Research

I primarily study and write about the relationships between silence and oppression in health and healthcare, especially as these concern disabled, queer, and/or transgender people. I also conduct research on accessibility, disability, technology, and education, and the relationships between all of these things!

In academic terms, my main research areas include: Practical ethics (including bioethics), queer and transgender philosophy, philosophy of disability, philosophy of medicine, and social epistemology. I have other teaching and research competence in Chinese philosophy, ethics (broadly construed), health studies, disability studies, and many other disciplines and niches: my work tends to be quite interdisciplinary!

Below, I describe my two current research projects: (1) my dissertation project on silence and oppression in health and healthcare; and (2) a further project on suicide, disability, and death. A note: The summaries below are written to be more accessible to a broader audience, because my research impacts and is impacted by a broad audience. Are you looking for a more disciplinary summary of my research that uses academic phrases like “epistemic oppression,” “debility,” or “necropolitics”? Please email me for other resources!

My main research: Silence in health and healthcare

In everyday language, I study and research issues where topics of knowledge and health overlap. My main interests around knowledge and health are about which kinds of knowledge are valued or “listened to,” and what the consequences are when certain kinds of knowledge aren’t valued, aren’t listened to, or are otherwise “silenced.” I believe this is especially important in healthcare, because sometimes the consequences mean that some people don’t get the care they need, or even die preventable deaths. My hope is that studying the different kinds of silences that exist can help us to access and provide better health care, and to build toward more desirable futures.

Maybe you or someone you know has visited a hospital and felt frustrated because you weren’t being taken seriously, that you were sent home without getting the care you need because of a misunderstanding. If that deliberately vague sentence doesn’t already resonate with you, you may have seen many stories of these sorts in the news: Indigenous people who die in waiting rooms because their concerns aren’t taken seriously, or fatter or plus-sized people who were refused the medical tests they needed because it is assumed that they just need to eat differently or exercise differently. (And maybe those “misunderstandings” are because of something more like outright prejudice or discrimination based on your appearance or identity). These are everyday examples of the kinds of things I research: what would have helped avoid those ways of silencing, or to help us be heard in the right kinds of ways?

But there are many further reasons we might not be “heard” in the right ways. For example, sometimes people can’t even get into a hospital in the first place due to public policies, economic disparities, citizen status, distance to health institutions, or other access barriers. Those people aren’t listened to either, because they can’t even enter the conversations! Or, we could think about medical research and teaching, and wonder why certain groups of people aren’t represented in how we teach or talk about medicine and health. How is it, for example, that our skin care specialists have gone on for so long being trained to recognize skin conditions on white people, but not conditions on the skin tones of people of colour? But we might also think about the ways we might choose to be silent in order to protect ourselves or to resist things we think aren’t fair. Many people involved in sex work, for example, won’t tell their doctors about their work or sexual activity (even though it might seem medically relevant), because many doctors treat sex workers with a lot of stigma that leads to them getting worse medical care. Or if you live in a state that no longer allows for therapeutic abortions, and where you could even be criminally persecuted if you have a pregnancy that ends, you might understand why many people are choosing to remain silent, and refuse to answer questions about pregnancy status when they visit their doctors.

In general, I’m interested in exploring questions like: Who appears and disappears in the ways we do healthcare research, practice, and education? Who gets to be heard, and who gets overlooked or silenced? And also: What kinds of things cause certain people to choose silence or to have silence forced upon them? Often when we look closer at these kinds of questions, we find that they are very closely connected to histories of oppression, and that these issues impact certain social groups more than others. I focus most on people who are disabled, queer, or transgender, since these are groups and communities I belong to. But there is a lot of overlap between these groups, and between each of these groups and other groups of people as well. This is what my dissertation is about: the different ways we might understand silence in health and healthcare, and what a more nuanced understanding of silence would mean for specific theories about providing better healthcare.

That’s generally what I research, and it is also important to consider where I research. I conduct my research through the Department of Philosophy and the Joint Centre for Bioethics at the University of Toronto in Canada. The University of Toronto is located on land that has been long protected by many Indigenous peoples, including the Huron-Wendat, the Seneca, and the Mississaugas of the Credit River, and that is subject to many important treaties and promises, including the One Dish One Spoon (or Dish With One Spoon) wampum belt covenant. I think it is important to name these peoples, promises, and places when we talk about research, not only to get settler colonials like me to reflect on the ongoing history and legacy of colonialism and the privileges we’re afforded, but also to try to resist the “silences” around Indigenous presences and issues in healthcare. Often, conversations with and about Indigenous peoples are absent from research. Other times, our research profits from the using ideas and histories of Indigenous peoples without credit. And all too regularly we ignore the ways that violence to the land and the environment have influenced all of these.

For example, a lot of my research of silence talks about what some people call “narrative bioethics” and “narrative medicine.” That is, theories that talk about the general importance of stories for health (since focusing on stories should require we also focus on what happens when stories aren’t heard or available). With only very few exceptions, most of these hundreds of articles and conversations on narrative bioethics don’t mention or try to learn from the rich narrative practices of the Indigenous peoples local to where they research and learn, despite millenniums-old theories and practices concerning storytelling and health. This kind of silence, I think, harms our own research by missing out on really well established ways of thinking about stories and communication (kind of like trying to ‘reinvent the wheel’). And it also harms our research and Indigenous peoples themselves by excluding them from the “our” in “our research” and by discrediting many different Indigenous knowledges that are already undervalued by Western approaches to knowledge and research.


Another project: Suicide beyond death and death data

I’m someone who has a lot of different relationships to what we commonly call suicide: I have witnessed people die by suicide, I have had people close to me die by suicide, I have attempted myself to die by suicide. Notice that in those examples, I talk about those who “die” by suicide: I’m putting a deliberate emphasis on death. I believe that thinking more fully about suicide requires that we make more clear what the relationship is between suicide and death, and that we think about suicide as more than just the moment or outcome of death. I don’t think this is a relatively surprising claim: we regularly talk about varieties of self harm, about suicidality or suicidal ideation, and other related data. (Well, I say “regularly talk about,” but we actually don’t tend to talk about suicide very much at all). Still, when it comes to a lot of public talk and research on suicide, we usually measure the impacts of suicide largely just in terms of death, and I think this is a possibly harmful practice. Instead, I’m interested in building a broader picture of suicide, and in thinking about the relationships between suicide, death, and disability. It might seem odd to wonder about the relationship between suicide and death, since suicide is usually just understood as a particular kind of death. But I think that the closer we look, the more we can find interesting middle spaces between the two.

Here’s one example which I’ve been using to talk about suicide and death lately: the COVID-19 pandemic. While the science is not yet settled, and while there are going to be many differences for different groups of people around the world, one outcome people have found surprising is that the rate of deaths by suicide in Canada have seemed to drop during the COVID-19 pandemic. Why is this surprising? Well, many of the models we have for understanding suicide tell us that people who are experience social isolation and loneliness, and those who have less access to healthcare support, seem to be at greater risk of engaging in suicide behaviours. So, many people expected to see an increase in suicide rates because the pandemic increased our isolation (those of us who follow basic public health guidance anyway), and have made it harder for many people to access forms of healthcare. But it seems like the opposite has happened: the rates of deaths by suicide seem to have gone down!

I don’t want to suggest that this isn’t possibly a good thing (though I also don’t think that all suicides need preventing… but that’s a different topic). Instead, what I want to do with my research is complicate this picture a little bit and see what conclusions we’re warranted in drawing from this data. Here is one story I think we could find plausible: maybe the number of people who died by suicide went down because people who tried to die by suicide didn’t have the same access to more lethal means of dying by suicide. With the pandemic, there have been many public health measures that make it harder for people to access certain lethal means of dying by suicide, and because they did not have access to more lethal means, those who did try to die did not end up dying at the same rate our data is used to.

Here’s an example of what what I mean (if you don’t want to read about a more slightly detailed case, I very much understand, and you can skip to the next paragraph instead). One way that people try to die by suicide is through overdosing on prescription medication. That is, they take more medicine than it is safe to, with the intended side effects leading to death. These kinds of deaths are less common these days than in the past, because we’ve changed a lot about the kinds of medicines we use to make them ‘safer,’ but deliberate overdoses definitely happen. However, during the pandemic, it was very common for pharmacies to be required to limit how much medication they gave a patient at a time. The main reason for this was to make sure we didn’t risk a shortage of any medications, and this is why you might have only gotten two weeks’ worth of medication instead of two months. One indirect consequence of this might be that people who did try to die by an overdose would not have always had a more lethal dosage. Instead, they likely would have survived, and either ended up ‘fine’ or ended up with undesired health outcomes or disabilities (overdosing on many medications can lead to organ failure, nerve damage, and cognitive injuries). Similarly, isolation policies meant people had less access to tall buildings if they intended to fall to their death, or to purchasing firearm ammunition, while people being surrounded by family and roommates meant they were more likely to be found and resuscitated if they did attempt to die. But if these cases did happen (and we can easily find testimony from people saying they did experience these barriers to dying!), then this might be a reason our suicide fatality rates declined.

Note that I am not saying that this is in fact what led to a decline in suicide rates in Canada (we don’t have enough evidence to say either way), just that it might seem like a plausible story. And if it is plausible, then we might think that while death rates have decreased, that the broader picture of suicide hasn’t necessarily improved, since it could be that fewer people died, but just as many people remained suicidal or even attempted to die. So, this is one example of why focusing on death numbers doesn’t necessarily give us the best picture of the state of suicide in the world. Suicide cannot be measured by death data alone, and there are many other outcomes than just death: attempts to die by suicide can also lead to life-altering injuries and disabilities, and these are not regularly measured when we’re measuring suicide.

Why does this matter? Well, suicide is already very widely misunderstood and stigmatized, and no matter what your personal opinions are about suicide, I think we should want to be more informed and careful with how we understand suicide generally. But I also think this has important implications for how we respond to suicide. Currently, when researchers measure whether something was “successful” as a suicide prevention strategy, they are looking to see whether the number of known deaths went down. But my research argues this is not enough information for a fuller picture: it is possible that the number of deaths goes down even if our broader phenomenon of suicide doesn’t really change (see the COVID-19 example I gave above). And it’s also possible that when a number of deaths goes down, it’s replaced by other severe injuries or disabilities, and so not as “pure” of a success as our studies tend to suggest.

This is what my suicide project is mainly exploring and criticizing: the relationships between death and suicide. But a fuller goal for this project is also to look closely at the role of disability in all of this. Above I suggested that non-fatal attempts to die by suicide can lead to people acquiring disabilities, and we in fact have many stories from people showing that this happens a fair bit. Still, I worry that if we say something like “our suicide situation may be just as bad, or worse, because people are becoming disabled instead of dying,” that this plays into a really harmful way of thinking about and talking about disability: that disability is a necessarily undesirable way of being in the world.

But, while I think we really shouldn’t be saying that disability is necessarily undesirable, I also think disabilities can be undesirable in at least some cases. One ways that disabled life can be hard is if there isn’t adequate social or health support available for people to live a more full, disabled life. Unfortunately, research tells us that suicide stigma creates a lot of barriers for suicidal people seeking forms of support: insurance companies often won’t cover injuries resulting from attempts to die by suicide; some places will institutionalize suicidal people against their will in a psychiatric hospital or other facility; people can be fired from their jobs, or evicted from their homes; and surveys show that many health professionals are less willing to work with patients who have attempted to die by suicide, and might even rank them lower for receiving medical care. So I think there is also a lot to explore about how we value or talk about disability in these cases, and that we need a lot more care than often appears in our suicide research.

Overall, my research plan is to explore this fuller, messier, and underexamined sides of suicide: the relationships between suicide and disability, disability and death, suicide and death, and all the other complicated ways these things overlap, intertwine, and mix together.