The Democratizing Priority of Consensual Self-Determination in the Emerging Era of Non-Normalizing Healthcare

Upgraded and Adapted from the Moot:

The emergence of non-normalizing genetic, cognitive, and prosthetic therapies seems to me to demand a shift in the language of democratizing progressive healthcare advocacy from universal access (at least as its sole or even primary organizing principle) to consensual self-determination.

This suggestion raises understandable red-flags to those who know well how a focus on consent-talk over access-talk or over more "neutral" harm-reduction-talk in this area has often functioned as a reactionary strategy simply to deny healthcare to vulnerable people as a way of engaging in class warfare, often with the ugliest kinds of sexist, racist, colonialist inflections.

I would like to think I manage to circumvent appropriation of my own argument by such reactionary politics since I do insist that consent, when it is substantial rather than vacuously formal, must be actually informed and actually non-duressed -- a requirement that demands strong regulation and a substantial provision of social services (as close to universal basic income as we can manage, the widest possible access to reliable public knowledges, and so on) that tend to make my own version of consent-talk unappealing to anti-democratic politics.

Be all that as it may, a shift into consensual therapeutic self-determination is indeed a real shift for democratic-minded progressives to come to terms with, and much of that work remains for now in its barest beginnings.

Among the implications of this shift for me is that progressives need to understand that the familiar technocratic forms of eugenics (for which the transhumanists I decry here represent an extreme case) that would police lifeway diversity into "optimal/normal" forms is matched by conservative forms of eugenics (for which the bioconservatives I decry here represent an extreme case) that would police wanted lifeway diversity into "natural/customary" forms, and that some traditional progressive advocacy language is quite vulnerable to appropriation by anti-democratic politics in these two modes in the aftermath of the shift into non-normalizing therapy.

Further, both superlative and supernative futurological discourses (as well as the more mainstream developmental discourses these sometimes symptomize, sometimes exaggerate, and sometimes pioneer) seem to me to derange our capacity to think about this shift in a reasonable way at a time when it is fairly urgent that we do so.

I am interested in progressive healthcare discourse in an era of emerging non-normalizing therapy. I strongly regret and worry about the extent to which public discourse on these questions has been framed or frustrated by hyberbolizing and faith-based formations of superlativity and supernativity.

I also strongly regret that topics that are perfectly fitting and edifying (if your tastes incline that way, as mine do) for sf literary salons -- such as the question of what kind of coherent narrative subjecthood could be maintained through a completely speculative radically underspecified prosthetic prologation to the tune of centuries of something akin to what we presently mean by the terms lifespan or consciousness -- are sometimes treated as topics connected in even the remotest way to healthcare policy discourse. Nothing at all good ever comes of such confusions.