Controle e saúde mental: o governo do mal-estar contemporâneo / Control and mental health: the government of contemporary unease / Control y salud mental: el gobierno del malestar contemporáneo

O objetivo deste trabalho é demonstrar como o regime de afetos do capitalismo, impulsionado pelos ditames do governo neoliberal dos corpos, avança sua influência para além da órbita econômica, atuando diretamente no processo de construção das subjetividades contemporâneas. Logo, serão analisados quais são os impactos desta "nova razão do mundo" na vida e no psiquismo das pessoas, principalmente no que diz respeito às categorias psicopatológicas inerentes a ela. Por fim, utilizando-se a técnica de pesquisa da documentação indireta, será realizada uma revisão bibliográfica de cunho interdisciplinar, que busca desvendar a problemática apresentada de forma crítica, exemplificando como a psiquiatria reprogramou sua atividade de controle para atender às demandas do mal-estar atual, centralizando-se na medicalização em larga escala da sociedade. (AU)

The objective of this work is to demonstrate how the regime of affections of capitalism, driven by the dictates of the neoliberal government of bodies, advances its influence beyond the economic orbit, acting directly in the process of construction of contemporary subjectivities. Therefore, it will be analyzed what arethe impactsof this "new reason ofthe world" on people's lifeand psyche, especially with regard to the psychopathological categories inherent to it. Finally, using there search technique of indirect documentation, an interdisciplinary bibliographic review will be carried out,which seeks to uncover the problem presented in a critical way, exemplifying how psychiatry reprogrammed its control activity to meet the demands of thecurrent malaise, centeringon the large-scale medicalization of society. (AU)

El objetivo de este trabajo es demostrar cómo el régimen de afectos del capitalismo, impulsado por los dictados del gobierno neoliberal de los cuerpos, avanza su influencia más allá de la órbita económica, actuando directamente en el proceso de construcción de las subjetividades contemporáneas. Por lo tanto, se analizarán cuáles son los impactos de esta "nueva razón del mundo" en la vida y la psique de las personas, especialmente con respecto a las categorías psicopatológicas inherentes a ella. Finalmente, utilizando la técnica de investigación de documentación indirecta, se llevará a cabo una revisión bibliográfica interdisciplinaria, que busca descubrir el problema presentado de manera crítica, ejemplificando cómo la psiquiatría reprogramó su actividad de control para satisfacer las demandas del malestar actual, centrándose en la medicalización a gran escala de la sociedade. (AU)

Ações de humanização das enfermeiras obstétricas mineiras: resistência e contraconduta à medicalização do parto / Humanization actions of the obstetric nurses from minas gerais: resistance and counter-conduct to the medicalization of childbirth / Acciones de humanización de las enfermeras obstétricas de minas gerais: resistencia y contraconducta a la medicalización del parto

Objetivo: discutir as ações de enfermeiras obstétricas e seu potencial de resistência e contraconduta à medicalização da assistência ao parto. Método: pesquisa descritiva e exploratória, de abordagem qualitativa e fundamentação genealógica. A coleta dos dados foi feita, por meio de entrevistas semiestruturadas, junto a 11 enfermeiras obstétricas. Os dados foram analisados pela técnica de Análise de Discurso. Resultados: as ações de humanização das primeiras enfermeiras obstétricas se conformaram como resistência e contraconduta à medicalização do parto, uma vez que eram pautadas no enfrentamento das práticas médicas intervencionistas, na defesa da fisiologia do parto e na integralidade do cuidado. Conclusão: reconhece-se que, no cotidiano da prática profissional, enfermeiras obstétricas precisam adotar ações de resistência e contraconduta como tentativa de subversão do paradigma biomédico, o qual impõe a medicalização da assistência e a apropriação do corpo feminino, cerceando a autonomia das mulheres no processo de parturição.(AU)

Objective: to analyze the practices of humanization in childbirth care, developed by nurse midwives, capable of constituting actions of resistance and counter-conduct to the medicalization of the female body. Method: this is a descriptive and exploratory research, with a qualitative approach and genealogical inspiration. The research was developed in the context of hospital care. Research data were produced through semi-structured interviews with 11 nurse midwives and submitted to Discourse Analysis. Results: the actions of the first obstetric nurses conformed as resistance and counter-conduct to the medicalization of childbirth, as they were based on confronting interventionist medical practices, defending the physiology of childbirth, and providing comprehensive care. Conclusion: it is recognized that, in their daily professional practice, obstetric nurses need to adopt resistance and counter-conduct actions capable of going beyond the concept of the body under the biomedical paradigm.(AU)

Objetivo: analizar las prácticas de humanización de las enfermeras obstétricas, caracterizadas como acciones de resistencia y contraconducta a la medicalización del cuerpo femenino. Método: investigación descriptiva y exploratoria, con enfoque cualitativo e inspiración genealógica, desarrollada en el contexto de la atención hospitalaria. Los datos de la investigación se produjeron a través de entrevistas semiestructuradas con 11 enfermeras parteras y se sometieron al Análisis del Discurso. Resultados: las acciones de las primeras enfermeras obstétricas se conformaron como resistencia y contracultura a la medicalización del parto, ya que se basaban en enfrentar las prácticas médicas intervencionistas, defender la fisiología del parto y brindar cuidado integral. Conclusión: se reconoce que, en la práctica profesional diaria, las enfermeras obstétricas necesitan adoptar acciones de resistencia y contraconducta para superar el concepto de cuerpo bajo el paradigma biomédico.(AU)

Prevenção quaternária e medicalização: conceitos inseparáveis / Prevención cuaternaria y medicalización: conceptos inseparables / Quaternary prevention and medicalisation: inseparable concepts

Prevenção Quaternária (P4) é a ação de identificar pacientes em risco de sobremedicalização, para protegê-los de novas invasões médicas e sugerir-lhes intervenções eticamente aceitáveis. Recentemente, três artigos europeus propuseram uma nova definição: "proteger indivíduos de intervenções mais danosas que benéficas". O objetivo é discutir criticamente essa proposta. Sete críticas à definição original foram identificadas e analisadas. Cinco são improcedentes: (1) Eticamente vaga; (2) Escopo restrito; (3) Cria etapa desnecessária; (4) Focalização na medicalização; (5) Desmedicalização sem base científica. As remanescentes não justificam uma nova definição: (6) Mudança na representação visual; (7) Foco na Medicina Baseada em Evidências (MBE). A nova proposta reduz o escopo da P4 e o protagonismo do profissional. A definição original é robusta e desafia a evitar a iatrogenia social/cultural decorrente da sobremedicalização, parcialmente inapreensível via MBE. (AU)

Prevención Cuaternaria (P4) es la acción de identificar pacientes en riesgo de sobremedicalización, para protegerlos de nuevas invasiones médicas y sugerirles intervenciones éticamente aceptables. Recientemente, tres artículos europeos propusieron una nueva definición: "proteger a los individuos de intervenciones más dañosas que benéficas". El objetivo es discutir críticamente esa propuesta. Se identificaron y analizaron siete críticas a la definición original. Cinco son improcedentes: (1) Éticamente vaga; (2) Alcance restringido; (3) Crea etapa innecesaria; (4) Enfoque en la medicalización; (5) Desmedicalización sin base científica. Las restantes no justifican una nueva definición: (6) Cambio en la representación visual; (7) Enfoque en la Medicina Basada en Evidencias (MBE). La nueva propuesta reduce el alcance de la P4 y el protagonismo del profesional. La definición original es robusta y desafía la iatrogenia social/cultural proveniente de la sobremedicalización, parcialmente inalcanzable vía la MBE. (AU)

Quaternary Prevention (P4) is an action taken to identify patients at risk of overmedicalisation, to protect them from new medical invasions, and to suggest interventions ethically acceptable. Recently, three European articles have proposed a new definition: "to protect individuals from more harmful than beneficial interventions". The objective is to discuss this proposal critically. We have identified and analysed seven criticisms to P4 original definition. Five are unfounded: (1) Ethically vague; (2) Restricted scope; (3) Creation of an unnecessary step; (4) Focus on medicalisation; (5) Demedicalisation non-scientific based. The remaining two do not justify a new definition: (6) Changing visual representation; (7) Centeredness on Evidence-Based Medicine (EBM). The new proposal reduces the scope of P4 and the professional role. The original definition is robust and incorporates the challenge of social/cultural iatrogeny resulting from overmedicalisation, partially unattainable via EBM. (AU)

Medicalización de la vida y daño poblacional: revisión bibliográfica no sistematizada / Medicalization of life and population damage: non-systematic bibliographic review

La práctica de la medicina se encuentra atravesando una crisis, en la cual muchas de las prácticas médicas que se realizan son de poco valor y con frecuencia generan daño a las personas. Se presenta una revisión bibliográfica no sistematizada en la que se analizan en conjunto los diversos factores que contribuyen al desarrollo de excesos médicos y a los daños que estos generan. Consideramos que su conocimiento puede contribuir a mejorar la calidad de los cuidados que se ofrecen a nuestros pacientes. (AU)

The practice of medicine is going through a crisis, in which many of the medical practices that are carried out are of little value and often cause harm to people. An unsystematic bibliographic review is presented in which various factors that contribute to the development of medical excesses are analyzed. Their knowledge can contribute to improving the quality of medical care offered to our patients. (AU)

Medicalization of female genital cutting in Malaysia: A mixed methods study.

BACKGROUND: Despite the clear stand taken by the United Nations (UN) and other international bodies in ensuring that female genital cutting (FGC) is not performed by health professionals, the rate of medicalization has not reduced. The current study aimed to determine the extent of medicalization of FGC among doctors in Malaysia, who the doctors were who practiced it, how and what was practiced, and the motivations for the practice. METHODS AND FINDINGS: This mixed method (qualitative and quantitative) study was conducted from 2018 to 2019 using a self-administered questionnaire among Muslim medical doctors from 2 main medical associations with a large number of Muslim members from all over Malaysia who attended their annual conference. For those doctors who did not attend the conference, the questionnaire was posted to them. Association A had 510 members, 64 male Muslim doctors and 333 female Muslim doctors. Association B only had Muslim doctors; 3,088 were female, and 1,323 were male. In total, 894 questionnaires were distributed either by hand or by post, and 366 completed questionnaires were received back. For the qualitative part of the study, a snowball sampling method was used, and 24 in-depth interviews were conducted using a semi-structured questionnaire, until data reached saturation. Quantitative data were analysed using SPSS version 18 (IBM, Armonk, NY). A chi-squared test and binary logistic regression were performed. The qualitative data were transcribed manually, organized, coded, and recoded using NVivo version 12. The clustered codes were elicited as common themes. Most of the respondents were women, had medical degrees from Malaysia, and had a postgraduate degree in Family Medicine. The median age was 42. Most were working with the Ministry of Health (MoH) Malaysia, and in a clinic located in an urban location. The prevalence of Muslim doctors practising FGC was 20.5% (95% CI 16.6-24.9). The main reason cited for practising FGC was religious obligation. Qualitative findings too showed that religion was a strong motivating factor for the practice and its continuation, besides culture and harm reduction. Although most Muslim doctors performed type IV FGC, there were a substantial number performing type I. Respondents who were women (adjusted odds ratio [aOR] 4.4, 95% CI 1.9-10.0. P ≤ 0.001), who owned a clinic (aOR 30.7, 95% CI 12.0-78.4. P ≤ 0.001) or jointly owned a clinic (aOR 7.61, 95% CI 3.2-18.1. P ≤ 0.001), who thought that FGC was legal in Malaysia (aOR 2.09, 95% CI 1.02-4.3. P = 0.04), and who were encouraged in religion (aOR 2.25, 95% CI 3.2-18.1. P = 0.036) and thought that FGC should continue (aOR 3.54, 95% CI 1.25-10.04. P = 0.017) were more likely to practice FGC. The main limitations of the study were the small sample size and low response rate. CONCLUSIONS: In this study, we found that many of the Muslim doctors were unaware of the legal and international stand against FGC, and many wanted the practice to continue. It is a concern that type IV FGC carried out by traditional midwives may be supplanted and exacerbated by type I FGC performed by doctors, calling for strong and urgent action by the Malaysian medical authorities.

Is ugliness a pathology? An ethical critique of the therapeuticalization of cosmetic surgery.

Pathologizing ugliness refers to the framing of unattractive features as a type of disease or deformity. By framing ugliness as pathology, cosmetic procedures are reframed as therapy rather than enhancement, thereby potentially avoiding ethical critiques regularly levelled against cosmetic surgery. As such, the practice of pathologizing ugliness and the ensuing therapeuticalization of cosmetic procedures require an ethical analysis that goes beyond that offered by current enhancement critiques. In this article, I propose using a thick description of the goals of medicine as an ethical framework for evaluating problematic medical practices. I first describe the goals of medicine based on Daniel Callahan's account. I then propose that the goals work best in conjunction with ancillary ethical concepts, namely medical knowledge and skills, standards of practice and medical duties and virtues. Next, I apply the thick description of the goals of medicine in critiquing the practice of framing ugliness as disease. Here, I demonstrate ethical conflicts between aesthetic judgments that underpin the practice of pathologizing ugliness and medical judgments that inform ethical medical practices. In particular, the thick description of the goals of medicine helps reveal ethical conflicts in at least three key domains common to clinical practices, which include (a) disease determination, (b) diagnostic evaluation and (c) establishing clinical indications. My analysis offers a novel way of critiquing the practice of pathologizing ugliness in cosmetic surgery, which tends to be neglected by enhancement critiques.

Procreation machines: Ectogenesis as reproductive enhancement, proper medicine or a step towards posthumanism?

Full ectogenesis as the complete externalization of human reproduction by bypassing the bodily processes of gestation and childbirth can be considered the culmination of genetic and reproductive technologies. Despite its still being a hypothetical scenario, it has been discussed for decades as the ultimate means to liberate women from their reproductive tasks in society and hence finally end fundamental gender injustices generally. In the debate about the application of artificial wombs to achieve gender equality, one aspect is barely mentioned but is of crucial relevance from a medical-ethical perspective: whether and how could full ectogenesis be justified as a proper use of medicine? After characterizing the technology as a special form of human enhancement and as an extension of medical practice that goes beyond the traditional field of medicine, this paper critically assesses the theoretical possibilities of legitimizing this extension. We identify two ways of justification: either one argues that ectogenesis fulfils a proper goal of medicine (a justification we call pathologization), or one argues that the application of ectogenesis achieves a non-medical goal (which we call medicalization). Because it is important from a medical-ethical point of view to avoid an inappropriate instrumentalization or misuse of medicine and thus an undue medicalization of non-medical problems, a set of necessary conditions has to be met. It is doubtful whether full ectogenesis for non-medical purposes could fulfil these conditions. Rather, its comprehensive usage could be seen as a revolutionary modification of what it means to be human.

How sociophenomenology of the body problematises the 'problem-oriented approach' to growth hormone treatment.

This article examines how people who are shorter than average make sense of their lived experience of embodiment. It offers a sociophenomenological analysis of 10 semistructured interviews conducted in the Netherlands, focusing on if, how, and why height matters to them. It draws theoretically on phenomenological discussions of lived and objective space, intercorporeality and norms about bodies. The analysis shows that height as a lived phenomenon (1) is active engagement in space, (2) coshapes habituated ways of behaving and (3) is shaped by gendered norms and beliefs about height. Based on this analysis, the article challenges what we label as the 'problem-oriented approach' to discussions about growth hormone treatment for children with idiopathic short stature. In this approach, possible psychosocial disadvantages or problems of short stature and quantifiable height become central to the ethical evaluation of growth hormone treatment at the expense of first-hand lived experiences of short stature and height as a lived phenomenon. Based on our sociophenomenological analysis, this paper argues that the rationale for giving growth hormone treatment should combine medical and psychological assessments with investigations of lived experiences of the child. Such an approach would allow considerations not only of possible risks or disadvantages of short stature but also of the actual ways in which the child makes sense of her or his height.

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.

A medicalização da morte e os cuidados paliativos / Medicalization of death and palliative care / La medicalización de la muerte y los cuidados paliativos

Objetivo: refletir sobre o processo histórico da medicalização da morte e como os cuidados paliativos podem modificar esse cenário. Conteúdo: o ponto de partida é a discussão de como ocorreu, ao longo dos séculos, o processo de medicalização da sociedade e da morte. É analisada a proposta dos cuidados paliativos, destacando como essa abordagem pode promover a desmedicalização do processo de morte. Conclusão: a medicalização da morte é um processo que se consolidou ao longo dos séculos, ganhando força através do modelo hospitalocêntrico de atenção à saúde. Por outro lado, a proposta dos cuidados paliativos se apresenta como uma possibilidade de mudança de paradigma na convivência com uma doença ameaçadora da vida e frente ao processo de morte, uma vez que seu propósito é melhorar a qualidade de vida do indivíduo de acordo com as suas prioridades, valorizando a sua autonomia. O cuidado paliativo pode ser promotor da desmedicalização da morte.

Objective: to reflect on the historical process of the medicalization of death, and on how palliative care can modify this scenario. Content: the starting point was the discussion of how the process of medicalization of society and death has occurred over the centuries, then to examine the palliative care proposal, and discuss how this approach can promote the demedicalization of dying. Conclusion: the medicalization of death, a process that has become established over the centuries, gained strength through the hospital-centered model of health care. On the other hand, the palliative care proposal offers the possibility of a paradigm shift towards coexisting with life-threatening diseases and the process of dying, because its aim is to improve individuals' quality of life according to their own priorities by favoring their autonomy. Palliative care can thus promote the de-medicalization of death.

Objetivo: reflexionar sobre el proceso histórico de la medicalización de la muerte y cómo los cuidados paliativos pueden modificar ese escenario. Contenido: el punto de partida es la discusión de cómo ocurrió, a lo largo de los siglos, el proceso de medicalización de la sociedad y de la muerte. Se analiza la propuesta de los cuidados paliativos, poniendo en relieve cómo ese enfoque puede promover la desmedicalización del proceso de muerte. Conclusión: la medicalización de la muerte es un proceso que se ha consolidado a lo largo de los siglos, ganando fuerza a través del modelo hospitalocéntrico de atención a la salud. Por otro lado, la propuesta de los cuidados paliativos se presenta como una posibilidad de cambio de paradigma en la convivencia con una enfermedad amenazadora de la vida y ante el proceso de muerte, una vez que su objetivo es mejorar la calidad de vida del individuo de acuerdo con sus prioridades, valorando su autonomía. El cuidado paliativo puede ser promotor de la desmedicalización de la muerte.

Not Sick: Liberal, Trans, and Crip Feminist Critiques of Medicalization.

Medicalization occurs when an aspect of embodied humanity is scrutinized by the medical industry, claimed as pathological, and subsumed under medical intervention. Numerous critiques of medicalization appear in academic literature, often put forth by bioethicists who use a variety of "lenses" to make their case. Feminist critiques of medicalization raise the concerns of the politically disenfranchised, thus seeking to protect women-particularly natal sex women-from medical exploitation. This article will focus on three feminist critiques of medicalization, which offer an alternative narrative of sickness and health. I will first briefly describe the philosophical origins of medicalization. Then, I will present three feminist critiques of medicalization. Liberal feminism, trans feminism, and crip feminism tend to regard Western medicine with a hermeneutics of suspicion and draw out potential harms of medicalization of reproductive sexuality, gender, and disability, respectively. While neither these branches of feminism-nor their critiques-are homogenous, they provide much-needed commentaries on phallocentric medicine. I will conclude the paper by arguing for the continual need for feminist critiques of medicalization, using uterus transplantation as a relevant case study.

How to distinguish medicalization from over-medicalization?

Is medicalization always harmful? When does medicine overstep its proper boundaries? The aim of this article is to outline the pragmatic criteria for distinguishing between medicalization and over-medicalization. The consequences of considering a phenomenon to be a medical problem may take radically different forms depending on whether the problem in question is correctly or incorrectly perceived as a medical issue. Neither indiscriminate acceptance of medicalization of subsequent areas of human existence, nor criticizing new medicalization cases just because they are medicalization can be justified. The article: (i) identifies various consequences of both well-founded medicalization and over-medicalization; (ii) demonstrates that the issue of defining appropriate limits of medicine cannot be solved by creating an optimum model of health; (iii) proposes four guiding questions to help distinguish medicalization from over-medicalization. The article should foster a normative analysis of the phenomenon of medicalization and contribute to the bioethical reflection on the boundaries of medicine.

Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability.

Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.

How Do Medicalization and Rescue Fantasy Prevent Healthy Dying?

Before antibiotics, cardiopulmonary resuscitation (CPR), and life-sustaining technologies, humans had little choice about the timing and manner of their deaths. Today, the medicalization of death has enabled patients to delay death, prolonging their living and dying. New technology, the influence of the media, and medical professionals themselves have together transformed dying from a natural part of the human experience into a medical crisis from which a patient must be rescued, often through the aggressive extension of life or through its premature termination. In this paper, we examine problematic forms of rescue medicine and suggest the need to rethink medicalized dying within the context of medicine's orientation to health and wholeness.

Michel Foucault and the Problematics of Power: Theorizing DTCA and Medicalized Subjectivity.

This article explores Foucault's two different notions of power: one where the subject is constituted by power-knowledge relations and another that emphasizes how power is a central feature of human action. By drawing out these two conceptualizations of power, Foucault's work contributes three critical points to the formation of medicalized subjectivities: (1) the issue of medicalization needs to be discussed both in terms of both specific practices and holistically (within the carceral archipelago); (2) we need to think how we as human beings are "disciplined" and "subjectivated" through medicalization, as discourses, practices, and institutions are all crystallizations of power relations; and (3) we need to reflect on how we can "resist" this process of subjectification, since "power comes from below" and patients shape themselves through "technologies of the self." Ultimately, Foucault's work does not merely assist us in refining our analysis; rather, it is essential for conceptualizing medicalization in contemporary society.

Aspectos éticos implicados en la medicalización de las personas trasn en la infancia y adolescencia / Ethical aspects involved in the medicalization of trans people in childhood and adolescence

El término 'trans' engloba a todas las personas que se identifican con un género diferente al asignado al nacer o que expresan su identidad de género de una manera no normativa (transexuales, transgéneros, genderqueers). En estas personas se evidencia una relación entre el malestar experimentado y el rechazo social sufrido con la intención clara de que se adecúen a las normas de género vigentes. Este aspecto no ha sido tenido en cuenta en la perspectiva médica que ha mantenido actitudes patologizantes. Desde una aproximación ética, planteo un enfoque despatologizador de las personas trans y un análisis tanto de las respuestas médicas (diagnosticas y terapéuticas) como de las respuestas sociales

The term 'trans' encompasses all people who identify with a gender different than that assigned at birth, or who express their gender identity in a non-normative manner (transsexuals, transgender, genderqueers). For these people, a relationship between the discomfort experienced and the social rejection suffered is evident from the clear intention of adapting to current gender norms. This aspect has not yet been taken into account from a medical perspective that maintains pathological attitudes. From an ethical perspective, I propose a depathologizing approach to trans people and an analysis of both medical (diagnostic and therapeutic) and social responses

Medicalising short children with growth hormone? Ethical considerations of the underlying sociocultural aspects.

In 2003, the Food and Drug Administration approved the use of growth hormone treatment for idiopathic short stature children, i.e. children shorter than average due to an unknown medical cause. Given the absence of any pathological conditions, this decision has been contested as a case of medicalisation. The aim of this paper is to broaden the debate over the reasons for and against the treatment, to include considerations of the sociocultural phenomenon of the medicalisation of short stature, by means of a critical understanding of the concept of medicalisation. After defining my understanding of medicalisation and describing both the treatment and the condition of idiopathic short stature, I will problematise two fundamental issues: the medical/non-medical distinction and the debate about the goals of medicine. I will analyse them, combining perspectives of bioethics, medical sociology, philosophy of medicine and medical literature, and I will suggest that there are different levels of normativity of medicalisation. Ultimately, this study shows that: (1) the definition of idiopathic short stature, focusing only on actual height measurement, does not provide enough information to assess the need for treatment or not; (2) the analysis of the goals of medicine should be broadened to include justifications for the treatment; (3) the use of growth hormone for idiopathic short stature involves strong interests from different stakeholders. While the treatment might be beneficial for some children, it is necessary to be vigilant about possible misconduct at different levels of medicalisation.

The muddle of medicalization: pathologizing or medicalizing?

Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one "medical model" and that the expanding realm of "the medical" can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices.