Legal embodiment: Analysing the body of healthcare law

Medical Law Review

Volumn 16, Issue 3, 2008, Pages 321-345

  Fletcher, Ruth ^a   Fox, Marie ^a   McCandless, Julie ^a  

^a KEELE UNIVERSITY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ATTITUDE TO HEALTH; FEMALE; FEMINISM; HEALTH CARE DELIVERY; HEALTH SERVICE; HUMAN; LEGAL ASPECT; PATIENT RIGHT; PERSONAL AUTONOMY; UNITED STATES; WOMEN'S RIGHTS;

ATTITUDE TO HEALTH; DELIVERY OF HEALTH CARE; FEMALE; FEMINISM; HUMANS; PATIENT RIGHTS; PERSONAL AUTONOMY; REPRODUCTIVE HEALTH SERVICES; UNITED STATES; WOMEN'S HEALTH SERVICES; WOMEN'S RIGHTS;

EID: 55149112627     PISSN: 09670742     EISSN: 14643790     Source Type: Journal    
DOI: 10.1093/medlaw/fwn017     Document Type: Article

References (148)

1. In this sense, we are drawing on the legacy of critical social theory, which distinguishes between traditional and critical perspectives, but advocating that critical perspectives move beyond immanent critique to work with the normative values that are implicit in their critical perspectives. See further M. Horkheimer, 'Traditional and Critical Theory', in Critical Theory: Selected Essays (Herder and Herder 1972) trans. M.J. O'Connell et al., pp. 188-243
2. N. Fraser, Unruly Practices: Power, Discourse and Gender in Contemporary Social Theory (Polity Press 1989) ch. 1.
3. A. Hyde, Bodies of Law (Princeton University Press 1997) at 6.
4. We adopt the term 'healthcare law' in preference to medical law because of its broader ambit: See J. McHale and M. Fox, Healthcare Law: Cases and Materials, 2nd edn (Sweet & Maxwell 2007) at 4.
5. R. Diprose, 'A 'Genethics' that Makes Sense: Take Two' in M. Shildrick and R. Mykitiuk (eds) Ethics of the Body: Postconventional Challenges (MIT Press 2005) at 237-238.
6. See also K. Inckle, Writing on the Body? Thinking Through Gendered Embodiment and Marked Flesh (Cambridge Scholars 2007) ch. 3
7. for feminist critiques of mainstream bioethics, see S. Wolf 'Introduction: Gender and Feminism in Bioethics' in S. Wolf (ed), Feminism and Bioethics: Beyond Reproduction (Oxford University Press 1996)
8. and R. Diprose, 'The Body Biomedical Ethics Forgets' in P. Komesaroff (ed), Troubled Bodies: Critical Perspectives on Postmodernism, Medical Ethics and the Body (Duke University Press 1995) at 203.
9. For notable exceptions, however, see Alison Young's analysis of forced Caesareans in 'Decapitation or Feticide: The Fetal Laws of the Universal Subject' (1993) 4 Women: A Cultural Review 288 and Jo Bridgeman's critique of the decision to forcibly treat an anorexic adolescent in 'Old Enough to Know Best?' (1993) 13 Legal Studies 69, which addresses explicitly the dramatic physical consequences of court-ordered interventions in the lives of these women.
10. Major textbooks in the field illustrate how medical ethics is assumed to be the primary conceptual framework for healthcare law. For a more detailed analysis, see J. Miola, Medical Ethics and Medical Law: A Symbiotic Relationship (Hart 2007). In its useful survey of the discipline, this monograph also exemplifies the dominance within healthcare law of the case study methodology.
11. See, for instance, T. Koch, 'Absent Virtues: The Poacher Becomes Gamekeeper' (2003) 29 Journal of Medical Ethics 337
12. J. Herring, Medical Law and Ethics (Oxford University Press 2006) at 19,
13. and Wolf, supra n.4.
14. E.g. L. Mulcahy, Disputing Doctors: The Socio-Legal Dynamics of Complaints about Doctors (Open University Press 2003)
15. M. Maclean, 'How Does an Inquiry Inquire? A Brief Note on the Working Methods of the Bristol Royal Infirmary Inquiry' (2001) 28 Journal of Law and Society 590.
16. C. Andrain, Public Health Policies and Social Inequality (Macmillan 1988)
17. D. Coburn, 'Income Inequality, Social Cohesion and the Health Status of Populations: The Role of Liberalism' (2000) 51 Social Science and Medicine 135.
18. E.g. S. Franklin, Embodied Progress: A Cultural Account of Assisted Conception (Routledge 1997)
19. M. Thomson, Endowed: Regulating the Male Sexed Body (Routledge-Cavendish 2007).
20. For examples of feminist legal work on embodiment, see J. Bridgeman and S. Millns (eds), Law and Body Politics (Routledge 1995)
21. P. Cheah, D. Fraser and J. Grbich (eds) Thinking Through the Body of Law (Allen & Unwin 1996)
22. N. Naffine and R. Owens (eds) Sexing the Subject of Law (Sweet & Maxwell 1997).
23. Bridgeman, supra n.5
24. P. Lewis, 'Feeding an Anorexic Patient Who Refuses Food' (1997) 7 Medical Law Review 21.
25. The embodied consequences of denying such choices may be seen in cases such as Diane Pretty - R (on the application of Pretty) v. DPP [2001] UKHL 61 condemned to die through motor neurone disease in the very way which she sought to avoid. See also n.5 and 73.
26. Re Y (Mental Patient: Bone Marrow Donation) [1997] 2 F.C.R. 172.
27. S. Sheldon and M. Thomson (eds), Feminist Perspectives on Healthcaer Law (Cavendish, 1998) at 8.
28. M. Freeman, 'Rethinking Gillick' (2005) 13 International Journal of Children's Rights 201.
29. M. Shildrick, Embodying the Monster: Encounters with the Vulnerable Self (Sage 2002) ch. 3.
30. K. Macintosh, Illegal Beings: Human Clones and the Law (Cambridge University Press 2005).
31. M. Fox, 'Exposing Harm: The Erasure of Animal Bodies in Healthcare Law' in S. McLean (ed), First Do No Harm: Law, Ethics and Healthcare (Ashgate 2006).
32. See also M. Brazier, 'Human(s) (as) Medicine(s)' in McLean ibid. at 196-200.
33. E. Jackson, Regulating Reproduction (Hart 2001) ch. 1.
34. N. Lacey, 'Theories of Justice and the Welfare State: A Feminist Critique' in Unspeakable Subjects: Feminist Essays in Legal and Social Theory (Hart 1998) at 46-70.
35. K. Fletcher, 'Reproductive Consumption' (2006) 7(1) Feminist Theory 27-48.
36. M. Fox and J. McHale, 'Introduction: Regulating Human Body Parts and Products', (2000) 8(2) Health Care Analysis 83
37. R. Gold, Body Parts: Property Rights and the Ownership of Human Biological Materials (Georaetown University Press 1996).
38. S. Wilkinson, Bodies for Sale: Ethics and Exploitation in the Human Body Trade (Routledge 2003).
39. E.g. M. Davies and N. Naffine, Are Persons Property? Legal Debates about Property and Personality (Ashgate 2001)
40. D. Morgan, 'Where Do I Own By Body? (And Why?)' in Issues in Medical Law and Ethics (Cavendish 2001)
41. J.W. Harris, 'Who Owns My Body?' (1996) 16 Oxford Journal of Legal Studies 65.
42. P. Matthews, 'The Mnn of Property' (1995) 3 Medical Law Review 251.
43. C Stychin, 'Body Talk: Rethinking Autonomy, Commodification and the Embodied Legal Self' in Sheldon and Thomson, supra, n. 15.
44. R. Rao, [Property, Privacy, and the Human Body' (2000) 80 Boston University Law Review 359.
45. Dobson v. North Tyneside Health Authority [1996] 4 All ER 474
46. R v. Kelly [1998] 3 All ER 714.
47. Parallel trends can be traced in policy recommendations - see Nuffield Council of Bioethics, Human Tissue: Ethical and Legal Issues, 1995, para. 9.5.
48. E.g. I. Kennedy and A. Grubb, Medical Law: Text and Materials 3rd edn (Butterworths 2000) at 1780
49. J.K. Mason, Human Life and Medical Practice (Edinburgh University Press 1988)
50. J. Robertson, In the Beginning: The Legal Status of Early Embryos (1990) 76 Virginia Law Review 437.
51. J. K. Mason and G.T. Laurie, 'Consent or Property: Dealing with the Body and Its Parts in the Shadow of Bristol and Alder Hey' (2001) 64 Modern Law Review 710 at 710.
52. R. Hardcastle, Law and the Human Body: Property Rights, Ownership and Control (Hart 2007).
53. R.P. Petchesky, 'The Body as Property: A Feminist Re-vision' in F.D. Ginsberg and R. Rapp (eds), Conceiving the New World Order (University of California Press 1995) at 387.
54. L.S. Underkuffler, The Idea of Property: Its Meaning and Power (OUP 2003): M. Davies, Property: Meanings, Histories, Theories (Routledge-Cavendish 2007).
55. Critics also point to the problematic gendering of the concept of self-ownership in liberal thought - see N. Naffine, 'The Legal Structure of Self-Ownership: Or the Self-Possessed Man and the Woman Possessed' (1998) 25 Journal of Law and Society 193.
56. Petchesky, supra n.35.
57. Davies, supra n.36, ch. 4.
58. For instance, Hegelian conceptions of property rooted in ideas of person-property connection have been invoked by feminist theorists, most influentially by Margaret Radin - see Reinterpreting Property (University of Chicago Press 1993).
59. See also D. Dickenson, Property in the Body: Feminist Perspectives (Cambrihe Universitv Press 2007), ch. 2.
60. A more pyschoanalytical account of property is espoused by J. Schroeder. 'The Vestal and the Fasces: Property and the Feminine in Law' (1995) 16 Cardozo Law Review 805.
61. M. Ford, 'A Property Model of Pregnancy' (2005) 1 International Journal of Law in Context 261.
62. J. Nedelsky, 'Property in Potential Life: A Relational Approach to Choosing Legal Categories' (1993) 6 Canadian Journal of Law and Jurisprudence 343.
63. D. Price, 'My view of the Sanctity of Life: A Re'sponse to John Keown's Critique' (2007) 27 Legal Studies 659.
64. E.g. J. Harris, The Value of Life (Routledge 1985).
65. See, further, N. Rose, The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century (Princeton University Press 2007) at 38.
66. 'Stem Cell Stories 1998-2008' (2008) Special Issue, Science as Culture 17(1)
67. S. Holland et al., The Human Embryonic Stem Cell Debate: Science, Ethics and Public Policy (MIT Press 2001).
68. C. Stychin, 'Body Talk: Rethinking Autonomy, Commodification and the Embodied Legal Selt' in Sheldon and Thomson, supra n. 15 at 211.
69. Inckle, supra n.4 at 97.
70. E. Grosz, Volatile Bodies: Towards a Corporeal Feminism (Indiana University Press 1994) at 13-14.
71. S. de Beauvoir, The Second Sex (Knopf 1953) at 295
72. see also A. Rich, Of Woman Born: Motherhood as Experience and Institution (Virago 1976).
73. See, for example, S. Firestone, The Dialectic of Sex: The Case for a Feminist Revolution (William Morrow 1970).
74. K. Davis, 'Reclaiming Women's Bodies: Colonialist Trope or Critical Epistemology' in C. Shilling (ed), Embodying Sociology (Blackewll 2007) at 53.
75. See further, C. Smart, 'The woman of Legal Discourse' (1992) 1 Social and Legal Studies 29-44
76. and J. Scott, 'Gender: A Useful Category of Historical Analysis' (1986) 91 American Historical Review 1053.
77. See L. McNay, Foucault and Feminism: Power, Gender and the Self (Northeastern University Press 1993)
78. and C. Jones and R. Porter (eds), Reassessing Foucault: Power, Medicine and the Body (Routledge 1994).
79. B. Brooks, Feminist Perspectives on the Body (Pearson Education Limited 1999) at 11.
80. Davis, supra n.52 at 53.
81. Grosz, supra n.49 at 17.
82. M. Evans and E. Lee (eds) Real Bodies: A Sociological Introduction (Palgrave 2002).
83. Grosz, supra n.49 at 20.
84. Evans and Lee, supra n.58 at 1.
85. See further, C. MacKenzie, 'Abortion and Embodiment' in S. Sherwin and B. Parish (eds), Women, Medicine, Ethics and the Law (Ashaate 2002)
86. B. Duden, Disembodying Women: Perspectives on Pregnancy and the Unborn (Harvard University Press 1993).
87. Sheldon an Thompson, supra n.15
88. A. Morris and S. Nott (eds), Well Women: The Genaerea Nature Healthcare Provision (Ashgate 2002).
89. E. Grabham et al., Intersectionality and Beyond: Law, Power and the Politics of Location (Routledge-Cavendish 2008) (forthcoming).
90. D. Roberts, Killing the Black Body: Race, Reproduction and the Meaning of Liberty (Pantheon 1997)
91. D. Roberts, 'Privatization and Punishment in the New Age of Reprogenics' (2005) 54 Emory Law Journal 1343
92. R. Fletcher, 'Reproducing Irishness: Race, Gender and Abortion Law' (2005) 17 Canadian Journal of Women and the Law 365
93. E. Grabham, 'Flaging the Skin: Corporeal Nationalism and the Properties of Belonging' (2008) Body and Society forthcoming).
94. R. Fletcher, 'Reproducing Irishness: Race, Gender and Abortion Law' (2005) 17 Canadian Journal of Women and the Law 365; E. Grabham, 'Flagging the Skin: Corporeal Nationalism and the Properties of Belonging' (2008) Body and Society (forthcoming).
95. R. Garland-Thomson, 'Integrating Disability, Transforming Feminist Theory' (2002) 14 National Women's Studies Association Journal 1
96. K. Keywood, 'Disabling sex - Some Legal Thinking about Sterilization, Learning Disability and Embodiment' in Morris and Nott, supra n.62
97. I. Karpin, 'Peeking Through the Eyes of the Body: Regulating the Bodies of Women with Disabilities' in M. Jones and L. Marks (eds), Disability, Diversability and Legal Change (Martinus Nijhoff 1999 at 283.
98. C. Daniels, Exposing Men (Oxford University Press 2006)
99. M. Fox and M. Thomson, 'Short Changed? The Law and Ethics of Male Circumcision' (2005) 13 International Journal of Children's Rights 161
100. S. Sheldon, 'Reconceiving Masculinity: Imagining Men's Reproductive Bodies in Law' (1999) 26 Journal of Law and Society 129
101. Thomson, supra n.10.
102. Shildrick, supra n.17.
103. See, generally, S. Kruks, Retrieving Experience. Subjectivity and Recognition in Feminist Politics (Cornell University Press 2001)
104. S. Stone-Mediatore, 'Chandra Mohanty and the Revaluing of "Experience"' (1998) 13 Hypatia 116.
105. N. Crossley, The Social Body: Habit, Identity and Desire (Sage 2001) at 2-3; see also Inckle, supra n.4.
106. See S. Elliston, The Best Interests of the Child in Healthcare (Routledge-Cavendish 2007).
107. P. Fennell, Treatment without Consent (Routledge 1996). 72 S.27(4) Human Tissue Act 2004.
108. H. Biggs, 'A Pretty Fine Line: Life, Death, Autonomy and Letting It B' (2003) 11 Feminist Legal Studies 291 at 299.
109. K. O'Donovan and R. Gilbar, 'The Loved Ones: Families, Intimates and Patient Autonomy' (2003) 23 Legal Studies 332 at 333.
110. K. Weston, Families We Choose: Lesbians, Gays, Kinship (Columbia University Press 1997/1991).
111. Mental Capacity Act 2005, ss.9, 24-26.
112. It thus has some similarities to the notion of 'intrinsic value' employed in bioethics - see J. Glover, Causing Death and Saving Lives (Penguin 1977) at 45-50; but also has the potential to move debates beyond the intrinsic/instrumental binary.
113. See further, M. O'Brien, The Politics of Reproduction (Routledge & Kegan Paul 1981)
114. S. Gill and I. Bakker, 'New Constitutionalism and the Social Reproduction of Caring Institutions' (2006) 27 Theoretical Medicine and Bioethics 35.
115. Department of Health, A Code of Practice for the Diagnosis of Brain Stem Death (1998); Working Party of the Academy of the Royal Medical Colleges and the English Department of Health, Draft Revised Code of Practice for the Diagnosis and Verification of Death, May 2006. http://www.aomrc.org.uk/aomrc/admin/news/docs/ Section1DraftforConsultation14.05.06.pdf (accessed on 10 June 2008).
116. At common law, see Re A (a minor) [1992] 3 Med. L.R. 303; Re TC (a minor) [1994] 2 Med. L.R. 376.
117. Concerns surface periodically about legal definitions of death, most recently with media reports that patients in five English hospitals have been incorrectly diagnosed as dead in the past five years - see 'Patients wrongly certified dead' BBC news, 25 May 2008. http://news.bbc.co.uk/1/hi/uk/7419652.stm (accessed on 10 June 2008). Such stories seem to tap into deep-rooted concerns about the meaning of death and what it is to be embodied.
118. See also the recent government proposal to forego the current tests to establish brain stem death - L. Rogers, 'Brain-death test dropped to boost organ donation' Sunday Times 29 June 2008.
119. Nuffield Council on Bioethics, Critical Care Decisions in Fetal and Neonatal Medicine: Ethical Issues (November 2006) http://www.nuffieldbioethics.org/go/ourwork/neonatal/ publication_406.html
120. Rance v. Mid-Downs HA [1991] 1 All ER 1230.
121. Jackson, supra n.21.
122. N. Priaulx, The Harm Paradox: Tort Law and the Unwanted Child in an Era of Choice (Routledge-Cavendish 2007).
123. S. Sheldon, Beyond Control: Medical Power and Abortion Law (Pluto 1997).
124. S. Franklin, Dolly Mixtures: The Remaking of Genealogy (Duke University Press 2007).
125. See S. Franklin, 'Embryonic Economies: The Double Reproductive Value of Stem Cells' (2006) 1 BioSocieties 71.
126. See H. Landecker, Culturing Life: How Cells became Technologies (Harvard University Press 2007).
127. J. Herring, 'Giving, Selling and Sharing Bodies' in A. Bainham et al., Body Lore and Laws (Hart 2002) at 55.
128. Human Tissue 2004 s.53; such a distinction seems likely to be rejected in the new Human Fertilisation and Embryology Act.
129. Human Tissue Authority, Code of Practice, 'Donation of Organs, Tissues and Cells for Transplantation' (Code 2, July 2006) paras 10-14.
130. For instance, the values we attribute to organs and retention of body parts have been a key factor historically in prompting legislative reform.
131. L. Birke, 'The Broken Heart' in M. Shildrick and J. Price (eds), Vital Signs: Feminist Reconfigurations of the Bio/logical Body (Edinburgh University Press 1998) at 197. The brain may also be invested with particular symbolic significance.
132. Ibid. at 207.
133. C.Waldby and R. Mitchell, Tissue Economies: Blood, Organs and Cell Lines in Late Capitalism (Duke University Press 2006) at 38.
134. See also M. Dixon-Woods et al., 'Human Tissue and 'the Public': The Case of Childhood Cancer Tumour Banking', (2008) 3 Biosocieties 57
135. and N. Machado, Using the Bodies of the Dead (Dartmouth 1998).
136. Cultural and religious arguments pertaining to bodily interventions or how body parts may be used may be more likely to be constructed as symbolic arguments - which can lead to them being downplayed - see the debate between Harris and Brazier on this issue - J. Harris, 'Law and Regulation of Retained Organs: The Ethical Issues' (2002) 22 Legal Studies, 527
137. and M. Brazier, 'Retained Organs: Ethics and Humanity' (2002) 22 Legal Studies 550.
138. M. Parker, 'The Best Possible Child' (2007) 33 Journal of Medical Ethics 279-283.
139. C. Novas and N. Rose 'Genetic Risk and the Birth of the Somatic Individual' (2000) 29 Economy and Society 485 at 487.
140. They are concerned particularly with the creation of the subject 'genetically at risk' but developments such as biobanks may also foster this vision of the body - see Dickenson, supra n.40, ch. 6.
141. As these authors document, a number of private firms now offer cryopreservation facilities for parents who wish to sort their child's cord blood for future use in order to avoid the vagaries of public-cord-blood matching procedures - see Waldby and Mitchell, supra n.94, ch. 4.
142. Ibid. at 129.
143. They point to its therapeutic value in replacing transplanted bone marrow as a treatment for blood disorders, although note that the new valuation of the umbilical cord is in fact more accurately categorised as a transformation in value - ibid. at 114.
144. Ibid. at 120.
145. Dickenson, supra n.40 at 86. She argues that the labour expended by the pregnant woman should accord her property rights in the umbilical cord and, consequently, it was wrong to regard such tissue as ever having been mere waste that had been abandoned, notwithstanding influential legal views to the contrary.
146. Increasing controversy over the practice of cord blood banking has recently seen the issuance of new rules on cord blood collection under the EU Tissue and Cells Directive and Human Tissue (Quality and Safety for Human Application) Regulations which subject it the practice to the jurisdiction of the Human Tissue Authority - see HTA Press release 'New Rules for Cord Blood Collection', 30 April 2008.
147. J. Farquhar and M. Lock, 'Introduction', in J. Farquhar and M. Lock (eds), Beyond the Body Proper: Reading the Anthropology of Material Life (Duke University Press 2007) at 2.
148. M. Shildrick, 'Beyond the Body of Bioethics: Challenging the Conventions' in Shildrick and Mykitiuk, supra n.4 at 17.