Browsing by Subject "Medical ethics"

Recent accounts of authenticity have defined the concept in terms of self-creation, self-discovery, or some combination of the two. While these accounts get something right about the concept, I argue that they fail to capture all the elements of authenticity that an adequate account ought to capture. In this dissertation, I develop and defend a novel account of authenticity that preserves some features of previous accounts while also introducing new ones. My account is two-pronged (recognizing what I term the ‘target’ and ‘response’ dimensions of authenticity), and through it I come to the conclusion that authenticity is best characterized as the practice of living in accordance with one’s values. After outlining and defending this account, I consider how it might impact or inform current debates regarding how the use of psychoactive drugs for so-called ‘enhancement’ purposes affect users’ authentic selves.

This dissertation explores the formational power of healthcare as revealed in the modern hospital, offering a constructive theological and moral response to two interrelated questions. First, how should the work of healthcare be described? Answering this question requires careful attention to distinct formations of patients and practitioners undergirded by tacit theological assumptions. Second, what moral responses are fitting for these descriptions of the work of healthcare? In contrast to the standard prescriptive approach in modern bioethics, the moral concerns and sources present in contexts of action must be articulated in order to enable prudential moral guidance. Through engaging the relationship between moral description and prescription in the modern hospital, this dissertation argues that the practice of healthcare should be ordered within an overarching moral and theological vision of hospitable bodily care.

In dialogue with writings in phenomenology, ethnography, and history, the dissertation excavates the theological, philosophical, and political assumptions that undergird different accounts of the work of healthcare in the hospital. Within this institution, bodily disruption is imagined and engaged in distinct ways, which form how patients and practitioners speak, perceive, and act. This formation is examined in three paradigmatic medical sites within the modern hospital: the surgical ward, the Intensive Care Unit, and the labor and delivery ward. Within them, the patient’s body is imagined and engaged as enemy, object, and friend. These medical imaginaries are made possible by the development within the modern hospital of distinct arrangements of discourses, practices, and practitioners, each undergirded by particular normative schema.

By articulating the moral sources and conflicts within the modern hospital, the project illuminates the moral theories of three prominent Christian bioethicists: James Childress, H. Tristram Engelhardt, Jr., and Stanley Hauerwas. I argue that Childress offers a just-war inspired bioethics fitting for conflictual encounters, and that Engelhardt’s position, as developed by Jeffrey Bishop, ultimately counsels separation in light of the objectification of the body that occurs in the modern hospital. In his writings, Hauerwas offers an account of care befitting the institution’s roots in practices of hospitality. By developing this moral vision through the work of Luke Bretherton, the dissertation articulates a postsecular approach to bioethics, one that seeks to work within and across robust moral communities to foster the conditions and possibilities of hospitable bodily care.

The project argues that the dominant modes of imagining and engaging the patient’s body in the modern hospital—as enemy and object—do not have to be fundamental. Instead, a constructive normative vision of hospitable bodily care can order the practice of healthcare within the modern hospital. The theological underpinnings of this overarching moral framework are provided through understanding the encounter between patient and practitioner as a Christologically charged event, as depicted in Matthew 25 and the work of St. Basil. This is developed further through a pneumatological account of healthcare. The project concludes by arguing for a theological construal of the practice of healthcare as a means of participating in the Spirit’s work of befriending flesh. Through acts of hospitable bodily care, patients and practitioners are formed into the image of Christ through the power of the Spirit.

This dissertation examines the colonial history of medical rights in Latin America through a study of the world’s first vaccine. The Spanish introduced the smallpox vaccine to their empire in 1804, along with royal orders that vaccination be voluntary and medical consent a natural right ceded to parents. Yet, the vaccine first arrived there incubated in the bodies of two enslaved girls. Doctors would continue to rely on enslaved, indigenous, and other dispossessed bodies to conserve the vaccine for those otherwise accorded this ostensibly universal right. Their doing so prompted profound questions about individual liberty, embedding vaccination into struggles over the abolition of slavery, parental rights, and the preservation of colonial rule. By analyzing the politicization of preventative health, the dissertation follows the vaccine through the Spanish Caribbean and Mexico to ask why imperial—and later, national—authorities protected voluntary vaccination, what this choice meant for parents and patients, and what this story can tell us about the meaning and value of consent in an era of both race and rights-making.

To understand how consent operated, I trace the vaccine through the bodies that sustained it, examining the gendered and racialized claims to medical authority that legitimized the vaccine, the state’s patriarchal formulation of consent to it, and the responses and rejections of colonized subjects to both. Medical texts, newspapers, legal codes, orphanage records, plantation guides, and government reports related to the vaccine reveal that recognition of medical rights was inconsistent and often determined by elite assumptions about reason and bodily difference. Racial and sexual politics informed decisions about which bodies were best suited to incubate and test the vaccine, whose knowledge was deemed a threat to public health campaigns, and ultimately, who should be recognized as a parent, worthy of rights and capable of informed consent.

Amidst political and social unrest, I argue that these articulations worked to uphold colonial structures of power, as healthcare became woven into the fractional freedoms accorded to and claimed by subjects and citizens. Medical consent, as it was envisioned and employed in vaccination policies, helped to reinforce these hierarchies even after independence. Mexico retained voluntary vaccination, but the medical rights of women and men, particularly those of indigenous and African descent, remained restricted by assumptions about culture and competence. By tracing the vaccine through the postcolonial era, my project addresses the enduring effects of colonialism across political discourses of liberalism and access to resources and care. Such historicization suggests the limits of consent and prompts a more ethical conceptualization of "informed refusal" that embraces and respects indigenous and other cultural articulations of bodily autonomy.

Respect for autonomy is the foundation of modern bioethics, even (or especially) where bioethics is attentive to the problem of suffering caused by the practice of medicine itself. It provides guidance in the midst of therapeutic and moral uncertainty, justification for morally problematic enterprises, and the promise of protection against self-serving or predatory medical personnel. Yet bioethical arguments that appeal to the injustice or the horror of suffering depend on an instinctual and uncomplicated association of suffering, especially imposed suffering, with evil. This uncomplicated association, this flattening of the complexities of the moral landscape, must lead to a diminished capacity to navigate the very difficulties that define the field of bioethics. This dissertation explores the relationship, particularly, of autonomy, suffering, and happiness in modern bioethics, as represented by three key theorists (James Childress, Tom Beauchamp, and H. Tristram Engelhardt). It then contrasts these findings with resources from the Christian tradition: Luke-Acts, the letters of Paul, and the theologians Thomas Aquinas, Catherine of Genoa, and Margaret Ebner. Their accounts of the meaning and experience of suffering within well-lived lives makes for a more robust account of the moral life, one in which suffering plays a formative part.