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11/09/2018

Bathroom Bioethics

What do many transgender persons, farmworkers, homeless persons, people with disabilities, and many other persons in the United States have in common? One answer: they/we live and work in spaces lacking safe, accessible, and adequate toilet facilities. Think about that for a minute. Think about how you respond–multiple times each day–to your needs to eliminate your body’s wastes. Think about the distress you feel when finding a bathroom becomes difficult – or impossible.

Virtually all humans have toileting needs and these needs vary, as do our bodies in their social-political contexts. Our particular needs vary by gender, age, pregnancy, menstruation, medical condition, and work, as well as by cis-centric, andro-centric, and ableist societal norms that obscure some persons and their needs as well as the caregivers that some need for toileting. Drawing attention to the global inadequacy of toilets, the United Nations has declared November 19, World Toilet Day. This year’s theme is  “When Nature Calls.”

An extraordinary panel on “toilet justice” at the 2017 American Academy of Religion’s annual meeting explored the nature of toilet justice/injustice in refreshingly candid, inclusive, and insightful ways. (Some of what was said there is available here.) I attended this session because three decades ago I, with other public health workers in Colorado, advocated for “field sanitation,” that is, for porta-potties and drinking water in the state’s agricultural fields. Most farmworkers then and many still now work long and hot days in fields without effective access to a toilet, to hand washing, and to safe drinking water. Working with community and migrant health centers, the state Department of Health, and farm labor groups, we testified to the state legislature on a proposed field sanitation bill. I spoke specifically about the bodily needs of female farmworkers and their children, children who were also working or otherwise present in the fields.

The American Academy of Religion panel offered a scope and depth of discussion that led me to recognize the similar (but not the same) experiences of farmworkers and many others: transgender persons who are effectively barred from using bathrooms because of their gender identity; homeless persons who must rely on quasipublic spaces to relieve themselves, to varying degrees naked and squatting, and thus at risk of arrest for indecent exposure and at risk of physical and sexual violence; persons with a wide range of disabilities who are unable to find accessible toilets that meet their needs; and many others. Not only do these people share related toileting experiences, they are members of groups that are societally stigmatized and marginalized in many ways.

Back in Colorado, supporters of the field sanitation legislation argued in the name of individual health, public health, respect for human dignity, and the equal moral worth of all persons. Opponents of the bill were largely farm owners and representatives of farm bureaus and farm associations who argued that the bill’s economic costs, its challenge to the “rights” of private employers and property owners to decide how to treat employees, and its government overreach made field sanitation not only unnecessary but unfairly burdensome.

After a multiyear effort, a substantial field sanitation bill passed. In the process, the deep moral values undergirding the political debate were revealed and they made clear that this was not a debate simply about porta-potties but rather about whose lives mattered. It was about who would be supported in meeting their essential bodily needs and who would not. Perhaps most vividly expressed, the chairperson of the House Agriculture Committee stated, in an article in The Denver Post in 1987, that farmworkers were “a different class of people” and suggested that they neither needed nor desired toilet facilities. It is not a stretch to say that such dehumanizing attitudes persist today in relation to many oppressed groups.

Since that American Academy of Religion meeting, my toilet justice “radar” has been up, including while attending last month’s American Society of Bioethics and Humanities annual meeting at Disneyland. While toilet justice was not on the program, these issues were alive in Anaheim. A quick Google search revealed that city officials had recently removed three donated portable toilets from an encampment of hundreds of homeless persons along the Santa Ana River. (The toilets had not been appropriately permitted and insured. After the toilets were removed, the area was cleared of all residents.)

What might the field of bioethics contribute to growing discussions of toilet justice? We might begin with an ethical analysis that speaks to our obligation to respect persons, understanding persons as embodied beings. That is, to respect all persons as fleshy, dynamic organisms that must eat and drink to live and that must shed the byproducts of food and drink as well as of other bodily processes including blood. Respecting persons means respecting these bodily needs. The preventable lack of accessible and adequate toilet facilities denies the reality of personal embodiment and fundamentally disrespects persons.

The disparities in toilet access warrant an exploration of the myriad injustices operating here. As noted, toilet access is aligned with various forms of privilege and oppression related to, for example, gender, ability, and occupation. Given the significant physiological, psychological, social, public health, and moral effects of not having toilet access, we might consider whether public policies that deny this access constitute a form of violence.

We should ask whose responsibility it is to assure toilet access. Public health is often described as “what we, as a society, do collectively to assure the conditions for people to be healthy.”  Safe and accessible water and food fall under this purview–safe and accessible toilet facilities too?

Recently my hometown of Cambridge, Massachusetts installed two free, public,  accessible toilets that are available 24 hours a day, seven days a week: one in Harvard Square (in 2016) and another in Central Square (in 2018). A Public Toilets Working Group, formed in 2012, began a series of community processes involving many individuals and group representatives that led to this outcome. Which points to another item worthy of bioethical attention: who participates and who should participate in discussions of toilet access and resources. Are those most affected in the conversation and do they have effective voices?

Finally, do those doing the work of bioethics have important contributions to make to “toilet justice”? Certainly!

Charlene Galarneau, PhD, is core faculty at Harvard Medical School’s Center for Bioethics, and an associate professor emerita in the Women’s and Gender Studies Department at Wellesley College.

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