Private Bodies, Public Texts: Race, Gender, and a Cultural Bioethics

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Overview

In Private Bodies, Public Texts, Karla FC Holloway examines instances where medical issues and information that would usually be seen as intimate, private matters are forced into the public sphere. As she demonstrates, the resulting social dramas often play out on the bodies of women and African Americans. Holloway discusses the spectacle of the Terri Schiavo right-to-die case and the injustice of medical researchers’ use of Henrietta Lacks’s cell line without her or her family’s knowledge or permission. She offers a provocative reading of the Tuskegee syphilis study and a haunting account of the ethical dilemmas that confronted physicians, patients, and families when a hospital became a space for dying rather than healing during Hurricane Katrina; even at that dire moment, race mattered. Private Bodies, Public Texts is a compelling call for a cultural bioethics that attends to the historical and social factors that render some populations more vulnerable than others in medical and legal contexts. Holloway proposes literature as a conceptual anchor for discussions of race, gender, bioethics, and the right to privacy. Literary narratives can accommodate thick description, multiple subjectivities, contradiction, and complexity.

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Editorial Reviews

From the Publisher

“In her exceptional book, Holloway turns to literature to ‘illustrate matters of ethical concern and to assist listeners in hearing a patient’s story, in order to develop a more thoughtful perspective on treatment.’ . . . Holloway offers incisive comments that relate fictional episodes to real-life events, enhancing the ability of both to reveal the deep connections that bind ethics to culture, race, and gender. Private Bodies, Public Texts invites health professionals, lawyers and ethicists to honor those connections.” - Karunesh Tuli, ForeWord Reviews

‘[Holloway] offers a cultural bioethics that may be able to help us understand and navigate the complex narratives we are co-creating.”
- Brent Winter, News and Observer

Private Bodies, Public Texts is a creative and complicated call to do bioethics differently. . . . Holloway's encyclopedic collection of legal and bioethical cases, melded with captivating fiction and discriminating analyses, make this book nourishing sustenance for anyone who believes that bioethics
has a way to go in understanding not only that race and gender matter but also how they matter.” - Charlene Galarneau, Women’s Review of Books

“The strength of Private Bodies, Public Texts is that it effectively demonstrates how the moral subject of bioethics is universal and impartial only insofar as it assumes the perspective of white, middle-class men.” - Stephanie Jenkins, Signs

“Holloway’s book is undoubtedly a significant achievement, especially in its deep exposition of how racial and gender constructs shape and frame attitudes, practices, and beliefs towards the value of privacy in medicine and science. Scholars using tools drawn from narrative and cultural studies in bioethical inquiry will find in Holloway’s approach a model for the potential of such frameworks to enrich and thicken bioethical analysis and a road map for important and developing modalities in second-generation American bioethics.” - Daniel S. Goldberg, Journal of Medical Humanties

Private Bodies/Public Texts is an illuminating meditation on the social construction of personal identity, with special focus on gender and racial categorizations in biomedical ethics. Drawing on diverse sources from medicine, law and literature, Karla FC Holloway shows how devalued gender and racial identities not only set the stage for past biomedical abuses but are ironically replicated in the paradigmatic examples that contemporary bioethics invokes in the supposed service of correcting those abuses. This is a subtle, challenging book.”—Robert A. Burt, Alexander M. Bickel Professor of Law, Yale University

Private Bodies/Public Texts is as powerful as it is beautifully written. Karla FC Holloway’s is a very different kind of bioethics, one that challenges us to think both more broadly and more specifically about what privacy and justice mean. And she reminds us, with sometimes piercing insight, just how critical gender and race can be in making meaning out of both.”—Ruth R. Faden, Director, Johns Hopkins Berman Institute of Bioethics

“Karla FC Holloway has written an important book that challenges the objectification of patients’ stories that is so common in the practice of bioethics. She persuasively argues for a cultural ethics, an ethics which gives constitutive weight to the cultural context of those stories, especially the cultural contexts of race and gender identity. Using this approach, she presents crucial new insights into issues of reproduction, clinical trials, genomics and death and dying. Her discussion of the events at Memorial Medical Center after Katrina will become a classic in the field. But most importantly, she shows us that the practice of bioethics must change if it is to successfully relate to the issues raised by the thick narratives of reality.”—Baruch A. Brody, Baylor College of Medicine

<I>Women's Review of Books</I> - Charlene Galarneau

Private Bodies, Public Texts is a creative and complicated call to do bioethics differently. . . . Holloway's encyclopedic collection of legal and bioethical cases, melded with captivating fiction and discriminating analyses, make this book nourishing sustenance for anyone who believes that bioethics has a way to go in understanding not only that race and gender matter but also how they matter.”
Journal of Medical Humanties - Daniel S. Goldberg

“Holloway’s book is undoubtedly a significant achievement, especially in its deep exposition of how racial and gender constructs shape and frame attitudes, practices, and beliefs towards the value of privacy in medicine and science. Scholars using tools drawn from narrative and cultural studies in bioethical inquiry will find in Holloway’s approach a model for the potential of such frameworks to enrich and thicken bioethical analysis and a road map for important and developing modalities in second-generation American bioethics.”
ForeWord Reviews - Karunesh Tuli

“In her exceptional book, Holloway turns to literature to ‘illustrate matters of ethical concern and to assist listeners in hearing a patient’s story, in order to develop a more thoughtful perspective on treatment.’ . . . Holloway offers incisive comments that relate fictional episodes to real-life events, enhancing the ability of both to reveal the deep connections that bind ethics to culture, race, and gender. Private Bodies, Public Texts invites health professionals, lawyers and ethicists to honor those connections.”
Signs - Stephanie Jenkins

“The strength of Private Bodies, Public Texts is that it effectively demonstrates how the moral subject of bioethics is universal and impartial only insofar as it assumes the perspective of white, middle-class men.”
News and Observer - Brent Winter

‘[Holloway] offers a cultural bioethics that may be able to help us understand and navigate the complex narratives we are co-creating.”
American Literature - Jos� E. Lim�n

“...Holloway’s Private Bodies, Public Texts, is a tour de force of interdisciplinary analysis...All of Holloway’s disciplinary investments are evident in this book, as she deftly weaves between works of American literature, landmark cases in American legal history, and moments in the history of American medical experimentation to advance her argument.”
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Product Details

  • ISBN-13: 9780822348948
  • Publisher: Duke University Press Books
  • Publication date: 3/14/2011
  • Pages: 256
  • Product dimensions: 5.80 (w) x 8.30 (h) x 0.90 (d)

Meet the Author

Karla FC Holloway is James B. Duke Professor of English at Duke University, where she also holds appointments in the Law School, Women’s Studies, and African & African American Studies, and is an affiliated faculty with the Institute on Care at the End of Life and the Trent Center for Bioethics, Humanities & History of Medicine. She serves on the Greenwall Foundation’s Advisory Board in Bioethics, was recently elected to the Hastings Center Fellows Association, and is the author of many books, including BookMarks: Reading in Black and White; Passed On: African American Mourning Stories: A Memorial, also published by Duke University Press; and Codes of Conduct: Race, Ethics, and the Color of Our Character.

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Table of Contents

Contents

Preface....................xv
Acknowledgments....................xxi
INTRODUCTION The Law of the Body....................1
ONE Bloodchild....................25
TWO Cartographies of Desire....................67
THREE Who's Got the Body?....................101
FOUR Immortality in Cultures....................137
Notes....................173
Bibliography....................199
Index....................211
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First Chapter

PRIVATE BODIES, PUBLIC TEXTS

Race, Gender, and a Cultural Bioethics
By KARLA FC HOLLOWAY

Duke University Press

Copyright © 2011 Duke University Press
All right reserved.

ISBN: 978-0-8223-4894-8


Chapter One

Bloodchild

This chapter explores the intersections of gender, race, and ethics in contemporary issues in reproduction, and it outlines issues in U.S. history that have rendered women's bodies available for a certain kind of public scrutiny. The nation's early connection between citizenship and identity contextualizes the evolution of state interest in intimate matters of sexuality. The histories of scrutiny and the ethical questions that attach to women and race suggest that contemporary ethical issues in reproductive medicine are not tied to the technologies of modern birth. Instead, the issues are apparent in the relationship that women's public and private lives have to their citizenship and the vigorous circulation of women's bodies in public, legal, and medical discourse. The history of this identitarian relationship, evident in our country's founding cultures, offers an interpretive frame for medical and legal issues in privacy, ethics, and reproduction. Privacy connects the issues of race and gender from the earliest eras of U.S. history to the contemporary moment.

* * *

Although death was a constant threat to American colonists in the seventeenth century, birth was their vital promise. Children who survived the rugged conditions of the early settlements would not only ensure a future for New Eng land colonies, but they would develop and sustain the ideals and principles that led to the nation's founding. The early nation's interest in the fertility of its citizens was intimately attached to the religious fervor of the English colonists. For Puritans, "be fruitful and multiply" was a biblical dictum, and "fruitfulness itself conferred status." Pregnancies were viewed as "a contribution ... to the common task."

A viable nation meant the deliberate and intentional production of (and discernment between) its first citizens. The colonists were not only concerned about their immediate survival. Because the first settlements were seen as religious and political evidence of a particular set of principles, their physical survival was attached to the implementation of those principles. The polity of the nation was substantively embedded in its domestic vision.

The ideals of the new nation followed its expansion across the continent. Early America was necessarily public. Survival depended on everyday commerce and contact between settlers. However, a consequence of the country's growing security and independence was that family life became increasingly insular. Cities displaced communal colonial landscapes, and family homes—once they were removed from the interdependencies of colonial villages—evolved into "a separate place of work, leaving the family domain a private retreat [and] family life as the training ground for citizenship."

One aspect of the loss of interdependency was the consequent escalation of slavery. In terms of reproduction and labor, the bodies of slave women were as vital to the South as white women's had been to the survival of the colonies. Because reliably available populations of enslaved Africans were essential to the plantation economy of the South, manipulating the reproductive capacities of slave women became an economic issue that trumped slavery's ethical problem. The expansion of the population was related to geographical expansion and mirrored associated developments of the nation's legal and social systems. Discoveries in medicine were similarly patterned, focusing on the successful growth and stability of the nation.

The connections between reproductive science and medicine, public policies, and ethics evidence the ways in which these fields are shaped within a national frame and are aligned with the social. Interest in the most intimate and gendered matters of the private body—specifically sexual reproduction—quickly became a matter for national and legal notice. From its founding, the nation had a consuming interest in women's biology. Whether it was the necessary fertility of enslaved black women or white women colonists, women's reproductive potential and the national interest in sustaining and increasing its population rendered women's bodies especially compromised with regard to privacy. Privacy becomes one of the most consistent focuses as we follow the histories of cultural practice and ethical attentiveness from the nation's earliest days to the contemporary moment. Its consistency gives it a consequentialist value, as well as an analytical heft.

It is important to clarify the difference between the idea of privacy and the legal notion of a right to privacy. The legal right was given its most noticeable expression in an 1890 essay by Samuel Warren and Louis Brandeis in the Harvard Law Review. Their essay, prompted by the authors' outrage over the intrusion of the press into their family lives, argued for making this kind of invasive interest a wrongful act—a tort—in the law.

The cultural context of their essay is important. This early call for a privacy tort is thoroughly engaged with matters of culture and identity—the same substance that, eighty years later, motivated the declaration of a right to privacy in constitutional law. Warren and Brandeis wrote: "Gossip is no longer the resource of the idle and of the vicious, but has become a trade, which is pursued with industry as well as effrontery. To satisfy a prurient taste the details of sexual relations are spread broadcast in the columns of the daily papers. To occupy the indolent, column upon column is filled with idle gossip, which can only be procured by intrusion upon the domestic circle."

Who are those who gossip? What is the material difference in their lives, or their bodies, that makes them available for this kind of aspersion? The class presumptions of Warren and Brandeis clearly separate certain bodies from the privacies that the Boston lawyers argued as their birthright. Their rhetorical approach in making the argument was to distinguish themselves from another class of Bostonians, whose disreputable habits included their interest in the lives of the rich and famous. This issue of the invasion of class privacy was arguably the one that grated the most for the authors of "The Right to Privacy"—and that may have prompted its composition.

It is important to contextualize the claim that Warren and Brandeis made, noting that the era in which they wrote was one in which women had no right of franchise and were arguably sequestered rather than sheltered within the domestic sphere, while blacks—although considered citizens by the Constitution—lived under the Plessy v. Ferguson doctrine of "separate but equal" that continued the segregationist policies and attitudes that had earned black bodies differential and dangerous treatment under the law for scores of years past Plessy.

For Warren and Brandeis, the legal idea of privacy would be most properly shaped through the law of torts—in Judge Thomas Cooley's words, "the right to be left alone." From his phrasing, Warren and Brandeis argued for a right to an "inviolate personality." In order to explain the desirability of an integrated (inviolate) personhood, the authors articulated a difference between privacy and property. Property was a right that existed outside of a person—what the authors called an "incorporeal" right. Their essay suggested that privacy was an intimate aspect of identity.

The legal theorist Jonathan Kahn has explained the distinction, noting that a privacy right would be "manifested in the integrity of one's individual identity or persona." In fact, as Kahn reminds his readers, the first case to recognize a right to privacy, Pavesich v. New Eng land Life Ins. Co. (1905), was indeed about someone's persona—the complainant sued over the right to use his image. Paolo Pavesich found his likeness published in an advertisement for the life insurance company in an Atlanta newspaper. He sued, arguing that his privacy had been compromised. The court's judgment in support of his claim structured an association between the right to liberty and the idea of a right to privacy. The court held that liberty included the right to be let alone, and that this was an entitlement to determine "one's mode of life, whether it shall be a life of publicity or of privacy." In finding for Paolo Pavesich, the Georgia Supreme Court became the first court in the nation to recognize a distinct right to privacy. The first citizen in the United States to gain this legal recognition was white and male.

There is good reason to associate the early legal frames of privacy with contemporary issues in bioethics. Kahn locates the value of privacy quite clearly in the principlist language of bioethics, when he writes of privacy "as it explicitly implicates dignity, autonomy, and the integrity of the self." Engaged as well with the language of ethics is the legal scholar Anita Allen's assessment that "we promote and protect privacy to show moral respect ... and to confer moral dignity." Despite the shared residency of privacy and ethics, the idea of privacy as an ethical value is not without potential contradiction. Different values attach to privacy when the reference is to a private place, rather than to a private body or private knowledge.

If privacy means location and concealment—a private place—social history offers abundant evidence that private domestic spaces (homes) have been places where bad acts are practiced on vulnerable women. Warren and Brandeis argued specifically for the privacy of the home as a domestic space free from the intrusion of gossip or the invasions of the press. But it is specifically because of the privacy ordinarily granted to families and homes that the bad acts that happen within can be concealed from the public view. This is the argument of some feminist legal theorists, whose cautionary stance regarding privacy points to the ways that women's history indicates their specific vulnerability to domestic (home-centered) violence. Although there are several considerations that fairly easily blunt the force of an argument against women's embrace of the private because of the histories of violence and hegemony, these gendered perspectives of privacy are further nuanced when race is added to the identitarian mix. Race problematizes concealment as a thoroughly pejorative space. The theorist Patricia Hill-Collins reminds her readers that black women could not even anticipate the idea of sanctuary within private family spaces. She writes that "under slavery, U.S. Black women worked without pay in the allegedly public sphere of Southern agriculture and had their family privacy routinely violated." For enslaved black women, private spaces were both desired and potentially harmful. The difference of gender by itself cannot explain the cultural complexities invested in the idea of privacy.

The idea of a body's privacy includes the reasonable expectation of being free from unwanted touch and exposure. Consider the kind of wariness that parents and guardians frequently impart to youngsters about how they should consider their own bodies in terms of the touch or attention of strangers. Violations of that expectation are governed by criminal law. Underlying the ethic of this claim is the idea that a person should be able to anticipate his or her body's insular integrity. Nevertheless, despite the reasonableness of such an expectation, women's bodies have become sites for public regulations that belie those notions of integrity and insularity.

In 1890, a dispute regarding private knowledge prompted the Warren and Brandeis essay. The authors complained over the intrusive habits of the press that they wanted to render liable to tort law. In Pavesich, the 1905 Georgia case, the plaintiff had an expectation that his personal information (a photograph of him) should not be circulated in the public sphere without his knowledge and consent. Three years before Pavesich, however, New York courts overturned a similar claim made on behalf of Abigail Roberson, a minor, whose image had been used without her permission to advertise flour. The language was clearly gendered in the Roberson case. In turning down her privacy claim, the court noted that the image was a flattering one, and remarked that it was reasonable to have found the company's interest in her beauty complimentary. With reference to the privacy she claimed, the court declared there was no precedent available on which to base her claim for a right to privacy. Only three years later the Georgia Supreme Court determined that it was undesirable for Paolo Pavesich to have his image on an advertisement. That court was able (and willing) to determine a way in which his privacy claim had standing. The matter of the desirability of the image did not reach the court's determination. Rather, the Georgia court constructed a relationship between privacy and liberty (a constitutionally enumerated right) that allowed it to rule for the plaintiff. Although other factors were probably in play, it is important to ask what difference the plaintiffs' gender might have made in the judicial review of the two cases.

In the evolution of privacy interests and rights, gender is a particularly rich area for consideration. Women are the public face of domestic violence, and women and girls are publicly seen as particularly vulnerable to sexual violence. These social indices inform contemporary public dimensions of reproductive rights issues—legal, medical, and social—and help us to understand the ways in which these private matters entered the public square accompanied by certain bodies, but not by others. U.S. history illustrates that women's fertility had an early impact on commerce and the nation's sustainability, and that other advances in our nation, especially with regard to scientific research and medical practice, tied the social judgments regarding gender to the construction of public policies. As the so-called weaker sex, women were seen as being in need of particular kinds of protections. That social perspective encouraged states to claim legislative authority in matters that involved women's bodies. Although a federal right to abortion was eventually upheld in the 1973 ruling in Roe v. Wade, a subsequent case, Planned Parenthood of Southeastern Pennsylvania v. Casey, indicated that states could assert interests that limited that right because of their protective authority over their residents. In other words, women's bodies can be associated with rights in which others might have (or claim) legal, if not ethical, interests. Is a woman's womb a private space? If so, whose?

The issues in medical ethics and law that are the focus of this chapter do not escape the gendered social histories that accompanied the evolution of privacy. Consider the way in which the practices of modern gynecology depend on a U.S. medical history that included experimentation on enslaved women and girls. J. Marion Sims, a nineteenth-century physician, developed a surgical remedy for vesicovaginal fistulas that depended on the availability of subjects from enslaved women. His operations were performed "openly and publicly on nude African American women, when to do so with white and middle- and upper-class women patients would have caused severe repercussions ... Having patients who were his property or were given over completely to his authority and care gave him a carte blanche that did not apply to patients who owned their own bodies."

It is clear that Sims's black patients had neither legal nor cognizable moral claims to autonomy. They were enslaved, and their bodies were legally considered to be property. Warren and Brandeis's consideration of bodies as incorporeal did not apply during the days of slavery. Although there have been some modern suggestions that it would be appropriate to regard his practices as bound to the social conduct of his era, these arguments ignore the era's critiques of slavery and its vigorous abolitionist movement. Sims's decision to own slaves indicates his choice between competing ethical paradigms. But it cannot be said that he was without the moral alternative that the abolitionist movement provided. The historian Marie Schwartz explains that "encounters between enslaved women and slaveholders' doctors endow the themes familiar in the historical literature on slavery ... The importance of their wombs and breasts for the future of slavery meant that the struggle for domination centered on women's bodies. The women suffered a peculiar form of violence as slaveholders and doctors exploited female anatomy for their own purposes. Thus women experienced slavery differently from men precisely because of their childbearing experiences."

Marion Sims's nineteenth-century practices mirror patterns of practice with regard to reproductive medicine in the United States, where racial disparities in notice, treatment, and outcomes persisted throughout the nineteenth and twentieth centuries and into the twenty-first. Sims's conduct was an early illustration of the way in which black women's bodies acquired distinctiveness and interest—not often benign—that would follow them throughout the nation's history.

When we notice the ways in which the founding of the nation was critically attached to its interest in women's fertility and reproduction, it is difficult not to notice that this early pattern of public interest in women's reproduction eventually extended to state interests and constitutional questions. Women's individual autonomy in regard to their bodies' privacy as it specifically related to their reproductive potential has been a matter of ethical compromise shaped in part by the identity of the woman's body in question.

(Continues...)



Excerpted from PRIVATE BODIES, PUBLIC TEXTS by KARLA FC HOLLOWAY Copyright © 2011 by Duke University Press. Excerpted by permission of Duke University Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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