Placental Ethics: Addressing Colonial Legacies and Imagining Culturally Safe Responses to Health Care in Hawai'i

feminist scholars studying gender in the Pacific have analyzed the conditions of Pacific Islander women with an acute analysis on how the intersections of gender, culture, colonization, and strategies of decolonization aid in framing the experiences of Pacific Islander women. Like many introduced Western institutions in Hawai'i, medical practices in hospitals and clinics have been both criticized and welcomed among Pacific Islanders. Feminist anthropologists Vicki Lukere and Margaret Jolly have diagnosed these conflicting receptions to medical institutions in the Pacific Islands as a reliance on a problematic binary of "modern" and "traditional" medical care (Lukere and Jolly). According to Lukere and Jolly, the biomedical approach is usually associated with assumptions of the technological and the modern. The traditional approach is associated with assumptions of the indigenous and the natural. Consequently, these problematic binaries fail in assessing the experiences of Pacific Islander women and their expressions of agency, especially those who navigate their agencies within hospital settings. Moreover, this binary framework fails in cultivating culturally sensitive approaches that hospitals can utilize in making policy decisions related to the cultural requests of Native Hawaiian women.

Prior to 2006 in Hawai'i, modern medicine has understood the placenta as industrial human waste, posing threats to public health. Hence, placentas were never given back to the parents but disposed under hospital protocols as biological human waste. However, Native Hawaiians view the placenta with cultural significance in which the placenta is cared for in respectful ways involving ritual ceremonies and proper burial back to the earth followed by a planting of a tree symbolizing the child's connection back to the earth. These "traditional" methods have been trumped by concerns of public health perceived by a Western medical framework resulting in the enforcement of certain hospital policies to withhold the placenta from Native Hawaiian mothers who made requests to their doctors. This issue became a controversial topic ensuing in a legal battle that highlighted the confrontation when culture and medicine collide.

In this essay, I would like to examine the case of the placenta in Hawai'i as an example of what José Medina characterizes as "epistemic injustice," and attempt to disrupt the pervasive "tradition and modern" binaries that constitute the experiences of Native Hawaiians within the medical context. I critically examine the epistemological frameworks that justify the exclusion of cultural claims, particularly the cultural practices of caring for the placenta within hospital policies. Through an examination of Native Hawaiian epistemology understood within the intertwined practices of placenta care, mothering, Hawaiian women's sexuality, and the context of colonization, the aim of the essay is to develop a more pluralistic epistemological framework that might be able to broaden the perspectives and change the ways in which hospitals understand the tension of public health and cultural concerns.

First, I examine the medicalization of the placenta within hospital settings that emerged during the controversy in Hawai'i. Second, I explore Manu Meyer's work on Native Hawaiian epistemology to help articulate the cultural significance of the placenta. Third, I discuss how the context of colonization fails to recognize the epistemological frameworks of Native Hawaiians related to women's sexuality and mothering practices. These colonial misinterpretations have had a lasting effect in genuinely understanding the cultural importance of the placenta in modern hospital settings. Finally, I attempt to utilize Medina's and Meyer's work to carve out a community-oriented epistemological perspective that is culturally sensitive to the communities that hospitals serve in Hawai'i.

The Medicalization of Native Hawaiian Culture and the Epistemologically Resistant Placenta

A woman's placenta becomes a contested site, which can be interpreted through various cultural lenses. The plight of women's placentas in Hawai'i became known in 2005 when Native Hawaiians protested the state's declaration that the "placenta tissue [is] an infectious waste" (Lauer). Prior to 2005, the Stibbard and Nahale-a couple from Hilo, Hawai'i, requested their first child's placenta at Kaiser Medical Center. According to the reports, their doctor "did not see a problem" with this request. Later, Kaiser called and...