On December 29, 2010, Mississippi governor Haley Barbour suspended the dual life sentences of two African American sisters who had spent sixteen years in prison, imposing an extraordinary condition: that Gladys Scott donate a kidney to her ailing sister, Jamie Scott. Close attention to the event and the context of Governor Barbour’s decision to make prison release contingent upon organ donation helps to situate mass incarceration as a key site of the contemporary biopolitics of racism.
Though not as high profile as many of the other cases discussed in this book, the plight of the Scott sisters had been a rallying point for both mainstream and radical civil rights advocates, and the Scott sisters’ conditional release garnered commentary both from civil rights advocates who had long sought the sisters’ release1 and from bioethicists and critical legal scholars.2 This chapter attends to the Scott sisters case in light of the broader critique of mass incarceration as a structurally racist institution and in light of how prison imposes biological control on prisoners—both in ordinary circumstances, by structuring access to health care, and in extraordinary circumstances, such as organ donation schemes. The biomedical process of organ donation renders particular relations visible, and my analysis puts different models of biological citizenship and therapeutic citizenship into relief to highlight the specificity of the U.S. context of famously high-tech medicine and infamously unequal access to care.
Jamie and Gladys Scott were young mothers aged nineteen and twenty-one without previous criminal records when they were charged with a role in a December 1993 robbery in Forest, Mississippi. The sisters do not speak about the case, but according to the transcript of the criminal trial, they allegedly lured two male acquaintances into a secluded area, where three other men, who were armed, struck them with a gun and robbed them of their wallets.3 No one was hurt, and the robbery has been widely reported to have netted only eleven dollars.4 Two of the three young men who were convicted of actually doing the armed robbery testified against the sisters as part of plea bargains in exchange for reduced sentences, and all three of the men served fewer than three years.5 Although even the prosecutor in the case has described it as “not a particularly egregious case,” the sisters were convicted in October 1994 and given extraordinary sentences: double life.6
Jamie Scott wrote a pamphlet from prison about their case in 2003, in what would mark the beginning of a long campaign. She credited “the voice of God” as inspiration and described praying while she typed.7 Their mother, Evelyn Rasco, started a blog to publicize the pamphlet and, later, to coordinate protests.8 As in a great deal of prison organizing, faith and family intertwined: according to a reporter for Jackson’s African American newspaper the Jackson Advocate, the Scott family showed “the power of a God-fearing family.”9 Mainstream and radical civil rights organizations campaigned for the sisters as well, including the NAACP and the Malcolm X Grassroots Movement.10 The inspiring Black nationalist lawyer and city council member who would later become the mayor of Jackson, Chokwe Lumumba, played an important role.11
Fifteen years into their imprisonment, organizing around the sisters’ case was gaining strength, but their bodies were very weakened: demands for their release became particularly urgent in January 2010, when Jamie went into end-stage kidney failure. According to a flyer for a fundraiser for the sisters, medical maltreatment in prison had caused the health crisis and, in the absence of adequate care, “Jamie Scott has now effectively been sentenced to death.”12 Gladys volunteered to donate a kidney to her sister and stipulated as much in a petition for pardon submitted on the sisters’ behalf by Chokwe Lumumba in September 2010—but she did not even know if she would be a match, since such a procedure would not be available in prison.13
That year, there were increasing actions both online, such as a “Day of Blogging” in March 2010,14 and offline, including marches in Mississippi’s capital, attended by many people, including prominent civil rights figures.15 The case achieved increasing mainstream national awareness, including an editorial by the influential New York Times columnist Bob Herbert.16
The sisters have always maintained their innocence of the crime, though after a decade and a half of incarceration, guilt or innocence had come to seem less salient than questions about excessive sentencing. As one headline in late 2010 put it, “Sisters May or May Not Be Guilty, but Mississippi Assuredly Is.”17
The sought-after pardon was not to come. Mississippi governor Barbour instead declared that their sentences should be “indefinitely suspended,” on the condition that Gladys donate a kidney to Jamie. In Barbour’s statement on the suspension of their sentences, he noted:
Jamie Scott requires regular dialysis, and her sister has offered to donate one of her kidneys to her. The Mississippi Department of Corrections believes the sisters no longer pose a threat to society. Their incarceration is no longer necessary for public safety or rehabilitation, and Jamie Scott’s medical condition creates a substantial cost to the State of Mississippi.18
He also laid out the peculiar condition of Gladys’s release:
Gladys Scott’s release is conditioned on her donating one of her kidneys to her sister, a procedure which should be scheduled with urgency.
In this statement on their release, there is neither acknowledgment of excessive sentencing nor compassion for a gravely ill woman. Yet since Barbour was a contender for the Republican presidential nomination at the time, many analysts suggested that the release reflected his desire to appear racially tolerant and compassionate for national audiences.19 At the same time, as an article in the American Journal of Bioethics pointed out, “by suspending their sentence on medical grounds instead of pardoning them outright, Barbour can remain ‘tough on crime’ while acquiescing to the sisters’ supporters and saving the state about $200,000 per year in dialysis costs.”20
It is worth unpacking the two reasons that Barbour gave for suspending the sisters’ sentences: that they were no longer a threat to society and that releasing them would save the Mississippi taxpayers money. The first is striking for its “no longer”—it strains credibility to suggest that the sisters, who have never been accused of any crime except for involvement in this one robbery, were ever a serious threat to society. Barbour’s rhetorical move erases the long-standing injustice with a temporal framing. The second reason is more obviously insidious and part of a broader neoliberal logic of governance: Barbour has explicitly and repeatedly said that he was interested in saving the taxpayers of Mississippi the money that the prison system was paying for Jamie Scott’s expensive dialysis treatment.
In January 2011, Jamie and Gladys Scott were finally released, after serving sixteen years.21 The sisters’ release was long overdue and worth celebrating, a testament to the activism around the case. And yet the fact that the sisters were not simply pardoned makes for an incomplete victory.
Barbour’s executive orders for the release of the Scott sisters were explicit that “the indefinite suspension of sentence” “may be revoked at any time, without notice or hearing, for violation of any condition set out by the Mississippi Department of Corrections or for any reason deemed sufficient by the Governor at his sole discretion.”22 Even aside from the extraordinary condition of organ donation in this case, suspended sentences allow only a very limited form of freedom. The sisters’ unpardoned felony convictions effectively exclude them from the labor force as well as the right to vote.23 They must pay for the administration of their parole, some fifty-two dollars a month, and so their freedom is literally not free.24 They have endured police harassment since their release, occasioning the editorial comment in Jackson’s African American newspaper that “nothing is free for the Scott Sisters; not even the Florida highway.”25 The year following their conditional release, in Barbour’s final days in office, he pardoned an extraordinary number of prisoners, but the Scott sisters were not among them.26
Neither the sister-to-sister transplant nor the reincarceration has come to pass. In the months after their release, reports emerged that the sisters were too unhealthy and obese to be eligible to give or receive a kidney.27 Years of health and logistical challenges followed: Jamie was making progress after weight loss surgery but lost a foot to amputation, and the expense of staying in a hotel to remain near the transplant center for follow-up care after surgery was onerous.28 Gladys turned out not to qualify as a donor, and although Jamie eventually received a transplant in 2019, it was not from Gladys.29 Their parole continues, yet there are no signs that they are being returned to prison. Nevertheless, this narrative of prison release conditional upon organ donation is a revealing site for considering how incarceration plays a role in the constitution of racialized biological citizenship in the United States.
No other country has an incarceration rate as high as that of the United States, and our prison system is rooted in our history of slavery.30 I refer to the U.S. prison system as “our” prison system, at the risk of sounding parochial to non-U.S. readers, to underscore the responsibility that I and others writing from this critical location must take for this moral emergency. At the end of the nineteenth century, in the wake of the fall of Reconstruction after the U.S. Civil War, the swelling prison system in the South did more than appropriate labor; incarceration and a prison record also became a mode of denying citizenship rights more broadly.31 The Scott sisters have themselves put their experience into this larger context of the social role of criminal justice in perpetuating racial inequality. For example, the sisters participated in a town hall meeting at a Jackson church on the topic “Saving Black Boys from the Cradle to Prison Pipeline to Help Ourselves.”32 And speaking via Skype at a forum in Brooklyn, Jamie Scott herself said, “When I was a little girl . . . my grandma used to tell me . . . slavery is not dead in the south, it’s called the law now.”33
Barbour’s notion of prison release as a way of saving money points to the peculiar character of the right to health care in the United States. As sociologist Anthony Ryan Hatch has pointed out, in the United States, the only people with a constitutional right to health care are prisoners;34 any state is perfectly within the law to disregard the health of any ordinary citizen. This peculiar structuring of the right to health care—such that deprivation of liberty and access to a right to health care are explicitly intertwined—is part of how citizenship is negotiated in the United States, by institutional actors such as states and diverse health care providers as well as by people.
The U.S. Supreme Court has ruled that failure to provide adequate medical care to prisoners is considered “cruel and unusual punishment” under the Eighth Amendment to the U.S. Constitution. Thus Mississippi is not legally allowed to disregard the health of a person in its custody in prison. In the 1976 ruling Estelle v. Gamble, the Supreme Court liberally cites a still-active provision of the Civil Rights Act of 1871, which provides federal recourse for those whose constitutional rights are being violated by a state.35 The Supreme Court’s invocation of a Reconstruction-era law hints at the state and federal racial politics at stake in requiring states to provide health care for their prisoners.
By making the state’s release of the Scott sisters conditional upon the state’s release from any obligation toward them at all, a perverse form of freedom is constituted. Mississippi officials have explicitly articulated medical release of prisoners as a means of shifting costs from state to federal obligation.36 If released prisoners qualify for Medicaid, a program for poor and disabled people jointly funded by states and the federal government, Mississippi’s financial burden for their care is lowered to 25 percent. If released prisoners qualify for Medicare, a national program for Americans over the age of sixty-five, the financial burden is completely shifted to the federal government. And in this particular case, the sisters were allowed to move to Florida, where their mother, children, and grandchildren were living. The permission to move across state lines is an unusual privilege for people on parole, and while it is morally just and compassionate, that move also effectively diminishes still further any contribution by the state of Mississippi to their care. Any Medicaid or other state contribution for the Scott sisters’ care will be paid for by the state of Florida, not by the state of Mississippi.
The Scott sisters case is embedded within the larger problematic of the public health consequences of mass incarceration.37 As early as 1991, as the prison population was starting to grow tremendously, the American Public Health Association issued a statement decrying mass imprisonment on the grounds that “prisons disproportionately confine sick people . . . and . . . prisoners are subject to further morbidity and mortality in these institutions,” noting that this burden falls particularly heavily on poor people and people of color.38 Now that more than two million people are in U.S. prisons at any given time—by far the highest number and highest rate in the world—the racially disparate impact of incarceration not only on prisoners but also on their families and communities is widely recognized in public health scholarship.39
More recently, amid scholarship showing that Black/white health disparities are smaller among prison populations than among the general population, Dumont and colleagues point out that much of the impact on the social determinants of health appears after prisoners are released, creating “a perverse relationship between public health and incarceration: even as correctional facilities appear to provide a venue for addressing health disparities by accessing a high-need, medically-underserved, largely non-White population, incarceration itself ultimately perpetuates those disparities in the community.”40 Any health gains of African American prisoners from prison’s access to care are undone postrelease. As authors in the medical journal The Lancet point out, “although current incarceration has mixed effects on prisoners’ health, past incarceration has a clearly deleterious impact on health.”41
Of course, even though prison confers a right to health care, in practice, prisoners are often very poorly cared for. That Jamie Scott was in such poor health—after spending essentially her whole adult life in the custody of the prison—points to the inadequacy of that care. The living conditions of incarceration, including poor nutrition, which play a role in health problems like Jamie Scott’s, are foundational to the bodily control that the flawed medical care in prisons extends.42 Dialysis itself provokes comparisons with incarceration—it is routine for nonincarcerated people with end-stage renal disease to describe themselves as “doing time.”43 In this sense, Jamie Scott’s kidney failure is its own life sentence. Even the kidney transplant does not free her from the obligations of disease management but trades one intensive medical regime for another, albeit a less onerous one. And the medical system that cared so poorly for Jamie also demanded bodily sacrifice from Gladys.
The structurally racist criminal justice system is the context of both Jamie’s organ failure and Gladys’s offered donation, in a way that resonates with analyses of organ donation in low- and middle-income countries. For example, in her account of dialysis and kidney donation in Egypt, Sherine Hamdy posits that “disease processes” of kidney failure and survival are “already political” along lines of class and access to welfare services and “contest the very opposition between the biological and the political.”44 Both Jamie Scott’s organ failure and Gladys Scott’s promise of organ donation are rooted in their racialized class position and relationship to the state and thus have what Hamdy would flag as a “political etiology.”
After their release, the sisters cared for their ailing mother (since deceased), while striving to get themselves healthy enough for transplant surgery, for which they lacked the necessary financial resources.45 They eventually crowdsourced the funds. The inadequacy of health care for prisoners is in this sense continuous with the inadequacy of health care for racially stratified American publics.
Many readers will have heard of legal scholar Michelle Alexander’s highly influential book The New Jim Crow: Mass Incarceration in an Age of Color Blindness. That book persuasively argues that the denial of full citizenship that was explicitly racialized in the early twentieth century as “Jim Crow” was renewed in a putatively color-blind way through the intensification of mass incarceration, especially through the War on Drugs that has been pursued in a way that differentially exposes Black and poor communities to the criminal justice system and in turn differentially denies citizenship rights.
Here, I extend this engagement with citizenship rights to consider what scholars in the sociology and anthropology of biomedicine have termed “biological citizenship.” I describe how this term emerges from two related literatures: one developed for analysis of resource-poor settings and the other for rich countries. I argue that oppressed populations within the United States can be betwixt and between, enrolled in both kinds of biological citizenship projects. The Scott sisters’ extraordinary experience at the intersection of organ donation and incarceration can provide valuable insight into biological citizenship in the United States.
The first way of thinking about biological citizenship emerges from scholarship of postsocialist contexts, especially from anthropologist Adriana Petryna. Petryna has given a rich account of fieldwork in post-Chernobyl Ukraine, “where an emergent democracy is yoked to a harsh market transition, the damaged biology of a population has become the grounds for social membership and the basis for staking citizenship claims.”46 Petryna defines biological citizenship as “a massive demand for but selective access to a form of social welfare based on medical, scientific, and legal criteria that both acknowledge biological injury and compensate for it.”47
The second way of thinking about biological citizenship emerges from scholarship of contexts characterized by consumer capitalism and advanced biomedicine and has been developed by sociologist Nikolas Rose and his colleagues. They make an explicit contrast with post-Soviet contexts in which demands are being made of the state and argue that the most relevant biological citizenship projects in “the West” are less nationally oriented and are “taking place within a ‘regime of the self’ as a prudent yet enterprising individual, actively shaping his or her life course through acts of choice.”48
To understand the U.S. context, both deprivation and expressive choice are at stake—and the Scott sisters case can help to tease out how.
First, how might we think about the contours of American biological citizenship in Petryna’s terms—negotiations over scarce state recognition and medical resources that invoke medical, legal, and scientific criteria to stake out membership in the U.S. body politic? Petryna’s form of biological citizenship is being negotiated when prisoners demand the right to health care and is being both validated and denied when prisoners are released because of illness: release from prison somewhat restores the citizenship of the ill prisoner, but it also releases the state from obligation.
Indeed, a key contrast between the United States and “the West” in general is that the United States lacks a guarantee of baseline material security or access to health care. This leads to a resonance with biological citizenship forms in resource-poor settings, such as the “therapeutic citizenship” that Vinh-Kim Nguyen describes in West Africa. Nguyen writes about contexts of participation in HIV drug research and activism for drug access “in a setting where the disease may be the only way to get any of the material security one usually associates with citizenship.”49 He compellingly argues that therapeutic citizenship has “emerged as a rallying point for transnational activism in a neoliberal world in which illness claims carry more weight than those based on poverty, injustice, or structural violence.”50 Yet it matters that Nguyen draws his contrasts between West Africa and Canada, rather than between West Africa and the United States, because the United States is an exception to what he characterizes as the norm in rich countries.51 The situation of incarcerated and formerly incarcerated people in the United States is like the West African one in that “widespread poverty means that neither kinship nor a hollowed-out state can offer guarantees against the vicissitudes of life.”52 Nguyen describes therapeutic citizenship as particularly “thin” compared to places with stronger states, where both Rose’s and Petryna’s biological citizenships are enacted.53 Yet the biological citizenship rights of the Scott sisters are by no means thick. For the Scott sisters, as in Nguyen’s site, “profoundly ethical predicaments shaped the therapeutic citizenship that emerged in places where other forms of citizenship could not be relied upon to secure life itself.”54 Illness claims by the poor can carry more weight than social justice claims “here,” too, most blatantly in the case of the incarcerated. Leaving “the West” uninterrogated renders invisible the radically uneven thickness of biological citizenship within the United States.
Prison activism as a site of antiracist politics should itself be understood as a biological citizenship project. Experiences of imprisonment informed the health activism of the Black Panther Party,55 and in her analysis of that political movement, Alondra Nelson calls for “a return to the work of Adriana Petryna and, in particular, to the milieu of catastrophe and deprivation that impelled her theorization of biological citizenship.”56
Some analysts have suggested that, indeed, Rose’s prudential and expressive model of biological citizenship does not apply in contexts of deprivation.57 But even in a landscape of mass incarceration and profound deprivation, I would suggest that the “first world” model captures something important about the transformative power of biological knowledge, and it is why Gladys’s offer to donate a kidney to Jamie should not be understood in terms of coercion but acknowledged to be an expressive act in which transplant medicine becomes a site of kinship and care as well as entrepreneurial choice. Participation in donation, of blood or of organs, is part of participation in biosociety in these terms. For example, as Jessica Martucci has argued, young gay male would-be blood donors’ contestation of the Red Cross exclusion of men who have sex with men from its donor pool “has less to do with the national blood supply, and everything to do with access to a political forum in which citizenship claims can be made and listened to.”58 Michele Goodwin, a legal theorist of organ donation who is attentive to the experiences of African Americans, argues that the quasi-ownership of the body by both a potential organ donor and the donor’s kin is “one way of looking at rights connected with the power to donate.”59 It is not clear at the outset which presents a deeper denial of prisoners’ independent personhood: denying a “right” to donate and receive organs in an act of kinship and care60 or demanding organ donation in exchange for release.
We might also note that Gladys’s offer to donate a kidney to her sister should be understood as authentically expressive of her Christian commitments, in a way that is distinct from “the West” in general but characteristic of the United States. The valorization of organ donation in the United States draws on two distinct conceptions of eternal life: a consumerist fantasy that the body can be forever fortified61 and the Christian veneration of giving of one’s body that another might live.62 In the United States, and especially in Mississippi, Christianity is not just a past that informs the present but a living site of the pursuit of succor and justice. The Black church has been an important site of advocacy for the Scott sisters, as it has been for prisoners in general. This articulation travels well throughout U.S. society.63 Throughout the West, organ donation is framed by a broadly Christian trope: a demonstration of the laudable characteristic of altruism—the “gift of life”—and so the fact that Gladys Scott is willing to give her kidney to her sister demonstrates that she is a good person and may fortify public sympathy even among those who lack compassion for those unjustly imprisoned.
At stake here in antiprison activism as it intersects with the right to donate and receive an organ transplant is not any essential idea of race but a contestation of racism. Any ontological anxieties about the reality of race are beside the point, and race is not operating as a site of eugenic control. Indeed, in the Scott sisters’ case, any genetic notions play an expressive role rather than a eugenic one: their genetic tie naturalizes the specific plausibility of kidney donation from one sister to the other. Notably, this is very different from the role that genetics usually plays in the analysis of race and racism in biomedicine. In this case, genetic ties become the site of kinship and care among individuals, rather than, as many critics of race in contemporary biomedicine contend, being the means by which specious notions of essential biological differences between members of different racial groups are reinforced.64 And yet the expressive elements of biological citizenship in this case are inextricable from the mobilization of biological suffering to make demands for scarce resources. As anthropologist of race and biopolitics Jonathan Xavier Inda has explored in his work on race and pharmaceuticals, calling attention to the experience of bodily suffering of African Americans can become a locus of solidarity.65 Mass incarceration and its contestation are vital sites for this project.
I argue that these models of biological citizenship and of therapeutic citizenship should be combined to understand the biopolitics around the Scott sisters case and the role of mass incarceration in constituting biological citizenship in the United States more broadly. The United States is simultaneously a society of scarcity and deprivation negotiated through biological diagnoses and legal categories, and of expressive agency enacted in biological terms, and of struggle for life amid abandonment by the state. Indeed, the tensions between racialized exclusions, the promise of consumerist freedom, and the lack of expectations of the state are foundational to a distinctly American biological citizenship.
Notions of biological citizenship that elide distinctions between and within rich countries evacuate their particular racial histories; the United States was founded on racial genocide and racial slavery as fundamentally as it was founded on notions of liberal democracy, and race remains fundamental to the new biocitizen, as it was to the old.66 Moreover, the new biological citizenship does not simply replace the old. Any understanding of biological citizenship in the United States should not ignore the radically unequal access to biomedical consumption in America and the role of racialized incarceration in structuring access to health care and exclusion from personhood.
If we are to grapple with biopolitics in the United States, both our famously high-tech medicine and our infamously unequal access to it are fundamental. Our very bodies are shaped by our historical and contemporary contexts, characterized by both radical disenfranchisement and rhetorics of just treatment. In the United States, prison is not just a metaphor for power and control but a major way of organizing bodies in space and of constituting and depriving citizenship. Free at last, the Scott sisters and their supporters won a significant victory as they negotiated this terrain. The inhumane conditions imposed on these sisters by the state are a grotesque instantiation of disparities in access to citizenship and health, but one that reflects a broader context.
Barbour’s perverse condition is extraordinary but not unprecedented. In 2007, state legislators in South Carolina considered a bill that would have shortened, by 180 days, the sentences of prisoners who agreed to donate a kidney. As legal scholars have pointed out, this represents a collision of two markets: the open market of criminal justice plea bargaining and the closed market of human body parts.67 Plea bargains for reduced prison time are normalized forms of coercion, but the fact that prison power is enacted on prisoners’ bodies becomes starkly explicit once the boundaries of the prisoner’s body are called into question.
Although the South Carolina prisoner organ scheme was never enacted, it is not unheard of to exchange medical treatment for decreased sentences. Normally those are framed as crime prevention. The most prominent example of a quid pro quo of enduring medical treatment in exchange for release is so-called chemical castration for sex offenders.68 Another example is anti-addiction pharmaceuticals for repeat drunk drivers, which sociologist Scott Vrecko has argued is perhaps emblematic of an emerging model, a shift from imprisonment to direct biological control.69 The proposed South Carolina legislation and the Scott sisters case are different from these forms of control, because organ transplantation is not related to crime prevention. Chemical castration and anti-addiction pharmaceuticals are meant to prevent future criminal behavior, whereas the exchange of time for an organ highlights the ways in which prison sets up a debt relationship that is never closed.
In this sense, the transplant bargains are more of a piece with the routine character of criminal justice in the United States. Insofar as prison extracts a “debt to society” from the prisoner, the prisoner’s body itself is always part of the payment. Extraction from the body in these cases points to an ever-demanding structure of debt peonage, analogous in a profound way to the debt peonage of the kidney sellers in India described by anthropologist Lawrence Cohen.70 Debt constitutes the context for those in Cohen’s account, which is a situation of poverty: “persons sell a kidney to get out of debt, but the conditions of indebtedness do not disappear.”71 Formerly incarcerated people in the United States are in a similarly fraught situation with regard to “debt to society,” a debt that has theoretically been paid and yet is not erased. With suspended sentences, the continuation of the power of the debt is explicit. The sisters are in a situation in which both their financial sustainability and their legal freedom are precarious.
Moreover, also like kidney sellers in Cohen’s account in India, incarcerated and formerly incarcerated donors in the United States face many bodily risks before and potentially from kidney extraction. Although the risk to the living donor is overwhelmingly described in abstract terms in bioethics literature, in an unequal world, risk is unevenly distributed. Living kidney donors from racialized populations in the United States on average have higher risks than white donors do: African American and Hispanic living donors have elevated risk of hypertension, diabetes, and chronic kidney disease.72 In this case, Gladys Scott was less ailing than her sister but not healthy—indeed, although the full medical details are unknown, it seems that her own health was a reason that ultimately deemed her to be an inappropriate candidate as a donor.73
Paying attention to structural racism is also important for moving discussion of the Scott sisters case beyond a traditional bioethical approach, which would focus on whether it is ethical to offer Gladys Scott prison release in exchange for her kidney. In his discussion of the case, prominent bioethicist Arthur Caplan has put the focus precisely there, quoted on ABC News as saying “as soon as the governor began throwing around commutation—getting out of her prison sentence—he began to undercut the ethical framework.”74 Caplan’s scholarly consideration of the issue is a bit broader and more grounded because it acknowledges both ethical concerns and practical issues that make organ donation by prisoners infeasible.75 Yet there is no room in his framework for what Karla Holloway would highlight as “a cultural bioethics,” how race and gender differentially constitute the independent personhood at stake in the Scott sisters’ “private lives” that have become “public texts.”76 Neither is there space for reopening questions about the unjust treatment of the sisters before their conditional release or the ethics of mass incarceration itself. Indeed, interrogation of mass incarceration may present an opportunity for science and technology studies (STS) scholarship, as sociologists Laura Mamo and Jennifer R. Fishman have argued, to “participate in efforts that seek justice in ways that are associated with, yet distinct from, the study of ethics.”77
Prison release in exchange for kidney donation does present an ethical problem, but we should resist putting it into a quandary paradigm, in which “a problem arises (what shall we do with the frozen embryos? shall euthanasia be authorized?) and ethicists spring into action.”78 As philosopher Anthony Appiah argues, ethical inquiry should not be so reduced. Anthropologist Paul Farmer, too, points out that posing questions as “ethical quandaries of the individual” dominates discussions of medical ethics, especially the decision whether to pull the plug on life support; in contrast, the everyday passively caused deaths of masses of poor people through denial of care are too rarely topics of ethical discussion.79 Consideration of the Scott sisters case can exemplify this tendency, unless it is put into the context of the racialized system of mass incarceration.
This contextualization is resonant with recent scholarship of the ethical violations of the Tuskegee Syphilis Study80 and brings to the fore different aspects of how medicine and structural racism are intertwined. Like the pervasive eugenically oriented and often deceptively implemented forced surgical sterilizations of Black women that the twentieth-century civil rights leader Fannie Lou Hamer evocatively decried as “Mississippi appendectomies” and coercive sterilizations of women prisoners that has continued well into the twentieth century, the coercive surgeries, in the Scott sisters case, justified on moral and cost-saving grounds, are consistent with rather than anomalies to broader social inequalities.81
From a biopolitical perspective, one of the things that prisons do is to instantiate exclusion from membership in the society whose life is fostered. In Discipline and Punish, Michel Foucault theorized that prison’s obvious failure to rehabilitate is actually part of its function.82 In the profoundly racialized U.S. prison system, the role of prisons in constituting a class of society that is excluded from society is particularly blatant.83 Indeed, in the post–Jim Crow era, as sociologist Loïc Wacquant argues, the “carceral institution . . . has been elevated to the rank of the main machine for ‘race making.’”84 Wacquant argues that race-making institutions “do not simply process an ethnoracial division that would somehow exist outside of and independently from them. Rather, each produces (or co-produces) this division (anew).”85 Prisons don’t just reflect racial inequality; they are part of that inequality’s construction.
The word carceral means simply “relating to a prison,” and for Foucault, that extends well beyond prisons themselves to describe the broader systems of surveillance that control urban space. For example, systems ranging from surveillance cameras to electronic ankle monitors extend control well beyond the prison walls. The observation of the extensiveness of carcerality has been important in a growing body of critical race studies of science and technology, including by Ruha Benjamin, Nadine Ehlers and Shiloh Krupar, and Tony Hatch.86 In this work, attention to control beyond the prison complements rather than replaces attention to the power of the actual prisons themselves. There is a danger in Foucauldian scholarship less attentive to race that the relationship of the term carceral to actual prisons becomes so abstract as to become almost metaphorical—but in the United States, both surveillance deploying carceral logics and prisons themselves contribute to the production of racial inequality.
The ethics of the event—the Scott sisters case—should not be extricated from an ethics of the uneventful: the routine structural violence of mass incarceration. Analysis of this case in these terms provides an opportunity to consider not only the residue of a horrific history and the specter of an unacceptable future but also the unbearable present.