The Biopolitics of Bioethics

[This post originally appeared at Discrimination and Disadvantage.]

In a chapter of my forthcoming book, I argue that (most of the) claims advanced in the sub-field of mainstream bioethics and even feminist bioethics rely upon an outdated conception of power that manifests in ideas about “choice,” “informed consent,” and “autonomy.” (Most) bioethicists assume what Foucault referred to as a juridical, or juridico-discursive, conception of power. In the terms of juridical conceptions, the individual possesses power—as one possesses commodities—in the form of inherent, inalienable rights, the transfer or surrender of which (through a juridical act or contract) constitutes a sovereignty.

In a lecture that Foucault gave at the Collège de France in January 1976—the lecture in which he introduced a new conception of power—he argued that power is not something that is exchanged, given, or taken back, but rather is exercised and exists only in action. Thus, Foucault maintained that the question we should ask about power is not: On what grounds is it legitimate? or Who should hold it? Rather, the central question we should ask about power is this: How, that is, by what means, is it exercised?

One of the most original features of Foucault’s analysis was his claim that power functions best when it is exercised through productive constraints. Power, he argued, is not fundamentally repressive, as juridical conceptions of it invariably assume; rather, the most effective forms of power enable people to act in order to constrain them. Indeed, Foucault argued that the continued preoccupation with juridical conceptions of power in political philosophy has obscured the productive capacity and subtle machinations of a form of power that began to coalesce at the end of the eighteenth century, namely, biopower.

This new technology of power—this biopower—takes as it object life itself, the life of the human qua living being, that is, the life of the human being insofar as it is a living being. Biopower operates primarily through incremental normalization, coercing subjects who believe that they are autonomous and free, that their actions are freely chosen, uncoerced. It operates in accordance with the aims of neoliberal capitalism: efficiency, strength, productivity. It is both intentional and nonsubjective.

In short, it is biopower (and thus, biopolitics), I argue in my book, that conditions current debates in bioethics, including debates about reproductive freedom, prenatal testing, and selective abortion, enhancement, and (so-called) assisted dying.

Remarks that Dr. Catherine Frazee (whom I had the great pleasure to work with at Canada’s national policy research institute to promote the human rights of disabled people) made at a conference on assisted dying in Ottawa over the weekend drew attention to some of the implications of normalizing power for the perception of the value of disabled people’s lives.

Here is an excerpt from the article about the event that appeared in the Ottawa Citizen:

Vulnerable people need to be protected from being induced to seek assisted death as “shame relief,” a former Ontario Human Rights Commission chief commissioner told a conference on assisted dying in Ottawa Saturday.

“We cannot understand vulnerability, or protect vulnerable persons, without first grappling with inducement,” said Catherine Frazee, who was chief commissioner between 1989 and 1992. Frazee was speaking to an audience of doctors, lawyers, academics and policymakers during a conference at the University of Ottawa.

Inducement is something attractive that leads or persuades someone to take action. And relief from frailty, dependence, incontinence and immobility is an inducement for many seeking assisted death, she said. In Oregon, where assisted suicide is legal, half of the people who requested it cited “losing control of bodily functions” among their primary concerns. Up to three-quarters cited “loss of dignity.”

“If shame is a kind of social pain, and if we are in the business of protecting vulnerable persons from inducement, then I think we do need to be attentive to the forces and structures, policies and practices that produce it,” she said.

Frazee has spinal muscular atrophy, a neuromuscular disorder. She was a professor of disability studies at Ryerson University until her retirement in 2010, and is now an advisor to the Vulnerable Persons Standard, a coalition of groups advocating to protect people who might be coerced or induced to seek assisted death.

Society is “able-ist” — it prizes independence and those who are autonomous, able and productive, she said. The ideal is based on the expectation that everyone will have the same kind of body for all of their lives — and preys on the fear of losing ability.

Frazee is concerned that severely disabled people who cannot access the kind of care they need will “choose” assisted death out of desperation, and points to the case of Archie Rolland, a 52-year-old Montreal man with advanced ALS who requested and received assisted death earlier year.

Rolland was eligible for assisted death and chose it, but that was because he could not get the care he needed, said Frazee. In a series of emails with a Montreal Gazette reporter, Rolland said he was tired of fighting for compassionate care in his long-term care facility, calling his situation “unbearable.”

“What Mr. Rolland wanted was not too much to ask – simple respect and excellent care,” she said. “When Archie Rolland could not, after persistent attempts, have what he wanted, he chose assisted death. And that choice was honoured.”

Frazee urged those at the conference to come up with creative strategies, energized ethics and policies to “break out of the old scripts.” The challenge is to help vulnerable people imagine a good future, she said. Doctors need to ask patients what a good future would look like to them and help them find the technologies and services to make that possible.

Lawyers also need to back legal challenges, she said. “If we have the right to die, will the court recognize the right to good care so we have the right to live?”

In a session on conscientious objections, Dr. Harvey Schipper, a professor of medicine at the University of Toronto, told the conference that the temptation for physicians now is to look at whether a patient meets the criteria for assisted death.

“Before Bill C-14 [which legalized medically-assisted suicide in Canada], when physicians walked into a room, the question was what kind of care they could provide,” he said. “After C-14, the question changes. Does this patient meet the criteria for medical assistance in dying?”

Read the entire Ottawa Citizen article here.

The original post at Discrimination and Disadvantage is here.

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