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New genetics, new ethics? Globalisation and its discontents.

The paper discusses the rapid and significant development of new genetic technologies (in health, food and agriculture) in the theoretical context of the globalisation debate. We show how the studies on the ethical, legal and social implications of biotechnological innovation have themselves emerged as an important factor in the technological innovation and product development process. Ethical considerations are becoming integral to attempts to understand techno-scientific developments in late modernity. However, ethical studies have so far been more focused on the medical rather than the overall commercial application of genomics. Their relevance to this wider context of the globalised commodification of new genetics needs to be explored. Of special significance is the introduction of ethical considerations into the debates on globalised risk, which we will explore in relation to increasing disparities between the global North and South.

Biotechnology↗

Regulating the market for human eggs.

This essay provides a rationale for a regulated market for human oocytes. Although the commodification of human oocytes raises important moral concerns, these concerns do not justify laws banning commerce in human eggs. Given the burgeoning ART industry and the growing oocyte market, the most prudent course of action is to develop regulations for the human oocyte market that are designed to protect and promote important social values, such as health, safety, liberty, and respect for human life. Other responses, such as banning the sale of eggs altogether or allowing donors to be compensated only for their services, would either create a black market or would lead to corruption and abuse. Society still needs to debate specific rules and policies that should govern the human egg market, but further discussion of that important task is best left to legislative bodies and other commentators.

Adult↗

Patient or consumer? The colonization of the psychiatric clinic.

Information is given a privileged place in the psychiatric clinic, as illustrated by the prevalence and volume of data to be collected and forms to be completed by psychiatric nurses. Information though is different to knowledge. The present paper argues that information is part of a managerial discourse that implies commodification whereas knowledge is part of a clinical discourse that allows room for the suffering of the patient. Information belongs to the discourse of managerialism, one that positions the patient as customer/consumer and in doing so renders them unsuffering. The patient's suffering is silenced by their construction as a consumer. The discourse of managerialism seeks a complete data set of information. By way of contrast, another discourse, that of psychoanalysis offers the institution the idea that there are always holes, gaps, and uncertainty. The idea of uncertainty, gaps, things remaining unknown and a limit sits uncomfortably with the dominant discourse of managerialism; one that demands no limits, complete data sets, and many satisfied customers. This market model of managerialism denies the potential of the therapeutic relationship; that something curative might be produced via the transference. In addition, the managerialist discourse potentially positions the patient as both illegitimate and unsuffering.

Ambulatory Care Facilities↗

Oocyte cytoplasm transfers and the ethics of germ-line intervention.

Author advances the discussion about positive genetic selection by looking at the use of oocyte cytoplasm transfers as a possible means to prevent disease and to overcome fertility, focusing on the issues of family and kinship, commodification of eggs and egg donors, and germ-line alterations.

Adult↗

Defending commercial surrogate motherhood against Van Niekerk and Van Zyl.

The arguments of Van Niekerk and Van Zyl that, on the grounds that it involves an inappropriate commodification and alienation of women's labour, commercial surrogate motherhood (CSM) is morally suspect are discussed and considered to be defective. In addition, doubt is cast on the notion that CSM should be illegal.

Commerce↗

Is life of infinite value?

It is possible and necessary to compare stretches of human life with other goods, such as the good of conserving resources for others. A minute of human life is not of infinite value; all else being equal, a minute of life is less valuable than 10 years of the same life. Nevertheless, this ability to evaluate human life does not necessarily lead to total commodification of human life.

Adult↗

Response: persistent perplexities.

This response to the preceding five articles highlights the stubborn persistence of the philosophical perplexities surrounding commodification in the realm of medicine and biotechnology.

Bioethical Issues↗

The kindness of strangers: organ transplantation in a capitalist age.

The topic of organ transplantation is examined from the perspective of three authors: Robert Bellah, Jeremy Rifkin, and Margaret Jane Radin. Introduced by reflections on the development of the justification of organ transplantation within the Roman Catholic community and the various themes raised by the historical study in Richard Titmuss's The Gift Relationship, the paper examines how and in what ways the possible commodification of organs will affect our society and the impacts this may have on the supply of organs.

Altruism↗

Organ donation: a communitarian approach.

Recently, various suggestions have been made to respond to the increasingly great shortage of organs by paying for them. Because of the undesirable side effects of such approaches (commodification, injustice, and costs), a communitarian approach should be tried first. A communitarian approach to the problem of organ shortage entails changing the moral culture so that members of society will recognize that donating one's organs, once they are no longer of use to the donor, is the moral (right) thing to do. This approach requires much greater and deeper efforts than sharing information and making public service announcements. It entails a moral dialogue, in which the public is engaged, leading to a change in what people expect from one another. Among the devices that could help change the moral culture are a public statement, endorsed by community members and leaders, that expresses the community sense that donation "is what a good person does" and a community-specific web page that lists those who have made the commitment. A change in law so that a person's wishes in the matter are recognized as final and binding are also desired. This position paper deals only with cadaver organs and not living donors.

Altruism↗

Commodified kin: death, mourning, and competing claims on the bodies of organ donors in the United States.

A pronounced disjunction characterizes symbolic constructions of the cadaveric donor body in the United States, where procurement professionals and surviving donor kin vie with one another in their desires to honor this unusual category of the dead. Of special concern is the medicalized commodification of donor bodies, a process that shapes both their social worth and emotional value. Among professionals, metaphorical thinking is key: death and body fragmentation are cloaked in ecological imagery that stresses renewal and rebirth. Such objectification also obscures the origins of transplantable organs, renders individual donors anonymous, and silences kin who mourn their dead. In response, donor kin have grown increasingly assertive, generating alternative public mortuary forms that exclude professional mediators. In so doing, they challenge the medical assumption that anonymity is central to transplantation's continued success. Through donor quilts and Web cemeteries, they proclaim the personal identities of donors who, at times, may speak beyond the grave, offering critiques of donation as socio-medical process in the United States.

Anthropology, Cultural↗

Payment for egg donation and surrogacy.

This article examines the ethics of egg donation. It begins by looking at objections to noncommercial gamete donation, and then takes up criticism of commercial egg donation. After discussing arguments based on concern for offspring, inequality, commodification, exploitation of donors, and threats to the family, I conclude that some payment to donors is ethically acceptable. Donors should not be paid for their eggs, but rather they should be compensated for the burdens of egg retrieval. Making the distinction between compensation for burdens and payment for a product has the advantages of limiting payment, not distinguishing between donors on the basis of their traits, and ensuring that donors are paid regardless of the number or quality of eggs retrieved.

Commodification↗

Disentangling privacy from property: toward a deeper understanding of genetic privacy.

With the mapping of the human genome, genetic privacy has become a concern to many. People care about genetic privacy because genes play an important role in shaping us--our genetic information is about us, and it is deeply connected to our sense of ourselves. In addition, unwanted disclosure of our genetic information, like a great deal of other personal information, makes us vulnerable to unwanted exposure, stigmatization, and discrimination. One recent approach to protecting genetic privacy is to create property rights in genetic information. This Article argues against that approach. Privacy and property are fundamentally different concepts. At heart, the term "property" connotes control within the marketplace and over something that is disaggregated or alienable from the self. "Privacy," in contrast, connotes control over access to the self as well as things close to, intimately connected to, and about the self. Given these different meanings, a regime of property rights in genetic information would impoverish our understanding of that information, ourselves, and the relationships we hope will be built around and through its disclosure. This Article explores our interests in genetic information in order to deepen our understanding of the ongoing discourse about the distinction between property and privacy. It develops a conception of genetic privacy with a strong relational component. We ordinarily share genetic information in the context of relationships in which disclosure is important to the relationship--family, intimate, doctor-patient, researcher-participant, employer-employee, and insurer-insured relationships. Such disclosure makes us vulnerable to and dependent on the person to whom we disclose it. As a result, trust is essential to the integrity of these relationships and our sharing of genetic information. Genetic privacy can protect our vulnerability in these relationships and enhance the trust we hope to have in them. Property, in contrast, by connoting commodification, disaggregation, and arms-length dealings, can negatively affect the self and harm these relationships. This Article concludes that a deeper understanding of genetic privacy calls for remedies for privacy violations that address dignitary harm and breach of trust, as opposed to market harms, as the property model suggests.

Commodification↗

Can a purchaser be a partner? Nursing education in the English universities.

Since the early 1990s, public sector management in England has been exhorted to follow the example of the private sector, and 'quasi-markets' have been established, for example in the health service. A quasi-market also exists between the NHS and higher education for the purchasing (or procurement) of nursing education. This paper uses policy documents such as the National Health Service Executive Circular (March 1999) on 'Good Contracting Guidelines' for Non-Medical Education and Training, plus other relevant literature on the commodification of higher education, quasi-markets and contract theory to examine this market, and the confusion of two rhetorics, those of competition and partnership. Nursing occupies a marginal place in higher education in England, having only recently become part of it. The emphasis of the quasi-market on the output of a trained 'fit for purpose' labour force combines with professional attempts to create an academic discipline, in complex ways which are as yet underanalysed.

Education, Nursing↗

[Basic ethical aspects of living organ donation].

A characteristic feature of transplanting organs from living donors is that not only patients in need for treatment but also healthy individuals are submitted to medical interventions. Ethical considerations in this field have to deal with the question of property attributes of the human body and conflicts with traditional medical principles. Altruistic organ donation, appreciated by Christianity as a sign of charity, is indeed contradictory to the classic maxim of medical ethics "primum nihil nocere, " meaning "first of all, do not harm." The autonomous choice of a potential donor has to be balanced thoroughly against his personal physical and psychological risks. Apart from organ donation with altruistic motives, commercial incentives or payment for organ donation, which are increasingly under discussion in many nations, need profound ethical reflection. Organ selling does not lead to long-term economic benefit for individual donors in developing countries and is associated with a decline in health. A market system of organ sales would foster exploitation of the poor, and it is substantially doubtful whether autonomy and self determination are valid under circumstances of poverty and coercion. Commodification of the human body risks viewing persons as marketable objects. The human body,however, is an integral element of an individual's personality and not a resource to be removed. It is therefore fundamental that the social good of altruism is preserved as the major principle in organ donation.

Altruism↗

Holistic health and the critique of Western medicine.

The holistic view of health has been accurately criticized in the literature for its individualistic, victim-blaming ideology that obscures the social origins of illness. The paper explains how the contrasting view of the body and illness provided by the holistic model can help to show how Western medicine reflects the capitalist system in which it is promoted. It shows how evaluation of holistic therapies is problematic insofar as it is based on the analytical, reductionist criteria of the Western model. It suggests that one reason why holistic practices are not more fully accepted by Western medicine may be the challenge they pose to the Western model, and to the commodification of health needs promoted by this model.

Economics, Medical↗

(Over)eating success: the health consequences of the restoration of capitalism in rural China.

This paper reviews and evaluates some of the changes that have occurred in the Chinese health care system during the reform era associated with Deng Xiaoping (1978-1993). The reforms have helped to enrich the long suffering peasants in the Chinese countryside, and in many areas the peasants have experienced a significant improvement in the quality of their lives, including greater access to health care facilities, and better diets. The paper also considers some of the potentially negative side effects of the reform era, including the increasing income inequality between urban and rural areas; the commodification of Chinese medicine; declining access to health care for peasants in the poorest regions; and a concern about the changing patterns of diet and nutrition in the newly enriched parts of the Chinese countryside.

Cause of Death↗

Smoking prevalence among women in the European community 1950-1990.

The paper reviews trends in tobacco use among women in the European Community (EC) between 1950 and 1990. The data suggest that EC countries occupy different points on what appears to be a common prevalence curve. Southern EC countries are represented in the early phases of this curve, marked out by sharply rising prevalence. In northern EC countries, female smoking prevalence appears to have peaked. Across the EC, the commodification of tobacco use, and the production and promotion of manufactured cigarettes in particular, underlies this prevalence curve. Young women in higher socio-economic groups have led the way into cigarette smoking in both northern and southern Europe, with smoking prevalence declining first among women who are privileged in terms of their education, occupation and income. Because the decline in prevalence has yet to be repeated among women in more disadvantaged circumstances, cigarette smoking among women in the EC is likely to become a habit increasingly linked to low socio-economic status.

Adolescent↗

Sexual violence and youth in South Africa: the need for community-based prevention interventions.

OBJECTIVES: South Africa is reported to have one of the highest rates of sexual violence in the world, with adolescent girls between the ages of 12-17 being particularly at risk. Given that adolescence is considered a critical developmental period for establishing normative sexual behavior, this study explored multiple levels of risk influences that render adolescent girls vulnerable to becoming victims of sexual violence and adolescent boys vulnerable to becoming perpetrators of such abuse in one South African community. METHOD: A case study approach using qualitative rapid focused ethnographic methods was used. This involved 10 focus group interviews and 10 individual interviews with a volunteer convenience sample of adolescent boys and girls between the ages of 14 and 16 years. RESULTS: Inductive thematic analysis revealed that there were indeed multiple levels of risk influences for adolescent girls and boys becoming either victims or perpetrators of sexual violence. Using the Theory of Triadic Influence as a framework, influences at the distal socio-cultural/environmental level included traditional notions of masculinity and normalization of inter-personal violence as well as poverty and the commodification of sex leading to rape supportive attitudes. Influences at the proximal situation context/social normative level included high-risk social norms as well as a weak adult and community protective shield. Finally, influences at the intra-personal level included low self-esteem and self-efficacy as well as inter-personal affective anger. CONCLUSION: Given the multiple levels of risk influences that need to be addressed to protect youth from becoming either perpetrators or victims of sexual violence in the South African context, prevention programs should necessarily be comprehensive, developmentally timed, and community-based.

Adolescent↗