The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

Zeitschrift für Praktische Philosophie / Die Rettung der größeren Anzahl : Eine Debatte um Grundbausteine ethischer Normenbegründung

Im Rahmen der sogenannten Taurek-Debatte wird die Frage diskutiert, ob in Rettungskonflikten die größere Anzahl an Opfern gerettet werden sollte oder nicht. Wir beziehen in dieser Kontroverse eine konsequentialistische und aggregationistische Pro-Anzahl-Position und verteidigen diese gegen verschiedene Einwände. Insbesondere halten wir die Position für kompatibel mit dem Prinzip gleicher Achtung. Angesichts des Umstandes, dass die Pro-Anzahl-Position in maßgeblicher Weise von der Annahme eines personenneutralen Wertes persönlichen Wohlergehens abhängt, bieten wir eine kohärentistische Rechtfertigung für diese Wertbehauptung. Systematisch argumentieren wir, dass weder ein reiner Wohlergehensaggregationismus noch seine komplette Zurückweisung überzeugend sein können. Die Vereinigung der beiden ethischen Dimensionen individueller Ansprüche und kollektiven Wohlergehens erfordert stattdessen eine hybride Position. Wir identifizieren drei mögliche Wege für die Konstruktion einer solchen Hybridposition und verteidigen diese abschließend kurz gegen einen aktuellen Vorwurf, demzufolge diese nicht auf kohärente Weise im Rahmen der rationalen Entscheidungstheorie abgebildet werden können.This paper addresses the so-called Taurek debate on whether or not to save the greater number of victims in rescue conflicts. In this controversy we take a consequentialist and aggregationist pro-numbers position and defend it against various objections. In particular, we consider it to be compatible with the principle of equal concern. Given that the pro-numbers position hinges to a significant extent on the acceptance of the person-neutral value of personal well-being, we offer a coherentist justification for this value claim. Systematically though, we argue that neither pure welfare aggregationism nor its strict rejection are convincing. Rather, rejoining the two ethical dimensions of individual claims and collective well-being requires a hybrid position. Identifying three possible ways of constructing such a position, we briefly defend them against a recent version of the charge that they cannot be coherently expressed in a rational choice framework.(VLID)463221

Ethics and effectiveness: rationing healthcare by thresholds of minimum effectiveness

Buyx AM, Friedrich DR, Schöne-Seifert B. Ethics and effectiveness: rationing healthcare by thresholds of minimum effectiveness. BMJ. 2011;342:d54.{\textless}h3{\textgreater}Objective{\textless}/h3{\textgreater} {\textless}p{\textgreater}To test the hypothesis that retinal vascular signs are associated with greater cognitive decline over 20 years in 12,317 men and women 50 to 73 years of age at baseline.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Methods{\textless}/h3{\textgreater} {\textless}p{\textgreater}A composite cognitive score was created with 3 neuropsychological tests measured at 3 time points (1990–1992 to 2011–2013). Retinal signs were measured with fundus photography (1993–1995). Differences in cognitive change by retinal signs status were estimated with linear mixed models. Cognitive scores were imputed for living participants with incomplete cognitive testing.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Results{\textless}/h3{\textgreater} {\textless}p{\textgreater}In multivariable-adjusted analyses that controlled for attrition, loss of vascular integrity (retinopathy and its components) was associated with greater 20-year decline (difference in 20-year cognitive change for moderate/severe vs no retinopathy −0.53 SD, 95\% confidence interval −0.74 to −0.33). Estimated differences were similar in participants with and without diabetes mellitus and in white and black participants.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Conclusions{\textless}/h3{\textgreater} {\textless}p{\textgreater}Retinopathy was associated with accelerated rates of 20-year cognitive decline. These findings support the exploration of more sensitive measures in the eye such as optical coherence tomography angiography, which may provide surrogate indexes of microvascular lesions relevant to cognitive decline in older adults.{\textless}/p{\textgreater

Ausschluss medizinischer Leistungen mit nur marginaler Wirksamkeit?

Friedrich DR, Buyx AM, Schöne-Seifert B. Ausschluss medizinischer Leistungen mit nur marginaler Wirksamkeit? Deutsches Ärzteblatt. 2009;106:A1562-A1564

Marginale Wirksamkeit als Posteriorisierungskriterium – Begriffsklärungen und ethisch relevante Vorüberlegungen

Buyx AM, Friedrich DR, Schöne-Seifert B. Marginale Wirksamkeit als Posteriorisierungskriterium – Begriffsklärungen und ethisch relevante Vorüberlegungen. Ethik in der Medizin. 2009;21(2):89-100

Mindestnutzenschwelle im Gesundheitswesen. Ethische Argumente, Befragungsdaten und gesundheitspolitischer Ausblick

Buyx AM, Friedrich DR, Schöne-Seifert B. Mindestnutzenschwelle im Gesundheitswesen. Ethische Argumente, Befragungsdaten und gesundheitspolitischer Ausblick. Gesundheit und Sozialpolitik. 2012;2012(2):37-44