Is medical ethics a branch of medicine?

Had one of those Delphic moments this morning where I began to despair about the number of medical ethics, and bioethics, departments situated within medical schools.  Lo and behold, my worries happened to coincide with the news that the bioethics centre at my neighbourhood university is about to be subsumed under the School of Medicine.  It’s an insidious move, and one that suggests that the hegemonic privilege of medicine shows no sign of loosening its grip.  Setting aside any considerations of whether academic disciplines must justify their practical utility, the current ethos in higher education demands that disciplines demonstrate ways in which they will be useful (to students, policy makers et cetera).  And, clearly, if medical ethics is to have any useful function, it is as a guide to the practice of medicine and healthcare.  When its role is subordinate to medicine–when it is a sub-speciality–it is, at best, a secondary consideration, or ignored altogether.  At worst, it becomes a vessel for harm.

If medical ethics is situated within medical schools, it runs the risk of being a reactive discipline, waiting for situations that its practitioners can comment upon, mouths for hire whenever someone wishes to die, programme a robot to kill Arab kids or give great blowjobs, or genetically engineer intersex folk out of existence.  This is not what medical ethics should be.  It is also not about finding justifications for things that medical practitioners and researchers want to do.  It is about finding–and teaching–ways to think about healthcare in broad ways.  It is about synthesising all that we understand about the structural issues of communities, administrations, society and environment, individuals, and those we share our worlds with, with the issues faced in healthcare service provision.  It is a rigorous examination of values, and an attempt to resolve the issues that arise when those values clash.

When it becomes nothing but a compulsory bolt-on to medical training or research applications, and a chortling justification of trauma, misery and suffering in the name of ‘science’, medical ethics becomes the vehicle for the very things it is intended to prevent.

Launching, and speaking out

After a couple of false starts, I’m relaunching.  I think it’s fair to say that the past year and a half have been pretty tough for me, which makes for rocky and sporadic blogging of an embittered or timorous nature; it’s also fair to say that I have been prone, in the past, to trying to be something that I’m not.  Or not quite. Or someone not entirely consonant with her past.  So let’s lay that out on the line, given that these are the things that I am preoccupied with, that I would like to talk about, and that are the things that I can bring my own experience to bear upon.

Fair to say that I will have things to say here about being intersex.  At some point I’ll get more into that; suffice to say, for now, that this has been something of a nightmare and a point of pride for me over the years, although for the past decade and a half I have been–except with closest and oldest friends–invisible intersex.  This desire to be invisible sharpened for me moving to New Zealand, back in 2002, after the death of someone very dear to me, although I had started to hide before that for a range of reasons, personal and professional.  One rarely approaches a new life trying to be an outsider, so that, along with sex work, kink, being queer, all got boxed up in the effort to escape the pain of mourning; funnily, in all that I hid, I became more of an outsider than I had ever been.  But, inasmuch as the past year and a half have been traumatic for a range of reasons, that trauma has also led to my being increasingly unable to hide–not least because of hospitalisations in the wake of adrenal crises.  The fun of having CAH.  This, along with taking a long hard look at my life, has caused me to reassess my decision to remain invisible as far as being intersex is concerned.  I admit to a certain level of discomfort and shame, although much of this relates back to the way my ‘condition’ has been dealt with; I just have not wanted to have those conversations, to talk about the humiliations and the pain and the hiding and the awful abuses, accidental and deliberate, that seem to accompany the experiences of way too many intersex people.  When you hide, you don’t know what you lose, and I think I have lost a lot, not least the companionship of people whom I could have called friends.

I’m also keen to talk about sex work.  I am not going to make any apologies for my commitment to sex work as work, and for my view that portraying sex work as a special domain of exploitation is a vile form of oppression.  Too much shame is piled upon people of all genders doing legitimate work, and that shame–in turn–is justified by reliance on a lot of nasty myths about people trafficking, modern slavery and the one about silly vulnerable people who get preyed upon by dinosaur pimps gobbling up virgins by the dozen.  Nor is that shame shoveling particular to sex workers; our clients are also subject to that, with suppositions that those who purchase sex in whatever form are exploitative, careless, brutish, immoral, misogynistic, desperate, pathetic et cetera (pretty much the same sort of labels that get leveled at us).  My clients–male and female–have rarely displayed any of those characteristics, unlike the sex work excluding feminists who maintain that ‘whore’ is a vile slur (looking at you, JK Rowling).

Another of my preoccupations is mental health, and mental healthcare.  Fair to say that I have used mental health services in the past, in the main as a consequence of the enduring traumas resulting from being an intersex kid.  It’s only been over the past year or so that I’ve been able to conceptualise my anxiety, depression and abject terror (as well as my pathetic optimisms!) as part of complex post-traumatic stress, and I’m really keen to explore (here and in my work elsewhere) how that intersects with things like agency, autonomy and identity.  I’m fascinated by attachment, and the ways in which we relate to each other as humans, and I tend to look at these things through a psychoanalytic lens.  I’ve been criticised for this in the past: as a person who is generally queer (my straight relationships, as limited as they have been, have been unmitigated disasters…), and unequivocally intersex, it seems odd to pick a paradigm that, on the surface, seems to depend on binary structures and a preoccupation with reproductive functioning.  Let me just throw it out there: I think Freud was misunderstood, and I think the extent to which psychoanalysis has wedded itself to theories that depend upon gender binaries driven by reproductive urges is misguided and has limited its utility.

I think that’s more than enough for a first post.  I will wake up at 3am and realise I sound like a pretentious arsehole, or worry that X or Y person will see this and I will again be the subject of ‘lol more crap from her’ emails (or worse), but there you have it.  Not sure what is worse: people reading this or nobody reading it.  Let’s see how it goes.  I’m not all misery and dark plots; bear with me 🙂