Medicine as Moral Technology: Somatic Economies and the Making Up of Adoptees
2013; Taylor & Francis; Volume: 33; Issue: 2 Linguagem: Inglês
10.1080/01459740.2013.776046
ISSN1545-5882
Autores Tópico(s)Neuroethics, Human Enhancement, Biomedical Innovations
ResumoAbstract This article focuses on adoption medicine as a subject of scientific knowledge that increasingly defines the parameters of adoptability in the world of international adoption. While this biomedical discourse alludes to the health of adoptee bodies, it also constitutes ethico-moral practices that produce new justificatory regimes of adoption in particular and humanitarianism in general. Drawing on discourse analysis of scientific texts in adoption medicine on the one hand, and interviews and ethnographic data from a Dutch adoption agency on the other, I demonstrate the emergence of a new moral economy facilitating the legitimacy of international adoption. I argue that this moral economy retools the humanitarian justification of international adoption by privileging the politics of “life itself.” This paradigmatic shift constructs new categories of adoptee bodies, rearranges orders of worth, and makes visible biopolitical techniques of morality in present-day humanitarian discourse. Keywords: adoption medicineglobalizationinternational adoptionknowledge practicesmorality and ethics ACKNOWLEDGMENTS This research was funded by a Rubicon grant from the Netherlands Organisation for Scientific Research (project number: 446-06-025) and an internal Research Seed Grant from the University of Western Sydney (project number: 20191.80816). I am grateful to the Center for Cultural Sociology at Yale University and the Pembroke Center for Teaching and Research on Women at Brown University for providing me with the intellectual space during my fellowships to think through the complex issues depicted in this article. I thank Bregje Van Eekelen, Marc de Leeuw, Nikolas Rose, and Terry Woronov for their critical comments on a previous version. I would also like to express my gracious thanks to the three reviewers who provided valuable comments and suggestions for improvement. I would particularly like to thank one of them, Barbara Yngvesson, who revealed her identity to me, and whose generous and insightful criticism was extremely useful in sharpening my arguments in this article. Notes This article is based on ongoing empirical research examining the ‘making of adoption’ in institutions, and uses ethnographic methods, in-depth interviews, and document analysis. I conducted ethnographic fieldwork at a Dutch adoption agency over a period of five months (for a total of 160 hours between March 2008 and July 2008 and between December 2011 and September 2012). I also made research visits to two other Dutch adoption agencies and six agencies in the United States (between 2007 and 2012). My data include ethnographic observations of institutional meetings, institutional events, meetings between social workers and prospective parents, meetings between social workers and medical practitioners, and audio recordings of 30 interviews with adoption professionals in the Netherlands and 30 interviews with adoption professionals in the Unites States. I also consulted and analyzed client records and policy documents from various institutions ranging from local agencies to national information and research centers (private, nonprofit, and state-regulated) and international bodies regulating international adoption. A minimal medical screening is compulsory by law in most receiving states. In the United States, the visa health exam was established to protect the American public and to exclude those who would become public charges (Nicholson 2002 Nicholson , L. A. 2002 Adoption medicine and the internationally adopted child . American Journal of Law & Medicine 28 ( 2002 ): 473 – 490 .[PubMed] , [Google Scholar]). Similarly, in the Netherlands, the Department of Justice defines ‘acceptable’ children as those who are not suffering from a dangerous contagious or physical or mental illness. Thus, the minimal requirements are aimed at protecting the general public and do not necessarily show concern for the child's health. Medical exams and screenings beyond these mandated screenings are conducted either as part of the placement policies of adoption agencies or at the discretion of adoptive parents seeking medical advice and treatment for their children before or after placement. Most screenings are not covered by health insurance, and in certain countries, for example the United States, they are provided by private clinics. There is disagreement about the reasons for the decline. Some argue that economic and social improvements in the sending countries such as economic growth, improvements in the child welfare system, increased numbers of domestic adoptions, and improvements in foster care have contributed to the decreasing numbers of internationally adoptable children (Fonseca 2006 Fonseca , C. 2006 Transnational influences in the social production of adoptable children: The case of Brazil . The International Journal of Sociology and Social Policy 26 ( 3/4 ): 154 – 171 .[Crossref] , [Google Scholar]; Johnson 2004 Johnson , K. A. 2004 Wanting a Daughter, Needing a Son: Abandonment, Adoption, and Orphanage Care in China . St. Paul , MN : Yeong & Yeong Book Company . [Google Scholar]; Leinaweaver 2008 Leinaweaver , J. B. 2008 The Circulation of Children: Kinship, Adoption, and Morality in Andean Peru . Durham , NC and London : Duke University Press .[Crossref] , [Google Scholar]; Selman 2010 ——— . 2010 The global decline of intercountry adoption: What lies ahead? Social Policy and Society 11 ( 3 ): 381 – 397 . [Google Scholar]). Others attribute the decreases to nationalist measures on the part of sending countries who respond to overseas abuse of ‘their’ children by imposing stricter adoption rules and to the increasing bureaucratization of international adoption by international conventions that make it more difficult for children to become available for adoption (Bartholet 2007 Bartholet , E. 2007 International adoption: Thoughts on the human rights issues . Buffalo Human Rights Law Review 13 ( 182 ): 151 – 203 . [Google Scholar]). The Guide to Good Practice established by the Hague Convention on Protection of Children and Co-operation in respect of Intercountry Adoption (hereinafter referred to as the Hague Convention) defined ‘special needs’ children as “those who may be: 1) suffering from a behavior disorder or trauma, 2) physically or mentally disabled, 3) older children (usually above 7 years of age), or 4) part of a sibling group” (HccH Guide to Good Practice 2008, art 7.3.1). The Hague Convention is available at http://hcch.e-vision.nl/index_en.php?act=conventions.pdf&cid=69, and the Guide to Good Practice is available at http://www.hcch.net/index_en.php?act=publications.listing&sub=4. The Dutch studies relied mostly on self-reporting and parental reporting and concluded that international adoptees experienced more behavioral and emotional problems than their nonadopted peers (Hoksbergen 1997 Hoksbergen , R. A. C. 1997 Turmoil for adoptees during their adolescence? International Journal of Behavioral Development 20 ( 1 ): 33 – 46 .[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]:33). Moreover, these problems seemed to be gender specific and related to the adoptees’ gendered identification with their appearance (43). The Swedish study conducted by Hjern and colleagues (1997), which was based on data from national registers, concluded that “intercountry adoptees are three to four times more likely to have serious mental health problems such as suicide, suicide attempts, and psychiatric admissions” (2002 Hjern , A. , F. Lindblad , and B. Vinnerljung 2002 Suicide, psychiatric illness, and social maladjustment in intercountry adoptees in Sweden: A cohort study . Lancet 360 ( 9331 ): 443 – 448 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]:446). Miller's book includes generally accepted protocols for pre-adoptive screenings, postadoptive screenings, and medical treatment, similar to the guidelines set out in the second readily available resource, the American Academy of Pediatrics’ Red Book (2003), which outlines procedures for disease testing and immunization for internationally adopted children (Welsh et al. 2007 Welsh , J. A. , A. G. Viana , S. A. Petrill , and M. D. Mathias 2007 Interventions for internationally adopted children and families: A review of the literature . Child and Adolescent Social World Journal 24 ( 3 ): 285 – 311 .[Crossref] , [Google Scholar]:293). Similar protocols can be found in the Netherlands, where the resource currently used by pediatricians to evaluate, screen, and treat internationally adopted children is the Workbook on Imported Diseases in Children (Werkboek Importziekten bij Kinderen 2000). The chapter on international adoption is informed (among others) by the work of Femmie Juffer and Renee Hoksbergen, two leading adoption experts in the Netherlands who are often cited in the context of agencies. The ecological niche theory stems from the work of the developmental psychologists Jean Piaget and Lev Vygotsky and is rooted in an alternative evolutionary theory that emphasizes that children's development must be examined in relation to their environment. For a thorough discussion of this theory, see Castaneda (2002 Castaneda , C. 2002 Figurations: Child, Bodies, Worlds . Durham , NC and London : Duke University Press .[Crossref] , [Google Scholar]:72–75). This slogan originated from Johnson and colleagues’ (1992 Johnson , D. E. , L. C. Miller , S. Iverson , W. Thomas , B. Franchino , K. Dole , et al.. 1992 The health of children adopted from Romania. Journal of the American Medical Association 268(24):3446–3450.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) study of children adopted from Romania, which examined 65 children who had been referred to an international adoption clinic. The children's ages at the time of their adoption ranged from 6 weeks to 73 months, and approximately two-thirds had spent their entire lives in institutional care. Johnson and colleagues noted that these children lost approximately one month of linear growth for every three months they spent in the orphanage. Moreover, only 15% of the children were judged to be developmentally normal and physically healthy at the time of adoption, while 50% had intestinal parasites or evidence of a hepatitis B infection, for example. Csordas explained how evidence is different from “data”: the latter “have nothing to prove in themselves” but can be used to prove something (2004:475). The rationale for the maximum age lies in research indicating that it is harder for older children to attach to their adoptive parents. For an account of visual representations of fetal alcohol syndrome, see Cartwright (2003 Cartwright , L. 2003 Photographs of “waiting children”: The transnational adoption market . Social Text 21 ( 1 ): 83 – 109 .[Crossref] , [Google Scholar]). The term ‘intersexed condition’ refers to a congenital ambiguity of sex, which can be related to chromosomal, morphological, genital, and/or gonadal anomalies. For example, some parents might regard hepatitis B as acceptable even though they have indicated that they want a child who is ‘as healthy as possible’ (zo gezond mogelijk). The social worker would then inform them that hepatitis B is a serious condition that does not really fall under the category ‘as healthy as possible.’ Through such negotiations, prospective parents are informally classified as those who would accept ‘real’ special needs (echte SN) and those who have a ‘weak’ special needs profile (magere SN). Such classifications are important not only for the matching process, but also for the length of the waiting period. The medical preferences are crucial information for social workers, who usually adhere to them. The discussions I observed during consultation meetings ranged from the actual age of children to vaccination requirements (e.g., for tuberculosis immunizations), congenital malformations, developmental delays, malnourishment, physical disabilities, and the completion of certain tests (e.g., for HIV or hepatitis A and B). See also Leinaweaver (2009) for an illustration of how biomedical measures are used to assess children's natal families as ‘inappropriate’ and are then employed as justifications for removing children from their families. Foster children are also framed differently when compared to the mediated figure of the ‘global orphan.’ While orphans conjure the image of ‘bare life,’ children in foster care are framed not as orphans but as victims of domestic abuse (Kim 2011 Kim , E. J. 2011 Adopted Territory: Transnational Korean Adoptees and the Politics of Belonging . Durham , NC and London : Duke University Press . [Google Scholar]:262). Additional informationNotes on contributorsSonja van WichelenSONJA VAN WICHELEN is Senior Research Fellow at the Institute for Culture and Society, University of Western Sydney. She received her PhD in social sciences at the University of Amsterdam and held positions in the Center for Cultural Sociology at Yale University and in the Pembroke Center at Brown University. Her books include Religion, Gender and Politics in Indonesia: Disputing the Muslim Body (Routledge, 2010) and Commitment and Complicity in Cultural Theory and Practice (Palgrave Macmillan, 2009, co-edited with Begüm Firat and Sarah De Mul).
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