Human-centred design, disability and bioethics

Human-centred design methodologies provide a means to align bioethical advocacy with the needs and desires of disabled people. As a method, human-centred design seeks to locate points of friction in an individual's experience of everyday interactions, specifically in relation to technologies, but potentially in relation to processes and institutions. By focusing on disabled persons and their experiences of institutional organisation, human-centred design practices serve to create a foundation for a bioethical practice that addresses idiosyncratic needs and desires while providing support for disabled persons and their families. In considering how a design-focused bioethics might operate in this way, I focus on advanced sleep phase syndrome and delayed sleep phase syndrome as a way to show how the temporal ordering of institutions disable the participation of individuals with atypical sleep needs. I then turn to the education of deaf students through the exclusive use of sound, which puts them at a significant disadvantage relative to their hearing peers; this example shows how normative ableism obscures itself in attempts to aid disabled people, but an attention to the experience of deaf students show how exclusively auditory learning can be redesigned. Advocating for flexible institutional organisation and practices situates bioethical advocacy as a means to engage with social organisations in ways that create novel opportunities for able-bodied and disabled people alike.

Neurological disorders, affective bioethics, and the nervous system: reconsidering the Schiavo case from a materialist perspective

This article proposes a novel approach to bioethics, referred to as "affective bioethics", which draws on traditions in anthropology, science and technology studies, disability studies, and Spinozist materialism. By focusing on the case of Michael and Terri Schiavo, in which Terri's personhood and subjectivity are challenged by dominant forms of neurological reductivism in the USA, this article suggests that approaching her condition as a set of relations with the people in her life and her socio-technical environment may have helped to develop new ways to conceptualise personhood and subjectivity moving beyond the view of her as a non-person. Drawing on Michael Schiavo's memoir of his legal battles, and Terri's diagnosis and care, this article shows how Terri's connections to the world disrupt American ideas about the isolatable individual as the basis for personhood and subjectivity. Attending to these interpersonal and socio-technical connections focuses bioethical attention on the worlds that individuals inhabit, and how those worlds might be designed to make more kinds of life livable and new forms of personhood and subjectivity possible.

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.

Chronic Subjunctivity, or, How Physicians Use Diabetes and Insomnia to Manage Futures in the United States

Prognostication has become central to medical practice, offering clinicians and patients views of particular futures enabled by biomedical expertise and technologies. Drawing on research on diabetes care and sleep medicine in the United States, in this article we suggest that subjectivity is increasingly modeled on medical understandings of chronic illness. These chronic conceptions of the self and society instill in individuals an anxiety about future health outcomes that, in turn, motivate practices oriented at self-care to avoid negative health outcomes and particular medical futures. At its most extreme, these anxieties of self-care trouble conceptions of self and social belonging, particularly in the future tense, leading patients and clinicians to consider intergenerational and public health based on the threats that individual patients pose for others.

Unifying minor sciences and minor literatures: Reproduction and revolution in quantum consciousness as a model for the anthropology of science

In this paper, we explore the possibility of using Gilles Deleuze and Felix Guattari’s theories of minor science and literature to examine the role of marginalized sciences, particularly in the United States. We suggest that by combining Deleuze and Guattari’s work on minor sciences and minor literatures that the framework for an anthropology of science which takes alternative and marginalized sciences seriously can be established. To elucidate this model of inquiry, we focus on three aspects defined by Deleuze and Guattari: the political relationship of minor to dominant sciences, the role of science in the state, and the ways that minor sciences reconfigure dominant sciences. As a case study, we examine the science of ‘quantum consciousness’ in the United States. Quantum consciousness research proposes to replace dominant metaphysics in Western science, and its minority status is perpetuated by the power structures that draw on dominant sciences’ relationships to the state and knowledge production.

Our Master’s Voice, the Practice of Melancholy, and Minor Sciences

How do scientists and experts in marginal scientific fields think about themselves, their knowledge production, and their practices in relation to dominant sciences? In this article, drawing on fieldwork with a group of Lacanian psychoanalysts, I argue that what motivates much of the training, practice, and thought of some contemporary psychoanalysts is their place as practicing a minor science in relation to dominant forms of psychiatry and neuroscience in the United States. They are exemplary marginalized experts who articulate themselves and their work against mainstream forms of neuroscientific and psychiatric expertise. I adopt the concept of minor sciences from Gilles Deleuze and Félix Guattari, who characterize them by their eminently political nature, their challenging of dominant sciences through intensive uses of language, and their disenfranchisement. Yet Deleuze and Guattari are relatively silent on the experiential qualities of practicing minor sciences. I turn to Sigmund Freud’s distinction of mourning and melancholia in relationship to lost objects, suggesting that one of the constituent components of minor sciences is a persistent state of melancholy related to the minor sciences’ struggling for relevance. Drawing on my fieldwork with a Lacanian community and their interest in who and what belongs to psychoanalytic thought, what threats endanger the status of psychoanalysis, and what is at stake in keeping psychoanalysis alive in the United States, I suggest that the power of melancholia proves vital to keeping minor sciences alive for marginalized experts.

Extremities: thresholds of human embodiment

Emergent conditions of life at the end of the first decade of the twenty-first century create new opportunities and challenges for medical anthropology. The articles included in this special issue of Medical Anthropology suggest four areas that call out for more attention: the changing scientific and philosophical status of the human, including definitions of life and biology more broadly; the material consequences of anticipatory fictions; the expanding and intensifying forces invested in the production of bodies; and the emergent and historical conditions shaping expectations and experiences of bodies as they are managed and lived. In elaborating the significance of these issues, we provide an introduction to the articles included in this special issue and point to how the contributions to this collection offer models for approaching emergent forms of life.