Going out on a limb: prosthetics, normalcy and disputing the therapy/enhancement distinction

Unfreedom or Mere Inability? The Case of Biomedical Enhancement

Mere inability, which refers to what persons are naturally unable to do, is traditionally thought to be distinct from unfreedom, which is a social type of constraint. The advent of biomedical enhancement, however, challenges the idea that there is a clear division between mere inability and unfreedom. This is because bioenhancement makes it possible for some people's mere inabilities to become matters of unfreedom. In this paper, I discuss several ways that this might occur: first, bioenhancement can exacerbate social pressures to enhance one's abilities; second, people may face discrimination for not enhancing; third, the new abilities made possible due to bioenhancement may be accompanied by new inabilities for the enhanced and unenhanced; and finally, shifting values around abilities and inabilities due to bioenhancement may reinforce a pre-existing ableism about human abilities. As such, we must give careful consideration to these potential unfreedom-generating outcomes when it comes to our moral evaluations of bioenhancement.

Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

BACKGROUND

Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.

METHODS

We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.

FINDINGS

This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.

CONCLUSION

We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

Reframing the Australian Medico-Legal Model of Infertility

Australian law affirms a binary construction of fertility/infertility. This model is based upon the medical categorization of infertility as a disease. Law supports medicine in prioritizing technology, such as in vitro fertilization, as treatment for infertility. This prioritization of a medico-legal model of infertility in turn marginalizes alternative means of family creation such as adoption, fostering, traditional surrogacy, and childlessness. This paper argues that this binary model masks the impact of medicalization upon reproductive choice and limits opportunity for infertile individuals to create families. While medical technology should be available to enhance reproductive opportunity, infertile individuals will benefit from regulatory change which disentangles the medico-legal construct of infertility as a disease from the desire to create a family. This paper suggests that the medico-legal model of infertility should be reframed to support all opportunities for family creation equally, including non-medical opportunities such as adoption, fostering, and childlessness.

Marketing the Prosthesis: Supercrip and Superhuman Narratives in Contemporary Cultural Representations

This paper examines prosthetic technology in the context of posthumanism and disability studies. The following research discusses the posthuman subject in contemporary times, focusing on prosthetic applications to deliberate how the disabled body is empowered through prosthetic enhancement and cultural representations. The disability market both intersects and transcends race, religion, and gender; the promise of technology bettering the human condition is its ultimate product. Bionic technology, in particular, is a burgeoning field; our engineering skills already show promise of a future where physical impediment will be almost obsolete. I aim to cross-examine empowering marketing images and phrases embedded in cinema and media that emphasize how disability becomes super-ability with prosthetic enhancement. Though the benefits of biotechnology are most empowering to the disabled population, further scrutiny raises a number of paradoxical questions exposed by the market’s advance. With all these tools at our disposal, why is it that the disabled have yet to reap the rewards? How are disabled bodies, biotechnology, and posthuman possibilities commodified and commercialized? Most importantly, what impact will this have on our society? This paper exemplifies empowering and inclusive messages emphasized in disabled representation, as well as raising bioethical concerns that fuel the ongoing debate of the technological haves and have-nots. Furthermore, this paper challenges the ideals of normative bodies while depicting the disabled as an open, embodied site where technology, corporeality, and sociology interact. To conclude, I believe that an interdisciplinary approach that balances the debate between scientific advance, capital gain, and social equality is essential to embracing diverse forms of embodiment.

Disabled or Cyborg? How Bionics Affect Stereotypes Toward People With Physical Disabilities

According to the Stereotype Content Model that construes attributions of warmth and competence as the core dimensions of stereotypes, people with physical disabilities are generally perceived as warm-but-incompetent, i.e., are faced with paternalistic stereotypes. We argue that the increasing proliferation of bionic technologies (e.g., bionic arm and leg prostheses, exo-skeletons, retina implants, etc.) has the potential to change stereotypes toward people with physical disabilities: The portrayal of people who use such devices in the media and popular culture is typically characterized by portraying them as competent - sometimes even more competent than able-bodied individuals. We thus propose that people with physical disabilities who use bionic prostheses are perceived as more competent than people with physical disabilities in general. We also propose that they can be seen as more competent than able-bodied individuals. We further propose that this increase in perceived competence may be associated with a decrease in warmth such that people who use bionic prostheses are perceived as less warm than people with physical disabilities in general and as able-bodied people. Based on labeling theory, we also propose that using the label "cyborg" for people who use bionic prostheses exacerbates these effects and that they are driven by the technicality of the bionic devices. The first of two online studies (n = 314) revealed mixed support for the hypotheses: People with physical disabilities who use bionic prostheses are seen as more competent than people with physical disabilities in general, but not as more competent than able-bodied individuals. They are perceived as even warmer than able-bodied individuals. On the contrary, cyborgs were perceived as competent-but cold, i.e., as threatening. With the second study (n = 87), we tested whether the perceived technicality of bionic technology drives some of the observed effects. Technicality only had marginal effects on competence perceptions and no effects on perceptions of warmth. We discuss potential implications and highlight that despite being somewhat mixed, these findings show that technology can affect stereotypes and interpersonal perceptions.

Does workforce regulation have the intended effect? The case of Chinese medicine practitioner registration

The Chinese Medicine Registration Act was passed through Victorian parliament in 2000, based on policy research that suggested the need for statutory registration as a means for protecting public health and safety. This paper reports on the implementation and the effect of this policy. By examining registration, complaints and prosecution data from the Chinese Medicine Registration Board as well as comparing the complaints data between 2003 and 2007 across all Victorian registration boards, this paper considers the extent to which the policy research and the policy intent were justified. Based on the experience of the Chinese Medicine Registration Board, the paper points to issues that should be further considered as Chinese medicine moves into the national registration scheme in July 2012.