Care and the self: biotechnology, reproduction, and the good life

Abstract

This paper explores a novel philosophy of ethical care in the face of burgeoning biomedical technologies. I respond to a serious challenge facing traditional bioethics with its roots in analytic philosophy. The hallmarks of these traditional approaches are reason and autonomy, founded on a belief in the liberal humanist subject. In recent years, however, there have been mounting challenges to this view of human subjectivity, emerging from poststructuralist critiques, such as Michel Foucault's, but increasingly also as a result of advances in biotechnology itself. In the face of these developments, I argue that the theoretical relevance and practical application of mainstream bioethics is increasingly under strain. Traditionalists will undoubtedly resist. Together, professional philosopher-bioethicists, public health policymakers, and the global commercial healthcare industry tend to respond conservatively by shoring up the liberal humanist subject as the foundation for medical ethics and consumer decision-making, appealing to the familiar tropes of reason, autonomy, and freedom.I argue for a different approach to bioethics, and work towards a new way to conceive of ethical relations in healthcare--one that does not presume a sovereign subject as the basis of dignity, personhood or democracy. Instead, I am critical of the narrow instantiations of reason, autonomy, and freedom, which, more recently, have been co-opted by a troubling neo-liberal politics of the self. Thus, I am critical of current trends in medical ethics, often running in tandem with corporate-governmental models of efficiency, accountability, and so-called evidence-based best practices. As an example of such market-driven conceptions of subjectivity, I discuss the paradigm of "self-care." Self-care shores up the traditional view of the self as a free agent. In this sense, self-care is looked upon favourably by mainstream bioethics in its focus on autonomy, while healthcare policy endorses this model for ideological and economic reasons. To contrast this, I propose a different model of care together with a different model of selfhood. Here I develop and apply Foucault's late work on the "care of the self." In this understanding of "care," I suggest that we might work towards an ethical self that is more commensurable both with recent theoretical views on subjectivity and--more pressingly--with the challenges of emergent biotechnologies. I end this paper with a discussion on ethical parenthood, which offers a practical reading of the "care of the self" in relation to new reproductive technologies (NRTs).

Towards an ethics of authentic practice

“…Suddenly, she is no longer dealing with a ‘real’ medical crisis, but with a potential one. In this gesture, she is quantified, reduced to a bare statistic' [24]. Her subjectivity will, in a sense, become unnavigable.…”

Self‐Care at the Margins: Meals and Meters in Migrants’ Diabetes Tactics

“…For Foucault (1990) the “care of the self” is a self‐reflective practice to achieve freedom, as an ethical exercise of maintaining a healthy body to become a good, autonomous citizen (Gordon 1991). Murray (2007:4) sharply distinguishes between Foucault's “care of the self” and the public health notion of “self‐care” that assumes an enlightened self “morally compelled always to act with ‘due care’ towards itself, morally obliged to avail itself of new biotechnological ‘resources.’” Turkish Berliners with diabetes negotiated the self‐care according to biomedical care plans in similar fashion, “responsibly” seeking health when services are not readily available or accessible. However, I will argue that neither the normative “self” is at stake here nor a moral “drive” toward adhering to clinical expectations, and practices may not foremost act to liberate or “regularize” the self (Murray 2007).…”

Road-maps and revelations: on the somatic ethics of genetic susceptibility

“…The value of one's genetic inheritance therefore takes two forms, one ethical and one pragmatic. On the one hand, it is a fixed object, constitutive of who one is, that cannot be transformed, only cared for (Murray 2007) by seeking wellness. On the other, it is a tool with hidden but exploitable instrumental value: "Like a bank filled with money, your genome is full of value" (Cline 2009).…”