The traditional biomedical and person-in-environment (PIE) perspectives are often found in conflict when framed within broader gender discrimination and consumerist health care practices. Our critical feminist analysis addresses the case of Katie, a vulnerable health care recipient, whose intersecting identities fall outside of the “margins of acceptability.” Communication deficits among team members and a lack of clear care protocols become evident. Insurance demands to justify coverage undermine the processes of beneficence and the ethic of care required for emancipatory advocacy. We present the tripartite paradigm of transformative complicity, cultural humility, and systems-based empowerment to address the complex ethical dilemmas that emerge. Strategies informed by experimental ethnography help us model effective transdisciplinary dialogue by inviting voices/commentators to rise from the margins (foot/endnotes) and decenter authorial power. Using an emancipatory social work framework, we offer actionable steps which, as revealed by our commentators, are often lacking from the medical team's and care recipient’s toolbox. We call ffor discursive courage to chip away at the socially constructed myths of biological and moral deficit that merge gender, colorism, class, and invisibility in the web of historical and structural discrimination. In addition, we welcome service seekers, as therapeutic colleagues, in the process of systemic empowerment.

Author Bio(s)


Dr. Roxanna Duntley-Matos is a cultural anthropologist and emancipatory social worker in community organizing and clinical practice. She has published in the areas of transnational community-based participatory action research, organizational justice, and ethical practice in higher education. She is the recipient of the University of Michigan Circle Award for bridging academia and the broader communities through excellence in transformative education, the ABSAME Rogues Jane Addams Scholarship from the Heart Social Justice Medallion, and the MI Hispanic/Latino Commission's Top 50 Latinas of Michigan Recognition. She is the former President of the Organization of Latino Social Workers, Michigan Chapter, a former board member of the MI Children's Trust Fund for the Prevention of Child Abuse and Neglect, designated by the Governor, and a former board member of the Association of Behavioral Sciences and Medical Education.

Dr. Robert M. Ortega is Associate Professor, the University of Michigan School of Social Work. He has written in the areas of child welfare, health and mental health, and culturally responsive practice. His current research focuses on child welfare workforce, social justice in groups, and culturally responsive practice. He is the recipient of numerous national awards including the 2013 Recent Distinguished Contributions to Social Work Education Award, the University of Michigan Circle Award, the Lisa Putnam Award for Excellence in Child Welfare, the ABSAME Rogues Jane Addams Scholarship from the Heart Social Justice Medallion, and the Organization of Latino Social Workers, MI Chapter Lifetime Achievement Award.

Maria M. Matos is a retired Professor from the University of Puerto Rico, Rio Piedras campus. Her academic interests are in General Studies and American Literature with a specialization in William Faulkner's use of time. Her awards include the Instituto de las Españas Medal for her critical analysis of Don Quijote de la Mancha, and the University of Puerto Rico Teodoro Aguilar Gold Medal recognition leading to her Harvard University full scholarship Masters Degree, She also received an Honorary Doctorate Designation by the Puerto Rican Board of Higher Education, Offices of Licenses and Accreditation, for her extraordinary work as President of the Consulting Board and for her contributions to Puerto Rican Higher Education.


A primary inspiration for this article lies with our dear colleagues from the former Association of Behavioral Sciences and Medical Education (ABSAME), co-directed by compassionate NSU humanists and outstanding transdisciplinary educators and scholars: Dr. Stan Cohen (co-founder), Dr. Patrick Hardigan (ABSAME former director), and Dr. Kathleen Hagen (ABSAME former Board of Director, outstanding musician, and transformative educator). Other highly supportive colleagues include Ms. Laurel Humbert (former ABSAME Vice-President), Dr. Don Self (former ABSAME journal editor), and Dr. Fred Hafferty (ABASME Board member. Our "familia academica" affiliated (past or present) to the University of Michigan, Ann Arbor: Dr. Lorraine Gutierrez, Dr. Norbert O. Ross, Dr. Charles Garvin, Dr. Linwood Cousins, Dr. Ruth Dunkle, Dr. Laura Lein, Dr. Steven Applewhite, and Dr, David Brose have been profound inspirations. The spirit of our social work students from various institutions, highlighting NASW Student of the Year Cindy Newberry, shines in this work as well. The unique contribution of our work could not be accomplished without the support of our authorial decentering "voices from the margins" (in alphabetical order): Alexandra Cubero-Matos (anthropology, conservation ecology, and animal behavior student), Daniel Cubero-Matos (musician and community philosopher), Dr Parul Sud, MD (Program Director of the Internal Medicine Residency Program at McLaren Hospital in Flint, MI), Ms. Dalia Reyes (Our Lady of Guadalupe Parish member, Flint, MI), and Dr. Odeather Hill, LMSW, PhD (Founder and President of Deaf Matters, Inc.). We would also like to thank Dr. Cheryl Hill, editor of the Internet Journal of Allied Health Sciences and Practice and the reviewers of our article for their thought provoking comments. Finally, our work would no have been possible without the technical support of Mr. Sean Hennessy.





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