Biopower, Normalization, and Slippery Slopes

[This post previously appeared on Discrimination and Disadvantage. In an upcoming post, I will discuss how the subfield of bioethics has shaped Canadian philosophy and how the predominance of the subfield of bioethics in Canadian philosophy is intertwined with prestige bias. An earlier post on prestige bias in Canadian philosophy can be found here.]

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People know what they do; frequently they know why they do what they do; but what they don’t know is what what they do does. — Foucault

In two posts last week, I argued that the force relations to which Foucault gave the name “biopower” condition current debates in bioethics. In my forthcoming book, I actually extend that claim in order to argue that biopower precipitated the emergence of bioethics as an area of inquiry whose linchpins are the constructs of “choice,” “informed consent,” and “autonomy”. Biopower, I pointed out last week, operates in particular through coercive, incremental normalization, enabling people to act in order to constrain them, putting in place the limits of possible action from which they may choose and guiding their possible choices.

Because, as I argued last week, mainstream and (most) feminist bioethicists continue to rely upon what Foucault called a juridical conception of force relations, they misunderstand how power operates in their field. One consequence of the failure on the part of bioethicists to apprehend how biopower circulates in bioethics is that they have, almost universally, misunderstood critiques of its incremental normalization that philosophers and theorists of disability and disability activists have advanced, dismissing these critiques as “slippery slope” arguments. The charge according to which philosophers and theorists of disability and activists produce slippery slope arguments is especially common with respect to our critiques of the normalization of prenatal testing and selective abortion, other genetic testing, and “assisted dying.” 

In my forthcoming book, I argue that, because  bioethicists do not understand how power operates in their field, they also do not understand how their dismissals are implicated in the neoliberalism with which biopower is intertwined. My post “Is the ‘Right to Die”  Racialized Biopolitics?” cited a Washington Post article that notes that some critics of legislation to entrench physician-assisted suicide in law argue that African Americans who are disproportionately disadvantaged economically may believe that ending their lives after a terminal diagnosis is the best option for them. Indeed, (neoliberal) austerity has been identified as a significant factor for the poor care received by Archie Rolland, who “chose” this option in the Spring. Furthermore, some U.S. insurance companies, driven by the neoliberal normalization of biopower, have implemented policies that promote this option, where legislation has enabled them to do  so.

A recent article in the Washington Times details the situation of Stephanie Packer, for example, whose insurance company refused to pay for the chemotherapy drug that her doctors had recommended, offering instead to pay for the drug that would end her life as the better option. Here is an excerpt from the article:

Stephanie Packer, a wife and mother of four who was diagnosed with a terminal form of scleroderma, said her insurance company initially indicated it would pay for her to switch to a different chemotherapy drug at the recommendation of her doctors.

“For a while, five months or so, we’ve been trying to get me on a different chemotherapy drug for the infusions, because my doctor felt that it would be less toxic than some of the other drugs that we were going to be using,” Ms. Packer said in a video distributed by The Center for Bioethics and Culture Network on Monday.“And I was going back and forth, and finally I had heard back from them, and they said, ‘Yes, we’re going to get it covered, we just have to fix a couple of things,’” she continued. 

But shortly after California’s End of Life Option Act, which authorizes physicians to diagnose a life-ending dose of medication to patients with a prognosis of six months or less to live, went into effect, Ms. Packer’s insurance company had a change of heart.

“And when the law was passed, it was a week later I received a letter in the mail saying they were going to deny coverage for the chemotherapy that we were asking for,” Ms. Packer said.

She said she called her insurance company to find out why her coverage had been denied. On the call, she also asked whether suicide pills were covered under her plan.

“And she says, ‘Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication,’” Ms. Packer said.

The entire Washington Times article is here. Another article about Packer’s situation is here.

The original post on Discrimination and Disadvantage is here.

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