortion and, also, provide ways to determine what embryo–foetus defects to look for and in which cases these should be looked upon as good reasons for performing an abortion. (shrink)

Although prenatal screening is routinely undertaken as part of a woman's antenatal care, the ethics surrounding it are complex. In this paper, the author examines the Jewish position on the permissibility of several tests, including those for Down's syndrome and Tay-Sachs disease, the latter being especially common in the Jewish community. Clearly, the status of the tests depends on whether termination of affected pregnancies is allowed, and contemporary rabbinical authorities are themselves in dispute as to the permissibility of (...) terminating affected pregnancies. The nature of these arguments is examined and the author concludes that there are grounds on which the full range of prenatal screening is permitted in Jewish law. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:104 Feminist Studies 44, no. 1. © 2018 by Feminist Studies, Inc. Estelle Carol The Chicago Women’s Graphics Collective: A Memoir In 1973, the Chicago Women’s Graphics Collective worked in an old run-down second-floor office on Belmont Avenue, which we shared with the main offices of the Chicago Women’s Liberation Union (CWLU).1 They call it New Town now, but in 1973, there wasn’t much new about it. We weren’t (...) the only artists in the building though; downstairs was a tattoo parlor. Still, it was better than having the studio located in my apartment on Newport Street, where there were silkscreen tables in the dining room and a bathroom that doubled as a darkroom. My bedroom door opened directly into the dining room and usually reeked of the foul chemicals we used to make the posters. Just one OSHA inspection would have shut us down forever, but it was not until later that we learned about the dangers of long-term exposure. On Newport Street, the apartment was right next to the Ravenswood Branch of the “L,” and it shook like the aftershock of a California earthquake each time a train passed. But we were in the midst of a women’s revolution, and our priorities were clear. 1. The Chicago Women’s Graphics Collective (WGC) was a “workgroup” of the CWLU from the very start. There were about 25 workgroups and other groups within the CWLU. CWLU outreach to recruit new members got a lot of new women into WGC. WGC, Women’s Liberation Rock Band, and Womankind Newspaper were the cultural arms of the CWLU. Cultural outreach to attract new CWLU members and new feminists to the movement in general was critical to the CWLU’s success. In Celebration of Amazons, 194. All posters designed and silkscreened collectively by the Chicago Women’s Liberation Union, www.cwluherstory.org. Courtesy of CWLU Herstory Project. All posters are on silkscreen. Turning Through Time, Workwoven, 195. Sisterhood Is Blooming, Springtime Will Never Be the Same, 190. Chicago Women’s Labor History, 194. International Women’s Day (reprinted from a Cuban poster). ABOVE Healthcare Is for People, Not for Profit, 195. OPPOSITE Abortion Is a Personal Decision, Not a Legal Debate, 190. ABOVE Healthcare Is for People, Not for Profit, 195. OPPOSITE Abortion Is a Personal Decision, Not a Legal Debate, 190. OPPOSITE Chicago Maternity Center, 192. ABOVE Lesbian Pride, 192. Mountain-Moving Day, 192. ABOVE Detail from Mountain-Moving Day, 192. OPPOSITE Women Unite, Take Back the Night, 199. Lipstick and Blood (reprinted from a Cuban design). Women Are Not Chicks, 191. Liberation School for Women, 192. Boycott Red Coach Lettuce, 192. Working Women Unite, 195. International Women’s Day, Many Waves But One Ocean, 192. Estelle Carol 121 If you look at Chicago Women’s Graphics Collective posters, you’ll rarely see a person’s name on them, because we decided early on that art had been done all wrong by men. It was based on egotism and the cult of the individual—the great-men-of-art syndrome. So we decided to throw all that out, and art now had to be a collective experience. So every poster that we created had to be done by committee. Every one. We had a system in which any one of the collective could get an idea or a phrase or an image and decide to do a poster. They would ask two or three other members to be their assistants and to help develop the idea. And then in little teams they would physically create the poster in silk screen. It had to be a collective process. There’s no way that one single woman could really do it because we were using very primitive reproduction methods, and we needed at least three people to run the silk screen. The silk screens were all hand printed. No machines. If a poster was more than one color, it had to be hand printed, one color at a time, so it was very, very labor intensive. And... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:One Interpreter's Journey of Interpreting for Pregnancy LossMarisa Rueda WillInterpreters have to know everything." This is what I thought as I watched and shadowed a seasoned interpreter at a world-renowned medical center, during my J-term internship. The fact that I had gotten this opportunity was still hard to believe. There I was, shadowing medical interpreters at one of the best hospitals in the world during my senior year of (...) college after abruptly dropping my secondary education minor to pursue a career in medical interpreting. I felt fortunate for the opportunity and seized the chance to learn from the best of the best.When that same institution hired me after I graduated college in 2006, my training consisted of shadowing other interpreters and having them shadow me. There was no strict process, just one-on-one on-the-job training. The training I received was the best it could be at the time, but not even close to what it takes for an interpreter to become confident and prepared to interpret for most appointments.Growing up I hadn't been interested in the medical profession. When I started working as an interpreter, I soon learned that in addition to my A and B languages, I also needed to learn a C language—the language of medicine. Just as I learned Spanish, I had to learn that a CAT scan was a type of imaging study, and a creatinine level was a measure of kidney function. I was fascinated by the language of medicine. The acronyms, medications, diseases, body parts, hormones, markers, genes, everything.As fascinating as medicine was, it wasn't the reason I considered medical interpreting my calling. As soon as I started working as a volunteer healthcare interpreter at a local free clinic, I knew it was the way I wanted to make a difference in the world. The Spanish speakers I was helping were low-income, underprivileged people with serious medical conditions and a host of other socioeconomic problems. These were people who needed help. These were people who needed to be heard. These were people who needed to be seen. As an interpreter, I would be able to give them a voice. Fast forward 18 years and I am still making a difference in the lives of patients with Limited English Proficient (LEP) by giving them the gift of communicative autonomy, or the right to be in control of and responsible for their own communication.Communicative autonomy is one of the founding principles of the medical interpreting profession. It differentiates the professionals from ad-hoc interpreters and bilingual family and friends. This is because upholding communicative autonomy means that regardless of my personal beliefs, I must remain impartial in all situations. I must interpret what is said and allow all parties involved [End Page 156] to guide the conversation as they see fit. Ideally, I only intervene to mediate for cultural or linguistic reasons when needed.Some of the most ethically conflicting cases I have had to interpret have centered around pregnancy loss and abortion. When I started interpreting, I was a young single woman with a relatively liberal view on reproductive rights. However, one stillbirth and three healthy pregnancies later, my personal beliefs on the subject have become more complicated. Each time I interpret for a loss or induced abortion, I must dig deep and ask myself if I can remain impartial. I can still remember the first time I faced this dilemma.One evening, I was called to interpret for a labor and delivery case. When I arrived, I was informed that it was an induction of an 18-week-gestation fetus that had tested positive for Down syndrome on genetic testing. At the time, I didn't have strong beliefs about abortion. I had never been pregnant and really wasn't sure where I stood on the spectrum of a woman's body, a woman's choice, and abortion is murder. However, there I was, smack dab in the middle of an elective abortion on a weeknight.The bereavement nurse was seasoned and experienced. If it hadn't been for her guidance and poise, the ordeal would have been... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Invisible HarmKimberly ZieselmanI’m a 48–year–old intersex woman born with Androgen Insensitivity Syndrome (AIS) writing to share my personal experience as a patient affected by a Difference of Sex Development (DSD). Although I appear to be a DSD patient “success story”, in fact, I have suffered and am unsatisfied with the way I was treated as a young patient in the 1980’s, and the continued lack of appropriate (...) care for intersex people even today.As the Executive Director of the advocacy organization Advocates for Informed Choice and a board member of the AIS–DSD Support Group since 2012, I have heard doctors reference the “silent happy majority” of DSD patients all too often. They speak [End Page 122] of patients who were treated in childhood and went on to live (seemingly) contented lives. It appears however that doctors have drawn this conclusion from the fact that most of their patients have not returned to complain about their treatment. While there is little evidence to support the success doctors claim, there is quite a bit of evidence that suggests my suffering is the norm rather than the exception.Medical professionals would likely include me in that “silent majority,” only seeing a woman who identifies and appears typically female, graduated law school, married for over twenty years, with adopted children and a successful career. And while I have been fortunate in many ways, I no longer want my voice to be presumed buried within that silent majority. Instead, I am speaking out today to tell my story.My StoryAt age 15 I was diagnosed with amenorrhea and referred to a reproductive oncologist who told my parents I had a partially developed uterus and ovaries that would likely soon become cancerous. We were told my vagina was abnormally short and might require surgery in order to have heterosexual intercourse.Neither my parents nor I was ever told I had AIS and XY chromosomes, or that the gonads being removed were testes, not ovaries. I was told I needed a “full hysterectomy” to prevent cancer and hormone replacement therapy. That summer I spent my 16th birthday recuperating from surgery. I spent the next 25 years living a lie.A lie that has had a profound and harmful impact on me.At some level, I knew I was not being told the whole truth. My parents’ and the doctors’ actions signaled to me something more might be going on. But I was afraid to ask questions; my parents were distressed and I didn’t want to cause them any more pain. Over the years I have wondered just how much my parents knew but withheld from me (albeit with good intentions). I sensed something awful was being hidden from me, and I didn’t know whom I could trust.When I asked my doctor if I could meet someone else with my condition, I was told I was different, that there was “nobody” with my medical condition in the world, that my situation was “very rare.” I was told to get on with my life and not talk about my surgery because it wasn’t important; I was healthy and could adopt if I wanted to become a parent. I was told I must take a hormone pill each day for the rest of my life to stay healthy.But what I heard was, “you are not a real woman: you are a damaged freak, so go out and fake the rest of your life and be sure nobody knows your secret.” So that’s what I did. I was a “good girl” and took my pills, didn’t ask questions and did what the men in white coats asked me to do. There was no support provided for either my parents or me. No social workers, no therapists. Perhaps most shockingly, there was no true informed consent.A few years ago I was diagnosed with post-traumatic stress syndrome caused by anxiety I had been harboring for over two decades about my past surgery and fear of getting cancer. I decided to obtain my medical records from the hospital and discover the truth.Covering several pages of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extramarital Contraception in the Catholic Faith:A Call to Action from a Physician and EthicistCara BuskmillerIntroductionDefinitionsBefore proceeding to a discussion of extramarital contraception, it is relevant to lay a foundation of definitions and limitations of this essay. Here, "sex" and "sexual act" will refer to acts of penile–vaginal intercourse and acts meant to lead to such intercourse, respectively. Other acts which are rightly called "sexual" are not relevant to this (...) essay, as the focus here is on encounters that could result in fertilization.The traditional natural law theory with its analysis of object, intention, and circumstances is at play in this essay, with a hylomorphic understanding of nature and ethics. In this understanding of ethics, the names of many acts include not only an object but an intention and circumstances (e.g., murder specifies an illegal type of killing with premeditation). Likewise, "contraception" here refers to the use of any drug or device which temporarily lowers fertility (object), to prevent fertilization (intention) due to presumed-fertile sex (circumstance). Such drugs or devices are called "contraceptives" in this essay. In this essay, "contraception" is not committed solely by intending to avoid fertilization, so acts such as trying to avoid fertilization by timing sex during infertile parts of a menstrual cycle are not contraception, and the pastoral term "contraceptive mindset" does not apply. "Contraception" is also not solely defined by the use of particular medical products, since the intention to avoid fertilization is part of the definition in this essay. Thus, [End Page 1245] prescribing or taking a birth control pill for polycystic ovarian syndrome, in the words of Pope St. Paul VI in his 1968 landmark encyclical Humanae Vitae (HV), is not at all illicit, here because such treatment is not contraception, and the problems of contraception do not apply (§15)."Marriage" in this essay refers principally to sacramental matrimony, made by the consent of a baptized man and a baptized woman.1 Civil marriage, cohabitation, long-term affairs, sex in dating, short-term hookups, prostitution, and sexual assault represent a spectrum of falling away from matrimony. This essay assumes that matrimony is God's one true plan for sex, fertilization, and childrearing. This essay also makes heavy use of the Scholastic-personalist perspective of HV on the unitive and procreative dimensions of sex. As sexual relationships "fall away" from matrimony, they lose resemblance to these dimensions."Consent" is here defined as a free act in which a person agrees to do, accept, or reject something.2 Consent is an act of the will, and it may be partial or total. Only when consent is total is a person held fully responsible for his or her actions; for example, only when consent is total can a person commit a mortal sin. Consent is different from assent, which is not of the will, but of the mind.3 In this paper, sex without consent is termed "sexual assault"—the status of the act as an assault is solely determined by consent. These definitions allow for a sexual assault in which a victim withholds consent and yet does not resist an attack,4 which is different from past legal and colloquial definitions.5 This definition also allows for assault victims that have positive emotional responses to or physical arousal from an attack. These responses from a victim do not make the assault consensual or desired, [End Page 1246] and in fact make post-traumatic recovery more difficult.6 Simply put, consent is of the will, and this is not diminished by whether the body follows suit; this differs from some legal definitions of consent in canon law, where the will of the person agreeing to a contract is signified by externals, even if there was no intention to fulfill the duties of the contract.7 Consent will be central to this essay, since it helps make the spectrum of relationships that "fall away" from marriage intelligible in two sets: one with consent, and one without."Intellectual disability" in medical and ethical literature refers to a large spectrum of differences in mental and behavioral performance, but this essay is only considering intellectually disabled persons who would be unable to... (shrink)

With the new and highly accurate noninvasive prenatal test, new options for screening become available. I contend that the current state of the art of NIPT is already in need of a thorough ethical investigation and that there are different points to consider before any chromosomal or subchromosomal condition is added to the screening panel of a publicly funded screening program. Moreover, the application of certain ethical principles makes the inclusion of some conditions unethical in a privately funded scheme, even (...) if such screening would enhance a woman’s reproductive autonomy. On the one hand, a screening program aimed solely at the detection of Down syndrome is subject to the technological imperative and should be reassessed in the light of technologies that allow for the detection of conditions that are at least as severe. On the other hand, some chromosomal conditions should not be included in any screening programs, because this would violate certain ethical principles, such as the right of the future child to genetic privacy. (shrink)

On September 27, 2016 people across the world looked down at their buzzing phones to see the AP Alert: “Baby born with DNA from 3 people, first from new technique.” It was an announcement met with confusion by many, but one that polarized the scientific community almost instantly. Some celebrated the birth as an advancement that could help women with a family history of mitochondrial diseases prevent the transmission of the disease to future generations; others held it unethical, citing medical (...) tourism and consequences for the future of the therapy. The child in question was actually born a few months earlier on April 6, 2016, but the research was published a few months later in the October edition of Fertility and Sterility. The mother carries DNA that could have given the baby Leigh Syndrome, a severe neurological disorder characterized by psychomotor regression that typically results in death between ages two and three.[1] Also known as subacute necrotizing encephalomyelopathy, Leigh Syndrome is caused by genetic mutations in mitochondrial DNA, which causes defective oxidative phosphorylation. Because people with this condition cannot re-form ATP, “demyleniation, gliosis, necrosis, spongiosis, or capillary proliferation”[2] can occur, thereby producing bilateral lesions across the central nervous system. The 36-year-old mother previously had four miscarriages and successfully birthed two children, both of whom survived less than six years due to the syndrome. For religious reasons, the mother opted for Spindle Nuclear Transfer instead of Pronuclear Transfer,[3] which many religious organizations oppose because it entails the destruction of fertilized eggs.[4] In Pronuclear Transfer, both the parent and donor egg are fertilized. The parent’s nuclear material is then removed from the egg containing mutated mitochondria and inserted into the fertilized donor egg—from which the original nuclear material has been removed and destroyed. Spindle Nuclear Transfer, on the other hand, removes the mother’s nuclear material from the egg with unhealthy mitochondria, then implants it into a donor’s egg. The newly created egg is then fertilized with the father’s sperm. This Spindle Nuclear Transfer was performed in Mexico by a team of doctors led by Dr. John Zhang, the founder of the New Hope Fertility Center in New York City. In their report, the doctors outline that five oocytes were successfully reconstituted, four of which developed into blastocysts. Only one was euploid: containing 46 XY chromosomes. Researchers then biopsied that blastocyst and found that the transmission rate of maternal mtDNA was, “5.10 ± 1.11% and the heteroplasmy level for 8993T>G was 5.73%.”[5] This indicates that at the blastocyst stage, around five percent of the mitochondria are from the original maternal egg with the mutation for Leigh Syndrome. After birth, they biopsied different tissues and found that they had an average of less than 1.60 ± 0.92% of transmitted mtDNA from the original maternal egg. The baby is reportedly doing well and the team of doctors concluded that “[h]uman oocytes reconstituted by SNT are capable of producing a healthy live birth. SNT may provide a novel treatment option in minimizing pathogenic mtDNA transmission from mothers to their babies."[6] Even when considered theoretically, Spindle Nuclear Transfer is controversial. Many doctors believe that the risks at this stage of research are too great. Dr. Trevor Stammers, a bioethicist at St. Mary’s University in London, points out: “We do not yet have a clear picture of the interaction between nuclear DNA and mitochondria.”[7] Others hold that faulty mitochondrial DNA can still be transferred during the procedure. Still more argue this technology could create problems because of germline modification.[8] Dr. Paul Knoepfler, a cell biologist at the UC Davis School of Medicine, explains: “Since this is uncharted territory and the children born from this technology would have heritable genetic changes, there are also significant unknown risks to future generations.”[9] However, proponents counter these arguments. They say the benefits outweigh the risks, as “mitochondrial replacement techniques [like Spindle Nuclear Transfer] would eliminate maternal transmission of mitochondrial disease… allowing a woman with a family history of mitochondrial diseases to ensure her children would not be affected.”[10] Additionally, experts say that no symptoms will occur if less than 20% of the transferred mitochondrial DNA is faulty.[11] And while opponents see potential germline modification as a problem, advocates answer that this could stop a family history of mitochondrial disease, which they deem a more serious concern. In this case specifically, however, there are more issues at hand. While the team of doctors did eliminate the possibility of germline modification by selecting a male embryo, there are other ethical concerns. Some argue that this case could be described as “medical tourism.” While New Hope Medical Clinic does maintain a branch in Mexico, Dr. Zhang stated that Mexico has “no rules.”[12] It is a country with underdeveloped regulations, making it difficult to confirm that doctors adhere to widely-held medical and ethical standards. Furthermore, while it is highly unlikely that the child will develop Leigh’s Syndrome, Dr. Dietrich Egli of the New York Stem Cell Foundation says the 5% mitochondrial transfer rate indicates that the technique “was not carried out well.”[13] He points to studies of embryos where the rate of mtDNA transfer was almost ten times lower. Spindle Nuclear Transfer is currently legal in the UK,[14] and many are hoping to see it legalized in the US, although Congress currently prohibits the FDA from considering applications that would entail trials in people.[15] While Dr. Zhang’s work is arguably revolutionary, many wonder if the manner in which this study was performed—in Mexico and with a high mitochondrial transfer rate—will impact the technology’s future in the US. Last week, Dr. Zhang presented the report to scientists gathered in Salt Lake City, saying that while science isn’t a race, it is “in a sense, a race for the family to find a cure, to find hope.”[16] Only time will tell if this study set back other families racing and hoping for a cure. References 1. "Leigh Syndrome." Genetics Home Reference, US National Library of Medicine, 25 Oct. 2016. Accessed 26 Oct. 2016. 2. McKusick, Victor A., and Ada Hamosh. "LEIGH SYNDROME; LS." Online Mendelian Inheritance in Man, Johns Hopkins University, 20 Jan. 2016. Accessed 30 Oct. 2016. 3. Zhang, J, H Liu, S Luo, A Chavez-Badiola, and Z Liu. "First live birth using human oocytes reconstituted by spindle nuclear transfer for mitochondrial DNA mutation causing Leigh syndrome." Fertility and Sterility, vol. 106, no. 3, 2016, pp. e375-76. Accessed 30 Oct. 2016. 4. Sample, Ian. "‘Three-parent’ babies explained: what are the concerns and are they justified?" The Guardian, 2 Feb. 2015. Accessed 30 Oct. 2016. 5. Zhang, et al. 6. Ibid. 7. Knapton, Sarah. "Three-parent babies: the arguments for and against." The Telegraph, 3 Feb. 2015. 8. Ibid. 9. Ibid. 10. "Mitochondrial Replacement Therapy FAQs." New York Stem Cell Foundation Research Institute, New York Stem Cell Foundation. Accessed 30 Oct. 2016. 11. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 12. Hamzelou, Jessica. "Exclusive: World’s first baby born with new “3 parent” technique." New Scientist, 27 Sept. 2016. Accessed 30 Oct. 2016. 13. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 14. "3-Person IVF: A Resource Page." Center for Genetics and Society, 24 Oct. 2016. Accessed 30 Oct. 2016. 15. Ritter, Malcolm. "Baby born with DNA from 3 people, first from new technique." Associated Press, 27 Sept. 2016. Accessed 30 Oct. 2016. 16. Chen, Daphne. "Controversy swirls around first three-parent baby." Deseret News, 19 Oct. 2016. Accessed 30 Oct. 2016. Works consulted Swetlitz, Ike. "FDA urged to approve ‘three-parent embryos,’ a new frontier in reproduction." STAT, 3 Feb. 2016. Accessed 30 Oct. 2016. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. (...) The following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

Life among most African families and communities revolves around women. In both African religion and culture, women’s lives oscillate between two opposite extremes of being at the centre and periphery at the same time. Women are both the healers and the often wounded by the system that respects them when there are problems and displaces them whenever there are opportunities. Their central role is expressed by a Shona proverb musha mukadzi (the home is a woman). This proverb expresses how (...) women endure the pain of both religion and culture to create a decent society. Women also endure the pain of pandemics such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and COVID-19 and at times succumb to the same while taking care of some family members who would have fallen victim to the epidemic. Countless married women have been made susceptible to HIV and AIDS as they try to live according to the African cultural dictates of mothering and/or motherhood. Other women and girls also contract the disease because of how religion and culture exert them to some unbearable circumstances. For example, women and girls nurse their ill relatives without protective equipment and clothing. At times they are abused by men because of some cultural beliefs that unprotected sex is a remedy for HIV and AIDS. In addition, most women and girls were also victims of COVID-19 while serving their family members. In doing all the good work to serve families, women are driven by the proverb musha mukadzi. Using desk research methodology, this paper argues that musha mukadzi is both a toolkit for women’s resilience to endure pandemics and at the same time a subtly oppressive statement often used to manipulate and abuse women to stand in places that are too difficult for their capabilities. Contribution: African women bear the brunt of pandemic burdens such as HIV, AIDS and COVID-19. Sometimes they become susceptible to the same while taking care of their family members affected by pandemics in the name of fulfilling the Shona proverb, musha mukadzi. The topic has contributed to the scope of the journal as it advocates to inculcate a peaceful society. The article also challenges African societies not to use musha mukadzi to ill-treat women as objects of African religio-cultural patriarchal ideology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Truth in WritingAmandaAn excerpt from my journal during a dark period in my life reads:I am a survivor of sexual mutilation, of coerced gender roles, and of perpetual lies all in the name of normalization. Sometimes I have a hard time even thinking about the true extent of what all happened. It’s like my mind doesn’t have that type of scope, like when I think about the word (...) “eternity.”I wrote this after combing through old medical records, reading comments like “her introitus has healed nicely and looks normal, but my exam suggests that her vagina is shortened,” and “reduction clitoroplasty... removal of testes.” The records go on to say that my “external genitalia is quite satisfactory,” and “on perineal exam, her neovaginal orifice is quite compliant and easily accepts my second and third digits.”My journal continues:I chose this fake hole when I was a teenager because I didn’t know there was another option. I was told from day one to be a female, to be heteronormative, to act like all the other girls, and the only way I could fully accomplish this is by looking the part. A fake hole would be necessary, I thought, to go along with the rest of the lies. Sometimes I think about how the doctors told me to lie about my surgeries and my scars. Sometimes I wonder what my parents would have told the world if I had died during one of surgeries. Maybe they would have said “we were just trying to make her fuckable.”My strength is growing from the stories and experiences I write and share. My journal started about four years ago, when I was in my early 20s, near the beginning of medical school. My initial purpose in writing the journal was to help sort through my feelings and experiences related to a newly discovered sexuality and a changing gender identity. Medical school was thousands of miles away from my previous life, my family, and my friends. Away from my old social network, I was free to self–discover on my own terms. In the first journal entry, I lay out reasons why I decided to get in contact with a therapist, something I had not done previously. Some of the reasons were fairly standard reasons one seeks out a therapist, such as moving away from home. But the fundamental reasons I sought out a therapist, and why I chose to journal, had to do with exploring feelings after my first sexual encounter with a woman, and then [End Page 98] accepting my intersexuality. My relationship with that therapist did not last, but the journaling did.In the beginning of the journal, I write:I am from a small, religious, white, non–diverse, family oriented suburb of Milwaukee. I was raised to be the picture–perfect daughter in a household that did not talk about feelings, sex, cultural or religious differences, etc. My brother and I also never talked about personal issues (and still don’t), which is quite remarkable since we are twins, and have grown up doing most everything together, from sharing birthday parties, to being locker buddies... [When my mother told me about having Androgen Insensitivity Syndrome (AIS)] knowing this little fact about my body kept me wanting to become as perfectly female in all ways possible.Growing up without being able to talk about having AIS was stifling to say the least. Closing communication implied great shame, and with the shame came even greater repression. My skate-boarding, baseball card collecting, and model car building interests disappeared after learning about my AIS, which I believe was when I was 12 years old, but I cannot remember exactly. Granted, it’s tough to say whether my interests just changed as I grew older, but I do remember having a fear of portraying any masculine tendencies that other girls in my town weren’t displaying (for example, playing soccer was okay, but I had to shave my legs). I also had crafted some pretty good covers for my AIS, including stories about when I first had my (fake) period, or how I acted fearful about a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standing at the Intersections: Navigating Life as a Black Intersex ManSean Saifa WallAs I sit down to write this narrative, my mind is reflecting on the past year. This year has seen numerous protests against state–sanctioned violence with the declaration that “Black Lives Matter”. As a Black intersex man, I have witnessed the impact of state–sanctioned violence on my family and my community, both from the police state and (...) medical community. I charge the police state and the medical community with state– sanctioned violence: Each targets non–normative bodies—the former through incarceration and execution, and the latter by means of surgical and hormonal intervention. As a Black intersex man, I stand at the intersection bearing witness to how this violence has incarcerated my friends and loved ones as well as being subjected to medically unnecessary surgical intervention. Although this is where I stand now, both socially and politically, I have not always existed here.I was born in the winter of 1978 at Columbia–Presbyterian Hospital in New York City. I was the youngest of five children and one of three children in my family who were born with an intersex trait now known as androgen insensitivity syndrome (AIS). At the time, AIS was referred to as “testicular [End Page 117] feminization syndrome.” Upon receiving my medical records years later at the age of twenty–five, I noticed scribbling and a barrage of notes indicating the process by which the doctors assigned my gender as female. Although I had ambiguous genitalia, which caused some initial confusion among the doctors, XY chromosomes were not enough for me to be raised as male. My mother was told I would be raised as a girl and, according to the medical records, “function as such.”Unlike my sisters who were also born with AIS, my mom was not swayed by the surgical recommendations doctors made about my body. As a matter of protocol, my sisters’ gonads were removed in infancy, however, my mom made the decision that my testes would remain with me until they had to be removed.Because of intense pain in my groin area, my testicles were removed when I was thirteen years old. The pain that I felt following the surgery was perhaps the worst pain that I have experienced in my entire life. After surgery, my pediatrician prescribed estrogen and Provera as a hormonal replacement regimen. Fatty deposits changed the shape and contours of my face. Once robust and chiseled thighs now harbored cellulite. The beginnings of facial hair and prominent body hair became wispy and nonexistent. What was hard and defined became soft.At no point did anyone ask me what I wanted to do with my body.I actually missed the effects of my natural testosterone such as a deepening voice, increased hair and muscle mass; when I asked if I could take both testosterone and estrogen after surgery, my mother remarked, “You would look too weird.”The hormone therapy was coupled with intense social conditioning. I feel as if the social conditioning for young women raised with AIS is suffocating. When doctors prescribed hormones for me to take, my mother constantly reminded me how “beautiful” the little yellow pills would make me. As a means of reassurance, my pediatrician told my mom that “a lot of fashion models” have AIS and that I would most certainly be beautiful. In our dominant US culture, gender norms can already be oppressive, but for women with AIS, there is the impact of gender norms and the underlying fear that women with AIS are not really women since they have XY chromosomes. I did not succumb to the pressure to be more feminine, but actually gravitated toward masculinity. Before transitioning to live as a man, I considered myself a butch woman. When I came out of the closet at fourteen years old and presented as a masculine young woman, I never felt safe. Because I dated women who were more feminine than I, my relationship with these women seemed threatening to men who repeatedly reminded me through harassment and threats that “I was not a man.” Of course, I wasn’t trying to be a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Normalizing” Intersex Didn’t Feel Normal or Honest to Me.Karen A. WalshI am an intersex woman with Complete Androgen Insensitivity Syndrome (CAIS). My 57–year history with this has its own trajectory—mostly driven by medical events, and how I and my parents reacted. Most of my treatment by physicians has not been positive. It didn’t make me “normal” at all. I was born normal and didn’t require medical interventions. (...) And by the way, I’ve never been confused about who or what I am.Truthful disclosure didn’t come to me about my biology and what was done to me as an infant until I was 33, when I forced the issue by removing my medical records from my endocrinologist’s office. I learned that there was never full disclosure to my [End Page 119] parents either, and therefore there was no informed consent for the “corrective” surgeries performed on me as an infant. My parents were only told that their little girl would get cancer and would not have a normal development as a girl unless her “deformed ovaries” were removed, and that they should never discuss these problems with me. Thus, after having presented with an inguinal hernia and having exploratory surgery at age 16 months, my intra–abdominal testes were removed in a second surgery two months later. I was pronounced a “male pseudohermaphrodite,” a diagnosis that was shared neither with my parents nor with me.Years later, I discovered an article my surgeon published in 1960 in the Delaware Medical Journal about me and another intersex person he operated on (whom he labeled a “true hermaphrodite”). The article gives a very detailed pathology report of my gonads, but only two sentences regarding my welfare and the rationale for performing those surgeries. Dr. J. F. Kustrup wrote in this article, “These [two cases] emphasize the need for early diagnosis and treatment in order to avoid the possibility of malignant change and to permit these individuals to follow a normal psychosexual pattern.” And: “Hermaphroditism and pseudohermaphroditism are conditions in which early diagnosis and treatment are essential to avoid malignant degeneration and to allow the child some chance toward normal pyschic [sic] development.” I was grateful to find this article because it revealed the unfounded assumptions underpinning the recommendations for treatment, much of which continues today. Worse even than the sort of social prejudice that shapes treatment is the absence of evidence for what doctors treat as “necessary” interventions. For my syndrome, CAIS, there never was—and still is not—data to support the cancer scare, or the opinion that I’d be confused and not have a normal life.From about the age of four, I can remember being different and being stonewalled by my doctor and prevented by my parents from talking about it. The feelings and fears I tried to express were shushed away, and I could tell that my questions were upsetting everyone. Even if I had wanted to be complicit with their lame diversions and nonsensical explanations, the massive abdominal scars were there as a daily reminder and hinted at a very different story.The Road to Hell is Paved with Good IntentionsGrowing up, I was treated like a fascinoma and a lab rat at a major teaching hospital on the East Coast. All I learned from those doctors as a young kid was what it feels like to be ogled, photographed and probed by a roomful of white–coated male doctors. Dissociation made itself my friend, and helped me to cope through the annual genital and anal exams and probing. I thought I was a freak and I felt completely powerless to protect myself from them and their “care”.At my annual appointment at age 12, with my mom present, three doctors told me I was infertile. Learning that I couldn’t have kids really saddened and shocked me, but there was no opportunity to talk about my feelings—either that day, or any time afterward. I was told to stop crying. I remember them telling me that there was no one else like me and that this was a random genetic anomaly, thereby reinforcing the freakishness... (shrink)

“Wrongful birth” is a controversial malpractice action, which has arisen in the past two decades, secondary to an expanding knowledge of human genetics and the constitutionally protected access to abortion. Under the wrongful birth claim, parents of a child with a congenital illness or abnormality may bring suit against a physician who allegedly failed to provide appropriate prenatal counseling or information. Typically, the parents claim that they were inadequately warned of a potential problem in their child, and that this paucity (...) of timely information prevented them from avoiding the pregnancy or from obtaining an abortion. While these cases have arisen in a variety of clinical circumstances, a characteristic example is the obstetrician who fails to offer amniocentesis to a woman of advanced maternal age who subsequently gives birth to a child with Down syndrome. Since the parents were prevented from learning of the abnormality and therefore exercising the option to terminate the pregnancy, they may claim damages for themselves for the wrongful birth of the infant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standing UpEmily QuinnA 10–year old and her mother walk into a male gynecologist’s office. That sounds like the beginning of a sick joke, right? Imagine how it must have felt to actually be that 10–year–old. I walked into the Salt Lake City ob–gyn office, terrified out of my mind. It was the year 1999 and due to the recent accessibility of the Internet, there was a surprising amount of (...) information about complete androgen insensitivity syndrome (CAIS) available. There was also an active and prominent support group for women with CAIS and other similar conditions. Despite all of this, I was standing in the office of a doctor who knew nothing about my body. He did not direct me to any actual support, and for the next twelve years I went from doctor to doctor, none of them really knowing what to do with me. For as much as I was in and out of the doctor’s office, I never seemed to receive any “care.”It was really difficult to have doctors who knew nothing about my condition. It was scary to be a kid with hundreds of questions but without an adult who had the answers. So many doctors were excited to look at me, to talk to me, to get the chance to meet me. As a child it made me feel like a freak. I felt alone, and scared, like I was on parade for all of these people who didn’t know anything about me except that I was “special.”I was savvy enough to turn to the Internet for help, but searching for “sex disorders” online was a terrifying thing to do back then. Even now, it’s not a safe space for a pre–teen looking for answers. I was so scared and ashamed of my body, and I desperately wanted someone to talk to about it. I found articles about celebrities who were rumored to be like me, and I saw the word “hermaphrodite” thrown around as carelessly as it had been used in my doctor’s office. I wished desperately that one of those celebrities would admit to having a body like mine. Because if any of them were like me, maybe I wouldn’t be the freak that the adults made me feel like I was. Maybe then I wouldn’t be so alone.As hard as all of this was, in a way my doctor’s lack of knowledge turned out to be both a blessing and a curse. I felt cursed and ashamed of this different, “broken” body that couldn’t be “fixed.” I felt like a problem that nobody had the solution to. I was told so many lies—that I would definitely get cancer, that I could never have sex, that I needed surgery immediately. Not once was I ever told the truth—that there were hundreds of others out there I could talk to, that I didn’t do anything wrong, that I was going to be okay. My doctors didn’t point me in the direction of a support group or a therapist who could help me work through what it all meant. In Utah, the most important thing a woman can do is to have children, and it was devastating to learn I would not to be able to conceive. I wish any of my doctors had pointed me in the direction of a professional I could talk to about it.It wasn’t until I was older that I discovered the blessing amongst all of this pain. As it turns out, my doctors were so entirely ignorant about my condition that they didn’t know how to remove or even find my internal testes. I’ve managed to make it 25 years without surgery. Now, when I speak to medical students, many of them balk at this idea that surgery is something I’ve “escaped.” But I know how many affected individuals see it as I do. It’s incredibly lucky that somebody with CAIS is surgically untouched, and I fully believe that rarity to be the saddest thing. It shouldn’t be the norm to... (shrink)

“Scripts and Revelations” argues that the gender reveal party is a creative response to the affordances of recent technologies: prenatal tests allow us to discern fetal sex before birth, and social media platforms allow us to share intimate moments for a potentially unlimited audience. Building on the work of scholars of gender (Astri Jack, Carli Gieseler) and disability (Robert McRuer, Tobin Siebers), and interpolating his experience as the father of a young woman with Down syndrome, the author argues (...) that gender and disability cannot be considered in separation, and that the ritual’s peculiarities are, in part, a reaction to prenatal tests that disclose both fetal sex and disability status; the gender reveal party strictly separates these—celebrating one, silencing the other—and thus tends to enforce strict norms around both disability and gender. Examining blog posts about gender reveal parties sponsored by prenatal testing companies, viral videos of catastrophic accidents, and compilations of “gender reveal fails,” the author considers the gender reveal party from multiple angles, including economic (the gender reveal is an expressive act within a system that monetizes expression) and technological (the ritual reveals the extent to which our lives are coextensive with digital technologies). The author then turns to personal experience, raising the question of how to publicly welcome children with disabilities and other differences, those for whom no script of welcome yet exists. (shrink)

The idea that the womb moved freely about a woman's body causing spasmodic disease enjoyed great popularity among the ancient Greeks, beginning in the classical period with Plato and the Hippocratic writers and continuing on into the Roman and Byzantine periods. Armed with sophisticated analyses of the medical tradition and new texts pertaining to the magical, this essay describes how both approaches to the wandering womb develop side by side in mutual influence from the late classical period onwards. Of (...) special interest will be the tendency in both traditions to imagine both demons and errant wombs as wild animals and to use fumigations to control both. It concludes with a discussion of the historical development of and consequences for the idea that women alone possessed an internal organ that was variously interpreted as a mechanically defective body-part, a sentient and passionate animal, and then finally a demon with malicious intent, who bites and poisons the female body. It also argues against the hypothesis or assumption that midwives or wet-nurses were the original source for the idea of the wandering womb, suggesting that the syndrome never fit comfortably into the category of gynecological illness, because the womb was not the site of disease, but rather a cause of spasmodic disease in other areas of the body. (shrink)

A recent article in this journal by Katrina Hutchison exposes and addresses the cumulative effects of implicit bias on women in surgery. We doubt that there is a single woman in any surgical field who has not experienced both implicit and explicit bias. Many of the issues facing women in surgery seem to be mirrored in both the developed and developing countries. There is little literature describing the exact situation in Africa. South African government institutions have made a concerted (...) effort to improve the representation of minorities in business, education and the health sector. In the hospital setting, hiring is done by means of a quota system based on demographics within that particular sector. This has also resulted in a number of unforeseen epistemic biases. This policy-driven ‘forced’ hiring of female candidates also led to feelings of doubt in the candidates themselves about their merits and competence and capabilities. This epistemic bias can then filter down, feeding the already prevalent imposter syndrome and confidence issues felt by many female surgical trainees. Not only do we need to aim to change the culture in surgical departments by changing the image of the ‘stereotypical surgeon’, we need to extend this message out into our training institutions, communities and peoples’ homes. We believe that this is the only way to change a culture steeped in implicit bias, to be more inclusive of women and other minority groups and shed the assumption that they are lesser. (shrink)

A 72-year-old widowed woman known to have an organic brain syndrome was hospitalised owing to gangrene of her lower limbs. The gangrene had been caused by an adduction contracture of her hip resulting in pressure on the medial surface of her left leg. In addition she had pressure sores over both trochanters and the sacrum. The smell of putrefication could be sensed from a distance and on examination large white worms could be seen slithering in the decomposing tissue. (...) The patient was pyrexial, oblivious of her surroundings, and without pain. Surgery--limb amputations--would not restore the patient to a cognitive state nor improve here quality of life, but abstinence posed an inherent threat of sepsis, and revulsion to the attendants. The sacral pressure sore was so large that surgical closure was impossible. The question of surgical intervention is discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Bad, the Ugly, and the Need for a Position by PsychiatryLloyd A. Wells (bio)Keywordsvice, psychiatric education, psychiatry-law interface, medicalizationSadler’s paper is thought provoking and will resonate with many psychiatrists who deal with the interface of vice and psychiatric syndromes. This interface and the dilemmas it poses are perhaps most discussed by residents, who are dealing with the issue for the first time and who often debate what is (...) “psychiatric” about these cases. Many residents have their own informal systems of classifying vice, often with a divide between the criminal population and those perceived as avoiding work and responsibility. These unofficial classifications are usually judgmental and often pejorative, but the residents rarely get much help from faculty in this area. Indeed, many of the faculty have equally judgmental and pejorative views, which are neither systematized nor subject to systematic analysis.By clarifying the importance of the issue of the vice–mental disorder relationship (VMDR) to psychiatry, Sadler may move this topic to one that receives Socratic discourse in our training programs and serious consideration in the training of psychiatrists rather than an idiosyncratic lumping of these patients into the broad category of “patients I don’t like.”Sadler asks for comments in several categories: historical intractability, goals of psychiatry, taxonomy, implications for the criminal justice system, implications for the law, and ethical/political implications.Issues of historical intractability are long standing. In A Tour of the Whole Island of Great Britain, written in the early eighteenth century, Daniel Defoe (1724–1727) describes many asylums, often with the comment, “as it is a madhouse, so is it also a house of correction.” Some of the great public hospitals of the seventeenth and eighteenth centuries were built at least as much to get antisocial and homeless people off the streets as to provide care for the mentally ill. The moral treatment of France and Great Britain, which added much to the practice of psychiatry, clearly had punitive “treatments” for patients with vice-laden behaviors, and this was very explicit in the American moral model of treatment of the late nineteenth century with its obsessive need to prevent patients from masturbating. In the nineteenth and early twentieth centuries, there was great debate about the inclusion of Pritchard’s “moral insanity”—now sanitized into “personality disorders”—into the psychiatric domain, and Kraepelin referred to this group as “enemies of society.”Sadler next asks us to consider the goals of psychiatry in regard to “a proper VMDR.” He wonders [End Page 43] whether a strict medicalization account can be defended. I think it is clear from a large literature and from clinical experience that it cannot be defended —now. But it may become defensible in this century, which will pose enormous challenges to psychiatry, lawmakers, and the courts (vide infra). A strict moralization model is defended by many in society, including some psychiatrists, but has severe limitations and seems illogical. It is hard to make a case (though juries have done so) that, for example, a very delusional young woman with postpartum psychosis who murders her children because of the belief that far worse things than death will happen to them imminently if they live, fits the moralization approach. The Dahmer case is especially instructive. Although there was enormous “vice” (and perhaps “evil”), it is hard to make a case that a sane man would make temples out of the body parts of victims and would attempt to commune with the dead through them.He wonders whether a “mixed” version of medicalization/moralization can be developed and defended. I would argue for both a mixed approach and a “shared” approach. A middle adolescent with bipolar disorder burned his house to the ground. (Fortunately, he and family members were injured but not killed.) He was wildly manic at the time and set the fire because he wanted to prove that he was immortal and totally impervious to flames. He was delusional, extraordinarily impulsive, and completely without judgment, and it would be extraordinarily difficult to exclude the medical frame in any consideration of the vice involved. The vice, indeed, may be more involved in his decision while euthymic to stop taking... (shrink)

Objective Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening.Methods Forty-one semi-structured interviews were conducted with gynaecologists–obstetricians and midwives in a large Swiss city.Results Three professional profiles were constructed along a continuum that defines the relative distance or proximity towards patients’ demands for professional involvement in (...) the decision-making process. The first profile insists on enforcing patient responsibility, wherein the healthcare provider avoids any form of professional participation. A second profile defends the idea of a shared decision making between patients and professionals. The third highlights the intervening factors that justify professionals’ involvement in decisions.Conclusions These results illustrate various applications of the principle of autonomy and highlight the complexity of the doctor–patient relationship amidst medical decisions today. (shrink)

This is a poem about my experience with one of my most meaningful patients, a woman with Takotsubo (translated from Japanese as "Octopus Trap") Cardiomyopathy. Also known as "broken heart syndrome," Takotsubo is a rare condition that results from periods of extreme physical and/or emotional stress. This is an account of my patient's story as "heard" through the EKG, and how despite arrival at the correct diagnosis through careful history taking and EKG findings, no measure of science or (...) diagnosis could offer the comfort we could provide by simply listening to her story and affirming her in her grief. (shrink)