Consumer Medicine’s Origins and Harms

Consumer medicine consists of medical interventions pursued for non–health-related goals with the locus of the goals residing solely with the patient. Currently, contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia fall in this category. Consumer medicine originates from the fusion of expressive individualism with its sole focus on the subjective psychological well-being intersecting with an expansion of health now including well-being combined with an exaltation of autonomy. Expressive individualism is inward-focused and entirely subjective reducing the human to a psychologic self while instrumentalizing the biological and social dimensions and neglecting the spiritual dimension. Expressive individualism is currently manifested through economic activity (career and consumption) and particularly sexual expression. This contrasts with the holistic biopsychosocial-spiritual model of health with its deep inter-relationships and prioritization of the spiritual. Consumer medicine has damaged the profession of medicine. Physicians now have conflicting roles of healer versus body engineer, and conflicting obligations to do no harm while performing medical harms unrelated to objective health. There is now division within medicine and increasing external state regulations both seriously harming its professional status. The traditional teleologically driven ethical framework that is objectively disease-focused is now confused with a subjective list of non–health-related values as goals for medical interventions leading to an incoherent ethical framework. Biologic solutions best address biological problems and do not effectively address psychological, social, or even spiritual problems but rather make them worse. Medicine now reinforces and is complicit with expressive individualism and its attendant shallow and narrow understanding of what it means to be human with the current valuation of sexual expression and economic activity. Medical harms and social costs have resulted while challenging the value of those who are disabled, elderly, or marginalized. This shallow view has likely fueled the current existential crisis contributing to the marked increase in PAS/euthanasia in the West. Summary: Consumer medicine currently includes contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia. These medical interventions are pursued for subjective non–health-related goals as opposed to the traditional goal of treating sick patients for their objective health. Consumer medicine’s origins lie in the intersection of expressive individualism, the exaltation of patient autonomy combined with health’s redefinition as subjective well-being. This has resulted in harms to the profession of medicine, ethical incoherence, and medical injury. Consumer medicine promotes a truncated understanding of the human at odds with the biopsychosocial-spiritual model and human flourishing. This has likely contributed to the rise of PAS/euthanasia.

Dementia and sexuality in long-term care: Incompatible bedfellows?

Despite the recognized benefits of sexual expression and its importance in the lives of people living with dementia, research demonstrates that there are multiple barriers to its positive expression (e.g., expression that is pleasurable and free of coercion, discrimination, and violence) in RLTC homes. These barriers constitute a form of discrimination based on age and ability, and violate the rights of persons living with dementia to dignity, autonomy, and participation in everyday life and society. Drawing on a human rights approach to dementia and sexual expression, we explored the experiences of diverse professionals, family members, and persons living with dementia with explicit attention to the ways in which macro-level dynamics are influencing the support, or lack thereof, for sexual expression at the micro level. Focus groups and in-depth interviews were conducted with 27 participants, and the collected data were analyzed thematically. While all participants acknowledged that intimacy and sexual expression of persons living with dementia should be supported, rarely is such expression supported in practice. Micro-level factors included negative attitudes of professionals toward sexual expression by persons living with dementia, their discomfort with facilitating intimacy and sexual expression in the context of their professional roles, their anxieties regarding potential negative reactions from family members, and concerns about sanctions for failing to prevent abuse. In our analysis, we importantly trace these micro-level factors to macro-level factors. The latter include the cultural stigma associated with dementia, ageism, ableism, and erotophobia, all of which are reproduced in, and reinforced by, professionals’ education, as well as legal and professional standards that exclusively focus on managing and safeguarding residents from abuse. Our analysis demonstrates a complexity that has enormous potential to inform future research that is critically needed for the development of educational initiatives and to promote policy changes in this area.

Sexual Expression, Policy, and Practices in Skilled Nursing Facilities: An Updated Assessment in the State of Kansas

Prior studies have reported barriers to meeting the sexual needs of older adults within skilled-nursing facilities, such as a lack of privacy, lack of supportive practices and policies, and judgement or discomfort on the part of the staff (Doll, 2013; Hajjar & Kamel, 2003). In 2008, Doll and colleagues assessed the scope of sexual behaviors, staff perceptions of and responses to such behaviors, and whether facilities had a sexual policy in place in SNFs in the state of Kansas (Doll, 2013). In the present study, an online survey was distributed to the same population to provide an updated assessment of sexual behaviors, policies, and practices. Of 60 survey respondents, 62.7% reported knowledge of individual sexual acts (e.g., masturbation) within the past year and 34.5% reported interactional (between two or more residents) sexual acts. When encountering a sexual event, staff were most likely to report the incident to an administrator (76.7%) and treat residents with respect (70.0%), while 35.0% and 41.7% were expected to respond with embarrassment and discomfort, respectively. Only 40% of administrators reported having a policy related to sexual expression. Findings indicate that staff are likely to respond differently to LGBTQ residents due to discomfort and those living with cognitive impairment due to concerns related to consent. The proportion of facilities in Kansas with policies related to sexual expression has increased from 26% to 40% in the past 12 years, but there remains a need for greater specificity of sexuality-related policies and trainings.

Comparison of Two Surveys Using the Sexuality Assessment Tool (SexAT) in Flanders

From 2015 it is mandatory in Flanders, Belgium, to develop a policy to deal with sexual abuse in elderly care. Residential Aged Care Facilities (RACF'S) try to focus on this mandatory, but should also pay attention to implement an overall Sex and Intimacy Policy. This study contains a Comparison of two surveys (Messelis & Bauer, 2020 and Vander Stichele, e.a. 2020) in Flanders, Belgium, both using the Sexual Assessment Tool (SeAT, Messelis & Bauer, 2017). Both studies aimed to assess how supportive residential aged care facilities are of residents' sexual expression. In the survey of Messelis & Bauer 750 aged care facilities were contacted in 2017-2018 and 69 (9,2%) completed the SexAT survey after three reminders. Vander Stichele e.a. contacted 100 aged care facilities managers in 2019. Twenty of them (20% response rate) completed the SexAT after three reminders. Findings of the Messelis & Bauer survey indicate that 70% of the facilities rated 'very good' to 'good' (score between 21-59/69), while Vander Stichele e.a. found a prevalence of 76% of this score. Both found no facilities were rated 'excellent' (score greater than 60/69). In the category 'improvement needed' (score less than 20/69), percentages were 30% and 23%; a difference of 7% (CI95% of difference in percentage includes zero, not significant). There is room for improvement in residential aged care facilities for the support of sexual expression of residents. The more recent study confirms results of the previous one, and no significant evolution was observed in two consecutive cross-sectional surveys.

Regulating and representing camming: Strict limits on acceptable content on webcam sex platforms

This article analyses the discursive construction of the limits of webcamming in terms of service agreements by BongaCams, LiveJasmin and Chaturbate, three of the world’s most popular webcam sex platforms. Through this analysis, the moderation practices in the webcamming industry are examined. Regulation of sexual platforms and its implications for representations of online sex work are still largely unclear. Through a critical discourse analysis of seven webcam platform terms of service documents, this article scrutinises the norms for camming as dictated by industry leading platforms. This analysis shows that these platforms, for legal and financial reasons, reject the idea of camming as sexually explicit or as (sex) work. Such a construction of camming limits sexual expression online, obstructs online sex workers’ labour rights and perpetuates sex work stigma. This article sheds light on how digital platforms can establish and maintain norms which regulate users’ online expressions, working conditions and representations.

Defining gay-friendly city as a space of resistance for Indonesian gays in Paris and Jakarta

Migration is associated with the search for a more permissive environment. By linking Paris as a place of attachment, the author sees that Paris in this case can be indicated as the “home” for Indonesian gays. The feeling of “full gay” is a feeling that they never get when they stay in Indonesia. That is why many Indonesian gays decide to move out of Indonesia in any way regardless of the difficulties they face in the destination country. This paper answer two questions: what do we understand by “Gay-friendly city”? And if we talk about Jakarta, “can Jakarta be categorized as a gay-friendly city”? The author interviewed eight Indonesian gays directly in Paris with the naturalistic paradigm and analyzed with the qualitative research, and what will be found in this paper is the narrative of the eight informants. It can be said that the Indonesian gays who have migrated to Paris do not feel that their lives have been wasted. They do diaspora by going to gay bars and participating in gay pride parades. What they feel is a feeling of freedom to be able to channel their gender and sexual expression, and they found that Paris as a gay-friendly city is a kind of space of resistance.

Polygamous breeding system identified in the distylous genus Psychotria: P. manillensis in the Ryukyu archipelago, Japan

Distyly is a genetic polymorphism composed of long-and short-styled flowers in a population. The evolutionary breakdown of distyly has been reported in many taxa, and mainly involves a shift toward monomorphism or dioecism. However, a shift toward monoecism has not been reported in distylous species. Psychotria (Rubiaceae), one of the world largest genera, consists of distylous species and their derivatives. In our preliminary study, however, we identified some monoecious individuals in a population of Psychotria manillensis. To understand the breeding system and reproductive biology of P. manillensis, we investigated floral traits, open fruit set, and flower visitors, and performed hand pollination and bagging experiments in five populations of Okinawa and Iriomote islands, Ryukyu Islands, Japan. The populations of P. manillensis were composed mainly of monoecious individuals (54%), followed by female (30%), male (14%), and hermaphroditic (2%) individuals at the time of flower collection. Of the collected flowers, 93% were functionally unisexual (male or female), whereas only 6.5% were perfect (hermaphroditic). However, some individuals changed sex mainly towards increasing femaleness during the flowering period. Moreover, 35% of the studied plants changed their sexual expression over the years. P. manillensis showed self-compatibility and no agamospermy. The fruit set under open pollination varied among populations and years (1.8–21.9%), but it was significantly higher than that of auto-selfing (0.68–1.56%). Wasps and flies were the main flower visitors and probably the main pollinators of the species. In conclusion, P. manillensis was revealed to be polygamous, involving monoecious, female, male, and hermaphroditic individuals. This is the first report of the polygamous breeding system not only in the genus Psychotria, but also in all heterostylous taxa.

Customer Abuse and Aggression as Labour Control Among LGBT Workers in Low-Wage Services

This study examines the relation between customer abuse and aggression, the gender and sexual expression of workers, and labour control in low-wage services. In-depth interviews with 30 lesbian, gay, bisexual, and transgender (LGBT)1 low-wage service sector workers reveal how customer abuse and aggression works in consort with management strategies to reproduce cis- and heteronormativity. Customer abuse and aggression disciplined worker expressions of non-normative gender and sexual identities, leading to concealment and self-policing. Management was complicit in this dynamic, placing profitability and customer satisfaction over the safety of LGBT workers, only intervening in instances of customer abuse and aggression when it had a limited economic impact. It is posited that customer abuse and aggression is not only a response to unmet expectations emanating from the labour process but is also a mechanism of labour control that disciplines worker behaviour and aesthetics, directly and indirectly, by influencing management prerogatives.

Emotional clashes and female public nudity in Thailand

This article revisits cultural controversies over female public nudity in Thai society. It uses Songkran’s topless dancing in 2011 and a bare-breast painting performance on the ‘Thailand’s Got Talent Show’ in 2012 to explore cultural and emotional clashes in Thailand’s 21st century. It shows that these two cases of public female nudity drew deep and divergent emotional responses from different groups in Thai society. These cases clearly revealed a clash in viewpoints with regard to Thai notions of feminine respectability associated with national identity and women’s sexual expression. On the one hand, the controversies prompted moral panic and backlashes against women’s sexual rebelliousness. On the other hand, they set off counter-backlashes against hegemonic discourse that tends to normalise oppressive sexual culture, nationalism and totalitarianism.