Where was I?

29 12 2011

No work, not enough work, too much work, work.

That’s been the last six months. Nowhere near enough money, even with too much work (really blew it on this last freelance job—shoulda charged double), but now things to be evening out: three courses for the spring, half-time admin work for a local-international organization.

I have some idea of what I’ll be doing with the teaching, no clue on what exactly I need to do with the admin work, but hey, I’ve gone from clueless to clue-full before.

~~~

Hey, I’ve got some a few new readers! HI!

Thanks for poking your head through my window! I’ll try not to slam it down on your noggin’. . . .

(And yes, I’ll return the favor and check out your blogs as well, now that I have the time to do so.)

~~~

I really hate not knowing things.

The problem, of course, is that the more I learn, the more I learn what I don’t know. Frustrating, that.

And embarrassing. Before I embarked on my jaunt through the European medieval period, I knew nothing about this history. Nothing.

Oh, something about the break with the Eastern Church in the 11th century, and Luther in the 1500s, but I couldn’t have told you the difference between the Renaissance and the Enlightenment, or between the various emperors and the pope.

Yeah, it was bad.

So now I’m learning stuff (yay!), but I’m running up against the parameters that I had initially set for this project. It was conceived as an investigation of intellectual history, with not much room for social (writ large) history, but I’m too much of a materialist to dismiss the conditions (see below) under which these ideas were generated and spread.

This is a very long way of thanking petefrombaltimore for his suggestions in reading.

Yes, a project like this can sprawl out over any boundaries set—hence my initial attempts at capturing only intellectual history—but sometimes the most interesting bits are discovered in the spillage.

Anyway, I just finished Peter Gay’s The Enlightenment and am now on Diarmaid MacCulloch’s The Reformation; I may then mix in some close-up histories, as well as tackling some of the primary sources.

Can’t say I’ve yet gotten anything solid on the late-margins of modernity by poking around in the early margins, but I am still poking along.

~~~

Got my first round of applause for teaching in. . . ever?

It was for my bioethics course, a class which was terrible the first time I taught it (at another university), pretty good the first time I taught it here, and now, well, good. I’ll continue to tweak it as I go along, but I’ve got a solid set-up which should hold for at least another few semesters.

It’s much easier to keep teaching the same thing over and over—all that prep work is already done—but I get antsy. I don’t think there’s a perfect syllabus or course (see: not a Platonist), so after a certain number of repetitions I overhaul the course to try to capture something missing from the previous go-around.

It’s not always better, and almost always requires adjustment, but it keeps me thinking.

Anyway, the applause.

It was common at UW-Madison to applaud professors at the end of the semester. Most of my classes were large lectures, so the performative aspect of teaching was more apparent than in seminars, but classes were similarly large at Minnesota, and I don’t recall the students applauding professors there.

It’s nice, both to applaud and be applauded. I liked that I could show my appreciation for a good professor (or lack thereof with tepid clapping); it seemed to signal that there was something more going on in that lecture hall than a contractual transmission of information from instructor to user.

The best professors gave us knowledge far and beyond that necessary for a good grade: they gave us an appreciation for the wonder of knowing.

I don’t know if that’s what my students were applauding. I work hard to tamp down my urge to overwhelm them with my words—as the person who constructs the syllabus and leads the discussions, I already have great, if indirect, influence on how they approach the subject—but on this last day of class I gave them a concentrated shot of my approach to bioethics.

I started with a truncated version of the epistemology/ontology/practical lecture, zeroing in on the significance of being (or Being, if you please) in one’s understanding of practical ethics. I then moved on to Hannah Arendt’s distinction between human nature and the human condition, namely, that while we cannot with any certainty know our nature, we can approach our condition.

And the most basic of our conditions are that we are biological beings, we are social beings, and we are mortal beings. We may be more than this, I noted (spiritual, philosophical, etc.), but we are damned-near-incontestably conditioned by our biology, our relationships to others, and the fact that we are born and will some day die.

This matters to bioethics, I argued, because any ethics which does not take account of these conditions cannot be of any practical worth.

(You might think that this would be so obvious as to be banal, but it is not.)

I can’t tell you that consequentialism or deontological ethics or casuistry or any other way is the correct approach, I said. We need standards to keep us from justification-by-convenience, to force a critical appraisal of our actions, but, pace our conditions, we have to allow deviation from those standards: the rules are to serve the human, not the human, the rules.

Finally, I said, circling back around, this is where I center my ethics, on the matter of  human being. What makes us who we are, and what we could become? It’s not that our abilities have to be unique among species, but we should think about ourselves, as humans, in how we approach one another.

We don’t have to be heroes, I observed. It’s not about pulling someone out of a burning car or tackling the bad guy or dodging bullets; it’s about recognizing one another as humans.

And then I told the story of a group of people in a small town in Wisconsin who decided to hold a funeral for an unknown woman who had been found, murdered, in their town. She wasn’t one of their own, and would never know what had been done for her, but through the donations of the funeral home and money raised for a plot and marker, and in the service at the cemetery, these people did in fact claim her as one of their own.

There was nothing heroic in this ordinary act of burying the dead, but by taking care of this dead woman’s body, they recognized her as one of them; they demonstrated their humanity in their recognition of her humanity.

We can take care of one another, I said. Our ethics ought to be centered on how we take care of one another.

They seemed to like that. I didn’t expect the applause—I thought I had gone too far—but even if I had, they didn’t seem to mind.

It was nice.

~~~

As a coda, I’ve consolidated my earwig approach to teaching (“I want this stuff to bother you for the rest of your lives”) into a line stolen and adapted from Serenity:

I aim to trouble you.

It’s not me, really, who can do this, but I can bring the trouble of politics and theory and ethics to my students, and hope that it disturbs them a good long time.





Between the pen and the paperwork

12 09 2010

I finally did it.

After clearing out the 4 boxes and separating the recorded from the unrecorded articles, I piled up all the recorded articles  until I figured out what to do with them.

All that work—years worth of work—and the one, great, broken promise that those articles collectively represented sat in my small hallway, just outside of my bedroom. For months.

Yesterday, I went through the stacked meter of them one last time, pulled out a few to offer to my bioethics students, and carried the rest to the recycling bin. Today they were gone.

I still have about another foot left; these are the articles to be entered into my database and then, like the others, taken away. And there are still the hard copies of all those Human Genome Reports, the reports from DOE and NIH and NHGRI and OTA, along with some number of articles that I couldn’t quite part with; perhaps by the time I move again I’ll have figured out how to toss these, as well.

It’s not that big of deal, I tell myself. All of this is available online, either through the CUNY library system or, if I ever remember to join the Wisconsin Alumni Association, through the UW library system. It’s all still there, not gone at all.

But it feels like waste: a waste of paper, a waste of a career. All of this work I gathered (or which was gathered for me—thanks R.!) was to have led me further into an academic life, one in which I built a political theory of bioethics, taught medical and graduate students, participated in colloquia and conferences, and secured myself inside a tenured professorship.

Didn’t happen. Obviously.

I held on to those articles, nonetheless, never quite sure of when I might—might—need them again. After all, I’m still teaching, and who knows when that Theoretical Medicine or Human Gene Therapy or Philosophical Nursing piece might be exactly what I need. I once needed them, or at least, once thought I needed them; so who knows. . . .

I know: I don’t. They’ve been a kind of heavy security blanket, boxes of files I’d carted with me from Montreal to Somerville to (storage locker to storage locker in) Brooklyn. I’m done, I said, as I refused to get rid of all that with which I was done.

So about a year ago I decided it was time. I did nothing. Then I said, Hey, I have a file of all of those articles, so it’s not like I’m losing access to everything. I did nothing. Then I disinterred them from the boxes, sorted through them, piled them a meter high in the small hallway outside of my bedroom. Where they sat. Until yesterday.

It felt good to get rid of the clutter. I have pack-ratish tendencies, but I love the relief of unburdening myself of unnecessities.

It just took awhile to admit that these thousands of pieces of paper were a part of those unnecessities.





(Almost) No comment

30 06 2010

“The challenge here is . . . to see what could be done to restore this baby to the normal female appearance which would be compatible with her parents presenting her as a girl, with her eventually becoming somebody’s wife, and having normal sexual development, and becoming a mother. And she has all the machinery for motherhood, and therefore nothing should stop that, if we can repair her surgically and help her psychologically to continue to grow and develop as a girl.”

Pediatrician Maria New, in a 2001 presentation to the CARES Foundation, a ‘nonprofit organization committed to improving the lives of families and individuals affected by Congenital Adrenal Hyperplasia.’  Girls affected by CAH have been prenatally exposed to higher-than-normal levels of androgens, and can lead to ambiguous genitalia; there may—emphasize may—also be a link to bi- and homosexuality.

New has been experimenting—without any institutional review board approval or the usual experimental controls—on pregnant women, dosing them with the steroid dexamethasone. Notes Alice Dreger, Ellen Feder, and Anne Tamar-Mattis in a recent Hastings Center Bioethics Forum post quote another paper by New & her colleague Saroj Nimkarn:

“Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become masculinized in 46,XX girls and women with 21OHD deficiency [CAH]. These abnormalities have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior.”

Dreger et. al. note that ‘It seems more than a little ironic to have New, one of the first women pediatric endocrinologists and a member of the National Academy of Sciences, constructing women who go into “men’s” fields as “abnormal.”’

(h/ts: Andrew Sullivan, Dan Savage, the Bioethics Forum)





No more words

24 07 2009

I think I shocked my bioethics students tonight: A number of them visibly started when I referred to the process of selective reduction as ‘killing’ fetuses.

No one said anything one way or the other, and the discussion (on multiple births) continued on its merry way.

Why would I do that, talk about killing, I mean? There’s a perfectly fine term for the procedure whereby the number of fetuses in a woman’s uterus is reduced to a more manageable (for her, and for the remaining fetuses) number, so no need to bring up the distasteful associations of ‘killing.’

Except, of course, that’s what happens during a selective reduction: After examination and evaluation of the fetuses, a needle is slid through the woman’s abdominal wall and into the heart of the fetus. A potassium chloride solution is then injected into its heart, and the fetus dies, after which it is reabsorbed into the surrounding tissue.

It is not, strictly speaking, an abortion, which involves the evacuation of the uterus.

And the situation is utterly unlike that of an abortion. When a woman gets an abortion, it’s because she does not want to be pregnant, does not want to be a mother. When a woman undergoes selective reduction, it is precisely because she wants to continue the pregnancy, because she wants to be a mother.

How awful, I said, to be in that situation: She has to kill her potential offspring in order to save her potential offspring.

I understand why people want to refer to this as selective reduction, especially those who perform and undergo the procedure. About the only thing worse than the situation itself is not having this as an option.

And the term itself is accurate enough: fetuses are selected and the number is reduced.

Still, I think it’s a form of moral cowardice for those of us who support the ability of women to decide on this option not to speak honestly about what’s involved, i.e., killing.

I’ve mentioned in previous posts on abortion the necessity of recognizing that abortion involves killing—not as a means of decrying the so-called tragedy of abortion—but as a recognition of the morality of the decision to abort, and, most importantly, of the moral capabilities of the woman who makes the decision.

We’re not a bunch of weak sisters who must be shielded from the consequences of our own actions. We may be sad or relieved or numb or any number of other emotions, and our feelings about it may change over time, but we can handle it. Really.

I’ve become even more adamant about avoiding euphemisms since Chelsea’s death. I killed my cat, I kept saying to myself, and told C. over beer and whiskey.

C., thankfully, did not correct me, but another friend admonished me when I told her I ‘mercy-killed’ Chelsea. Don’t say that, she said. You put her to sleep.

My friend was trying to be kind, but, no, I did not put her to sleep. I lay her on the table and put one hand on her chest and another on her ears and talked to her as the vet shaved her leg, soothed her as she cried a bit as he slid the needle in, felt one, maybe two breaths, then watched as her eyes dilated and she stilled.

I didn’t need the vet to tell me she was gone.

She wasn’t sleeping. No, Chelsea sleeping was curled up, tail nestled along her body or wrapped around her nose. Chelsea sleeping was her face tucked into her paws or her head twisted upside down, her body corkscrewed.

Chelsea sleeping was her soft purr into my ear as she propped herself on my shoulder or beside my pillow, her breath steady puffs in, out, in, out.

No, I know what I did to my beloved kitty, and it wasn’t putting her to sleep.





Rooting thru my rutabega

19 07 2009

I am a lousy sick person.

I don’t ‘soldier on’ or ‘buck up’ or ‘git er done’ or any of that when I’m sick. Nope, I drag my sorry carcass home, try to sleep, sleep some more, and then, mm, sleep.

A little bit of reading, online and off, but no writing, no blogging, no trying to get in front of my class prep, no errands, no exercise.

Sleep, cough, sleep.

Of course, Jasper-the-vampire’s nocturnal rampages do add a bit of a variety, but not of the helpful sort.

(Okay, so, yeah, I watched some ‘Buffy’ on Hulu. Sue me.)

(And when the hell are they going to get more seasons?!)

Anyway. There’s the weekend.

———————-

Reading a story in the NYTimes on Green-Wood cemetery and wondering, once again, about my [lack of] plans for the forever-future.

No, I wasn’t that sick.

Still, the thought recurs: Where to rest my bones? Along with, Who will do to the digging/burning/tossing into the sea?

For better and for worse, New York is now my city, but I don’t know that I want to be buried here.

Bills and money and work and dating and life and writing  and I’ll spend my time worrying over my funeral.

Sounds about right.

—————————

Is there anything I could have said about the Sotomayor hearings that hasn’t already been said?

Didn’t think so.

—————————-

The virus that ran rampant through my body got in the way of my responding to a post at The Pursuit of Harpyness on the response to the death of a 69 yo woman who had given birth to twins 3 years earlier.

. . . And I was going to discuss it in brief, here, but then it got all out of control and so I made it a different post. Which may or may not get posted.

That’s how it is.

——————————-

This American Life is airing a story about bedbugs, and just finished a piece on cockroaches crawling into peoples’ ears.

Good lord.

Makes me want to puncture my eardrums.

———————–

This course I’m teaching is kicking my ass.

I’ve taught a version of it—bioethics—to undergraduates before, but it didn’t go well, so I completely revamped it. Out with a general discussion of genetics and stem cells and biotechnology, and in with concentration on human embryonic stem cells and assisted reproductive technologies.

(An aside: I’m using Liza Mundy’s Everything Conceivable to survey the ART field. Recommended.)

So far, so good, but man, shit has changed since I last taught it. This is the bummer about teaching about tech: Unlike, say, the ideas of Plato or Machiavelli, technologies do change, and are changed by the societies into which they’re introduced.

In other words, I can’t coast.

I hate that.

———————-

Re-entering the world of biotech and bioethics has caused me, once again, to question whether I should have stuck with it.

I know, I can only make decisions based on the information I have at the time, so retrospective decision-making is pointless, but.

But when one is dissatisfied with one’s current life, and one’s previous life had its pleasures, it’s tough not to wonder why I ditched that previous life.

Again, I know: how easy to forget the dissatisfactions of that previous life.

Still, I’ve spent my life jumping, and landing always with an eye toward the next jump. When I moved to New York, I said, That’s it. This is home.

Only I put a hidden asterisk by the declaration: (*If it works).

As if this place, and my life in this place, is supposed to work for me, as opposed to me working for my life.

I am not the first to note that a person carries her troubles with her, so it shouldn’t surprise me that my dissatisfactions have made their way to Brooklyn.

So now what? I bitch about the something more and the something else and then do nothing more or nothing else.

Can I blame that on the cold virus?





It’s all the same: dead is dead

16 03 2009

Drill Babies, Drill’?

Ah, yes. Another stunning allegory from William Saletan. He’s just discovered that scientists find fetal tissue useful, and wonders why arguments in favor of human embryonic stem cell (hESC) research aren’t similarly applied to research on fetuses.

What he neglects is that federal guidelines on fetal research have long been in place (here’s the relevant statute, revised in 2005; see subpart B), as well as being subject to ethical and political skirmishes (regarding, for example, the admissibility of transplants of fetal material; cf. then-Secretary of HHS Sullivan’s rulings in the late 1980s).

So what’s new in what Saletan has to say? Not much.

I guess he’s going after the rhetoric: Those in favor of hESC research tend to argue for the urgency of such research: It’ll save lives! It’ll improve quality of life! We’ll learn so much more about human development. . . which will help us save lives and improve the quality of life!

If this is the case for hESC research, he wonders, why aren’t those in favor of research on fetuses making similar claims?

Well, in some cases, they have (I’ll have to dig out the cites), but these were arguments made years and decades ago. More to the point, perhaps, is precisely what Saletan both highlights and elides: Partisans in the hESC debate deploy rhetoric strategically (disassembling a blastocyst versus dismembering a human being), such that those who favor fetal research are likely not to want to trumpet a line of research which would create rhetorical openings to those opponents.

After all, many people distinguish between the status of an embryo and that of the fetus, such that most folks (if you trust poll data) don’t see embryo destruction as equivalent to dismemberment, while harvesting tissue from a fetus might seem, mm, grotesque.

Thus the reaction of Rod Dreher at Crunchy Con, who theorizes that fetal research will lead to the mining and cannibalization of babies.

As I point out in the comments to his initial post, however, I question the logic which links the harvesting of cadaveric fetal tissue to cannibalization—not least because he doesn’t consider how this situation is any different from the harvesting of adult cadaveric tissue for research and transplantation.

In other words, as grotesque as research on cadaveric fetal tissue may appear, it’s not clear to me that it is in kind any different from research on any other cadaver-derived tissue. The only difference is what led to the availability of that tissue: Abortion, in the first case, and death caused by accident or disease.

I have my own questions regarding transplantation and the pressures to donate (or create a market for)  tissues and organs, and generally think skepticism ought to be applied to any claims of Imminent Medical Breakthroughs! That said, I think that those who criticize fetal-tissue research exclusively are unwilling to allow that there could be any medical-social benefits from abortion.

They might truly be appalled by research on fetuses. I simply wonder why they are not similarly appalled by research on adults.





Hollowing out medicine (or, Leavitt is a bastard)

19 12 2008

Those fuckers have done it. Everybody knew it was coming, but it’s so egregiously bad that, somehow, I thought it might disappear into the trailing vapors of the soon-to-be-ex Bush administration.

From a story by David Stout, of the New York Times:

“Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience,” Michael O. Leavitt, the secretary of Health and Human Services, said in a statement on his department’s Web site.

The rule prohibits recipients of federal money from discriminating against doctors, nurses and health care aides who refuse to take part in procedures because of their convictions, and it bars hospitals, clinics, doctors’ office and pharmacies from forcing their employees to assist in programs and activities financed by the department.

Excellent. Never mind professional standards, fiduciary responsibility, and, oh, patient health and well-being. Nope, if you’re too wobbly, er, conscience-stricken to deal with birth control or IVF or emergency contraception or even letting a woman know that there’s this procedure known as (shhh!) abortion, and that the doctor down the hall might just be willing to provide you with one, you now have an executive-branch rule to NOT DO YOUR JOB. And still get paid, presumably.

I was never much of a fan of the so-called conscience rule (dating back to the 1970s Church amendments and to a 1996 directive), believing that if you choose to enter a particular discipline, then you agree to adhere to the standards of that discipline. This is particularly important in medicine, insofar as your primary duty is to your patient, i.e., not a theoretical construct but an actual, mortal, human being.

If you want to practice medicine, then you ought to think about what that entails. I briefly considered trying to earn a spot at the US Air Force Academy, but as my pop (who put in his own stint as an Air Force enlistee) pointed out, once you’re in, you do what you’re told. I don’t particularly like to be told to do anything, and the thought of carrying out the policies of the then-Reagan administration really didn’t work for me. My efforts ended with those stray thoughts. (For the record, I doubt I would have passed the psych tests.)

I’m not saying that all doctors have to perform abortions. However common a procedure, it’s a fairly narrow one, unlike, say, drawing blood or inserting a catheter. In other words, it’s pretty damned easy to avoid doing abortions. Not all doctors want to cut someone open, or examine children or work with old people; the appropriate response to these disinclinations, then, is to avoid surgery, pediatrics, and gerontology. That said, there may be times, however rare, when surgery, children, or old people are unavoidable: you then have a duty to care for that patient until you are able responsibly to hand that care over to another doctor. Along those same lines, then, it seems to me that knowledge of how safely to perform abortions should be a basic part of medical education—not even that every resident must induce abortion, but that each should know the process for doing so.

Still, mine is a minority opinion: the conscience clause for abortion seems pretty well set in American medical ethics. And I guess that as long as those who decline to do abortions are willing to refer a patient to a willing doctor, it is a reasonable compromise.

It is not clear to me (I’ll try to find this out) that the old conscience clause require such willingness to refer; what is clear is that new regs not only do not require this, they protect a wide variety of ‘health care providers’ from their refusal to assist in any way with procedures they find morally objectionable—including not only abortion, but also sterilization and the provision of contraception (including emergency contraception), and undefined research activities. (cf. p. 15 of the pdf doc in the above link).

I’ve only skimmed the document, so my rant is based more on impressions than a good, critical read. Key sections appear to be II. Comments on the Proposed Rule (pp. 13-  ; esp. 14-25 , 34-60, 68-77). Let’s just say that even this preliminary once-over is. . . GAH! I can’t even detail how fucking awful it is! Mealy-mouthed in its refusal fully to define or limit terms! Blandly dismissive of counter-conscience claims (and yes, Mr. Secretary, health care providers who perform abortions, prescribe contraceptives, and fill those prescriptions also have consciences!)! Condescending in its approach to patient concerns! Stupidly ignorant of how actual human beings make use of actual medical services! Derisive in its approach to informed consent and standards of medical care! And on and on and on. . . !

One more perverse invocation from an administration far more in love with its own mirrored image than the people it purports to serve.