This week’s quote of the week (though it’s only Thursday) returns us to earlier discussions of MAiD (on BIOPOLITICAL PHILOSOPHY and here) in which I point out that proponents of this mechanism of eugenics generally hold dated understandings about contemporary forms of power (its character, how it coalesces, how it operates, etc.), assuming facile liberal conceptions of agency and choice in order to argue that people who undergo this grievous intervention are exercising their respective inherent rights to autonomy. Examples of these outdated juridical understandings of power, according to which power is repressive and subtracts from individual liberty, were evident in discussions about MAiD that took place in various fora over the past couple of weeks (for example, here), especially in the aftermath of a CBC News report about the situation of Normand Meunier.

This week’s highlighted quote derives from Normand Meunier. Meunier, who was hospitalized in January for a respiratory virus, required frequent rearrangement of his body and a specific kind of mattress—an alternating pressure mattress—to prevent the development of pressure sores, which can increase in size rapidly, can deepen to the point at which bone and muscle are exposed, and can be life threatening. Although the hospital in Saint-Jérôme, Québec that admitted Meunier was advised of these requirements, no alternating pressure mattress was made available to him. Instead, Meunier spent four days on a stretcher in the hospital’s emergency room, developed a large pressure sore on his buttocks for which the prognosis was grim, and eventually was moved to the intensive care unit of the hospital.

Meunier was euthanized at his home on March 29th. Meunier, who spoke to CBC Radio-Canada’s Rachel Watts on the day before he was killed, said, according to Watts, that he “preferred [to put] an end to his physical and psychological suffering by opting for medical assistance in dying” (Watts, CBC News, emphasis added). André Picard, the Globe and Mail “health columnist,” whose recurring defenses of MAiD unabashedly display his limited understanding of modern power (as I have shown in previous posts), had these remarks to say about Meunier’s death:

I believe all Canadians should have prompt access to safe, effective care. 95 hours on a stretcher in ER is unacceptable. I also believe in patient choice and agency. So I respect this patient’s decision to choose MAiD to relieve his unbearable suffering…. When a person is in unbearable pain, they need the agency to end their pain. How they got to that point is another matter. As I said, the days on a stretcher causing bedsores was unconscionable. But you don’t correct one injustice, poor care, with another injustice, denying MAiD. (emphasis added)

Let me point out, first of all, that not everyone who resides in the settler state of so-called Canada is a Canadian. For example, many Indigenous people who live “in Canada” do not consider themselves to be Canadians and reject the application of that designation to themselves; hence, we should recognize that Picard’s remarks evince exclusionary settler-colonial assumptions about (among other things) identity and distributive justice, entitlement, and nationalism.

Note, furthermore, the way in which Picard (1) foregrounds “unbearable pain” and “unbearable suffering” as the determining factors in Meunier’s request for MAiD; and (2) predictably, rehearses the shibboleths of liberalism and liberal bioethics–according to which a disabled person’s choices are unfettered, somehow occupying a domain beyond or outside of power–as the inherent and irrefutable justification for Meunier’s request and its subsequent fulfillment.

Contra Watts and Picard, however, Meunier himself articulated his “choice” in this way:

“I don’t want to be a burden. At any rate, the medical opinions say I won’t be a burden for long; as the old folks say, it’s better to kick the can.”

Against Watts’s and Picard’s explanations—which effectively obscure Meunier’s motivations—I want, therefore, to underscore that pain and suffering seem not to have played the decisive role in Meunier’s request for MAiD as Watts and Picard claim that they did. Rather, Meunier’s request was based on his perception that his life was a “burden” to society. For Meunier, it seems, it was better that he, an elder, “kick the can” than be a social burden. Picard seems to share this sentiment, as his remarks about why elders should seek out nursing homes demonstrate. Indeed, a 2022 report from Oregon, where euthanasia/assisted suicide has been legal since 1997, indicates that for 44 percent of people who were killed with the procedure in that year concerns that they were a burden on family and friends were contributing factors in their decision.

Consider Meunier’s perceptions in this regard. The hospital staff had made it clear to him and his partner Sylvie Brosseau that acquisition of the appropriate mattress was extra-ordinary, outside of its protocol, a hassle, burdensome; that turning Meunier in his bed was not a priority for them. In other words, Meunier’s life was deemed less valuable and less deserving of staff attention and time than the lives of other patients, a potentially fatal sore ensued from this neglect, and Meunier felt compelled to adopt the disvalue that this predicament conferred upon him and the expedient action that this disvalue recommended.

In short, Meunier internalized oppressive interpretations of his situation that circulate in ableist social discourses and institutions in Canada, including in Canadian hospitals, physician’s offices, the mainstream media, and bioethics journals and classrooms; that is, Meunier’s choices were mutually constitutive with, and products of, a subjectivity that was itself constituted by and through an ableist sociocultural milieu.

Insofar as apologists for MAiD largely refuse to acknowledge that ableism contributes to the constitution of disabled subjectivities and disabled people’s choices (e.g., here), that is, insofar as proponents of MAiD refuse to acknowledge that ableism limits and enforces the ways in which disabled subjectivities and the actions that follow from them are constituted, they naturalize and depoliticize the disabled subject and its values, choices, and actions. In doing so, furthermore, they ultimately enable the naturalization and depoliticization of the apparatus of disability more broadly to persist. For these proponents of MAiD, it seems, only nondisabled people’s subjectivities—including their values, beliefs, choices, perceptions, goals, and intentions—are socially constituted and potentially political in character, that is, only nondisabled people’s subjectivities are potential targets of, and susceptible to, oppression and constraint.

We should reject the facile construals of the disabled subject’s constitution that proponents of (neo)liberal eugenics increasingly advance; that is, we must argue that the constitution of the disabled subject, its decisions, and its motivations to act are far more complex and complicated than Picard, Udo Schüklenk, and other socially and economically privileged proponents of and apologists for MAiD are willing to acknowledge.

Michel Foucault’s work on the subject, subjectivity, and power is an instructive antidote to the simplistic (mis)representations of productive power relations that one encounters in the claims of liberal philosophers, bioethicists, and journalists who serve as proponents of MAiD. For Foucault was concerned to articulate the ways in which the subject is formed by, through, and in accordance with force relations.

In this regard, I have copied below an excerpt from my chapter in Genealogy: A Genealogy, a forthcoming collection edited by Verena Erlenbusch-Anderson and Daniele Lorenzini (Columbia University Press). This passage of the chapter is especially pertinent to my claims about the constitution of the disabled subject and its subjectivity/subjection under the productive constraints of (neoliberal) ableist oppression.

___________________________________________________________

In Foucault’s work on governmentality, he aimed to show how the double bind of individualization and totalization, which characterizes the modern nation-state, is the mechanism through which the nexus between force relations and freedom is produced. Indeed, the power of the modern (neo)liberal state to produce an ever-expanding and increasingly totalizing web of social control of subjects is inextricably intertwined with, and dependent upon, its capacity to generate a growing array of progressively finer specifications of the individuality of subjects: by performatively differentiating and distinguishing them from each other, ranking and hierarchizing them, and categorizing and classifying them, all in accordance with a set of normalizing and homogenizing criteria, effectively producing them as identifiable and recognizable kinds of subjects, while simultaneously rendering them interchangeable.

Given the inexorable bind between the individual and the totality in modern liberal states, Foucault argued that analyses of subjection should not attempt to identify some centralized and overarching font of subjecting power, but rather “should try to grasp subjection in its material instance as a constitution of subjects.” In another, earlier context, Foucault had remarked that in his work he had been trying to render evident the “constant articulation of power on knowledge and of knowledge on power,” especially with respect to the experiences of the subject. In other words, Foucault was keenly aware of the ways in which the coalescence and emergence of disciplines such as bioethics are mutually constitutive with forms of power. Power—that is, its exercise—he argued, perpetually creates knowledge and knowledge constantly induces effects of power. Indeed, Foucault was especially concerned to show how the emergence of the human sciences (of which bioethics is but one) over the last two centuries has been entwined in the problems and practices of biopower and the social management (government) of subjects.

Thus, Foucault’s remarks on biopower, the subject, and government in his later work direct theorists to discern the multifarious ways that “subjects are gradually, progressively, really and materially constituted through a multiplicity of organisms, forces, energies, desires, thoughts, [and so on].” Although Foucault’s work is commonly characterized as centrally concerned with power, he stated in a number of his writings that inquiry into the complicated constitution of subjects (how humans are made subject) was the crux of his theoretical endeavors.

He was concerned to show that despite the fact that modern governmental force relations appear to regulate political life in purely negative—that is, repressive—terms by prohibiting and controlling the subject, their logic is far more byzantine than traditional conceptions of juridical power represent: modern force relations actually govern subjects by guiding, influencing, and limiting their actions in ways that accord with the exercise of their agency and freedom. In other words, autonomy is an instrument of power rather than a principle of resistance to it, rather than its adversary. In short, the autonomous subject of bioethics is thoroughly within the grip of power.

Indeed, Foucault maintained that the most effective exercise of modern power relations consists in guiding the possible conduct of free and autonomous subjects and influencing the possible outcomes of their actions by putting in place the possible courses of action from which they may choose. Relations of governmental power enable subjects to act in order to constrain them. By virtue of their subjection to governmental force relations, subjects are in effect formed, defined, and reproduced in accordance with the requirements of them. Furthermore, the production of these practices—these limits of possible conduct from which subjects choose their acts and hence are self-constituting—goes hand-in-hand with concealment of them, allowing the naturalization and legitimation of the discursive formation in which they circulate. Autonomy is a trap.

In an interview that contains some of the most explicit and straightforward explanations of his ideas about the constitution of the subject, Foucault put it like this:

I don’t think that we should consider the “modern state” as an entity which was developed above individuals, ignoring what they are and even their very existence, but on the contrary as a very sophisticated structure, in which individuals can be integrated, under one condition: that this individuality would be shaped in a new form, and submitted to a set of very specific patterns.

In Foucault’s terms, to be a subject is to be simultaneously subject to external control and dependence, on one side, and tied to one’s own identity by a conscience or self-knowledge, on the other side. Thus, although Foucault claimed that subjectivity is a secondary phenomenon, that the subject is an effect of the nexus of power-knowledge, he did not deny that the individuation of its agency and the lived character of its experiences are real. On the contrary, he acknowledged that these aspects of subjects are very real constituents of and for them, as much of his later work shows. Nevertheless, he endeavored to underscore that such constituents of the subject are contingent and historically specific, not inherent to them, nor historically continuous.

Furthermore, subjectivity itself, that is, subjectivity as a property that the subject possesses, was, for Foucault, neither eternal, nor fixed, nor are the concepts of freewill and autonomy (among others)—concepts on which the field of bioethics depends—inherent and immutable. Indeed, Foucault’s genealogical work on the subject aimed to show that none of these concepts is a historical constant. Instead, each of these putatively inherent and foundational properties or attributes of the subject has come into being through certain historically contingent practices, accidents, events, and interests. Thus, each of them has its own history of which it is the task of the genealogist to chart.