Doing diabetes (Type 1): Symbiotic ethics and practices of care embodied in human-canine collaborations and olfactory sensitivity Submitted by Fenella Eason to the University of Exeter as a thesis for the degree of Doctor of Philosophy in Anthrozoology in August 2017 This thesis is available for Library use on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. I certify that all material in this thesis which is not my own work has been identified and that no material has previously been submitted and approved for the award of a degree by this or any other University. Signature.................................................................. 1 ABSTRACT The chronically ill participants in this study are vulnerable experts in life’s uncertainties, and have become aware over time of multiple medical and social needs and practices. But, unlike the hypo-aware respondents documented in some studies of diabetes mellitus Type 1, these research participants are also conscious of their inability to recognise when their own fluctuating blood glucose levels are rising or falling to extremes, a loss of hyper- or hypo-awareness that puts their lives constantly at risk. Particular sources of better life management, increased self-esteem and means of social (re-)integration are trained medical alert assistance dogs who share the human home, and through keen olfactory sensitivity, are able to give advance warning when their partners’ blood sugar levels enter ‘danger’ zones. Research studies in anthrozoology and anthropology provide extensive literature on historic and contemporary human bonds with domestic and/or wild nonhuman animals. Equally, the sociology of health and illness continues to extend research into care practices performed to assist people with chronic illness. This study draws from these disciplines in order to add to multispecies ethnographic literature by exploring human-canine engagement, contribution and narrative, detailing the impact each member of the dyad has on the other, and by observing the 'doing' of the partnerships' daily routines to ward off hypo-glycaemia and hospitalisation. In addition, the project investigates the place, role and 'otherness' of a medical alert dog in a chronically ill person's understanding of 'the-body-they-do'. The perspective of symbolic interactionism assists in disentangling individual and shared meanings inherent in the interspecies collaboration by examining the mutualistic practices of care performed. The often-flexible moral boundaries that humans construct to differentiate between acceptable use and unacceptable exploitation of nonhuman animals are questioned within ethics-of-care theory, based on the concept of dogs as animate instruments and biomedical resources. 2 Title page 1 Abstract 2 List of contents 3 1 Introduction 6 1.1 Humans and other animals: the familiar and the foreign 11 1.2 Becoming 'one-self' 13 1.3 Facilitators of human-human relationships 15 1.4 Multispecies cooperation 17 1.5 Aims and objectives 21 1.6 Additional research purpose 25 1.7 Care practices and problems 30 1.8 Blood, hygiene and biotherapy 32 1.9 Commodification and the ethics of care 34 2 Methodology 36 2.1 Qualitative mixed methods 39 2.2 Interspecies participants 44 2.2.1 Sara and Apple 44 2.2.2 Terry and Jim 45 2.2.3 Richard and Higgins 45 2.2.4 Paul and Nero 48 2.2.5 Janet and Alfie 49 2.2.6 Tina and Harley 51 2.2.7 Mel and Gemma 51 2.3 Social sensitivity and self-reflexivity 54 2.4 Trans-species communication 55 3 Review of historical and contemporary literature 61 3.1 Examining research 64 3.2 Morals and minority groups 66 3.3 Marks’ amoral animal ethics 70 3.4 Moral principles and dilemmas 71 3.5 Interspecies empathy 73 3.6 Animal personhood in a shared identity 75 4 Anthrozoological and sociological perspectives 78 4.1 Symbiotic relationships 81 3 4.2 The working dog 85 4.2.1 Domestication and the history of the working dog 85 4.2.2 Stray dogs and village dogs 89 4.2.3 Canine ergonomics: the science of the working dog 93 4.2.4 ‘Works-in-progress’ 102 4.2.5 Medical detection dogs in training 104 4.2.6 Medical Detection Dogs in work 108 4.3 Needs and complex issues in chronic illness 109 4.4 In/dependence 114 4.5 Self and social identity formation 117 5 The canine sense of smell and olfactory acuity 121 5.1 Smelling like a dog 122 5.2 Consequences of scenting 123 5.3 Canine nasal structure 126 6 ‘Doing’ diabetes Type 1 131 6.1 The illness, Type 1 diabetes 132 6.2 Effects of the diagnosis 133 6.3 Canine 'alert' communication 135 6.4 Blood and pollution 136 6.5 Injecting insulin 137 6.6 The insulin pump 138 6.7 The test strips 141 6.8 Cannula and pump 142 6.9 Nutrition 143 6.10 ‘Not fit for purpose...’ 145 6.11 Vision difficulties 146 6.12 Driving and transport 149 6.13 School 150 6.14 Losing hypo-awareness 151 6.15 The impact of ‘mood swings’ 153 6.16 Mortality and improving control 155 6.17 Keeping ‘high’ and life expectancy 156 6.18 Type 1 diabetes and pregnancy 158 6.19 Measuring and recording 158 7 Dogs as biomedical resources 160 4 7.1 Transhumanism 165 7.2 Animate instruments 168 7.3 Exploitation 172 7.4 Use and exploitation 174 7.5 Anxiety: fear of failure 177 7.6 Parasitism: a selfish harvesting? 180 7.7 Recognition 182 7.8 An ‘alliance of friendship’? 185 7.9 Xenotransplantation; animal models for human treatment 187 7.10 Wearing status 192 7.11 Disabling identity 195 8 Animals as health technologies 194 8.1 Contemporary canine domestication 200 8.2 A theory of domestication 202 8.3 Tools and devices 206 9 Symbiotic practices of care 210 9.1 Meanings of care 210 9.2 Understanding nonhuman animal work 212 9.3 Morally acceptable? 214 9.4 Compassion, empathy, sympathy 217 9.5 Ethics of care 223 9.6 Where the social contract fails... 227 9.7 Why veganism? 228 9.8 Morality and symbiotic ethics 231 9.9 Object and subject of care - collective identities 235 9.10 Systems of cooperation and mutuality 237 9.11 Communication and understanding 238 9.12 Welfare concerns 243 10 Endings and 'ethical decision-making' 246 10.1 No longer useful? 246 10.2 Recycling 247 10.3 Replacing 249 10.4 What next for human-canine biomedical collaboration? 251 References 257 5 Tina (her voice drops as she speaks): I just thought they’re going to come and find me dead. I: That must be frightening? Tina: Well, you’d go to bed of a night and sleep straight out so if they come, they haven’t got much to do...(she demonstrates as if lying on her back, legs together, arms close to her body, resembling an alabaster effigy of a medieval knight on a church tomb chest). I: So you were preparing? Tina: Yes, have I got everything clean and I’d get into my new pyjamas... 1 Introduction Complacency, likely created by ignorance, laziness or disinterest, allows all manner of negligence, unkindness and condescension to occur in everyday life. For example, an overheard coffee-shop conversation might reveal: ‘Oh, Jenny told me she’s got diabetes...’ Response: ‘Poor thing, no more cream teas for her. Did you see that film on ...?’ Instantly the unfortunate Jenny is disenfranchised, boxed into the category of invisibly-unwell individuals who could probably do something to improve their health if they made an effort. There is no endeavour by her friends to discover which type of diabetes was diagnosed, whether she might need to increase rather than decrease carbohydrate ingestion; it is as if Jenny has ‘a bit of a headache’. Complacency enables disparaging sympathy, even vague condemnation, and an avoidance of the need to care, to ‘do something about it’ or to question the significance of such a diagnosis. When Tina, a participant in this research who has Type 1 diabetes, describes her long-term fight to live on her own and ‘survive’ frequent and lengthy hypoglycaemic collapses, any trace of complacency in my attitude to this illness is given a trenchant shake-up. Her consideration of the feelings of others, such as care-workers and undertakers, in the situation above is mind- blowing and in total contrast to the attitude of my imagined café conversationalists. She adds: 'You get to the point in your life where you think, am I going to wake up? Or you spend all night up...' Tina could remain unconscious for four to five hours after a hypoglycaemic collapse at home. If she collapsed in the street, she recalls: People would just walk past. They’d think ‘you’re drunk’, and really it’s no different to what I’d do, but I was in desperate need, you know, for someone to know that I’m not right... 6 Mentally ripped out of their comfort zone by the unexpected tearing of their corporeal mantle, people are often forced to discover alternative modes of social existence and other resources that enable coping with newly-shaped ways of being. One method of locating these is to talk of upsetting events and experiences with psychologists and physicians, and with those who have had similar disruptions in their lives. Gradually and often uneasily, the altered selves are enabled to release stories of their embodied corruption and its forceful entourage of side effects. Sarah Nettleton exemplifies the significance of personal narrative: ‘When people have the opportunity to give voice to their experiences of illness, it becomes evident that their accounts are woven into their biographies’ (2013: 73).