Medicalization as a moral problem for preventative medicine

Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept ‘medicalization’ has been introduced by Zola to refer to processes in which the labels ‘healthy’ and ‘ill’ are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally problematic? My thesis is that such a contribution is indeed morally problematic. The concept is sometimes used to express moral intuitions regarding the practice of prevention and health promotion. Through analysis of these intuitions as well as some other moral concerns, I give an explication of the moral problems of medicalization within the context of preventive medicine.     

The Other Side of Medicalization: Self-Medicalization and Self-Medication

The concept of medicalization has given rise to considerable discussion in the social sciences, focusing especially on the extension of medicine’s jurisdiction and its hold over our bodies through the reduction of social phenomena to individual biological pathologies. However, the process leading to medical treatment may start when individuals engage in self-medication and thus practice “self-medicalization.” But, can we apply to this concept the same type of analysis as the first and see merely the individual’s replication of the social control mechanisms to which he/she usually falls victim? This article aims to demonstrate that the medicalization individuals practice on themselves takes on a completely different meaning to that practiced by the medical profession. Empirical data collected in France show that self-medicalization, which may involve treating a problem medically when doctors believe it to be of a non-medical nature, can be an attempt by individuals to furnish a social explanation for their somatic problems and experiences. In this article, I examine the social and political significance of this phenomenon.     

The “Normalization” of Intersex Bodies and “Othering” of Intersex Identities in Australia

Once described as hermaphrodites and later as intersex people, individuals born with intersex variations are routinely subject to so-called “normalizing” medical interventions, often in childhood. Opposition to such practices has been met by attempts to discredit critics and reasserted clinical authority over the bodies of women and men with “disorders of sex development.” However, claims of clinical consensus have been selectively constructed and applied and lack evidence. Limited transparency and lack of access to justice have helped to perpetuate forced interventions. At the same time, associated with the diffusion of distinct concepts of sex and gender, intersex has been constructed as a third legal sex classification, accompanied by pious hopes and unwarranted expectations of consequences. The existence of intersex has also been instrumentalized for the benefit of other, intersecting, populations. The creation of gender categories associated with intersex bodies has created profound risks: a paradoxically narrowed and normative gender binary, maintenance of medical authority over the bodies of “disordered” females and males, and claims that transgressions of social roles ascribed to a third gender are deceptive. Claims that medicalization saves intersex people from “othering,” or that legal othering saves intersex people from medicalization, are contradictory and empty rhetoric. In practice, intersex bodies remain “normalized” or eliminated by medicine, while society and the law “others” intersex identities. That is, medicine constructs intersex bodies as either female or male, while law and society construct intersex identities as neither female nor male. Australian attempts at reforms to recognize the rights of intersex people have either failed to adequately comprehend the population affected or lacked implementation. An emerging human rights consensus demands an end to social prejudice, stigma, and forced medical interventions, focusing on the right to bodily integrity and principles of self-determination.     

Medicine and Medicalization: A Response to Purdy

Many feminists are critical of the practices and institutions that medicalize people's lives, especially the lives of women and other members of marginalized groups. I argue that this critique does not necessarily imply a rejection of medicine. I give a brief analysis of the concept of medicalization that supports the view that one can desire medicine without desiring medicalization. I then discuss the relations among what is considered natural, socially constructed, and medicalized.     

Licorice in Leviathan: The medicalization of care for the Japanese elderly

Attitudes towards, and treatment of the elderly in Japan are discussed and the medicalization of their health care is examined. It is suggested that the ready availability of medical care will not eliminate the major problems that the elderly experience. The process by which traditional medicine has been incorporated systematically into the socialized health care system and its use in connection with the problems of elderly patients is documented. Modifications in the application of herbal medicine made by biomedical practitioners have been linked to cases of iatrogenesis in the elderly. In conclusion, the social construction of both traditional East Asian medicine and biomedicine in Japan is briefly examined; in both systems the somatic aspects of the problems of the elderly are emphasized while the social dimensions remain largely unquestioned.     

Procreation machines: Ectogenesis as reproductive enhancement,proper medicine or a step towards posthumanism?

Full ectogenesis as the complete externalization of human reproduction by bypassing the bodily processes of gestation and childbirth can be considered the culmination of genetic and reproductive technologies. Despite its still being a hypothetical scenario, it has been discussed for decades as the ultimate means to liberate women from their reproductive tasks in society and hence finally end fundamental gender injustices generally. In the debate about the application of artificial wombs to achieve gender equality, one aspect is barely mentioned but is of crucial relevance from a medical-ethical perspective: whether and how could full ectogenesis be justified as a proper use of medicine? After characterizing the technology as a special form of human enhancement and as an extension of medical practice that goes beyond the traditional field of medicine, this paper critically assesses the theoretical possibilities of legitimizing this extension. We identify two ways of justification: either one argues that ectogenesis fulfils a proper goal of medicine (a justification we call pathologization), or one argues that the application of ectogenesis achieves a non-medical goal (which we call medicalization). Because it is important from a medical-ethical point of view to avoid an inappropriate instrumentalization or misuse of medicine and thus an undue medicalization of non-medical problems, a set of necessary conditions has to be met. It is doubtful whether full ectogenesis for non-medical purposes could fulfil these conditions. Rather, its comprehensive usage could be seen as a revolutionary modification of what it means to be human.     

Multibiologism: An anthropological and bioethical framework for moving beyond medicalization

Recent approaches in the medical and social sciences have begun to lay stress on “plasticity” as a key feature of human physiological experiences. Plasticity helps to account for significant differences within and between populations, particularly in relation to variations in basic physiological processes, such as brain development, and, in the context of this article, daily sleep needs. This article proposes a novel basis for the redevelopment of institutions in accordance with growing awareness of human variation in physiological needs, and articulates a theory of multibiologism. This approach seeks to expand the range of “normal” physiological experiences to respond to human plasticity, but also to move beyond critiques of medical practice that see medicine as simply responding to capitalist demands through the medicalization of “natural” processes. Instead, by focusing on how the institutions of U.S. everyday life—work, family, and school—structure the lives of individuals and produce certain forms of sleep as pathological, this article proposes that minor alterations in institutions could result in less pathologization for individuals and communities. Multibiologism provides a foundation for shared priorities in the social sciences, in bioethics, and in medical practice, and may lay the groundwork for emergent collaborations in institutional reform.     

La médicalisation de la sexualité: Aspects sociologiques et historiques

The paper gives an introduction to a discussion about the process of medicalization of sexuality. This process is defined as: a social construction of knowledge on sexuality based on a biological conception of the body and health; clinical practice based on diagnosis and medical technologies; a strong relation between medecine and sexual morality. The paper is based on a study of the medical treatment of masturbation, sterilization and homosexuality in a historical perspective. Then the paper, shows how, currently, the process of medicalization of sexuality is twofold: on one hand stimulation of «normal» sexual activity (pharmacological treatment of sexual dysfunction) and inhibition of deviant sexual behavior (sexual abusers). At last, the paper, gives a short view on the potential transformations of the patient-doctor interaction.     

Expectant Israeli Fathers and the Medicalized Pregnancy: Ambivalent Compliance and Critical Pragmatism

This article addresses the medicalization of pregnancy in Israel and its effects on the experiences of Jewish-Israeli men who participated in various stages of their female partners' prenatal care. The highly medicalized arena of Israeli prenatal care, with its strong emphasis on prenatal diagnostic testing, provided the context in which the men's accounts of their interactions with reproductive biomedical authority, practitioners and knowledge were understood. It is suggested that the anthropological scholarship on reproduction assumes that men benefit from the medicalization of pregnancy and birth and comply with medicalization. Women, on the other hand, are often depicted as being subjected to harmful medical surveillance and responding to it in degrees, ranging from compliance to resistance, and mediated by pragmatism. Data derived from participant observation in multiple arenas and from 16 in-depth interviews with Israeli men whose female partners were pregnant or had recently given birth suggest that although some Israeli men regard the biomedicalization of pregnancy positively, most tend toward varying degrees of criticism. It is suggested that men's responses to reproductive biomedicine are far more complex than portrayed to date in the existing scholarship and that men's responses to biomedicalization reveal complex power negotiations.     

The ethics of cesarean section on maternal request: a feminist critique of the American College of Obstetricians and Gynecologists' position on patient-choice surgery

In recent years, the medical establishment has been speaking in favor of women's autonomy in childbirth by advocating cesarean delivery on maternal request (CDMR). This paper offers to look at the ethical dimension of CDMR through a feminist critique of the medicalization of childbirth and its influence on present-day medical ethics. I claim that the medicalization of childbirth reflects a sexist bias with regard to conceptions of the body and needs to be used with caution when applied to women's reproductive health. I then use this perspective to critically analyze the position of the American College of Obstetricians and Gynecologists (ACOG) on the ethics of decision-making in patient-choice surgery. I claim that informed consent cannot be meaningfully exercised unless women are made aware of the sexist underpinnings of the medical model of childbirth and its influence on the ethical reasoning of the American College of Obstetricians and Gynecologists. I also express concern about the effects of normalizing patient-choice cesarean sections on the choices available to pregnant women using as examples the institutional rules on mandatory cesarean sections for women with a previous cesarean delivery or breech presentation. I conclude with a call for more research into the real cost of convenience in CDMR, particularly as our increasingly strained publicly funded healthcare system would greatly benefit from the de-medicalization of normal body functions rather than an increased dependence on costly surgical technology.     

An ethics of enchantment: forming affect and information in experimental paediatric medicine

Science and medicine have been cast as disenchanted arenas of modernity, even as scholars have illustrated the many enchantments of everyday life. Taking these conversations into the context of experimental paediatric medicine, I explore the dis/enchantments produced through the research ethics systems that govern interactions between medical practitioners and patients’ families. Research ethics enact forms of disenchantment, aiming to produce the informed patient-subject who can knowingly submit to the unknowns of experimental medicine. However, by following one young patient's emotive disruption of the consent process, I suggest that we instead consider an ethics of enchantment: one that recognizes the affective logics of patienthood alongside the informatic. Elaborating how ethical practice is both institutionally structured and interpersonally improvised, I develop key conversations from the anthropology of ethics, and highlight the interplay of enchantment and disenchantment that constitutes modern medical subjects.     

Alberta euthanasia survey: 2. Physicians' opinions about the acceptance of active euthanasia as a medical act and the reporting of such practice.

OBJECTIVE: To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p < 0.01). CONCLUSIONS: This survey about active euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians'' obligations to society.     

CULTURAL CIRCUMCISION IN EU PUBLIC HOSPITALS – AN ETHICAL DISCUSSION

The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system.
We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation.
From the unique structure of patient-medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support a utilitarian argument that finds hospital-based circumcision safer than non-medicalized alternatives.
The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation.     

Can there be a "cultural epidemiology"?

A brief excursion through the history of social medicine suggests that, at least in principle, epidemiology and anthropology are natural allies in the study of disease in human populations. In practice, however, this alliance has been limited and remains problematic. This article examines the possibilities for interdisciplinary research, taking cancer epidemiology as a case in point. I argue, on the basis of participant-observation over a period of nearly two years in the epidemiology department of a medical research institute in Catalonia (Spain), that bioscientific uses of the concept of culture have led, disappointingly, to its reification as "beliefs" and its incorporation into the naturalist epistemology of Western institutional medicine. The unfortunate consequence is the medicalization of culture understood as "difference," which often stands in for social class.     

On good and bad forms of medicalization

The ongoing 'enhancement' debate pits critics of new self-shaping technologies against enthusiasts. One important thread of that debate concerns medicalization, the process whereby 'non-medical' problems become framed as 'medical' problems. In this paper I consider the charge of medicalization, which critics often level at new forms of technological self-shaping, and explain how that charge can illuminate - and obfuscate. Then, more briefly, I examine the charge of pharmacological Calvinism, which enthusiasts, in their support of technological self-shaping, often level at critics. And I suggest how that charge, too, can illuminate and obfuscate. Exploring the broad charge of medicalization and the narrower counter charge of pharmacological Calvinism leads me to conclude that, as satisfying as it can be to level one of those charges at our intellectual opponents, and as tempting as it is to lie down and rest with our favorite insight, we need to gather the energy to have a conversation about the difference between good and bad forms of medicalization. Specifically, I suggest that if we consider the 'medicalization of love,' we can see why critics of and enthusiasts about technological self-shaping should want (and in some cases have already begun) to distinguish between good and bad forms of such medicalization.     

医院后勤设备管理与低碳建设

医院后勤设备是保障医、教、研活动正常运转的基本条件,也是构成医院基础质量的基本要素。它不仅具有为医疗活动提供条件保障的一面,而且还具有为病人和医院职工提供生活服务的一面;不仅具有生产性的一面,而且还具有消耗性的一面。因此搞好医院后勤设备的管理,推行低碳经济建设,发挥后勤设备的功能和作用,使之更好地为医、教、研服务,为病人和医院职工服务,是医院管理的一个重要内容。     

The medicalization of "nature" in the "artificial body": surrogate motherhood in Israel

In this article, I draw on anthropological and feminist scholarship on the body and the nature/culture divide as a framework for understanding the place of surrogate mothers in a conceptual ideology that connects motherhood with nature. I explore links between the medicalization of childbirth in Israel and the personal agency of surrogate mothers as relayed through interviews. Taking the patriarchal context of the Israeli surrogacy law of 1996 into consideration, I underscore surrogates' imaginative use of medical metaphors as tools for the subversion of surrogacy's threatening social connotations. By redefining the surrogate body as "artificial" and locating "nature" in the commissioning mother's body, surrogates adopt medical rhetoric to transform surrogacy from a transgressive act into an alternative route toward achieving normative Israeli national reproductive goals.     

Making a difference--women, medicine, and the twenty-first century

Women can and should make a difference in how medical care is given in the future. The increased number of women physicians presents an opportunity to make a significant impact on the quality of medical care. Data is provided on the number of women applicants to medical school, matriculants and graduates, specialty choices, the status of women in academic medicine, and the income of women physicians. Four aspects of the environment that portend important changes for medicine in the future are identified: scientific developments, alternative delivery systems and the corporate practice of medicine, the aging population and other demographic changes, and the expanding number of physicians. Some of these changes suggest opportunities for making a difference in the traditional specialties of medicine, in providing care to underserved populations, in research careers, in the shortage areas of preventive medicine and public health, occupational medicine, child psychiatry, and physical medicine and rehabilitation, and in new areas such as community pediatrics, behavioral pediatrics, and adolescent medicine. There are many choices and many decisions to be made, and each individual can choose to make a difference.     

"The visible skeleton series": the art of Laura Ferguson

Laura Ferguson's The Visible Skeleton Series constitutes an artistic self-representation of scoliosis. Ferguson employs high-tech medical imaging and innovative graphical techniques to suggest a novel view of her skeletal "deformity." This section presents introductions to the series by a historian of medicine and by the artist herself, and offers personal and professional reflections on the work from an orthopedic surgeon, a social worker with lived experience of cleft lip, and a retired pediatric forensic pathologist.     

Crossing the Boundaries of ‘Colonial Psychiatry’. Reflections on the Development of Psychiatry in British India,c. 1870–1940

This article explores the development of psychiatric institutions within the context of British colonial rule in India, in particular during the late nineteenth and early twentieth centuries. Existing scholarship on ‘colonial medicine’ has tended to focus on colonial power and hegemony and the British endeavour to ‘colonize the Indian body’ during the nineteenth century. It is suggested here that reference to ‘colonial’ medicine and psychiatry tends to reify the ideology of colonialism and neglect other important dimensions such as the role of international scientific networks and the mental hospital as the locus of care and medicalization. From the later period of British colonial engagement in south Asia, people’s right and entitlement to medical care and the colonial state’s obligation to provide institutional treatment facilities received increased attention. As the early twentieth-century case of an Indian hospital superintendent shows, practitioners’ professional ambitions went beyond the confines of ‘colonial psychiatry’. He practiced in his institution science-based psychiatry, drawing on models and treatment paradigms that were then prevalent in a variety of countries around the globe.