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The Ethics of Gender-Specific Disease (Routledge Annals of Bioethics)
The Ethics of Gender-Specific Disease (Routledge Annals of Bioethics)
by Mary Ann Gardell Cutter
Edition: Hardcover
Price: $140.00
23 used & new from $65.00

4.0 out of 5 stars Academic Book Review, February 9, 2015
I am reposting here the text of an academic book review I wrote of Marry Ann Cutter's "The Ethics of Gender-Specific Disease." It was published in the American Philosophical Association's newsletter series, v12n12: 24-26. This will be most useful to academics considering whether add this book to their collections. For folks working in the medical humanities, and with adequate funding for the acquisition of research materials, I recommend this book. Pricing may have changed since the book was first reviewed in 2013.
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The Ethics of Gender-Specific Disease
Mary Ann G. Cutter (New York: Routledge, 2012). 151 pp. $125.00. ISBN 978-0-415-50997-8.
Reviewed by Alison Reiheld, Southern Illinois University, Edwardsville

Philosophers familiar with research ethics may recall that medical research performed on men was once used as the basis of treatment decisions for women. The corresponding lack of research on how women experience diseases shared by both men and women—heart disease, diabetes, asthma, etc.—is often cited by feminist bioethicists as an example of the classic assumption that “man is the measure of all things,” by which we really do mean “man.” As Lyerly et al. note, though progress has been made on this front, pregnant women are still generally excluded from research to their detriment and treatment of conditions in pregnancy is often poorly justified.Mary Ann Cutter’s recent book addresses the ethical implications of just such gender-specific diseases. By this, she does not intend only the classic examples of prostate cancer and uterine cancer, but also gender-specific manifestations of diseases shared by both men and women. However, she emphasizes diseases that primarily affect women. Her study therefore focuses on “women’s health care.”

A preliminary note is in order regarding terminology. Like many in philosophy and the larger world, Cutter at first seems to conflate sex and gender: many of the conditions she refers to as “gender-specific” are commonly referred to as “sex-specific.” One need only think of effective drag, in which a member of one sex is able to convincingly be taken as a member of the opposite sex, to be reminded that gender—man, woman, or gender queer—is distinct from the biological concept of sex, which itself is not a simple binary. However, unlike many who conflate these notions in their language use, Cutter uses this to very deliberately include both biological and cultural differences in her analysis. Using “gender” in this way allows her to apply concept of “gender-specific disease” not only to potential neurological differences in how depression manifests in men versus women but also to cultural differences in how it manifests due to gender stereotypes. As she puts it, “this inquiry focuses . . . on gender or sex” as an important variable in research and treatment (9). She proves well aware of arguments for the sex-gender distinction and those critiquing it, some of which argued for “feminine gender identities as expressing a social standpoint defining the lives and possibilities of women” (9–10). Cutter ultimately adopts Young’s position and “retains the categories of gender and sex in the context of gender-specific medicine” (11). Cutter’s analysis in the book as a whole “calls into question the possibility of arriving at an unequivocal unambiguous sociological account of gender and biological account of sex, as well as a binary account of woman and man, and female and male” (11). This account of sex and gender allows her to address the ethics of how gender-specific diseases are conceived and handled.

From her own experiences as a patient and caregiver, as well as her training in philosophy of medicine and applied ethics at the Kennedy Institute of Ethics, Cutter seeks to correct blind spots within medical ethics. Though others have discussed some of these issues piecemeal and in disparate literatures, her methodology is to “bring together some of the more recent discussions of gender in medicine found in feminist ontological, epistemological, bioethical, and sociological literature in order to forge a needed dialogue about the character of gender-specific disease” (xi). Indeed, Cutter’s ability to draw on tools from a wide range of fields within the medical humanities provides her readers with a similarly broad toolset and shows the value of pairing philosophy with other humanities.

Cutter’s first chapter gives quite good “Background” matter for her study. Therein, she explains several feminist analyses of gender and sex, discusses the history of gender-specific diseases, and lays out useful medical terms for the philosophically trained reader or someone new to the study of medicine. In so doing, she introduces the reader to the notion of disease as a concept with differing definitions, a classic issue in philosophy of medicine and one with great social power, as Conrad noted long ago in his early studies of attention deficit disorder. This background chapter, alone, is useful for readers and could also productively introduce students to these considerations.

Cutter’s next three chapters each address gender-specific disease from one of three perspectives: descriptive analysis (chapter 2), prescriptive analysis (chapter 3), and contextual analysis (chapter 4). In considering descriptive analysis of gender-specific disease, Cutter identifies and critiques the concepts behind naturalist views of gender and sex, and of disease and disease-causation. She does the same for nominalist views and concludes the chapter by noting that competing descriptive frameworks may in fact be “discovering a creation.” In other words, investigation of gender-specific disease does in fact provide information about a clinical world that “we do not simply make up,” while still leaving room for “the recognition that human knowers in part create a clinical reality” by creating language and the goals that are sought (33). This she terms the “methodological naturalist view of gender-specific disease,” in opposition to the strict naturalist or strict nominalist views. Readers interested in philosophy of science more generally, and in the classic debate over whether science studies an objective reality or a socially constructed one, should find this chapter particularly interesting. Chapter 3, in considering prescriptive views of gender-specific disease, rejects a value-neutral (neutralist) account in favor of a “normativist view of gender-specific disease,” which “recognizes that gender-specific disease serves to judge a clinical phenomenon as dysfunctional, to enlist the actions of health care professionals, and to guide treatment recommendations” (35). Here, Cutter follows in the steps of Conrad and others who have argued that medicalization of human conditions—the process whereby a condition becomes a fit consideration for medicine—enforces not only descriptive notions of what is or is not occurring but also normative ones of what should or should not be occurring with a patient’s behavior or body. Cutter gives a brief, successful account of the fact-value distinction and its troubling implications for objectivity in accounts of gender-specific disease (45). She resolves the issue in a manner worthy of consideration: the values that frame diseases, if they are objective rather than subjective, do not necessarily undermine the objectivity of value-laden accounts of disease. She concludes that “gender-specific disease is a “both/and” factual and evaluative concept in its meaning and use” (48). In chapter 4, her contextual analysis makes intriguing use of historical and cultural “frames” for gender-specific disease, arguing for a “ trans-local account.” This avoids the pitfalls of a global, universalist account of disease that ignores epistemic frames altogether, and yet also seeks to avoid the subjectivist problems posed by an entirely too local account of frames. Herein, she analyzes the WHO and UN discussions of gender and disease, herself concluding that this trans-local account will allow the concept of gender-specific disease to “be attentive to shared notions of gender, disease, and their relation, and yet accommodate differences across local communities and cultures” (59). In these three chapters, Cutter gives a whirlwind tour of epistemology of medicine and medicalization with respect to her subject, yet from it gleans three descriptive, normative, and contextual frameworks that allow for a nuanced and coherent account of gender-specific disease. These frameworks ameliorate the ethically problematic implications of simplistic and reductionist accounts of disease, and are quite promising in this respect.

By this point, it will not surprise the reader to learn that Cutter’s remaining substantive chapters focus on rethinking nomenclature and taxonomies for gender-specific disease (chapter 6) and on moving toward an integrative bioethical approach to gender-specific disease (chapters 5, 7, and 8). Such an integrative approach “sees gender-specific disease as biological dysfunction brought about by gender-specific factors explained via etiological laws, generalizations, or associations within particular historical and cultural frameworks for purposes of developing treatment warrants” (60). As with the earlier chapters, these highlight Cutter’s approach to treating knowledge of gender-specific diseases as “both/and,” an intriguing hybrid of scientific realism and social constructivism. She thus rejects gender-neutrality in favor of gender-inclusivity for both medicine and bioethics, calling in chapter 7 for an “eclectic” view of ethical appeals that draws on some of the most influential feminist bioethics of the last quarter century.

After resolving the meat and potatoes of her view on the nature of gender-specific disease and ethical appeals within a gender-inclusive—rather than gender-neutral—bioethics, Cutter considers (chapter 9) the ethical implications for men, children, and members of the LGBT communities. This reinforces the inclusivity and eclectic nature of ethical appeals. Therein, she considers how the implications of her analysis of women’s health care bear on these other groups. In particular, Cutter notes that, while men are generally the beneficiaries of the attention paid them in medical research, “a study of how men’s diseases are understood reveals some claims and assumptions about men that may be challenged” (111). She makes an analogy between the silence on AIDS in women’s health, which led to poor care, and the silence on depression in men, which is denied both by patients and providers because of the expectation that men will be “strong” or “tough,” and that “men are not emotional” (ibid.). In fact, men are more likely to die of suicide than are women. Conversely, and also because of damaging norms of masculinity, men may be overdiagnosed with erectile dysfunction (ibid.). She suggests a men’s health movement that would attend to how gender stereotypes affect health care delivery to men. Similarly, she argues that there is a widespread tendency in pediatrics to ignore gender-specific aspects of disease in children, especially for conditions such as ADHD, asthma, autism, obesity, violence, and sports-related head and other injuries. The latter is especially the case for boys who, again due to gender stereotypes, are expected to not only play rough but continue to play on after getting roughed up. The notion that “boys will be boys” is contrary to health, suggests Cutter.

And finally, we come to the portion of this chapter that reveals an area where I find Cutter’s study wanting: the implications of gender-specific disease for members of the lesbian, gay, bisexual, and transgender communities.Her discussion runs two pages altogether and yet offers far more potential for her subject. Cutter focuses here on how the identification of these communities with their sexual behavior has led to overattention in training to STDs and other infectious diseases. This has the pernicious effect, she argues, of “fueling the stereotype that LGBTs are riddled with sexual and infectious diseases” (117). I would have liked to see a great deal more discussion on this and related issues. Cutter leaves the analysis here, saying, “certainly more can be said about how LGBT’s health is understood in medicine on par with a more extensive analysis of women’s health found in the earlier chapters. But that is a matter for another time” (118). LGBT issues present far more of a challenge to research, treatment, and the patient-provider relationship than Cutter may be aware, especially trans individuals whose status has far more to do with gender and sex than with sexuality. For instance, transgender individuals challenge the traditional binary of male-female and its assumed equivalency with man-woman. Treatment of trans individuals thus presents real problems for physicians with fixed notions of sex and gender, and of gender-specific disease. Trans men—born female—routinely avoid preventive care such as PAP smears or mammograms even when they still possess the relevant anatomy. According to the Institute of Medicine, the most commonly cited reason is fear of enacted stigma, though physicians also often simply have no idea that a trans man would need such sex-specific treatment. Trans folk’s embodied experience with medicine is so distinct from that of LGB folks and hetero-gender-normative folks that it provides a powerful lens through which to question research and treatment of gender-specific disease. Of course, no one can do everything in a single text, and Cutter has done much of value here. Readers who wish to follow up on this issue can find out more by visiting the Queer Bioethics website ( www.queerbioethics.org) and perusing the recent theme issue of Journal of Bioethical Inquiry (9, no. 3), which focused on bioethics, sexuality, and gender issues.

Ultimately, this work is in the fine tradition of feminist analysis questioning how the status quo of gender and disease are damaging to all concerned. Cutter goes further to propose a particular gender-inclusive, eclectic vision of bioethics itself rather than turning her gaze only on the practice of medicine. In doing so, she utilizes an impressively wide array of tools within the medical humanities. That her study is, in the end, not entirely as radical as I would like makes it no less radical for the target audience of mainstream bioethicists and health care providers who may read it as part of Routledge’s Annals in Bioethics series.


Conceiving Masculinity: Male Infertility, Medicine, and Identity
Conceiving Masculinity: Male Infertility, Medicine, and Identity
by Liberty Walther Barnes
Edition: Paperback
Price: $26.10
46 used & new from $14.97

2 of 2 people found the following review helpful
4.0 out of 5 stars I do work in medical humanities, and I learned a great deal from this book, but anyone could, May 9, 2014
Verified Purchase(What's this?)
From the perspective of a plain old human being, there is a lot to like about this book. While the average reader might not be as interested as I am in analysis of medical practice and of gender norms, Barnes' prolonged study of infertile men and their partners is deeply human. Miscarriage and infertility are often not discussed (women who miscarry often find out only after the fact that people they have known for years also miscarried). Discussion of these facts in non-technical terms, in real human terms, is rare. People often consider discussing reproductive issues "oversharing" or don't know how to respond. They become taboo, and so folks don't know about other people who share their experiences or don't know the content of those experiences. This isolates people who experience infertility, both men and women, especially since infertility implicates femininity for women ("she is barren") and masculinity for men ("he is shooting blanks"). Barnes includes transcripts of her interviews with infertile men and their heterosexual partners which will give people looking for kindred souls a good start on hearing other people's stories of their experiences with this condition.

Of course, the scholarly value in Barnes' work comes from the way she uses frameworks analyzing gender norms (from sociology, primarily) to consider how masculinity drives docs and patients to respond to infertility and treatments for infertility, as well to consider how masculinity is constituted by fertility and by people's responses to infertility. It's a bi-directional relation, and Barnes shows some interesting examples of how men who are infertile seem to use some traditional aspects of masculinity (providing for the family; handling pain; taking on burdens) to reconstruct a version of masculinity that does not require actually being able to reproduce. That social norms and medical practice interact in such ways is not news. But this aspect of it--male infertility--is undertheorized.

I found the book fascinating and useful. I have some quibbles. At times, it can seem as though Barnes argues that everything men do with respect to fertility is about masculinity, even if they don't do what you would expect masculinity would drive them to do. This smacks of the scientific sin of a hypothesis that is unfalsifiable: no matter what the results, they can be explained away or explained to in fact support the hypothesis. However, by the end of the book it is clear that this is not the case (I wish Barnes had thought to address this more explicitly, but again, a quibble). Her arguments overall make it plausible that indeed, men who refuse to feel shame because they are less masculine for being infertile bolster that defense mechanism with other aspects of masculinity, thereby preserving much of traditional masculinity in a situation which would seem to undermine it.

The book is a good resource for my own work in medical humanities (I am a philosopher who does medical ethics). As usual with works of valuable thinking, the work itself has value but so does the degree to which it directs the reader to other valuable work. I will do some more digging, now, into some of the sociological theories of gender which Barnes deploys. Whether or not I draw again on Barnes' own study of men and infertility--which I suspect I will--I will almost certainly draw upon some of the tools that she draws upon, here.

Thusly do we learn from each other. As scholars. But also as humans seeking stories of those who struggle with subjects too rarely discussed in public.


Sharpie Paint Markers aqua blue medium
Sharpie Paint Markers aqua blue medium
Offered by Junipers'
Price: $4.66
18 used & new from $2.89

1 of 1 people found the following review helpful
5.0 out of 5 stars paint art, April 2, 2014
Verified Purchase(What's this?)
Awesome for decorating a homemade birdhouse. Much more control by a 6yo boy than a brush would afford. We also got a multicolor pack, but needed a lot more blue than the others.


Goggles (Picture Puffins)
Goggles (Picture Puffins)
by Ezra Jack Keats
Edition: Paperback
Price: $6.99
79 used & new from $1.21

0 of 1 people found the following review helpful
4.0 out of 5 stars Another winner from Keats, October 28, 2013
Verified Purchase(What's this?)
Seriously cool for explorer kids with imaginations. All the charm of Snowy Day or the one about the chair, but with more friends. Really good children's literature always re-surprises me with its emotional depth.


No Title Available

4.0 out of 5 stars Huh. Whaddayaknow. It actually works., October 28, 2013
Verified Purchase(What's this?)
Yes. Gross, smelly hats with those lines where the salt-bearing sweat stopped creeping through the fabric and dried? Those? Made it through the wash intact and in the correct shape. Woot.


Gila Monsters Meet You at the Airport (Reading Rainbow Book)
Gila Monsters Meet You at the Airport (Reading Rainbow Book)
by Marjorie Weinman Sharmat
Edition: Paperback
Price: $5.83
134 used & new from $0.01

4.0 out of 5 stars Fun tag line; read the book with kiddos, mention the title when you fly into the Southwest, October 28, 2013
Verified Purchase(What's this?)
This is a charming book about misunderstanding and fear of strangeness, becoming comfortable with new places and people, and trying to help others do the same.


Winsome Wood Foldable 4-Tier Shelf, Natural
Winsome Wood Foldable 4-Tier Shelf, Natural
Price: $72.19
26 used & new from $71.08

2 of 3 people found the following review helpful
3.0 out of 5 stars Shelf ok, but better have your own allen wrenches, September 2, 2012
Verified Purchase(What's this?)
Well, the shelf is actually just what I needed to fit against the wall where there is a bulky, protruding power outlet in my office. But when I assembled it, I managed to screw in 2.5 of lots more than that screws before the pot metal--soft, cheap--of which the allen wrench was made got the edges of the hexagon entirely stripped off. Fortunately, the screws held up better so once I got home and remembered to bring my own set of multiple-sized allen wrenches in to the office, I was able to assemble it in good order. Knowing this in advance would have made the assembly job a one hour affair instead of a 4 day affair with pieces strewn about my office while I went home every day and didn't quite remember to bring my wrenches in to work. Here's hoping to save you the trouble by letting you know in advance.


Kidoozie Super Shapes Dump Truck
Kidoozie Super Shapes Dump Truck

5.0 out of 5 stars Lasted 3 years so far; new sprout also loves it, August 12, 2008
= Durability:5.0 out of 5 stars  = Fun:4.0 out of 5 stars  = Educational:4.0 out of 5 stars 
We got this toy for our now-just-4-years-old son on his first birthday. He immediately played with it. Not only does have a very satisfying rolling action when pushed across carpet, tool-shaped buttons that make relevant tool noises when you push them, and a lever for lifting the dumping part up and therefore dumping the contents, but the shapes are individually good for playing with the truck or for tossing in a diaper bag, purse, pocket, or stroller to take a long as individual toys because:
- they hold up well to chewing, can't be swallowed, and can be held in little uncoordinated hands
- can be flipped out into various animals by using the cleverly disguised and--largely--unbreakable switches (a trunk and tail flip out of the square to create an elephant when you wiggle the semi-circle ear on the square). Our oldest calls the hexagon his "switch-turtle" and still plays with it, now using it in his stories and imaginary play.
- can be operated by parents to provide lasting amusement to children under the age of 18 months who may have trouble operating them on their own

We are getting this for our niece, the same age as our new boy (now 10 months) as the switch-turtle and switch-elephant (hexagon and square) were a huge hit when we recently traveled to visit, and our youngest just loves the truck. Oh, and he figured out months ago how to push the two buttons right up front (one of which is under the driver, so when you push on him or it, it's activated) to play music and/or engine noises.

Neither of our boys have had the the getting-hands-stuck problem that the other reviewer had, but I can see how it would happen and would be a big concern. If you're worried about that, you could use the shapes as individual toys, and then bring out the truck later when little hands are bigger, or just play with the child when you bring it out.


Unprincipled Virtue: An Inquiry Into Moral Agency
Unprincipled Virtue: An Inquiry Into Moral Agency
by Nomy Arpaly
Edition: Paperback
Price: $23.82
53 used & new from $13.38

4 of 4 people found the following review helpful
5.0 out of 5 stars Couldn't put it down, May 29, 2007
I started reading this book because I work in moral theory and, well, it's begun to get a lot of traction lately with philosophers who I respect (Jim Nelson, Hilde Lindemann, George Sher, and a number of others). I literally could not put it down and read it through in one sitting. Arpaly's writing style is very engaging; as one of the other reviewers mentioned, she makes copious use of real-world and literary examples. What was not mentioned is that she utilizes only those examples which are psychologically realistic. Thus, Arpaly asks us to consider Madame Bovarie's desire to be moral, her resulting charitable actions, and whether they are morally praiseworthy if they stem from the wrong reasons (the desire to be moral rather than moral reasons). There are no brains-in-vats or babies-strapped-to-tracks-about-to-be-run-over-by-trolleys-unless-you-switch-the-trolley-to-a-different-track-where-it-will-crush-10-adults. For those who don't know these two classic philosophical thought experiments have structured a great deal of reflection on relevant themes (whether we are our bodies or our brains; how we determine what the right action is).

For Arpaly, beginning with examples that reflect the way people realistically reason about moral problems is essential. Failure to do so, she suggests, has led us to some very wrong-headed ways of theorizing about morality and ethics. In particular, she considers moral reasoning's equivalency between freedom-of-the-will and the possibility of moral responsibility wrong-headed. As one of the other reviewers mentioned, a signal Arpaly contribution to moral philosophy from this text is the plausible case that moral responsibility does NOT require absolute freedom-of-the-will, but rather responsiveness to the right reasons and an appropriate level of concern for the moral problem at hand. These are the most immediate requirements for moral responsibility for actions, and in particular for being morally praiseworthy for one's actions.

Thus, Madame Bovary, while well-intentioned, is not RIGHTLY intentioned, and is thus not morally praiseworthy for charitably aiding others--at least, not in the same way that a rightly-reasoned person who performed the identical action would be.

In such an assessment, it matters little whether the actions of M.B. and the rightly-reasoned philanthropist were pre-determined by their constitution and facts of the world, or taken with absolute freedom of the will. What is really important about Arpaly's work is that she joins Fischer and Ravizza in having put forth a plausible conception of moral responsibility that does not turn on the idea that we are all completely free and unaffected by our environment. Hurrah! Reality and responsibility are compatible.

And as I began, let me end: it doesn't hurt at all that these excellent ideas are engagingly written out for our reading pleasure. Scholars will enjoy this, and laypersons will find it approachable; both will find it sophisticated and thoughtful.


The Historian
The Historian
by Elizabeth Kostova
Edition: Paperback
411 used & new from $0.01

2 of 4 people found the following review helpful
4.0 out of 5 stars Surprisingly good fun, as much travelogue and historical novel as vampire-hunting tale, February 6, 2007
This review is from: The Historian (Paperback)
I very much enjoyed The Historian. As a teacher and graduate student, I choose my leisure reading very carefully and decided to read this book when it came out in paperback, on the strength of a NPR interview with the author in which she impressed me with her erudition. I also confess to having been a fan of Buffy the Vampire Slayer. That said, I also like a good bit of Jane Austen. I say this as background for interpreting my evaluation of the book.

One of the most intriguing (and fairly sophisticated) literary devices in this book is the way the author weaves together a number of timelines, jumping back and forth as the protagonist recounts her discovery of her family's increasingly deep connection to Vlad Drakul. These timelines span nearly a century of personal and secondary accounts of her father's interest in Vlad, her father's dissertation director's interest in Vlad, and the costs that this series of interests have brought upon the interested. Travels range from Istanbul to western Europe, the UK to the former Soviet bloc countries in eastern Europe (when they were still Soviet). Istanbul is encountered in two different time periods. This makes the book a fascinating combination of elements of historical novel, travelogue, and of course the key narrative device of a vampire-hunting tale.

Fundamentally, though, this is not your Buffy-style hunt. It is a hunt for knowledge, in which the narrator and her chain of fellow vampire-hunters are not so much trying to eliminate Vlad (not SO much) as to resolve their insatiable quest for knowledge about whether there's anything to the myth of Dracula. It is a mystery about the characters and their fates and a mystery about history and myth.

So, if someone said to me, "woman, there is a nicely constructed, well-written, and entertaining novel that employs complex literary devices, demands a great deal of attention of the reader, and contains genre elements of mystery, history, fantasy, thriller, and travelogue"... well, I would say that such a thing must be a hodgepodge, a goblin, a chimera of truly horrific proportions. Only because the author is so skilled is this book in fact entertaining. I have since loaned it to friends and bought a copy for my sister-in-law.

I can strongly recommend this book. With the exception of Bram Stoker's "Dracula" this is the least junky vampire-related novel I have ever read. And that is not meant as faint praise. It is in fact entirely unjunky and has a great deal of merit.

If you read it and give it the attention it both demands and deserves (some is necessary for keeping the timelines straight in your head), I suggest that you will enjoy it immensely.


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