- Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy by Melinda Cooper and Catherine Waldby
Clinical Labor: Tissue Donors and Research Subjects in the Global Bio-economy presents an impressive and informative exploration of a form of labor that is rarely acknowledged as labor at all: the work performed by surrogates, tissue providers, and research subjects. Authors Melinda Cooper and Catherine Waldby refer to this type of work as clinical labor, which they describe as a form of embodied service work that relies on “in vivo, biological processing and the utilization of the worker’s living substrate as essential elements in the productive process” (65; emphasis in the original). Providing historical context together with insightful analysis of the rise of clinical labor, Cooper and Waldby give readers a wide ranging, critical look at the role of this hidden workforce within the contemporary bioeconomy.
The book is divided into three main sections. The first provides an introduction to the concept of clinical labor and its emergence in the post-Fordist economy. Cooper and Waldby track two developments that began in the late twentieth century: the move toward labor outsourcing, and the rise of human capital theory in which workers are viewed as entrepreneurs of their own productive, and reproductive, capacities (14–15). At the core of these two developments is a shift away from the permanent, full-time work that characterized the Fordist economy to the more flexible and precarious contract based work that characterizes twenty-first century employment. Clinical labor, according to Cooper and Waldby, has emerged not as an extreme or exceptional form of work within the post-Fordist economy. Rather, it is “emblematic of the conditions of twenty-first century labor” (17). It involves individuals acting as private contractors of their own biological capital (28). Unlike the factory workers of the twentieth century, contemporary clinical laborers lack protections such as health and unemployment insurance. Instead, they bear the risks associated with not only the potentially dangerous work they perform in clinics, but also the uncertainties that come with fluctuating demand. Clinical labor is precarious labor in which the worker assumes “both the economic and corporeal risks of the biomedical innovation economy” (29). [End Page 256]
Having introduced and situated the concept of clinical labor, Cooper and Waldby turn to analyzing two of the largest transnational clinical labor markets, the assisted reproduction market and the pharmaceutical market in human subjects research. The section on assisted reproduction examines the rise of fertility outsourcing and the role of surrogates and tissue providers within it. The authors understand fertility outsourcing as the contracting out of various elements of reproduction, including the provision of gametes and/or the gestation and birth of an infant, to a third party in exchange for a fee (37). From sperm banks to oocyte brokers to surrogacy clinics, Cooper and Waldby explore how fertility outsourcing has become a lucrative, and deeply problematic, transnational industry. They touch on many troubling aspects of the global fertility market. For instance, they explore how surrogates and oocyte venders are routinely excluded from negotiations over the payments they receive. The women providing these services are constructed within the fertility industry as selfless and nurturing, giving the “gift of life” to infertile couples (56). Any attempts on their behalves to bargain for more favorable terms of their contracts threatens, according to Cooper and Waldby, to “contaminate the maternal generosity that has formed part of [their] market appeal” (56).1 They also examine how fertility outsourcing markets are shaped by postcolonial and class power relations, analyzing, in particular, the Eastern European oocyte market and the Indian surrogacy industry (34).
In the final section of the book, Cooper and Waldby trace the development of the medical research industry from the days of prison research in the United States to the contemporary transnational research setting. They argue that the heart of the research subject’s clinical labor is the bodily assumption of uninsured, perhaps uninsurable, risks (128). They conceptualize clinical trial labor primarily as a form of...