Publications by Alison Reiheld
Journal of Medical Humanities , 2019
This poem is autobiographical and bioethical. In it, I reflect on one of the experiences in my l... more This poem is autobiographical and bioethical. In it, I reflect on one of the experiences in my life, not long before I wrote it, which most tested my ability to integrate my professional and personal lives: the end-of-life decisions that had to be made for a family member. I explore that limits of patient autonomy, and the extent to which the proxy's own suffering might play a role in end-of-life decisions for nondecisional patients whose wishes are known.
I hope it may be useful to patients and families, for any professional bioethicist thinking about these issues, or for teaching purposes in medical education or bioethics coursework.
Microaggressions and Philosophy (edited volume), 2019
I set out in this chapter to defend two claims. First, that many of the ways people behave toward... more I set out in this chapter to defend two claims. First, that many of the ways people behave towards fat folks are microaggressions specifically aimed at disciplining unruly bodies. Fat people are a marginalized social group, and microaggressions are a tool of their marginalization. This point allows me to make my second and most important claim: that if we are to make sense of how we wound each other to enforce bodily norms, we must expand the concept of microaggressions beyond its traditional focus on what is done to people targeted because of their
membership in marginalized social groups. That is, I will claim that in addition to harming fat people themselves, microaggressions directed toward fat people have the additional consequence of also harming those who are not (yet) fat. On my account, what makes a slight, snub, or insult a microaggression is not primarily that it is aimed at a marginalized person. Rather, it is that it props up an oppressive system that, among other things, marginalizes such persons. We must redefine microaggressions to include verbal, behavioral, and environmental slights, snubs, and insults that affect persons who are not marginalized as well as those who are and, in doing so, prop up the system of norms that justifies marginalization.
Examples include verbal and environmental microaggressions within friendships as well as with strangers, and in clinical and academic settings. I address concern trolling, and introduce a class of microaggressions I call "cautionary microaggressions" which are aimed at people who are not (yet) fat and which position fatness as to be avoided at almost any cost, including disordered eating.
I close by asking the reader to consider whether cautionary microaggressions might apply to members of other marginalized groups, as well, or whether the case I have made is unique to the use of microaggressions to discipline unruly fat and still-ruly not-yet-fat bodies.
Kennedy Institute of Ethics Journal, 2018
In this investigation, I focus on individual memory behaviors for which we commonly blame and pra... more In this investigation, I focus on individual memory behaviors for which we commonly blame and praise each other. Alas, we too often do so unreflectively. Blame and praise should not be undertaken lightly or without a good grasp on both what we are holding people responsible for, and the conditions under which they can be held responsible. I lay out the constructivist view of memory with consideration for both remembering and forgetting, and special attention to how we remember events as well as whether we remember them. I generate seven defeasible generalized moral rules that should govern individual memory behaviors including remembering our own past wrongs, holding grudges, and creating positive as well as negative memories. By such means may we all remember and forget rightly and not for ill.
Kennedy Institute of Ethics Journal, 2017
In this paper, I analyze multiple aspects of how gender norms pervaded the 2016 election, from th... more In this paper, I analyze multiple aspects of how gender norms pervaded the 2016 election, from the way Clinton and Trump announced their presidency to the way masculinity and femininity were policed throughout the election. Examples include Hillary Clinton, Donald Trump, Barack Obama, and Gary Johnson. I also consider how some women who support Trump reacted to allegations about sexual harassment. The difference between running for President as a man and running for President as a woman makes all the difference in the world.
Our complicated global system of agricultural production and distribution has already made some p... more Our complicated global system of agricultural production and distribution has already made some people vulnerable to hunger and, when disrupted by climate change, may exacerbate existing vulnerabilities and create new ones. Such vulnerability creates an ethical demand, the enormity of which might seem impossible to address given how widely it expands our moral community. However, an adequate conception of vulnerability such as Florencia Luna's layers of vulnerability, coupled with an adequate conception of obligation such as Onora O'Neill's, makes it possible to address even this most transnational and cosmopolitan of demands. Some people will become hungry because of climate change. It is up to us to determine how many, and how hungry, by addressing layers of vulnerability where we are capable and where we are culpable.
![Research paper thumbnail of "Just Caring For Caregivers: What Society and the State Owe to Those Who Render Care" [open access; official version available]](https://attachments.academia-assets.com/40304587/thumbnails/1.jpg)
I focus on unpaid direct care, a form of dependency work which has too long been treated as a pri... more I focus on unpaid direct care, a form of dependency work which has too long been treated as a private matter rather than a public concern. I include unpaid medical caregiving as well as the more general considerations of caregiving for dependent children and elderly or disabled persons. Persons who do this work are generally picked out by their relationship with the dependent individual, e.g. family and close friends, rather than by the professional descriptions that accompany paid work. I elaborate on the lives of unpaid caregivers and briefly show why they are unjust rather than merely unfortunate. There are at least three reasons: the division of labor is unjust, the nature of dependency work creates vulnerabilities for caregivers, and unpaid caregivers are disadvantaged in the world of paid work. Obligations to mitigate these facts are ultimately based on the truth that all members of society at some point in their lives benefit from caregiving and that noncaregivers benefit unfairly from the heavy distribution of dependency work to a small number of certain kinds of individuals. Feminist philosophers have long argued for recognition of these facts, and I draw together the work of major theorists on these claims. However, we must go further than arguing for the moral basis of society’s obligations to those who render care. We must also ask which agents of justice are responsible for remedying this state of affairs, and how. I propose a distributed scheme of obligation in which members of society and the state, as arbiter of social responsibility, share responsibility for the remedy. I consider an obvious objection to this scheme, that such obligations to care for caregivers may be just but are too expensive to be fulfilled, and offer several replies.
![Research paper thumbnail of "With All Due Caution: Global Anti-Obesity Campaigns and the Individualization of Responsibility" [follow link to JSTOR, or download a copy]](https://attachments.academia-assets.com/55721580/thumbnails/1.jpg)
International Journal of Feminist Approaches to Bioethics 8(2): 226-249, Oct 2015
Obesity is one of several health problems related to availability of and access to healthy foods.... more Obesity is one of several health problems related to availability of and access to healthy foods. Recent research indicates that obesity itself may not be the primary health problem, but rather underlying nutritional issues. Whether public health campaigns acknowledge this or not, anti-obesity efforts target food. The individualization of responsibility for obesity and nutrition occurs when public health and nutrition programs target those responsible for cooking. This individualization of responsibility is unethical and impractical. It also targets women as they are overwhelmingly responsibly for cooking the world over. The UN’s official platform is a multi-modal one, but requires addressing the global good market including whether cheaper foods are health goods, and requires addressing global food marketing. The tension between individual food decisions and social contexts of food production, preparation, and consumption makes targeting individuals deeply problematic and yet tempting. This paper warns public health campaigns against giving into that temptation, and presents an argument for why they should proceed with all due caution, advising providers and public health organizations to keep in mind structural factors rather than aiming at individuals.
![Research paper thumbnail of "Asking Too Much? Civility vs. Pluralism" [follow link to PDC, or download a copy]](https://attachments.academia-assets.com/55721569/thumbnails/1.jpg)
Philosophical Topics, 2013
In a morally diverse society, moral agents inevitably run up against intractable disagreements. ... more In a morally diverse society, moral agents inevitably run up against intractable disagreements. Civility functions as a valuable constraint on the sort of behaviors which moral agents might deploy in defense of their deeply held moral convictions and generally requires tolerance of other views and political liberalism, as does pluralism. However, most visions of civility are exceptionless: they require civil behavior regardless of how strong the disagreement is between two members of the same society. This seems an excellent idea when those required to do the tolerating might otherwise smash us. However, the demands of civility do not fall only on conservatives but also upon liberals and progressives, and may seem to require us to tolerate the intolerable, leading us not into pluralism but rather into functional relativism. They also place moral agents in a very difficult position with respect to realizing our deeply held moral values. Isaiah Berlin’s pluralism, by contrast, allows us to violate tolerance when we come up against values which, put into practice, are incompatible with a form of life we can tolerate. Despite the many fronts on which civility and pluralism align, they are also pitted against each other. I show this and, in the end, direct our attention toward a notion of civility which may actually cohere with pluralism and thus resolve the double bind in which the moral agent seemed to be placed, caught between commitment to deeply held personal values and commitment to civility in a morally diverse society.
International Journal of Feminist Approaches to Bioethics 8(1), 2015
In this roundtable-style discussion, five bioethicists consider the 2013 case of Marlise Munoz, a... more In this roundtable-style discussion, five bioethicists consider the 2013 case of Marlise Munoz, a pregnant woman declared brain dead whom the state of Texas refused to be allowed to be removed from life support based on the needs of the fetus despite her proxy's decision. We discuss the implications of this case for advance directives and for the medical autonomy of pregnant women generally, as well as the difficult situation of so-called maternal-fetal conflicts.
Journal of Social Philosophy, Vol 46 Iss 1, Mar 17, 2015
I argue that miscarriage, referred to by poet Susan Stewart as “the event that was nothing,” is a... more I argue that miscarriage, referred to by poet Susan Stewart as “the event that was nothing,” is a liminal event along four distinct and inter-related dimensions: parenthood, procreation, death, and induced abortion. It is because of this liminality that miscarriage has been both poorly addressed in our society, and enrolled in larger debates over women's reproduction and responsibility for reproduction, both conceptually and legally. If miscarriage’s liminality were better understood, if miscarriage itself were better theorized, perhaps it would not so easily be enrolled in these other debates to the detriment of women who miscarry, and their families. However, its very liminality and the fact that it is enrolled in these debates sheds light on the complicated network of concepts within which miscarriage lies.
Encyclopedia of Food and Agricultural Ethics
In this encyclopedia article, I discuss 3 forms of food behaviors and how they are both affected ... more In this encyclopedia article, I discuss 3 forms of food behaviors and how they are both affected by and constitute gender norms: food production, food preparation, and food consumption. A link to the online version of the Encyclopedia of Food and Agricultural Ethics at the Springer Reference site is provided below. The multi-volume print edition will be released in October of 2014.
International Journal of Feminist Approaches to Bioethics, 2010
"Abstract:
The process of medicalization has been analyzed in the medical humanities with disapp... more "Abstract:
The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS."
APA Newsletter on Feminism & Philosophy 12(2): 24-26. 2013.
Teaching Philosophy 36(4): 435-439, Dec 2013
Environmental Values, issue details forthcoming (go to http://www.whpress.co.uk/EV/reviews/71_Oliver.pdf for the advance copy of the review on EV's website)
AMERICAN JOURNAL OF BIOETHICS, Jan 1, 2006
The American journal of bioethics: AJOB, Jan 1, 2006
The American journal of bioethics: AJOB, Jan 1, 2007
APA Newsletter on Feminism and Philosophy, 2008
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Publications by Alison Reiheld
I hope it may be useful to patients and families, for any professional bioethicist thinking about these issues, or for teaching purposes in medical education or bioethics coursework.
membership in marginalized social groups. That is, I will claim that in addition to harming fat people themselves, microaggressions directed toward fat people have the additional consequence of also harming those who are not (yet) fat. On my account, what makes a slight, snub, or insult a microaggression is not primarily that it is aimed at a marginalized person. Rather, it is that it props up an oppressive system that, among other things, marginalizes such persons. We must redefine microaggressions to include verbal, behavioral, and environmental slights, snubs, and insults that affect persons who are not marginalized as well as those who are and, in doing so, prop up the system of norms that justifies marginalization.
Examples include verbal and environmental microaggressions within friendships as well as with strangers, and in clinical and academic settings. I address concern trolling, and introduce a class of microaggressions I call "cautionary microaggressions" which are aimed at people who are not (yet) fat and which position fatness as to be avoided at almost any cost, including disordered eating.
I close by asking the reader to consider whether cautionary microaggressions might apply to members of other marginalized groups, as well, or whether the case I have made is unique to the use of microaggressions to discipline unruly fat and still-ruly not-yet-fat bodies.
The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS."
I hope it may be useful to patients and families, for any professional bioethicist thinking about these issues, or for teaching purposes in medical education or bioethics coursework.
membership in marginalized social groups. That is, I will claim that in addition to harming fat people themselves, microaggressions directed toward fat people have the additional consequence of also harming those who are not (yet) fat. On my account, what makes a slight, snub, or insult a microaggression is not primarily that it is aimed at a marginalized person. Rather, it is that it props up an oppressive system that, among other things, marginalizes such persons. We must redefine microaggressions to include verbal, behavioral, and environmental slights, snubs, and insults that affect persons who are not marginalized as well as those who are and, in doing so, prop up the system of norms that justifies marginalization.
Examples include verbal and environmental microaggressions within friendships as well as with strangers, and in clinical and academic settings. I address concern trolling, and introduce a class of microaggressions I call "cautionary microaggressions" which are aimed at people who are not (yet) fat and which position fatness as to be avoided at almost any cost, including disordered eating.
I close by asking the reader to consider whether cautionary microaggressions might apply to members of other marginalized groups, as well, or whether the case I have made is unique to the use of microaggressions to discipline unruly fat and still-ruly not-yet-fat bodies.
The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS."
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This Powerpoint gives a rough idea of the issues at hand. Contact me directly for the draft paper that goes with this presentation and also covers the dismissal of fat patients' testimony about eating and exercise.
Part of a panel with Dr. Sergio Gallegos and Dr. Pamela Lomelino.
While members of the general public are often unaware that they have encountered transgender individuals, clinical providers are uniquely likely to “discover” the trans status of persons who are successfully performing a gender traditionally at odds with their sex; providers are thus far more likely than the general public to have to decide how to handle this knowledge. Using empirical data from the literature and descriptions of clinical encounters from interviews that I and others have conducted, I show that clinical staff all too often fail to treat transgender patients with the same respect they grant to patients with more conventional identities, and sometimes refuse to give medical treatment at all. The consequences of such encounters have profound effects on the health of this patient population: many transgender individuals report that they routinely do not seek medical care when needed even when this care is for conditions entirely unrelated to their trans status.
I am not concerned, here, with whether providers can refuse to assist in elective procedures such as hormone treatments or Sex Reassignment Surgery directly related to a transgender individual’s trans status. Rather, I focus on how nurses and physicians treat transgender individuals who seek care for conditions like broken bones, gynecological services, and respiratory infections. Such treatment is exemplified by a case in which a health care professional, after discovering a patient’s trans status, simply walked out of the examining room of a patient with a broken arm and never came back.
What might appear to be violations of ethically acceptable patient-provider relationships are not uncommon when providers refuse to treat patients only after discovering trans status. Such classical ethical elements of patient-provider relationships include—but are not limited to—respect for persons, beneficence, non-maleficence, fidelity, justice, and confidentiality. However, modern heated debates over conscientious objection raise the possibility that refusals to provide care are legitimate exercises of provider autonomy rather than unethical betrayals of the patient-provider relationship. Indeed, the AMA’s own code of ethics grants providers the opportunity to choose whom to serve. Ought providers be able to refuse to treat patients of whom they morally disapprove? Or are such refusals fundamental betrayals of the patient-provider relationship?
I argue that, while providers do have autonomy rights that can justify some cases of conscientious objection, these do not extend to refusing to provide basic, non-elective medical care regardless of whether emergency conditions obtain. In nearly all cases where a provider’s personal morality leads to refusal to treat a transgender individual for conditions unrelated to the patient’s trans status, the classical ethical elements of patient-provider relationships must take precedence. Such cases are not instances of legitimate conscientious objection.
Frameworks of civility, such as that developed by P.M. Forni during his time at the Johns Hopkins Civility Project, can provide us with both useful and justifiable guidelines for handling our disagreements with each other. However, literature on civility often allows room for violations of civility when the stakes are high; to require civility in all cases with no exceptions regardless of the particulars can result in a society whose members relate to each other and to its government in a Hobbesian state of near-perfect obedience to the sovereign or a Lockean state of allowing the majority to hold sway except in the most extraordinary of circumstances. Violations of civility which are sometimes argued to be permissible range from drawing a line beyond which we need no longer be charitable in our interpretation of others’ remarks, to allowing aggression—even revolution—in the defense of a righteous cause. Moderate forms of aggression include name-calling and ad hominem attacks; at the extreme end we see many a “civil war”, both in American history and globally. In the Culture War as in historical instances of perceived righteous cause, incivility and even violence are justified as warranted violations of accepted rules of civil behavior.
In this paper, I investigate the challenge that a morally diverse society and the Culture Wars pose for civility, and whether the Culture Wars in particular might be exactly the sort of circumstance under which “culture warriors” can justify incivility as warranted even by reference to existing civility frameworks. I seek to refine the criteria for how we ought, generally, to cope with disagreement in a morally diverse society and, specifically, for when—if ever—members of a body politic are justified in violating some or all aspects of civility.