Academic literature on the topic 'Aboriginal Australians Medical care Moral and ethical aspects'

In Australia the “intimacy” of citizenship (Berlant 2), is often used to reinforce subscription to heteronormative romantic and familial structures. Because this framing promotes discourses of moral failure, recent political attention to sexuality and same-sex couples can be filtered through insights into coalitional affiliations. This paper uses contemporary shifts in Australian politics and culture to think through the concept of coalition, and in particular to analyse connections between sexuality and governmentality (or more specifically normative bias and same-sex relationships) in what I’m calling post-coalitional Australia. Against the unpredictability of changing parties and governments, allegiances and alliances, this paper suggests the continuing adherence to a heteronormatively arranged public sphere. After the current Australian Prime Minister Julia Gillard deposed the previous leader, Kevin Rudd, she clung to power with the help of independents and the Greens, and clichés of a “rainbow coalition” and a “new paradigm” were invoked to describe the confused electorate and governmental configuration. Yet in 2007, a less confused Australia decisively threw out the Howard–led Liberal and National Party coalition government after eleven years, in favour of Rudd’s own rainbow coalition: a seemingly invigorated party focussed on gender equity, Indigenous Australians, multi-cultural visibility, workplace relations, Austral-Asian relations, humane refugee processing, the environment, and the rights and obligations of same-sex couples. A post-coalitional Australia invokes something akin to “aftermath culture” (Lambert and Simpson), referring not just to Rudd’s fall or Howard’s election loss, but to the broader shifting contexts within which most Australian citizens live, and within which they make sense of the terms “Australia” and “Australian”. Contemporary Australia is marked everywhere by cracks in coalitions and shifts in allegiances and belief systems – the Coalition of the Willing falling apart, the coalition government crushed by defeat, deposed leaders, and unlikely political shifts and (re)alignments in the face of a hung parliament and renewed pushes toward moral and cultural change. These breakdowns in allegiances are followed by swift symbolically charged manoeuvres. Gillard moved quickly to repair relations with mining companies damaged by Rudd’s plans for a mining tax and to water down frustration with the lack of a sustainable Emissions Trading Scheme. And one of the first things Kevin Rudd did as Prime Minister was to change the fittings and furnishings in the Prime Ministerial office, of which Wright observed that “Mr Howard is gone and Prime Minister Kevin Rudd has moved in, the Parliament House bureaucracy has ensured all signs of the old-style gentlemen's club… have been banished” (The Age, 5 Dec. 2007). Some of these signs were soon replaced by Ms. Gillard herself, who filled the office in turn with memorabilia from her beloved Footscray, an Australian Rules football team. In post-coalitional Australia the exile of the old Menzies’ desk and a pair of Chesterfield sofas works alongside the withdrawal of troops from Iraq and renewed pledges for military presence in Afghanistan, apologising to stolen generations of Indigenous Australians, the first female Governor General, deputy Prime Minister and then Prime Minister (the last two both Gillard), the repealing of disadvantageous workplace reform, a focus on climate change and global warming (with limited success as stated), a public, mandatory paid maternity leave scheme, changes to the processing and visas of refugees, and the amendments to more than one hundred laws that discriminate against same sex couples by the pre-Gillard, Rudd-led Labor government. The context for these changes was encapsulated in an announcement from Rudd, made in March 2008: Our core organising principle as a Government is equality of opportunity. And advancing people and their opportunities in life, we are a Government which prides itself on being blind to gender, blind to economic background, blind to social background, blind to race, blind to sexuality. (Rudd, “International”) Noting the political possibilities and the political convenience of blindness, this paper navigates the confusing context of post-coalitional Australia, whilst proffering an understanding of some of the cultural forces at work in this age of shifting and unstable alliances. I begin by interrogating the coalitional impulse post 9/11. I do this by connecting public coalitional shifts to the steady withdrawal of support for John Howard’s coalition, and movement away from George Bush’s Coalition of the Willing and the War on Terror. I then draw out a relationship between the rise and fall of such affiliations and recent shifts within government policy affecting same-sex couples, from former Prime Minister Howard’s amendments to The Marriage Act 1961 to the Rudd-Gillard administration’s attention to the discrimination in many Australian laws. Sexual Citizenship and Coalitions Rights and entitlements have always been constructed and managed in ways that live out understandings of biopower and social death (Foucault History; Discipline). The disciplining of bodies, identities and pleasures is so deeply entrenched in government and law that any non-normative claim to rights requires the negotiation of existing structures. Sexual citizenship destabilises the post-coalitional paradigm of Australian politics (one of “equal opportunity” and consensus) by foregrounding the normative biases that similarly transcend partisan politics. Sexual citizenship has been well excavated in critical work from Evans, Berlant, Weeks, Richardson, and Bell and Binnie’s The Sexual Citizen which argues that “many of the current modes of the political articulation of sexual citizenship are marked by compromise; this is inherent in the very notion itself… the twinning of rights with responsibilities in the logic of citizenship is another way of expressing compromise… Every entitlement is freighted with a duty” (2-3). This logic extends to political and economic contexts, where “natural” coalition refers primarily to parties, and in particular those “who have powerful shared interests… make highly valuable trades, or who, as a unit, can extract significant value from others without much risk of being split” (Lax and Sebinius 158). Though the term is always in some way politicised, it need not refer only to partisan, multiparty or multilateral configurations. The subscription to the norms (or normativity) of a certain familial, social, religious, ethnic, or leisure groups is clearly coalitional (as in a home or a front, a club or a team, a committee or a congregation). Although coalition is interrogated in political and social sciences, it is examined frequently in mathematical game theory and behavioural psychology. In the former, as in Axelrod’s The Evolution of Cooperation, it refers to people (or players) who collaborate to successfully pursue their own self-interests, often in the absence of central authority. In behavioural psychology the focus is on group formations and their attendant strategies, biases and discriminations. Experimental psychologists have found “categorizing individuals into two social groups predisposes humans to discriminate… against the outgroup in both allocation of resources and evaluation of conduct” (Kurzban, Tooby and Cosmides 15387). The actions of social organisation (and not unseen individual, supposedly innate impulses) reflect the cultural norms in coalitional attachments – evidenced by the relationship between resources and conduct that unquestioningly grants and protects the rights and entitlements of the larger, heteronormatively aligned “ingroup”. Terror Management Particular attention has been paid to coalitional formations and discriminatory practices in America and the West since September 11, 2001. Terror Management Theory or TMT (Greenberg, Pyszczynski and Solomon) has been the main framework used to explain the post-9/11 reassertion of large group identities along ideological, religious, ethnic and violently nationalistic lines. Psychologists have used “death-related stimuli” to explain coalitional mentalities within the recent contexts of globalised terror. The fear of death that results in discriminatory excesses is referred to as “mortality salience”, with respect to the highly visible aspects of terror that expose people to the possibility of their own death or suffering. Naverette and Fessler find “participants… asked to contemplate their own deaths exhibit increases in positive evaluations of people whose attitudes and values are similar to their own, and derogation of those holding dissimilar views” (299). It was within the climate of post 9/11 “mortality salience” that then Prime Minister John Howard set out to change The Marriage Act 1961 and the Family Law Act 1975. In 2004, the Government modified the Marriage Act to eliminate flexibility with respect to the definition of marriage. Agitation for gay marriage was not as noticeable in Australia as it was in the U.S where Bush publicly rejected it, and the UK where the Civil Union Act 2004 had just been passed. Following Bush, Howard’s “queer moral panic” seemed the perfect decoy for the increased scrutiny of Australia’s involvement in the Iraq war. Howard’s changes included outlawing adoption for same-sex couples, and no recognition for legal same-sex marriages performed in other countries. The centrepiece was the wording of The Marriage Amendment Act 2004, with marriage now defined as a union “between a man and a woman to the exclusion of all others”. The legislation was referred to by the Australian Greens Senator Bob Brown as “hateful”, “the marriage discrimination act” and the “straight Australia policy” (Commonwealth 26556). The Labor Party, in opposition, allowed the changes to pass (in spite of vocal protests from one member) by concluding the legal status of same-sex relations was in no way affected, seemingly missing (in addition to the obvious symbolic and physical discrimination) the equation of same-sex recognition with terror, terrorism and death. Non-normative sexual citizenship was deployed as yet another form of “mortality salience”, made explicit in Howard’s description of the changes as necessary in protecting the sanctity of the “bedrock institution” of marriage and, wait for it, “providing for the survival of the species” (Knight, 5 Aug. 2003). So two things seem to be happening here: the first is that when confronted with the possibility of their own death (either through terrorism or gay marriage) people value those who are most like them, joining to devalue those who aren’t; the second is that the worldview (the larger religious, political, social perspectives to which people subscribe) becomes protection from the potential death that terror/queerness represents. Coalition of the (Un)willing Yet, if contemporary coalitions are formed through fear of death or species survival, how, for example, might these explain the various forms of risk-taking behaviours exhibited within Western democracies targeted by such terrors? Navarette and Fessler (309) argue that “affiliation defences are triggered by a wider variety of threats” than “existential anxiety” and that worldviews are “in turn are reliant on ‘normative conformity’” (308) or “normative bias” for social benefits and social inclusions, because “a normative orientation” demonstrates allegiance to the ingroup (308-9). Coalitions are founded in conformity to particular sets of norms, values, codes or belief systems. They are responses to adaptive challenges, particularly since September 11, not simply to death but more broadly to change. In troubled times, coalitions restore a shared sense of predictability. In Howard’s case, he seemed to say, “the War in Iraq is tricky but we have a bigger (same-sex) threat to deal with right now. So trust me on both fronts”. Coalitional change as reflective of adaptive responses thus serves the critical location of subsequent shifts in public support. Before and since September 11 Australians were beginning to distinguish between moderation and extremism, between Christian fundamentalism and productive forms of nationalism. Howard’s unwavering commitment to the American-led war in Iraq saw Australia become a member of another coalition: the Coalition of the Willing, a post 1990s term used to describe militaristic or humanitarian interventions in certain parts of the world by groups of countries. Howard (in Pauly and Lansford 70) committed Australia to America’s fight but also to “civilization's fight… of all who believe in progress and pluralism, tolerance and freedom”. Although Bush claimed an international balance of power and influence within the coalition (94), some countries refused to participate, many quickly withdrew, and many who signed did not even have troops. In Australia, the war was never particularly popular. In 2003, forty-two legal experts found the war contravened International Law as well as United Nations and Geneva conventions (Sydney Morning Herald 26 Feb. 2003). After the immeasurable loss of Iraqi life, and as the bodies of young American soldiers (and the occasional non-American) began to pile up, the official term “coalition of the willing” was quietly abandoned by the White House in January of 2005, replaced by a “smaller roster of 28 countries with troops in Iraq” (ABC News Online 22 Jan. 2005). The coalition and its larger war on terror placed John Howard within the context of coalitional confusion, that when combined with the domestic effects of economic and social policy, proved politically fatal. The problem was the unclear constitution of available coalitional configurations. Howard’s continued support of Bush and the war in Iraq compounded with rising interest rates, industrial relations reform and a seriously uncool approach to the environment and social inclusion, to shift perceptions of him from father of the nation to dangerous, dithery and disconnected old man. Post-Coalitional Change In contrast, before being elected Kevin Rudd sought to reframe Australian coalitional relationships. In 2006, he positions the Australian-United States alliance outside of the notion of military action and Western territorial integrity. In Rudd-speak the Howard-Bush-Blair “coalition of the willing” becomes F. Scott Fitzgerald’s “willingness of the heart”. The term coalition was replaced by terms such as dialogue and affiliation (Rudd, “Friends”). Since the 2007 election, Rudd moved quickly to distance himself from the agenda of the coalition government that preceded him, proposing changes in the spirit of “blindness” toward marginality and sexuality. “Fix-it-all” Rudd as he was christened (Sydney Morning Herald 29 Sep. 2008) and his Labor government began to confront the legacies of colonial history, industrial relations, refugee detention and climate change – by apologising to Aboriginal people, timetabling the withdrawal from Iraq, abolishing the employee bargaining system Workchoices, giving instant visas and lessening detention time for refugees, and signing the Kyoto Protocol agreeing (at least in principle) to reduce green house gas emissions. As stated earlier, post-coalitional Australia is not simply talking about sudden change but an extension and a confusion of what has gone on before (so that the term resembles postcolonial, poststructural and postmodern because it carries the practices and effects of the original term within it). The post-coalitional is still coalitional to the extent that we must ask: what remains the same in the midst of such visible changes? An American focus in international affairs, a Christian platform for social policy, an absence of financial compensation for the Aboriginal Australians who received such an eloquent apology, the lack of coherent and productive outcomes in the areas of asylum and climate change, and an impenetrable resistance to the idea of same-sex marriage are just some of the ways in which these new governments continue on from the previous one. The Rudd-Gillard government’s dealings with gay law reform and gay marriage exemplify the post-coalitional condition. Emulating Christ’s relationship to “the marginalised and the oppressed”, and with Gillard at his side, Rudd understandings of the Christian Gospel as a “social gospel” (Rudd, “Faith”; see also Randell-Moon) to table changes to laws discriminating against gay couples – guaranteeing hospital visits, social security benefits and access to superannuation, resembling de-facto hetero relationships but modelled on the administering and registration of relationships, or on tax laws that speak primarily to relations of financial dependence – with particular reference to children. The changes are based on the report, Same Sex, Same Entitlements (HREOC) that argues for the social competence of queer folk, with respect to money, property and reproduction. They speak the language of an equitable economics; one that still leaves healthy and childless couples with limited recognition and advantage but increased financial obligation. Unable to marry in Australia, same-sex couples are no longer single for taxation purposes, but are now simultaneously subject to forms of tax/income auditing and governmental revenue collection should either same-sex partner require assistance from social security as if they were married. Heteronormative Coalition Queer citizens can quietly stake their economic claims and in most states discreetly sign their names on a register before becoming invisible again. Mardi Gras happens but once a year after all. On the topic of gay marriage Rudd and Gillard have deferred to past policy and to the immoveable nature of the law (and to Howard’s particular changes to marriage law). That same respect is not extended to laws passed by Howard on industrial relations or border control. In spite of finding no gospel references to Jesus the Nazarene “expressly preaching against homosexuality” (Rudd, “Faith”), and pre-election promises that territories could govern themselves with respect to same sex partnerships, the Rudd-Gillard government in 2008 pressured the ACT to reduce its proposed partnership legislation to that of a relationship register like the ones in Tasmania and Victoria, and explicitly demanded that there be absolutely no ceremony – no mimicking of the real deal, of the larger, heterosexual citizens’ “ingroup”. Likewise, with respect to the reintroduction of same-sex marriage legislation by Greens senator Sarah Hanson Young in September 2010, Gillard has so far refused a conscience vote on the issue and restated the “marriage is between a man and a woman” rhetoric of her predecessors (Topsfield, 30 Sep. 2010). At the same time, she has agreed to conscience votes on euthanasia and openly declared bi-partisan (with the federal opposition) support for the war in Afghanistan. We see now, from Howard to Rudd and now Gillard, that there are some coalitions that override political differences. As psychologists have noted, “if the social benefits of norm adherence are the ultimate cause of the individual’s subscription to worldviews, then the focus and salience of a given individual’s ideology can be expected to vary as a function of their need to ally themselves with relevant others” (Navarette and Fessler 307). Where Howard invoked the “Judaeo-Christian tradition”, Rudd chose to cite a “Christian ethical framework” (Rudd, “Faith”), that saw him and Gillard end up in exactly the same place: same sex relationships should be reduced to that of medical care or financial dependence; that a public ceremony marking relationship recognition somehow equates to “mimicking” the already performative and symbolic heterosexual institution of marriage and the associated romantic and familial arrangements. Conclusion Post-coalitional Australia refers to the state of confusion borne of a new politics of equality and change. The shift in Australia from conservative to mildly socialist government(s) is not as sudden as Howard’s 2007 federal loss or as short-lived as Gillard’s hung parliament might respectively suggest. Whilst allegiance shifts, political parties find support is reliant on persistence as much as it is on change – they decide how to buffer and bolster the same coalitions (ones that continue to privilege white settlement, Christian belief systems, heteronormative familial and symbolic practices), but also how to practice policy and social responsibility in a different way. Rudd’s and Gillard’s arguments against the mimicry of heterosexual symbolism and the ceremonial validation of same-sex partnerships imply there is one originary form of conduct and an associated sacred set of symbols reserved for that larger ingroup. Like Howard before them, these post-coalitional leaders fail to recognise, as Butler eloquently argues, “gay is to straight not as copy is to original, but as copy is to copy” (31). To make claims to status and entitlements that invoke the messiness of non-normative sex acts and romantic attachments necessarily requires the negotiation of heteronormative coalitional bias (and in some ways a reinforcement of this social power). As Bell and Binnie have rightly observed, “that’s what the hard choices facing the sexual citizen are: the push towards rights claims that make dissident sexualities fit into heterosexual culture, by demanding equality and recognition, versus the demand to reject settling for heteronormativity” (141). The new Australian political “blindness” toward discrimination produces positive outcomes whilst it explicitly reanimates the histories of oppression it seeks to redress. The New South Wales parliament recently voted to allow same-sex adoption with the proviso that concerned parties could choose not to adopt to gay couples. The Tasmanian government voted to recognise same-sex marriages and unions from outside Australia, in the absence of same-sex marriage beyond the current registration arrangements in its own state. In post-coalitional Australia the issue of same-sex partnership recognition pits parties and allegiances against each other and against themselves from within (inside Gillard’s “rainbow coalition” the Rainbow ALP group now unites gay people within the government’s own party). Gillard has hinted any new proposed legislation regarding same-sex marriage may not even come before parliament for debate, as it deals with real business. Perhaps the answer lies over the rainbow (coalition). As the saying goes, “there are none so blind as those that will not see”. References ABC News Online. “Whitehouse Scraps Coalition of the Willing List.” 22 Jan. 2005. 1 July 2007 ‹http://www.abc.net.au/news/newsitems/200501/s1286872.htm›. Axelrod, Robert. The Evolution of Cooperation. New York: Basic Books, 1984. Berlant, Lauren. The Queen of America Goes to Washington City: Essays on Sex and Citizenship. Durham: Duke University Press, 1997. Bell, David, and John Binnie. The Sexual Citizen: Queer Politics and Beyond. Cambridge, England: Polity, 2000. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1990. Commonwealth of Australia. Parliamentary Debates. House of Representatives 12 Aug. 2004: 26556. (Bob Brown, Senator, Tasmania.) Evans, David T. Sexual Citizenship: The Material Construction of Sexualities. London: Routledge, 1993. Foucault, Michel. Discipline and Punish: The Birth of the Prison. Trans. A. Sheridan. London: Penguin, 1991. ———. The Will to Knowledge: The History of Sexuality. Vol. 1. Trans. Robert Hurley. London: Penguin, 1998. Greenberg, Jeff, Tom Pyszczynski, and Sheldon Solomon. “The Causes and Consequences of the Need for Self-Esteem: A Terror Management Theory.” Public Self, Private Self. Ed. Roy F. Baumeister. New York: Springer-Verlag, 1986. 189-212. Human Rights and Equal Opportunity Commission. Same-Sex: Same Entitlements Report. 2007. 21 Aug. 2007 ‹http://www.hreoc.gov.au/human_rights/samesex/report/index.html›. Kaplan, Morris. Sexual Justice: Democratic Citizenship and the Politics of Desire. New York: Routledge, 1997. Knight, Ben. “Howard and Costello Reject Gay Marriage.” ABC Online 5 Aug. 2003. Kurzban, Robert, John Tooby, and Leda Cosmides. "Can Race Be Erased? Coalitional Computation and Social Categorization." Proceedings of the National Academy of Sciences 98.26 (2001): 15387–15392. Lambert, Anthony, and Catherine Simpson. "Jindabyne’s Haunted Alpine Country: Producing (an) Australian Badland." M/C Journal 11.5 (2008). 20 Oct. 2010 ‹http://journal.media-culture.org.au/index.php/mcjournal/article/view/81›. Lax, David A., and James K. Lebinius. “Thinking Coalitionally: Party Arithmetic Process Opportunism, and Strategic Sequencing.” Negotiation Analysis. Ed. H. Peyton Young. Michigan: University of Michigan Press, 1991. 153-194. Naverette, Carlos, and Daniel Fessler. “Normative Bias and Adaptive Challenges: A Relational Approach to Coalitional Psychology and a Critique of Terror Management Theory.” Evolutionary Psychology 3 (2005): 297-325. Pauly, Robert J., and Tom Lansford. Strategic Preemption: US Foreign Policy and Second Iraq War. Aldershot: Ashgate, 2005. Randall-Moon, Holly. "Neoliberal Governmentality with a Christian Twist: Religion and Social Security under the Howard-Led Australian Government." Eds. Michael Bailey and Guy Redden. Mediating Faiths: Religion and Socio- Cultural Change in the Twenty-First Century. Farnham: Ashgate, in press. Richardson, Diane. Rethinking Sexuality. London: Sage, 2000. Rudd, Kevin. “Faith in Politics.” The Monthly 17 (2006). 31 July 2007 ‹http://www.themonthly.com.au/monthly-essays-kevin-rudd-faith-politics--300›. Rudd, Kevin. “Friends of Australia, Friends of America, and Friends of the Alliance That Unites Us All.” Address to the 15th Australian-American Leadership Dialogue. The Australian, 24 Aug. 2007. 13 Mar. 2008 ‹http://www.theaustralian.com.au/national-affairs/climate/kevin-rudds-address/story-e6frg6xf-1111114253042›. Rudd, Kevin. “Address to International Women’s Day Morning Tea.” Old Parliament House, Canberra, 11 Mar. 2008. 1 Oct. 2010 ‹http://pmrudd.archive.dpmc.gov.au/node/5900›. Sydney Morning Herald. “Coalition of the Willing? Make That War Criminals.” 26 Feb. 2003. 1 July 2007 ‹http://www.smh.com.au/articles/2003/02/25/1046064028608.html›. Topsfield, Jewel. “Gillard Rules Out Conscience Vote on Gay Marriage.” The Age 30 Sep. 2010. 1 Oct. 2010 ‹http://www.theage.com.au/national/gillard-rules-out-conscience-vote-on-gay-marriage-20100929-15xgj.html›. Weeks, Jeffrey. "The Sexual Citizen." Theory, Culture and Society 15.3-4 (1998): 35-52. Wright, Tony. “Suite Revenge on Chesterfield.” The Age 5 Dec. 2007. 4 April 2008 ‹http://www.theage.com.au/news/national/suite-revenge-on-chesterfield/2007/12/04/1196530678384.html›.

Photo by Scott Graham on Unsplash INTRODUCTION It is a classic ethical dilemma to have something of potential value that comes at a tremendous cost to others.[1] To access the good, you must have the bad. For decision-makers, it becomes an onerous task of deciding if they would deny the world something 'good' or create something bad to achieve the good. Weighing the two possible outcomes has proven timelessly frustrating to those well-intentioned people who wish to "do the right thing." Medical research has yielded data derived from unethical situations wherein research participants were vulnerable and whose consent was questionable, absent, or not sought. The rules currently governing research allow for broad use of ill-gotten data. While providing a deterrent to unethical research practices, stricter rules still would allow some use of data. This paper argues the permissibility depends primarily on the nature of the unethical data collection and the potential benefits. ANALYSIS The American Medical Association (AMA) places additional obligations on researchers who utilize data obtained from unethical experiments. The Code of Medical Ethics Opinion 7.2.2[2] recommends that researchers and peer reviewers should take the following steps to best handle such data: (a) Disclose that the data derived from studies do not meet contemporary standards for the ethical conduct of research. (b) Clearly describe and acknowledge the unethical nature of the experiment(s) from which the data are derived. (c) Provide ethically compelling reasons for which the data are being released or cited, such as the need to save human lives when no other relevant data are available. (d) Pay respect to those who were the victims of the unethical experimentation. The AMA does not go far enough to protect past research victims or prevent future research ethics violations. Three additional considerations beyond the limitations offered by the APA are needed for ethical use of the data: who collected the data and ran the experiments, who would benefit from the data, and how much additional benefit would ensue from its use. A specific focus on data generated by Nazis whose research subjects were imprisoned in concentration camps highlights the ethical challenge. l. Who Created the Data? Medical research generated during the Holocaust subjected innocent people to torture in the name of science. Arguments can be made against the use of such data on the grounds that using the data represents a further indignity to those who suffered such horrific conditions and persecution. However, some of the data that emerged out of the Holocaust was not created by oppressors at the expense of the oppressed. Rather it grew out of the horrific conditions and was amassed by fellow prisoners. One prominent example is Myron Winick's work on hunger and disease, which edited the detailed records of Jewish physicians working in the Warsaw Ghetto, who traced the progression of starvation in stunning detail.[3] One obvious difference is that the Jewish physicians were not responsible for the conditions under which the data was gathered. But if we ask ourselves if their work represents a further indignity to those who had their starvation documented, the answer is not so clear. In this way, it is important to determine the explicit purpose of medical research as opposed to data generation as one aspect of the violation. To record the medical symptoms of a 'subject' who is, as you are, a victim of the circumstances with no other recourse, is different in kind from 'subjecting' a person to the condition in the first instance. Therefore, an analysis of the person doing the research provides an added limitation on using research performed by an oppressor yet allows some lenience for research by fellow victims. Research performed by oppressors must have a significantly higher marginal benefit over other available or collectable data. ll. Who Gains from the Data? Is it of Sufficient Benefit? (An effort to expand part C of the AMA unethical experimentation rules) In the spirit of contrition and commitment to the truth of historical ignominies, such as the Holocaust, the AMA created these best practices for physicians dealing with any ill-gotten data. In the case of the Holocaust, the period that has passed since 1945 would suggest that most, if not all, perpetrators of this research are deceased. However, prior to using data, modern researchers should ensure that there is no gain to be had on the part of the families of the perpetrators. When a large organization can offer mea culpa and seemingly genuine pledges toward reconciliation while still enjoying the advantages gained over others by virtue of their wrongdoing, it undermines sincerity, creates an incentive for more researchers to engage in unethical data collection, and would be an injustice to the relatives of victims. This matter may become more relevant going forward as private ownership and patents could play a role in sustaining the fiscal or reputational benefits to those who conduct science devoid of ethics. The Belmont Report lays out a risk-benefit equation which states that research that posed significant risks to the participants must also carry sufficient benefits to those who take risks. This element suggests two aspects that speak to the "justness" of a research project: First, a balance must be struck between potential harms and potential benefits; second, those who took risks must not be precluded from accessing the benefits of the products a successful trial would create.[4] Researchers must evaluate whether the data is both scientifically valid and usable from a methodological point of view, but also if what the use of the data promises is sufficiently compelling to benefit the progress of science. Second, the data must refer to some aspect of human health or illness, the amelioration of which would create an empirical improvement to all social and economic classes of humanity. The social justice issues embedded in the ethical use of the data are overlooked by the AMA. While the AMA suggests saving human lives makes the use of ill-gotten data acceptable, it fails to address any effort to make up for the wrongdoing. Examples of added considerations could be the use of the research to benefit people who were research subjects or their descendants or a broader race or ethnic group that was victimized. Examples of groups subjected to unethical research in the 20th century include Residential Schools for Aboriginal Canadians,[5] senior citizens,[6] and typically, members of socially deprived and undervalued populations.[7] The more reliable scientific data that emerged from Nazi experimentation is in the areas of hypothermia,[8] malnutrition and starvation,[9] and anatomical studies.[10] It is impossible to justify the use by the AMA criteria alone. If the research benefited relatives and descendants of Nazi prisoners or the broader marginalized community of which they belonged, its use might be considered ethical if there were no other way to obtain comparable data. The value and impact of Nazi science is minimal at this point, with much more reliable data available, but this type of transgression continues. There are modern examples of data procured in breach of ethics that still lend themselves to this question. CONCLUSION These suggestions would add complexity and substance to the AMA's Code of Medical Ethics Opinion. Beyond that scope, the considerations offered here would contribute to a stronger statement about the obligations and prohibitions in circumstances in which data was wrongfully collected. Too often, one could default to a brash 'means-to-an-ends' approach, especially when issues of funding and measured productivity come into the equation. The considerations here recognize that data gathered during the Holocaust is particularly sensitive. By eliminating any encouragement of unethical practices, a stricter test for the use of ill-gotten research is a deterrent but recognizes that sometimes the benefits call for the use of the research. The considerations also recognize that one legacy of such data is to create good in the modern-day, even as we recognize the shameful context of its creation and existence. [1] Marcus, Ruth B; Moral Dilemmas and Consistency. Journal of Philosophy. 1980;77(3):121-136. [2] American Medical Association. Opinion 7.2.2 Release of Data from Unethical Experiments Code of Medical Ethics. https://www.ama-assn.org/delivering-care/ethics/release-data-unethical-experiments. Accessed January 3, 2021. [3] Winick, 1979. [4] Freedman, B. Scientific value and validity as ethical requirements for research: a proposed explanation. IRB: Rev Hum Subj Res. 1987;17(6):7-10. [5] Mosby, I. Administering Colonial Science: Nutrition Research and Human Biomedical Experimentation in Aboriginal Communities and Residential Schools, 1942–1952. Histoire sociale/Social History. 2013;46(91): 615-642. [6] Beecher, H. Ethics and Clincial Research. N Engl J Med. 1966;274:1354-1360 [7] Rawlinson, P. Of Mice and Men: Violence and Human Experimentation. State Crime Journal. 2013;2(1):72-90. [8] Fernardez, J.P. et al; Rapid Active External Rewarming in Accidental Hypothermia. JAMA.1970;212:153 [9] Winick, M. (ed.). Hunger Disease. New York, NY: Wiley; 1979. [10] Norton, S.A.; On First Looking into Pernkopf's Atlas (part 1). Arch Dermatol. 2001;137:549-551

Photo by Andrew James on Unsplash INTRODUCTION Since its inception, bioethics has focused on Western conceptions of ethics and science. This has provided a strong foundation to build bioethics as a field and discipline. However, it has largely failed to consider non-Western systems of ethics and science like Indigenous American thought frameworks. This has important implications for the treatment of Indigenous Americans in healthcare settings, something that I have considered as a mixed Indigenous American researcher of sociology, global health and bioethics. While there has been recognition of other thought frameworks impacting bioethics, these have largely focused on differences among religions and their adherents. While religious frameworks are important, bioethics must also recognize, learn, and implement different cultural frameworks. Bioethics cannot simply recognize these non-Western frameworks; it must also legitimately incorporate them as frameworks. Non-Western conceptions have too often been used in a secondary status or as a historical outlier or curiosity which leads to failure in integrating non-Western frameworks to their full extent and benefit. BACKGROUND Indigenous American philosophy has strong foundations throughout North and South America[1] that can provide a base for developing Indigenous-focused bioethics. While Indigenous Americans cannot be considered a monolith, there are similarities across Indigenous cultures in their approach to reality—developing Indigenous bioethics will necessarily incorporate these shared philosophies.[2] These similarities are present in the US philosophical tradition of pragmatism. Pragmatism arises from the Indigenous pragmatism which values interacting with other beings and the environment, plurality of thought, connections to the community, and growth from the other three dimensions.[3] This shared pragmatism centers the actions of individuals as the defining feature of maintaining balance in all scenarios of socializing and work—achieving the “center good.” [4] Tlacoqualli in Monequi is a Mexica (Aztec) saying that translates to the “center good is required” and means “middle way of being” or consistently managing imbalances and obligations to achieve a long-term balance. For example, indulging in excesses requires the opposite to follow: making do with less for a period or balancing receiving with giving.[5] The actions of individuals must maintain the balance, which simultaneously encourages self-responsibility and responsibility to the community.[6] Additionally, the individual is not judged only by their actions but also by their omissions—failure to act either unintentionally or intentionally—and judged on the morality of their decision as if they had acted.[7] There have been calls for developing Indigenous bioethics,[8] including analyses of important distinctions between Western and Indigenous ethical approaches to health care such as how Indigenous patients understand core bioethical concepts like autonomy and non-maleficence.[9] These differences in thought impact all aspects of Indigenous health care and how providers approach fundamental tasks like revealing diagnoses or encouraging surgeries.[10] Indigenous ethics place great value on individual decisions made in the context of community input. Failing to appreciate this cultural difference can prevent an Indigenous patient from maintaining the center good and therefore violate a fundamental aspect of being.[11] Providers must also understand the nuances of religion and Indigenous ethics. While many Indigenous people adhere to elements of Christianity or other religious philosophies, many Indigenous people still maintain traditional cosmovisions.[12] These cosmovisions—ways that Indigenous communities understand life, earth, the universe and its moral constructs—demand adherence not to a supreme ethereal deity but to Indigenous pragmatism and, therefore, the “center good” so that an individual can live a happy and healthy life. Failing to adhere to the cosmovisions results in the decay of that person, and even their community, on physical, emotional, and spiritual levels.[13] ANALYSIS Previous work on Indigenous bioethics has referred to Indigenous philosophies in a secondary way. This placement of Indigenous ethics onto a second tier still demands that Indigenous patients adhere to dominant Western ethical discourses. Indigenous pragmatism calls for a plurality of thought and method. This means that Western ethics can apply in the treatment of Indigenous patients, but that Indigenous ethics must be on an equal plane or elevated above Western ethics in the treatment of Indigenous patients. The Indian Health Service (IHS) in the US provides an example. This system is treaty-obligated to provide health care to Indigenous Americans, the only racialized group in the US to have federal government-provided healthcare. However, many providers in the expansive IHS system operate from a Western ethic. This viewpoint leads to negative interactions and miscommunications.[14] It also adds to the persistent racism and ethnocentrism documented in the IHS by the US Commission on Civil Rights.[15] Multiple paths to achieving Indigenous health equity exist. However, a vital component is engaging a specific Indigenous ethic based on Indigenous philosophies rather than merely referencing them. Indigenous patients of the IHS can receive more culturally sensitive and competent care if they are engaged on a cultural level. A brief hypothetical to illustrate: a non-Indigenous IHS physician requests an ethics consult to convince a patient they need surgery; the provider views this as non-maleficence (a way to avoid harm to the patient) and is frustrated with the involvement of the patient’s family and close friends in the patient’s decision to delay the surgery; the doctor views the involvement of other people as a violation of the patient’s autonomy. The Indigenous patient views the physician’s continued insistence as offensive and becomes frustrated that their decision to delay is not respected. The physician and the patient view both autonomy and non-maleficence differently. The Indigenous patient views autonomy as a fundamental interaction between oneself and one’s communities, not as a purely individual choice. The patient also does not view the physician’s actions as doing no harm, as the violation of the Indigenous worldview is causing distress to the patient. In this hypothetical, the physician could alleviate the distress by understanding the patient’s ethics. The decision to delay the operation based on community feedback is an autonomous decision of the patient who does not view the delay as a harm but as a positive, since they are patiently exploring their options and ensuring that their community is equally comfortable with the decision. In this case, the insistence that the patient violate their Indigenous pragmatism causes the harm and violation of autonomy. l. Progress and Considerations Bioethics has made important strides toward cultural competency and many programs train students in medical disciplines. While there have been significant improvements in cultural competency training and recognition, programs still do not adequately consider care of Indigenous patients,[16] and they do not sufficiently consider the complexities of Indigenous decision making. US laws privilege the Western conception of autonomy and the accompanying understanding of individualism.[17] However, these laws and frameworks do not sufficiently consider complex Indigenous nuances and communal social structures. While Indigenous patients, or their proxy, will be the one to sign off on a decision, the process still centers a Western understanding of individualism, autonomy, and body[18] that constrains Indigenous patients and often demands violation of their balanced “center good.” Resolving this conflict conceptually and in practice is not easy and will continue to require patience and the necessary involvement of Indigenous communities, bioethicists, and practitioners. CONCLUSION Indigenous philosophies often oppose traditional Western ethics employed in US healthcare. The IHS provides care to Indigenous people and could employ and further develop the use of Indigenous pragmatism and ethics. An Indigenous patient that is treated based on Indigenous philosophies and ethics can receive care and consultations that incorporate their interactions and responsibilities to their families and communities and recognize that the Indigenous patient will have a plurality of thought systems and requests based in multiple cultural contexts that may seem foreign to non-Indigenous practitioners and ethicists. The center good here demands fully incorporating Indigenous philosophies and bioethics. Failing to maintain this center good and develop explicit Indigenous ethics for all Indigenous patients—inside and out of the IHS—only serves to continue the severe healthcare inequalities experienced by Indigenous communities. - [1] Léon-Portilla, Miguel. 1963. Aztec Thought and Culture: A Study of the Ancient Nahuatl Mind. Norman, OK: University of Oklahoma Press; Pratt, Scott L. 2002. Native Pragmatism: Rethinking the Roots of American Philosophy. Bloomington, IN: Indiana University Press. [2] Ellerby, Jonathan H., John McKenzie, Stanley McKay, Gilbert J. Gariépy, Joseph M. Kaufert. 2000. “Bioethics for clinicians: 18. Aboriginal cultures”. Canadian Medical Association Journal 163(7):845-850; Cordova, V.F. 2007. How It Is: The Native American Philosophy of V.F. Cordova. Tucson, AZ: University of Arizona Press. [3] Pratt 2002 [4] Dunbar-Ortiz, Roxanne. 2014. An Indigenous Peoples' History of the United States. Boston, MA: Beacon Press; Graeber, David and David Wengrow. 2021. The Dawn of Everything: A New History of Humanity. New York, NY: Farrar, Straus and Giroux. [5] Maffie, James. 2019. “Weaving the Good Life in a Living World: Reciprocity, Balance and Nepantla in Aztec Ethics” Science, Religion and Culture (https://dx.doi.org/10.17582/journal.src/2019.6.1.15.25). [6] Maffie, James. 2022. “Aztec Philosophy” Internet Encyclopedia of Philosophy. https://iep.utm.edu/aztec-philosophy/#H6 [7] Abarbanell, Linda and Marc D. Hauser. 2009. “Maya Morality: An exploration of permissible harms” Cognition 115(2010):207-224. [8] Ellerby et al. 2000; Abarbanell & Hauser 2009 [9] Kotalik, Jaro and Gerry Martin. 2016. “Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers”. The American Journal of Bioethics 16(5):38-43 (https://doi.org/10.1080/15265161.2016.1159749); Wescott, Siobhan and Beth Mittelstet. 2020. “Three Levels of Autonomy and One Long-Term Solution for Native American Health Care”. AMA Journal of Ethics 22(10):856-861 (https://doi.org/10.1001/amajethics.2020.856) [10] Ellerby et al. 2000 [11] Maffie 2022 [12] Leeming, Ben. 2013. “’Jade Water, Gunpowder Water’: Water Imagery in Nahuatl Descriptions of Heaven & Hell”. Presented at the American Society for Ethnohistory annual meeting. New Orleans, LA. (https://www.academia.edu/11810951/_Jade_Water_Gunpowder_Water_Water_Imagery_in_Nahuatl_Descriptions_of_Heaven_and_Hell). [13] Maffie 2022 [14] Gurr, Barbara. 2014. Reproductive Justice: The Politics of Health Care for Native American Women. New Brunswick, NJ: Rutgers University Press. [15] US Commission on Civil Rights. 2004. Broken Promises: Evaluating the Native American Health Care System. (https://www.usccr.gov/files/pubs/docs/nabroken.pdf). [16] Nortjé, Nico, Kristen Jones-Bonofiglio and Claudia R. Sotomayor. 2021. “Exploring values among three cultures from a global bioethics perspective”. Global Bioethics 32(1):1-14.; Winters, Alexandra. 2016. “Trespass to Culture: The Bioethics of Indigenous Populations’ Informed Consent in Mainstream Genetic Research Paradigms”. American Indian Law Review 41(1):231-251. [17] Norjé et al. 2021 [18] Winters 2016

BackgroundIn the past twenty years the discourse of the weight-centred health paradigm (WCHP) has attained almost complete dominance in the sphere of public health policy throughout the developed English speaking world. The national governments of Australia and many countries around the world have responded to what is perceived as an ‘epidemic of obesity’ with public health policies and programs explicitly focused on reducing and preventing obesity through so called ‘lifestyle’ behaviour change. Weight-related public health initiatives have been subjected to extensive critique based on ideological, ethical and empirical grounds (Solovay; Oliver; Gaesser; Gard; Monaghan, Colls and Evans; Wright; Rothblum and Solovay; Saguy; Rich, Monaghan and Aphramor; Bacon and Aphramor; Brown). Many scholars have raised concerns about the stigmatising and harmful effects of the WCHP (Aphramor; Bacon and Aphramor; O'Dea; Tylka et al.), and in particular the inequitable distribution of such negative impacts on women, people who are poor, and people of colour (Campos). Weight-based stigma is now well recognised as a pervasive and insidious form of stigma (Puhl and Heuer). Weight-based discrimination (a direct result of stigma) in the USA has a similar prevalence rate to race-based discrimination, and discrimination for fatter and younger people in particular is even higher (Puhl, Andreyeva and Brownell). Numerous scholars have highlighted the stigmatising discourse evident in obesity prevention programs and policies (O'Reilly and Sixsmith; Pederson et al.; Nuffield Council on Bioethics; ten Have et al.; MacLean et al.; Carter, Klinner, et al.; Fry; O'Dea; Rich, Monaghan and Aphramor). The ‘war on obesity’ can therefore be regarded as a social determinant of poor health (O'Hara and Gregg). Focusing on overweight and obese people is not only damaging to people’s health, but is ineffective in addressing the broader social and economic issues that create health and wellbeing (Cohen, Perales and Steadman; MacLean et al.; Walls et al.). Analyses of the discourses used in weight-related public health initiatives have highlighted oppressive, stigmatizing and discriminatory discourses that position body weight as pathological (O'Reilly; Pederson et al.), anti-social and a threat to the viable future of society (White). There has been limited analysis of discourses in Australian social marketing campaigns focused on body weight (Lupton; Carter, Rychetnik, et al.).Social Marketing CampaignsIn 2006 the Australian, State and Territory Governments funded the Measure Up social marketing campaign (Australian Government Department of Health and Ageing "Measure Up"). As the name suggests Measure Up focuses on the measurement of health through body weight and waist circumference. Campaign resources include brochures, posters, a tape measure, a 12 week planner, a community guide and a television advertisement. Campaign slogans are ‘The more you gain, the more you have to lose’ and ‘How do you measure up?’Tomorrow People is the component of Measure Up designed for Indigenous Australians (Australian Government Department of Health and Ageing "Tomorrow People"). Tomorrow People resources focus on healthy eating and physical activity and include a microsite on the Measure Up website, booklet, posters, print and radio advertisements. The campaign slogan is ‘Tomorrow People starts today. Do it for our kids. Do it for our culture.’ In 2011, phase two of the Measure Up campaign was launched (Australian Government Department of Health and Ageing "Swap It, Don't Stop It"). The central premise of Swap It, Don’t Stop It is that you ‘can lose your belly without losing all the things you love’ by making ‘simple’ swaps of behaviours related to eating and physical activity. The campaign’s central character Eric is made from a balloon, as are all of the other characters and visual items used in the campaign. Eric claims thatover the years my belly has ballooned and ballooned. It’s come time to do something about it — the last thing I want is to end up with some cancers, type 2 diabetes and heart disease. That’s why I’ve become a Swapper! What’s a swapper? It’s simple really. It just means swapping some of the things I’m doing now for healthier choices. That way I can lose my belly, without losing all the things I love. It’s easy! The campaign has produced around 30 branded resource items including brochures, posters, cards, fact sheets, recipes, and print, radio, television and online advertisements. All resources include references to Eric and most also include the image of the tape measure used in the Measure Up campaign. The Swap It, Don’t Stop It campaign also includes resources specifically directed at Indigenous Australians including two posters from the generic campaign with a dot painting motif added to the background. MethodologyThe epistemological position in this project was constructivist (Crotty) and the theoretical perspective was critical theory (Crotty). Multimedia critical discourse analysis (Machin and Mayr) was the methodology used to examine the social marketing campaigns and identify the discourses within them. Critical discourse analysis (CDA) focuses on critiquing text for evidence of power and ideology. CDA is used to reveal the ideas, absences and assumptions, and therefore the power interests buried within texts, in order to bring about social change. As a method, CDA has a structured three dimensional approach involving textual practice analysis (for lexicon) at the core, within the context of discursive practice analysis (for rhetorical and lexical strategies particularly with respect to claims-making), which falls within the context of social practice analysis (Jacobs). Social practice analysis explores the role played by power and ideology in supporting or disturbing the discourse (Jacobs; Machin and Mayr). Multimodal CDA (MCDA) uses a broad definition of text to include words, pictures, symbols, ideas, themes or any message that can be communicated (Machin and Mayr). Analysis of the social marketing campaigns involved examining the vocabulary, grammar, sentence structure, visuals and overall structure of the text for textual, discursive and social practices.Results and DiscussionIndividual ResponsibilityThe discourse of individual responsibility is strongly evident in the campaigns. In this discourse, it is ultimately the individual who is held responsible for their body weight and their health. The individual responsibility discourse is signified by the discursive practice of using epistemic (related to the truth or certainty) and deontic (compelling or instructing) modality words, particularly modal verbs and modal adverbs. High modality epistemic words are used to convince the reader of the certainty of statements and to portray the statement-maker as authoritative. High modality deontic words are used to instil power and authority in the instructions.The extensive use of high modality epistemic and deontic words is demonstrated in the following paragraph assembled from various campaign materials: Ultimately (epistemic modality adverb) individuals must take responsibility (deontic modality verb) for their own health, including their and weight. Obesity is caused (epistemic modality verb) by an imbalance in energy intake (from diet) (epistemic modality verb) and expenditure (from activity) (epistemic modality verb). Individually (epistemic modality adverb) we make decisions (epistemic modality verb) about how much we eat (epistemic modality verb) and how much activity we undertake (epistemic modality verb). Each of us can control (epistemic modality) our own weight by controlling (deontic modality) what we eat (deontic modality verb) and how much we exercise (deontic modality verb). To correct (deontic modality verb) the energy imbalance, individuals need to develop (deontic modality verb) a healthy lifestyle by making changes (deontic modality verb) to correct (deontic modality verb) their dietary habits and increase (deontic modality verb) their activity levels. The verbs must, control, correct, develop, change, increase, eat and exercise are deontic modality verbs designed to instruct or compel the reader.These discursive practices result in the clear message that individuals can and must control, correct and change their eating and physical activity, and thereby control their weight and health. The implication of the individualist discourse is that individuals, irrespective of their genes, life-course, social position or environment, are charged with the responsibility of being more self-surveying, self-policing, self-disciplined and self-controlled, and therefore healthier. This is consistent with the individualist orientation of neoliberal ideology, and has been identified in various critiques of obesity prevention public health programs that centralise the self-responsible subject (Murray; Rich, Monaghan and Aphramor) and the concept of ‘healthism’, the moral obligation to pursue health through healthy behaviours or healthy lifestyles (Aphramor and Gingras; Mansfield and Rich). The hegemonic Western-centric individualist discourse has also been critiqued for its role in subordinating or silencing other models of health and wellbeing including Aboriginal or indigenous models, that do not place the individual in the centre (McPhail-Bell, Fredericks and Brough).Obesity Causes DiseaseEpistemic modality verbs are used as a discursive practice to portray the certainty or probability of the relationship between obesity and chronic disease. The strength of the epistemic modality verbs is generally moderate, with terms such as ‘linked’, ‘associated’, ‘connected’, ‘related’ and ‘contributes to’ most commonly used to describe the relationship. The use of such verbs may suggest recognition of uncertainty or at least lack of causality in the relationship. However this lowered modality is counterbalanced by the use of verbs with higher epistemic modality such as ‘causes’, ‘leads to’, and ‘is responsible for’. For example:The other type is intra-abdominal fat. This is the fat that coats our organs and causes the most concern. Even though we don’t yet fully understand what links intra-abdominal fat with chronic disease, we do know that even a small deposit of this fat increases the risk of serious health problems’. (Swap It, Don’t Stop It Website; italics added)Thus the prevailing impression is that there is an objective, definitive, causal relationship between obesity and a range of chronic diseases. The obesity-chronic disease discourse is reified through the discursive practice of claims-making, whereby statements related to the problem of obesity and its relationship with chronic disease are attributed to authoritative experts or expert organisations. The textual practice of presupposition is evident with the implied causal relationship between obesity and chronic disease being taken for granted and uncontested. Through the textual practice of lexical absence, there is a complete lack of alternative views about body weight and health. Likewise there is an absence of acknowledgement of the potential harms arising from focusing on body weight, such as increased body dissatisfaction, disordered eating, and, paradoxically, weight gain.Shame and BlameBoth Measure Up and Swap It, Don’t Stop It include a combination of written/verbal text and visual images that create a sense of shame and blame. In Measure Up, the central character starts out as young, slim man, and as he ages his waist circumference grows. When he learns that his expanding waistline is associated with an increased risk of chronic disease, his facial expression and body language convey that he is sad, dejected and fearful. In the still images, this character and a female character are positioned looking down at the tape measure as they measure their ‘too large’ waists. This position and the looks on their faces suggest hanging their heads in shame. The male characters in both campaigns specifically express shame about “letting themselves go” by unthinkingly practicing ‘unhealthy’ behaviours. The characters’ clothing also contribute to a sense of shame. Both male and female characters in Measure Up appear in their underwear, which suggests that they are being publicly shamed. The clothing of the Measure Up characters is similar to that worn by contestants in the television program The Biggest Loser, which explicitly uses shame to ‘motivate’ contestants to lose weight. Part of the public shaming of contestants involves their appearance in revealing exercise clothing for weigh-ins, which displays their fatness for all to see (Thomas, Hyde and Komesaroff). The stigmatising effects of this and other aspects of the Biggest Loser television program are well documented (Berry et al.; Domoff et al.; Sender and Sullivan; Thomas, Hyde and Komesaroff; Yoo). The appearance of the Measure Up characters in their underwear combined with their head position and facial expressions conveys a strong, consistent message that the characters both feel shame and are deserving of shame due to their self-inflicted ‘unhealthy’ behaviours. The focus on ‘healthy’ and ‘unhealthy’ behaviours contributes to accepted and contested health identities (Fry). The ‘accepted health identity’ is represented as responsible and aspiring to and pursuing good health. The ‘contested health identity’ is represented as unhealthy, consuming too much food, and taking health risks, and this identity is stigmatised by public health programs (Fry). The ‘contested health identity’ represents the application to public health of Goffman’s ‘spoiled identity’ on which much stigmatisation theorising and research has been based (Goffman). As a result of both lexical and visual textual practices, the social marketing campaigns contribute to the construction of the ‘accepted health identity’ through discourses of individual responsibility, choice and healthy lifestyle. Furthermore, they contribute to the construction of the spoiled or ‘contested health identity’ through discourses that people are naturally unhealthy and need to be frightened, guilted and shamed into stopping ‘unhealthy’ behaviours and adopting ‘healthy’ behaviours. The ‘contested health identity’ constructed through these discourses is in turn stigmatised by such discourses. Thus the campaigns not only risk perpetuating stigmatisation through the reinforcement of the health identities, but possibly extend it further by legitimising the stigma associated with such identities. Given that these campaigns are conducted by the Australian Government, the already deeply stigmatising social belief system receives a significant boost in legitimacy by being positioned as a public health belief system perpetrated by the Government. Fear and AlarmIn the Measure Up television advertisement the main male character’s daughter, who has run into the frame, abruptly stops and looks fearful when she hears about his increased risk of disease. Using the discursive practice of claims-making, the authoritative external source informs the man that the more he gains (in terms of his waist circumference), the more he has to lose. The clear implication is that he needs to be fearful of losing his health, his family and even his life if he doesn’t reduce his waist circumference. The visual metaphor of a balloon is used as the central semiotic trope in Swap It, Don’t Stop It. The characters and other items featuring in the visuals are all made from twisting balloons. Balloons themselves may not create fear or alarm, unless one is unfortunate to be afflicted with globophobia (Freed), but the visual metaphor of the balloon in the social marketing campaign had a range of alarmist meanings. At the population level, rates and/or costs of obesity have been described in news items as ‘ballooning’ (Body Ecology; Stipp; AFP; Thien and Begawan) with accompanying visual images of extremely well-rounded bodies or ‘headless fatties’ (Cooper). Rapid or significant weight gain is referred to in everyday language as ‘ballooning weight’. The use of the balloon metaphor as a visual device in Swap It, Don’t Stop It serves to reinforce and extend these alarmist messages. Further, there is no attempt in the campaigns to reduce alarm by including positive or neutral photographs or images of fat people. This visual semiotic absence – a form of cultural imperialism (Young) – contributes to the invisibilisation of ‘real life’ fat people who are not ashamed of themselves. Habermas suggests that society evolves and operationalises through rational communication which includes the capacity to question the validity of claims made within communicative action (Habermas The Structural Transformation of the Public Sphere; Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society). However the communicative action taken by the social marketing campaigns analysed in this study presents claims as uncontested facts and is therefore directorial about the expectations of individuals to take more responsibility for themselves, adopt certain behaviours and reduce or prevent obesity. Habermas argues that the lack or distortion of rational communication erodes relationships at the individual and societal levels (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Structural Transformation of the Public Sphere). The communicative actions represented by the social marketing campaigns represents a distortion of rational communication and therefore erodes the wellbeing of individuals (for example through internalised stigma, shame, guilt, body dissatisfaction, weight preoccupation, disordered eating and avoidance of health care), relationships between individuals (for example through increased blame, coercion, stigma, bias, prejudice and discrimination) and society (for example through stigmatisation of groups in the population on the basis of their body size and increased social and health inequity). Habermas proposes that power differentials work to distort rational communication, and that it is these distortions in communication that need to be the focal point for change (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Theory of Communicative Action: The Critique of Functionalist Reason; Habermas The Structural Transformation of the Public Sphere). Through critical analysis of the discourses used in the social marketing campaigns, we identified that they rely on the power, authority and status of experts to present uncontested representations of body weight and ‘appropriate’ health responses to it. In identifying the discourses present in the social marketing campaigns, we hope to focus attention on and thereby disrupt the distortions in the practical knowledge of the weight-centred health paradigm in order to contribute to systemic reorientation and change.ConclusionThrough the use of textual, discursive and social practices, the social marketing campaigns analysed in this study perpetuate the following concepts: everyone should be alarmed about growing waistlines and ‘ballooning’ rates of ‘obesity’; individuals are to blame for excess body weight, due to ignorance and the practice of ‘unhealthy behaviours’; individuals have a moral, parental, familial and cultural responsibility to monitor their weight and adopt ‘healthy’ eating and physical activity behaviours; such behaviour changes are easy to make and will result in weight loss, which will reduce risk of disease. These paternalistic campaigns evoke feelings of personal and parental guilt and shame, resulting in coercion to ‘take action’. They simultaneously stigmatise fat people yet serve to invisibilise them. Public health agencies must consider the harmful consequences of social marketing campaigns focused on body weight.ReferencesAFP. "A Ballooning Health Issue around the World." Gulfnews.com 29 May 2013. 17 Sep. 2013 ‹http://gulfnews.com/news/world/other-world/a-ballooning-health-issue-around-the-world-1.1189899›.Aphramor, Lucy. "The Impact of a Weight-Centred Treatment Approach on Women's Health and Health-Seeking Behaviours." Journal of Critical Dietetics 1.2 (2012): 3-12.Aphramor, Lucy, and Jacqui Gingras. "That Remains to Be Said: Disappeared Feminist Discourses on Fat in Dietetic Theory and Practice." The Fat Studies Reader, eds. Esther Rothblum and Sondra Solovay. New York: New York University Press, 2009. 97-105. Australian Government Department of Health and Ageing. 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Wandering the aisles of my local Woolworths in April this year, I noticed a large number of chocolate bilbies replacing chocolate rabbits. In these harsh economic times it seems that even the Easter bunny is in danger of losing his Easter job. While the changing shape of Easter chocolate may seem to be a harmless affair, the expulsion of the rabbit from Easter celebrations has a darker side. In this paper I look at the campaign to replace the Easter bunny with the Easter bilby, and the implications this mediated conservation move has for living rabbits in the Australian ecosystem. Essential to this discussion is the premise that studies of ecology must take into account the impact of media and culture on environmental issues. Of particular interest is the role of narrative, and the way the stories we tell about rabbits determine how they are treated in real life. While I recognise that the Australian bilby’s struggle for survival is a tale which should be told, I also argue that the vilification of the European-Australian rabbit is part of the native/invasive dualism which has ceased to be helpful, and has instead become a motivator of unproductive violence. In place of this simplified dichotomous narrative, I propose an ethic of "ecological remembrance" to combat the totalising eradication of the European rabbit from the Australian environment and culture. The Bilby vs the Bunny: A Case Study in "Media Selection" Easter Bunny says, ‘Bilby, I want you to have my job.You know about sharing and taking care.I think Australia should have an Easter Bilby.We rabbits have become too greedy and careless.Rabbits must learn from bilbies and other bush creatures’. The lines above are taken from Ali Garnett and Kaye Kessing’s children’s story, Easter Bilby, co-published by the Australian Anti-Rabbit Research Foundation as part of the campaign to replace the Easter bunny with the eco-politically correct Easter bilby. The first chocolate bilbies were made in 1982, but the concept really took off when major chocolate retailer Darrell Lea became involved in 2002. Since this time Haigh’s chocolate, Cadbury, and Pink Lady have also released delicious cocoa natives for consumption, and both Darrell Lea and Haigh’s use their profits to support bilby assistance programs, creating the “pleasant Easter sensation” that “eating a chocolate bilby is helping save the real thing” (Phillips). The Easter bilby campaign is a highly mediated approach to conservation which demonstrates the new biological principle Phil Bagust has recognised as “media selection.” Bagust observes that in our “hybridised global society” it is impossible to separate “the world of genetic selection from the world of human symbolic and material diversity as if they exist in different universes” (8). The Australian rabbit thrives in “natural selection,” having adapted to the Australian environment so successfully it threatens native species and the economic productivity of farmers. But the rabbit loses out in “cultural selection” where it is vilified in the media for its role in environmental degradation. The campaign to conserve the bilby depends, in a large part, on the rabbit’s failures in “media selection”. On Good Friday 2012 Sky News Australia quoted Mike Drinkwater of Wild Life Sydney’s support of the Easter bilby campaign: Look, the reason that we want to highlight the bilby as an iconic Easter animal is, number one, rabbits are a pest in Australia. Secondly, the bilby has these lovely endearing rabbit-like qualities. And thirdly, the bilby is a beautiful, iconic, native animal that is struggling. It is endangered so it’s important that we do all we can to support that. Drinkwater’s appeal to the bilby’s “endearing rabbit-like qualities” demonstrates that it is not the Australian rabbit’s individual embodiment which detracts from its charisma in Australian society. In this paper I will argue that the stories we tell about the European-Australian rabbit’s alienation from Indigenous country diminish the species cultural appeal. These stories are told with passionate conviction to save and protect native flora and fauna, but, too often, this promotion of the native relies on the devaluation of non-native life, to the point where individual rabbits are no longer morally considerable. Such a hierarchical approach to conservation is not only ethically problematic, but can also be ineffective because the native/invasive approach to ecology is overly simplistic. A History of Rabbit Stories In the Easter Bilby children’s book the illustrated rabbit offers to make itself disappear from the “Easter job.” The reason for this act of self-destruction is a despairing recognition of its “greedy and careless” nature, and at the same time, its selfless offer to be replaced by the ecologically conscious Bilby. In this sacrificial gesture is the implicit offering of all rabbit life for the salvation of native ecosystems and animal life. This plot line slots into a much larger series of stories we have been telling about the Australian environment. Libby Robin has observed that settler Australians have always had a love-hate relationship with the native flora and fauna of the continent (6), either devaluing native plants, animals, and ecosystems, or launching into an “overcompensating patriotic strut about the Australian biota” (Robin 9). The colonising dynamic of early Australian society was built on the devaluation of animals such as the bilby. This was reflected in the introduction of feral animals by “acclimatisation societies” and the privileging of “pets” such as cats and dogs over native animals (Plumwood). Alfred Crosby has made the persuasive argument that the invasion of Australia, and other “neo-European” countries, was, necessarily, more-than-human. In his work, Ecological Imperialism, Crosby charts the historical partnership between human European colonisers in Indigenous lands and the “grunting, lowing, neighing, crowing, chirping, snarling, buzzing, self-replicating and world-altering avalanche” (194) of introduced life that they brought with them. In response to this “guilt by association” Australians have reversed the values in the dichotomous colonial dynamic to devalue the introduced and so “empower” the colonised native. In this new “anti-colonial” story, rabbits signify a wound of colonisation which has spread across and infected indigenous country. J. M. Arthur’s (130) analysis of language in relation to colonisation highlights some of the important lexical characteristics in the rabbit stories we now tell. He observes that the rabbits’ impact on the county is described using a vocabulary of contamination: “It is a ‘menace’, a ‘problem’, an ‘infestation’, a ‘nuisance’, a ‘plague’” (170). This narrative of disease encourages a redemptive violence against living rabbits to “cure” the rabbit problem in order to atone for human mistakes in a colonial past. Redemptive Violence in Action Rabbits in Australia have been subject to a wide range of eradication measures over the past century including shooting, the destruction of burrows, poisoning, ferreting, trapping, and the well-known rabbit proof fence in Western Australia. Particularly noteworthy in this slaughter has been the introduction of biological control measures with the release of the savage and painful disease Myxomatosis in late December 1950, followed by the release of the Calicivirus (Rabbit Haemorrhage Disease, or RHD) in 1996. As recently as March 2012 the New South Wales Department of Primary Industries announced a 1.5 million dollar program called “RHD Boost” which is attempting to develop a more effective biological control agent for rabbits who have become immune to the Calicivirus. In this perverse narrative, disease becomes a cure for the rabbit’s contamination of Australian environments. Calicivirus is highly infectious, spreads rapidly, and kills rabbits en masse. Following the release of Calicivirus in 1995 it killed 10 million rabbits in eight weeks (Ponsonby Veterinary Centre). While Calicivirus appears to be more humane than the earlier biological control, Myxomatosis, there are indications that it causes rabbits pain and stress. Victims are described as becoming very quiet, refusing to eat, straining for breath, losing coordination, becoming feverish, and excreting bloody nasal discharge (Heishman, 2011). Post-mortem dissection generally reveals a “pale and mottled liver, many small streaks or blotches on the lungs and an enlarged spleen... small thrombi or blood clots” (Coman 173). Public criticism of the cruel methods involved in killing rabbits is often assuaged with appeals to the greater good of the ecosystem. The Anti-Rabbit research foundation state on their Website, Rabbit-Free Australia, that: though killing rabbits may sound inhumane, wild rabbits are affecting the survival of native Australian plants and animals. It is our responsibility to control them. We brought the European rabbit here in the first place — they are an invasive pest. This assumption of personal and communal responsibility for the rabbit “problem” has a fundamental blind-spot. Arthur (130) observes that the progress of rabbits across the continent is often described as though they form a coordinated army: The rabbit extends its ‘dominion’, ‘dispossesses’ the indigenous bilby, causes sheep runs to be ‘abandoned’ and country ‘forfeited’, leaving the land in ‘ecological tatters’. While this language of battle pervades rabbit stories, humans rarely refer to themselves as invaders into Aboriginal lands. Arthur notes that, by taking responsibility for the rabbit’s introduction and eradication, the coloniser assumes an indigenous status as they defend the country against the exotic invader (134). The apprehension of moral responsibility can, in this sense, be understood as the assumption of settler indigeneity. This does not negate the fact that assuming human responsibility for the native environment can be an act of genuine care. In a country scarred by a history of ecocide, movements like the Easter Bilby campaign seek to rectify the negligent mistakes of the past. The problem is that reactive responses to the colonial devaluation of native life can be unproductive because they preserve the basic structure of the native/invasive dichotomy by simplistically reversing its values, and fail to respond to more complex ecological contexts and requirements (Plumwood). This is also socially problematic because the native/invasive divide of nonhuman life overlays more complex human politics of colonisation in Australia. The Native/Invasive Dualism The bilby is currently listed as an “endangered” species in Queensland and as “vulnerable” nationally. Bilbies once inhabited 70% of the Australian landscape, but now inhabit less than 15% of the country (Save the Bilby Fund). This dramatic reduction in bilby numbers has multiple causes, but the European rabbit has played a significant role in threatening the bilby species by competing for burrows and food. Other threats come from the predation of introduced species, such as feral cats and foxes, and the impact of farmed introduced species, such as sheep and cattle, which also destroy bilby habitats. Because the rabbit directly competes with the bilby for food and shelter in the Australian environment, the bilby can be classed as the underdog native, appealing to that larger Australian story about “the fair go”. It seems that the Easter bilby campaign is intended to level out the threat posed by the highly successful and adaptive rabbit through promoting the bilby in the “cultural selection” stakes. This involves encouraging bilby-love, while actively discouraging love and care for the introduced rabbits which threaten the bilby’s survival. On the Rabbit Free Australia Website, the campaign rationale to replace the Easter bunny with the Easter bilby claims that: Very young children are indoctrinated with the concept that bunnies are nice soft fluffy creatures whereas in reality they are Australia’s greatest environmental feral pest and cause enormous damage to the arid zone. In this statement the lived corporeal presence of individual rabbits is denied as the “soft, fluffy” body disappears behind the environmentally problematic species’ behaviour. The assertion that children are “indoctrinated” to find rabbits love-able, and that this conflicts with the “reality” of the rabbit as environmentally destructive, denies the complexity of the living animal and the multiple possible responses to it. That children find rabbits “fluffy” is not the result of pro-rabbit propaganda, but because rabbits are fluffy! That Rabbit Free Australia could construe this to be some kind of elaborate falsehood demonstrates the disappearance of the individual rabbit in the native/invasive tale of colonisation. Rabbit-Free Australia seeks to eradicate the animal not only from Australian ecosystems, but from the hearts and minds of children who are told to replace the rabbit with the more fitting native bilby. There is no acceptance here of the rabbit as a complex animal that evokes ambivalent responses, being both worthy of moral consideration, care and love, and also an introduced and environmentally destructive species. The native/invasive dualism is a subject of sustained critique in environmental philosophy because it depends on a disjunctive temporal division drawn at the point of European settlement—1788. Environmental philosopher Thom van Dooren points out that the divide between animals who belong and animals who should be eradicated is “fundamentally premised on the reification of a specific historical moment that ignores the changing and dynamic nature of ecologies” (11). Mark Davis et al. explain that the practical value of the native/invasive dichotomy in conservation programs is seriously diminished and in some cases is becoming counterproductive (153). They note that “classifying biota according to their adherence to cultural standards of belonging, citizenship, fair play and morality does not advance our understanding of ecology” (153). Instead, they promote a more inclusive approach to conservation which accepts non-native species as part of Australia’s “new nature” (Low). Recent research into wildlife conservation indicates a striking lack of evidence for the case that pest control protects native diversity (see Bergstromn et al., Davis et al., Ewel & Putz, Reddiex & Forsyth). The problematic justification of “killing for conservation” becomes untenable when conservation outcomes are fundamentally uncertain. The mass slaughter which rabbits have been subjected to in Australia has been enacted with the goal of fostering life. This pursuit of creation through destruction, of re-birth through violent death, enacts a disturbing twist where death comes to signal the presence of life. This means, perversely, that a rabbit’s dead body becomes a valuable sign of environmental health. Conservation researchers Ben Reddiex and David M. Forsyth observe that this leads to a situation where environmental managers are “more interested in estimating how many pests they killed rather than the status of biodiversity they claimed to be able to protect” (715). What Other Stories Can We Tell about the Rabbit? With an ecological narrative that is failing, producing damage and death instead of fostering love and life, we are left with the question—what other stories can we tell about the place of the European rabbit in the Australian environment? How can the meaning ecologies of media and culture work in harmony with an ecological consciousness that promotes compassion for nonhuman life? Ignoring the native/invasive distinction entirely is deeply problematic because it registers the ecological history of Australia as continuity, and fails to acknowledge the colonising impact of European settlement on the environment. At the same time, continually reinforcing that divide through pro-invasive or pro-native stories drastically simplifies complex and interconnected ecological systems. Instead of the unproductive native/invasive dualism, ecologists and philosophers alike are suggesting “reconciliatory” approaches to the inhabitants of our shared environments which emphasise ecology as relational rather than classificatory. Evolutionary ecologist Scott P. Carroll uses the term “conciliation biology” as an alternative to invasion biology which focuses on the eradication of invasive species. “Conciliation biology recognises that many non-native species are permanent, that outcomes of native-nonnative interactions will vary depending on the scale of assessment and the values assigned to the biotic system, and that many non-native species will perform positive functions in one or more contexts” (186). This hospitable approach aligns with what Michael Rosensweig has termed “reconciliation ecology”—the modification and diversification of anthropogenic habitats to harbour a wider variety of species (201). Professor of Ecology and Evolutionary Biology Mark Bekoff encourages a “compassionate conservation” which avoids the “numbers game” of species thinking where certain taxonomies are valued above others and promotes approaches which “respect all life; treat individuals with respect and dignity; and tread lightly when stepping into the lives of animals”(24). In a similar vein environmental philosopher Deborah Bird Rose offers the term “Eco-reconciliation”, to describe a mode of “living generously with others, singing up relationships so that we all flourish” (Wild Dog 59). It may be that the rabbit cannot live in harmony with the bilby, and in this situation I am unsure of what a conciliation approach to ecology might look like in terms of managing both of these competing species. But I am sure what it should not look like if we are to promote approaches to ecology and conservation which avoid the simplistic dualism of native/invasive. The devaluation of rabbit life to the point of moral inconsiderability is fundamentally unethical. By classifying certain lives as “inappropriate,” and therefore expendable, the process of rabbit slaughter is simply too easy. The idea that the rabbit should disappear is disturbing in its abstract approach to these living, sentient creatures who share with us both place and history. A dynamic understanding of ecology dissipates the notion of a whole or static “nature.” This means that there can be no simple or comprehensive directives for how humans should interact with their environments. One of the most insidious aspects of the native/invasive divide is the way it makes violent death appear inevitable, as though rabbits must be culled. This obscures the many complex and contingent choices which determine the fate of nonhuman life. Understanding the dynamism of ecology requires an acceptance that nature does not provide simple prescriptive responses to problems, and instead “people are forced to choose the kind of environment they want” (189) and then take actions to engender it. This involves difficult decisions, one of which is culling to maintain rabbit numbers and facilitate environmental resilience. Living within a world of “discordant harmonies”, as Daniel Botkin evocatively describes it, environmental decisions are necessarily complex. The entanglement of ecological systems demands that we reject simplistic dualisms which offer illusory absolution from the consequences of the difficult choices humans make about life, ecologies, and how to manage them. Ecological Remembrance The vision of a rabbit-free Australia is unrealistic. As organisation like the Anti-Rabbit Research Foundation pursue this future ideal, they eradicate rabbits from the present, and seek to remove them from the past by replacing them culturally with the more suitable bilby. Culled rabbits lie rotting en masse in fields, food for no one, and even their cultural impact in human society is sought to be annihilated and replaced with more appropriate native creatures. The rabbits’ deaths do not turn back to life in transformative and regenerative processes that are ecological and cultural, but rather that death becomes “an event with no future” (Rose, Wild Dog 25). This is true oblivion, as the rabbit is entirely removed from the world. In this paper I have made a case for the importance of stories in ecology. I have argued that the kinds of stories we tell about rabbits determines how we treat them, and so have positioned stories as an essential part of an ecological system which takes “cultural selection” seriously. In keeping with this emphasis on story I offer to the conciliation push in ecological thinking the term “ecological remembrance” to capture an ethic of sharing time while sharing space. This spatio-temporal hospitality is focused on maintaining heterogeneous memories and histories of all beings who have impacted on the environment. In Deborah Bird Rose’s terms this is a “recuperative work” which commits to direct dialogical engagement with the past that is embedded in the present (Wild Country 23). In this sense it is a form of recuperation that promotes temporal and ecological continuity. Eco-remembrance aligns with dynamic understandings of ecology because it is counter-linear. Instead of approaching the past as a static idyll, preserved and archived, ecological remembrance celebrates the past as an ongoing, affective presence which is lived and performed. Ecological remembrance, applied to the European rabbit in Australia, would involve rejecting attempts to extricate the rabbit from Australian environments and cultures. It would seek acceptance of the rabbit as part of Australia’s “new nature” (Low), and aim for recognition of the rabbit’s impact on human society as part of dynamic multi-species ecologies. In this sense ecological remembrance of the rabbit directly opposes the goal of the Foundation for Rabbit Free Australia to eradicate the European rabbit from Australian environment and culture. On the Rabbit Free Australia website, the section on biological controls states that “the point is not how many rabbits are killed, but how many are left behind”. The implication is that the millions upon millions of rabbit lives extinguished have vanished from the earth, and need not be remembered or considered. However, as Deborah Rose argues, “all deaths matter” (Wild Dog 21) and “no death is a mere death” (Wild Dog 22). Every single rabbit is an individual being with its own unique life. To deny this is tantamount to claiming that each rabbit that dies from shooting or poisoning is the same rabbit dying again and again. Rose has written that “death makes claims upon all of us” (Wild Dog 19). These are claims of ethics and compassion, a claim that “we look into the eyes of the dying and not flinch, that we reach out to hold and to help” (Wild Dog 20). This claim is a duty of remembrance, a duty to “bear witness” (Wiesel 160) to life and death. The Nobel Peace Prize winning author, Elie Wiesel, argued that memory is a reconciliatory force that creates bonds as mass annihilation seeks to destroy them. Memory ensures that no life becomes truly life-less as it wrests the victims of mass slaughter from “oblivion” and allows the dead to “vanquish death” (21). 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