To watch the videos presented in our manuscript, go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling. Type in the password "cripethics". Please note: these videos are intended for readers and classroom learning only and are not for broader public screening.

Introduction

Immediately following the WHO's announcement declaring COVID-19 a pandemic, Ontario Health released its "Clinical Triage Protocol for Major Surge in COVID Pandemic" (March 28, 2020), outlining who would, and would not, receive treatment if and when hospitals were filled to overcapacity. In providing a framework guiding medical providers' decision-making about whose access to life-saving treatment would be prioritized, the protocol cites the use of consequentialist ethics of utility (allocating resources for the greatest benefit), 1 proportionality (triaging practices so they do not adversely affect more people than would have been affected if a "first come, first served" approach were used), and fairness (using clinical criteria rather than income or political rank to allocate resources) (2020, p. 3). While Ontario Health insisted the protocol would not be used except when hospitals exceeded capacity, it nonetheless weaponized precarity as inherent in disabled (and aging) bodyminds. Largely because of resistance from disability organizations, the policy was rescinded; however, a second triage protocol titled "Adult Critical Care Clinical Emergency Standard of Care for Major Surge" (January 13, 2021) was subsequently leaked to the press (Gray, 2021). This second protocol prioritizes emergency care for those who physicians deem likely to survive beyond 12 months of onset of a critical illness and allows physicians to remove treatment without patient-client consent in instances where patient-client numbers exceed resources.

Concerns over discrimination against disabled people have weighed heavily against the stated non-discriminatory application of both protocols especially in an ableist "restricted imaginary" (Titchkosky, 2019) where disability circulates as inherently difficult, or worse, as life with no future (Kafer, 2013). As COVID-19 has shown, the logics governing hierarchical healthcare interactions, whereby disabled people's needs and interests are overridden, become transactional encounters that neither allow space for the expression of those needs and interests nor emphasize processes for their realization. Instead, decision-making becomes an exercise of control over disabled persons who are often placed in a triage protocol enacted by healthcare providers whose authority on paper is unquestioned, while providers' own precarity in literal do-or-die decisions remains unaddressed. In the COVID-19 context, naturalizing a specific group's (such as disabled and aged people's) susceptibility to disease and death becomes a way of masking oppressive histories and ongoing systemic inequities that cast their particular forms of dependency as a sign of less-than-human status. This view acknowledges that all of us are dependent on others albeit in different ways, foregrounding interdependence as a condition of life. By erasing the ways that triaging policies, warehousing practices, and other dehumanizing approaches to bodyminds marked as unproductive further exacerbate disabled and aged people's vulnerability, such discursive and material naturalization of embodied difference also weaponizes precarity to both produce and rationalize the disproportionately higher rates of COVID-19 and other disease and death evident amongst these groups (Collins, Temple Jones & Rice, in press; Rice et al., 2021b).

In this article, we develop a processual, disability-affirmative ethics, or what we call "crip-ethics," for the purpose of valuing disabled persons' experiences in healthcare encounters. Such ethics include and exceed ethics premised upon an Enlightenment humanist vision of the human as well as ethics premised on care that largely inform healthcare ethics today. For example, normative ethics, by which we mean the predominant ethical approaches of consequentialist (utility-based) 2 and deontological (rule-based) ethics informing healthcare interactions and organization, do not always work for disabled persons or their kin. Neither do distributive ethics or ethics of care (explained below). In the spirit of Braidotti's (2020) call for a relational ethics that encompasses the more-than-human world, we bring into view how healthcare providers working in disability-affirmative spaces "crip" the autonomous subject that informs their professionalized selves and enact a processual crip-ethics within and across human-nonhuman relationalities (see also Gibson et al., in press).

We begin by introducing some of the problematics with normative ethical approaches. We then briefly present our disability arts methodology before turning to analyzing six (of thirty-eight) short, first-person videos created by healthcare providers along the three major themes that emerged through our descriptive analyses of the videos: in/vulnerability; compassionate transgressions; and embodied fluidity and volatility. In analyzing healthcare providers' videos, we contend that storytellers productively "un-do" dominant ethical frameworks in ways that allow for the possibility of sketching out a new processual ethical framework—a crip-ethics—that affirms vitality and humanity in difference(s).

Cripping Autonomy

The normative concept of "individual autonomy" is key to personhood under Enlightenment humanism and imagined as able-bodied/able-minded, white, cis-male, and heteronormative; this qualifier thus constitutes disability, aging, racial and gender difference, and queerness as non-normative (Changfoot & Rice, 2020; Rice, Cook, & Bailey, 2021; Rice, et al., 2021a/b; Viscardis, et al., 2019). As a primary tenet enshrined in legal and policy regimes in democratic societies, the principle of autonomy protects and promotes the individual's a priori ability to act rationally and govern her/him/theirself while encoding an ableist, sanist standard of the human that treats all non-normative bodyminds as less than or threatening to that standard and hence, in need of fix, cure, or elimination (Ho, 2008; Shildrick, 2019). Other assumptions underlying autonomy presume that individuals transparently express themselves, understand others, and interact in respectful ways in decision-making, building toward and actualizing the best outcomes. There is no "outside" to the subject other than how they choose to self-represent in their world. In other words, the subject is assumed to be autonomous in their self-representational and reasoning capacities, and exercise universalizable choices regardless of ability, gender, class, race, sexuality, or other differences. This "universality," however, is rarely conferred beyond normative masculinity, male embodied subjects and the contained structure of modernist selfhood (Shildrick, 2019). Even in healthcare, patient/client-centered practitioners, with or without intention, manipulate their patient-clients to secure compliance in the name of educating them about "good choices" (Gibson et al., 2020, p. 5).

Feminist ethicists have exposed inequalities informed by systems of patriarchy, sexism, ableism, heterosexism, racism, and classism, arguing for care and redistributive ethics that are equity-advancing (Asch, 1998; Bresler, 2006; Fraser, 2000; Kittay, 2019), for creating care ethics in the everyday and biogerontology (Puig de la Bellacassa, 2017) and for deconstructing the rational, self-determining subject underwriting consequentialist and deontological frameworks informing healthcare. Feminist care and redistributive ethics seek to redress structural inequities to deliver better care and decisions by attending to positionalities in healthcare systems (such as the gendered and raced dimensions of caregiving) that create structural divisions in healthcare work, and to political economies of healthcare (under neoliberalism) that re-distribute dollars away from social needs toward biotechnology and pharmacology (Rogers, 2006). While feminist care and redistributive ethics looks beyond isolated healthcare interactions or immediate physical requirements of patient-clients toward an embedded perspective (Mol, 2008; Paulsen, 2011), some ethicists have argued for widening this lens with an embodied view that recognizes and respects the embodied knowledge of both provider and patient-clients to open new possibilities of care (Montgomery, et al., 2019; Viscardis et. al., 2019).

Embodied ethics emerges from the poststructuralist decentering of the mind as the defining feature of the human while affirming the body as agential in interactions, thus reclaiming "the unity of body and mind" (Shildrick, 1997, p. 168). Because embodied subjects interact continuously with their worlds, embodied ethics sees subjects as fluid and changing, and attunes to their differences and desires, both spoken and unspoken, as the ground of ethical interactions (Chaplick, Mykitiuk, & Rice, 2015; Rice, Cook & Bailey, 2021). Embodied ethics insists on perceiving meaningful dimensions of embodiment by attending to the relationality of bodies in specific encounters (Shildrick 1997). Such an approach rejects the notion of rigid spatial and temporal boundaries of the body and orients to the inter-connections and flows of language, emotion, sensation and affect within and between bodies as conduits of verbal and non-verbal communication (Rice, LaMarre, & Mykitiuk, 2018). In a healthcare context, this means attuning to words, gestures, affect, movement, and other languages of the body and their entanglements during encounters for meaning that can inform ethical action, making the centering of embodied difference key (Shildrick, 1997; 2001). Yet, a processual or new materialist ethics contributes additional dimensions to understanding entanglements—of humans and nonhumans, of matter and meaning—that occur in/around encounters and that help to shape what the outcomes will be.

Within a processual ethics, not only are providers and patient-clients acknowledged to have autonomy, but all life (e.g. human and nonhuman, such as service dogs), ideas (e.g., medical discourses, healthcare policies) and things (e.g., technologies such as wheelchairs) involved in healthcare are understood as influencing autonomy in the sense that they help to shape what happens in and the outcomes of interactions. This renders autonomy as emergent from within human-nonhuman relations, from living and nonliving entities, and from matter and meanings rather than solely from any one plane (Barad, 2007), thus beckoning toward a new understanding of ethics in healthcare encounters. Because processual ethics envisages decision processes as expressed by an ensemble of relationalities, we do not jettison autonomy; instead, we "crip" autonomy by extending it to include the apparatuses (Barad 2007, p. 142) of patient-clients, providers, and interrelated forces (affects, discourses, technologies, built environments) that come together to make reality and scaffold capacities for action in the moment.

In this context, we mobilize the verb "to crip" to centre the ways that disability disrupts the normative assumptions underpinning autonomy (i.e., able-bodiedness, masculinity, heteronormativity, whiteness) and to desire the disruption that disability brings (Fritsch, 2012). In cripping autonomy, we extend autonomy that is disrupted by disability in multiple directions beyond the individual healthcare provider and patient-client dyad; this connects all involved in healthcare exchanges not only to non-normative aspects of their selves—past, present and future—but also to kin and the more-than-human world, understanding that crip autonomy forms relational ensembles toward social justice outcomes focused on the best interests of the living and their flourishing. Goodley and Runswick-Cole propose the term "dis/autonomy" to capture "the relational rather than the individual nature of autonomy in the lives of disabled and non-disabled people" and a "distributed competence made so by the presence of disability" (2016, p. 10). For us, ensembles of relations extend human interrelations to more-than-human animacies (e.g., animals, plants, prostheses, wheelchairs, built environments, attendant supports, family and kin), which entangle to distribute and co-produce the assembled automony of subjects. And, instead of "distributed competence," cripping autonomy enlarges toward social justice envisioned as the best possibilities for living and flourishing.

Posthuman disability studies recognizes the political urgency of disabled people making claims to the category of "human"; yet to avoid reproducing humanism's ranking of the world according to a hierarchy of value that places white non-disabled men at the top, it also embraces posthuman possibilities of multiple and assembled agencies and autonomies (Goodley, Lawthom & Runswick-Cole, 2014). Relatedly, new materialist theorist Karen Barad argues that knowledge, reality, and ethics are mutually implicated and constituted through knowledge-making processes. Elements of any knowledge-producing apparatus (e.g., the researchers, the tools used, the research space, etc.) "intra-act" to shape the phenomenon being explored (Rice et al., 2021a). In surfacing "the changing and contingent ontology of the world" (2007, p. 73), Barad's new materialist theorizing invites us to think about how the confrontation of matter and meaning necessarily raises ethical questions recognizing that human discourses and research apparatuses intra-act with an indeterminate materiality to produce reality in ever-changing ways. Put differently, the knowledges we bring and make (as part of, and produced by, our research apparatus) play a part in shaping the realities we co-create and thus, have ethical implications for the kinds of worlds we want to create. When applied to healthcare, a cripped autonomy surfaces new possibilities in understanding healthcare provider-patient/client decision processes which shape healthcare outcomes.

Methodology: Visual Embodied Digital Storytelling

We developed our disability arts digital storytelling methodology through Mobilizing New Meanings of Disability and Difference (hereafter Mobilizing New Meanings), a funded research project run over three years in Ontario. For the project, we brought together non-mutually exclusive groups of disabled people, artists, healthcare providers, and researchers and mobilized video-making to transform negative concepts of bodymind difference that create barriers to healthcare. We ran digital/multimedia storytelling workshops as researchers affiliated with the Re•Vision Centre for Art and Social Justice, an arts-based research centre that works with equity-seeking communities and allies to transform systems (Rice et al., 2018; Rice et al., 2017; Rice et al., 2016; Rice et al., 2015). From 2012 to 2015, ten multimedia story-making workshops in three Ontario regions (northern, central and eastern) included the following: four workshops with adult women and gender variant people with disabilities, four with health care providers (disabled and non-disabled) and two workshops with our multi-disciplinary research team (which included disabled, non-disabled, artist, activist, and health provider researchers). This paper focuses on stories/videos created by healthcare providers (those with and without disabilities, and who are in relation with their disabled patient-clients).

In workshops held over a few days, healthcare providers created 2- to 3-minute-long videos using video clips, artwork, graphics, music, soundscapes, and more that centred the makers' voices (Rice & Mündel, 2018). The thirty-eight participating providers entailed 12 nurses, 16 social worker-counsellors, six occupational therapists, three physicians and one personal support worker; all were at different career stages, including those in training, currently practicing in clinical or educational settings, and identifying as former practitioners. We recruited through snowball and purposive sampling via professional networks of research team members. Workshops were designed for 6-12 participants and took place in institutional (hospital) and community (service organization) spaces. We chose these spaces to facilitate provider participation, and to give makers direct access to spaces, sounds and props that could be relevant to their video-making. With the consent of the makers, we have screened their videos widely in health care settings, at film festivals, in community spaces and beyond. Research processes were approved through the University of Guelph Research Ethics Board (REB# 12AP010), and participants given options to different levels of consent regarding the sharing of their stories, including whether or not their story could be screened in classrooms or festivals, analysed for research purposes, included in academic articles, or not used at all.

Digital storytelling methods invited healthcare providers to engage with and challenge systemic assumptions and practices of normative care practices, reflect on their own and others' embodied experiences and present these reflections in their multimedia stories for later analysis (Rice & Mündel, 2018, 2019) in ways complementary yet distinct to narrative methods (Smith & Sparkes, 2008) in that the output for each healthcare provider was a digital story/video. Each story centers a problematic dimension of healthcare practice identified by the storyteller and offers an aesthetic rendering of it using poetry, image, voice, ambient sound, music, and movement. The emotional work involved in creating videos that makes them sites for vulnerability, embodied learning and complex assemblages has been acknowledged and analyzed elsewhere (Rice, Cook & Bailey, 2021; Rice & Mündel, 2019); here we acknowledge that this makes them simultaneously important and risky sites for analysis. We also recognize the willingness of storytellers to share their memories of learning, often through discomforting ethical conundrums to shift healthcare encounters in ways that might benefit disability communities. Their stories question, albeit in unique ways, uneven power in healthcare systems and provide important insights into transformational and processual moments of attuning to relations in new ways.

Our analysis is informed by the following questions: In what ways do healthcare provider storytellers engage with ethical conundrums related to disability in healthcare? How do their stories illustrate the instability of providers' authority in encounters with patient-clients in ways that challenge, even transgress the ethical frames by which they abide in order to deliver care they understand to be ethical given the circumstances? How do the stories surface new ways of thinking about care arising from entanglements of matter and meaning in their accounts? These questions support the development of our understanding as noted above for how the storytellers productively "un-do" dominant ethical frameworks to begin sketching out a new processual crip ethics that affirms vitality and humanity in difference(s). Our analysis informs three dimensions of embodied and processual crip-ethics, namely in/vulnerability, compassionate transgressions, and fluid and volatile embodied entanglements, which we discuss below.

In their digital story-making, healthcare providers open up their professional and personal lives in reflexive ways to explore ethical conundrums they face in care provision and to push against norms governing their practice and healthcare more broadly. In doing so, they invite audiences to become attuned to the dominance of normative ethics and to provider processes of calling into question and generatively "staying with the trouble" (Haraway, 2016) of those ethics. The videos enact a sense of care specific to the patient-client, the relationship between patient-client and provider, and the broader relationalities at work shaping the encounters. In their stories, we sense a cripping of autonomy influencing the interactions of providers and patient-clients in institutional and intimate spaces, also connected and affected by other diverse forces through which care materializes, pointing toward processual crip-ethics.

In/Vulnerability

The multimedia stories of healthcare providers developed through Mobilizing New Meanings recount ways in which professional training for these storytellers produces pressures to enact uniformity of treatment (e.g., attentivity, duration, quality) in care encounters. Specifically, their professional instruction, in teaching homogenized and abstract approaches to care also operated to suppress difference—in others and in themselves. Their stories demonstrate how uneven power develops in situations where obligations of duty to respect individual autonomy, comply with checklists, and enact procedures to secure informed consent outweigh and diminish relationship building due to negative and dehumanizing stereotypes of disabled people. Uneven power relations infringe upon patient-client care when healthcare providers, who are flooded with patient-clients and/or lack difference-affirmative training, cannot sustain a caring practice. The stories reveal, as disability scholars Shildrick and Steinberg (2015) have argued, that uneven power is heightened within neoliberalized clinical settings where healthcare providers trained to enact treatment premised on unquestionable authority must rely on scientific knowing to enable, create, and impose social norms "that specify what does and does not count as health [and] that nominate some bodies as disabled and some minds as cognitively impaired" (p. 9). There are times when healthcare providers need to be certain. But, as the following stories by Cathy Graham and Hilde Zitzelsberger show, healthcare providers also need space from which to engage with their own susceptibility to biomedical power, that is an engagement with their own vulnerability, configured not as weakness, lack, or another negatively imagined attribute, but of an openness to the "condition of being affected" from which possibilities of refusing, revising, and re-imagining hierarchical power structures can emerge (Butler, 2016, p. 18). Vulnerability within these videos is explored not as oppositional to agency, but rather as the prerequisite from which resistance that mobilizes renewed engagements with agency become possible (Butler, 2016). Vulnerability thus provides clues to what may or may not work in specific encounters and surfaces the inadequacy of formal principles and rules to predict or prescribe with certainty what should/must happen across all situations.

In Telling (go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling; enter password "cripethics"), retired nurse and nursing instructor Cathy Graham illustrates the mantle of invulnerable authority that healthcare providers learn to assume and the suppressed vulnerability that inherently informs their embodied experiences. She uses prose and a black and white photo to introduce viewers to St. Joseph's Hospital in the 1960s where training "infused military, religious values of order, routine, compliance, and dedication." The rigid training methods are emphasized by photo images of nurses in uniform with bodies smiling and lined up like replicas of one another. With this training came the authority, and power, to "tell" patient-clients what to do. Graham narrates how she wanted to tell the young women who attended her clinic "all there was to know about birth control methods," and "to push them into a complex discussion that they weren't ready for." She suggests that while she aligned with normative ethics in giving young pregnant women authoritative advice and information "for their own good," her normative approach instead implicated healthcare institutions in serving the interests of a social order invested in the regulation of reproducing bodies. The regulation of who gets to reproduce for the perceived greater good (consequentialist ethics) is tied to a history of early to mid-20th century racial betterment thinking in Canadian healthcare systems (Kelly, Manning et al., 2021; Kelly, Boye & Rice, 2021; Stote, 2015; Wilson, 2018). Eugenicists justified coercive birth control of those deemed "unfit" because they believed it to be in the best interest of everyone (including the future health of the so-called Canadian race) (Buchanan, 2007). This is merely one example of the damaging disregard for human lives that do not fit into human norms underwritten by the autonomous subject.

The scene changes as Graham offers the hard-won wisdom that "telling as a way of learning is flawed…advice is cheap and not really what people want from nurses" and divulges what provoked her early career advice-giving drive: whisper campaigns, shame, and the secrecy around her sister's unauthorized (unmarried, young) pregnancy. In disclosing that overzealousness worked to "mask" her feelings of helplessness and the "calamity and chaos" that accompanied an unsanctioned pregnancy in the 1960s, Graham provides space for her imagined audience—current and future providers—to bring insights about their psycho-social lives into practice, and to mine their internal worlds for clues to power relations operating in external ones. In Graham's pedagogy, her performative invulnerability as a healthcare provider, exemplified in institutionalized expert authority and acts of advice giving to young pregnant women, breaks down when she connects the unreceptivity of her advice to the complex relationship she has to her sister's pregnancy within a disapproving family, community, religious and regional context.

This break down of biomedical invulnerability is expressed visually when Graham contrasts an image of her "telling" self as a young nurse in uniform with a more recent image of her non-conforming, entangled, and relational self with bright tufts of blue and pink hair sitting next to a bronze statue of a pregnant woman, holding her hand. The final image of an expansive garden—what Graham calls her "healing place"—provides us with an understanding of health that involves human and nonhuman life entanglements. Invulnerability gives way to vulnerability that is constituted by relational intra-connections of family, social history, and organic and inorganic matter (e.g. all of which connect in her garden) and produces affect-laden ethical conundrums that a presumed invulnerability misses. By bringing forward various constituting relational elements that comprise their experience of vulnerability into the open, Graham brings to light crip autonomy and possibilities different from "telling."

My (Im)possible (In)vulnerability (go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling; enter password "cripethics") by Hilde Zitzelsberger explores how the fluid movement between positions of practitioner vulnerability and invulnerability in nursing is precisely what is required to break down this binary. Rather than being fixed in one cohesive embodiment, Zitzelsberger's work considers her multiple, "messy" embodiments that cross, splice, blur, blend, and spin together with her occupations and relationships. She says,

I am an aromatherapist, nurse, professor, hairstylist, researcher, yoga practitioner. Some of my best friends are dogs." […] I wonder about the stories that we continue to tell each other and how this traps some of us into bearing the burdens of a messy and so-called problematic body while allowing others the illusion of mastery and control. As a nurse and patient, student and a professor, research participant and researcher, what side of the bed, lectorate or desk am I supposed to be on?

Her monologue gives us clues about the possibilities that embodied vulnerabilities, as openness to change from heterogenous human-nonhuman relations, affords. But she also tells us more about the complexities of vulnerability and how they foreclose possibilities for existence when bodies are expected to be cohesive, contained, and self-reliant and, therefore, invulnerable to pain, suffering, and failure. She says, "when I teach students about vulnerable persons, why do none of us admit, this is who we all are? If we do own it, why does this become all we are? When my own pain becomes visible does others' disappear?" Possible vulnerabilities turn to (im)possible vulnerabilities due to the negative stereotypes and judgements that target bodies that extend autonomy beyond individual borders. Vulnerabilities become realities in need of hiding and "protecting". Zitzelsberger explains further: "How can I feel attractive and self-assured but scared to strip off my protective layers in front of a stranger, my doctor, a friend, my student, my lover. I feel so much self-judgement when I reveal my failures, shame when I reveal my imperfections."

But Zitzelsberger's story makes one final tack towards sharing the embodied pleasures and possibilities of transgressing restrictive notions of invulnerability. She ends her story by revealing to her viewer/listener that when she shares her own (im)possible (in)vulnerability with others, including her so-called failures, shame, and imperfections, "I feel so alive in my skin." She follows this statement with laughter, a subtle indication that despite those who would negatively judge her for expressing her own complex in/vulnerabilities, she experiences possibilities that give her feelings of freedom to move with confidence and vitality in between her bodily relations, pleasures, and pains.

Her reflections that decentre/crip individual autonomy and expand it to include vulnerability are further expressed visually as we see images of a female human body that are always only partial and fragmented. While the images are static, they shift from showing one side of a body (from chin to ankle) with its shadow, to parts held together to form a new fractured yet whole body that twists, torques, to a swirling body with blurred boundaries—human yet no longer recognizable through the lens of autonomous invulnerable personhood. Reflecting on her different occupations and relationships with human and nonhuman bodies, Zitzelsberger shows how context shapes vulnerability, including the body inhabited. Reflexive questions emerge from her story about when to foreground and when to background positions of relatively less and relatively more vulnerability, depending upon the situation, what is required, and what her capacities allow and do not allow. Her complex tack between (im)possible (in)vulnerabilities ultimately leads to possible vulnerabilities that each take up different ethical conundrums.

Taken together, Graham's and Zitzelsberger's stories demonstrate an embodied openness configured as vulnerability that requires rethinking how autonomy emerges from processes of entangled relationalities. Within these stories wherein vulnerability, configured "as a deliberate exposure to power," is foregrounded, normative assumptions grounding vulnerability itself as equivalent to the "destructive denial" of one's autonomy or agency are challenged (Butler 2016, p. 25). Vulnerability, reimagined as an awareness of the varying social and materials relations that constitute the positions of precarity particular to one's 'multiple messy embodiments', allows for an identification and subsequent refusal of the performative re-productive coupling of passivity with vulnerability itself. In turn, one's expression of their own vulnerability through their intentional exposure to precarity creates space from which to begin imagining "unjust and violent regimes" otherwise" (Butler, 2016, p. 26).

Additionally, adopting a processual lens expands ethical possibilities beyond embodied ethics and exclusively human interactions in socio-economic systems and past the human mind as the authoritative route to a discoverable world in order to recognize the force of knowledge (i.e., discourse) and the nonhuman (i.e. organic and inorganic matter) in shaping that world. A processual ontology highlights the fluid, sometimes volatile, ever-changing nature of reality, orienting to organic and inorganic things as continuously moving and shifting, and always already entangled with knowledge. Graham's and Zitzelsberger's stories demonstrate pathways through which the illusion of autonomous invulnerability gives way to more porous and emergent embodiments involving much larger webs of human and nonhuman, material and discursive entanglements inclusive of disability. In the stories, concerns regarding normative ethics come into question, but are offered no resolutions. Graham and Zitzelsberger choose not to provide us with another rule or protocol premised on hierarchical power. Instead, they show the limitations of normative ethics and surface new spaces of possibilities in which conundrums are held. Such stories, and reflections on them, animate processual spaces for deontology and authority rooted in autonomy to be broken down.

Compassionate Transgressions

Healthcare provider stories by nurse practitioner Sylvia Arsenault and occupational therapist Isabelle Cheng address the double-edged sword of "care" in healthcare—encapsulating how the same care event can be both helpful and harmful. Storytellers caution against certainty and the assumption of what is right and how to achieve it. Instead, reflection and uncertainty need to be part of the patient/client-provider encounter. While care practitioners are required to follow particular guidelines (in terms of what they are assigned to do), compassionate transgressions respond to entangled ensembles that emerge from the iterative labour of those in the encounter and evolve from their differences. Referring to this entanglement as "desiring messy dependency" (2019), disability scholar Akemi Nishida has written,

[t]hrough this recursive collaborative dance of reconfiguration and adaptation, care partners begin moving their bodies to be in sync with other bodies in order to accomplish care tasks. Care practice, on paper, seems to be a rigid, clear-cut list of services that providers are assigned to perform for their clients. In reality, though, each task requires the collaboration of both bodies on multiple levels. A process which twirls both bodies beyond the boundaries of their skin. (2017, 95)

Drawing from a new materialist understanding in health care that there is a fluidity between body and environment (Abrams & Gibson 2017), compassionate transgressions involve uncertainty, humility, and doubt in one's expertise requiring constant questioning of "what to do, what is best, and what is person centered care within each moment of care" (Gibson et al. 2019, p. 1). In other words, compassionate transgressions foster flexible care that adapts to the specific context of entangled relations.

Arsenault, in her untitled video (go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling; enter password "cripethics"), shares that she decides to become a nurse and then discovers what she describes as the rigid code of rules that all nursing students must observe: "never sit on a patient's bed; only touch a patient if they require personal or wound care; never become friends or accept gifts; we are the healthcare providers, the experts, they are the patients, the afflicted." Arsenault accompanies her description of the code with the static image of a surveillance camera to express how it is enforced through a panoptic form of control whereby nursing students are seen but do not see. They are "[…] the object of information, never a subject in communication" (Foucault, 1975, p. 200)—a mode of training that establishes us-versus-them boundaries that when crossed are imagined having dangerous and volatile consequences. This is evidenced by Arsenault's inclusion of an image of a sign on a closed door that says "Danger. High Voltage." She continues to recount the code as if to underscore how it has been etched into her consciousness: "There is a well-entrenched boundary that separates us from them. It is never to be crossed. Never." Her point is all the more emphasized by her inclusion of a 2009 College of Nurses of Ontario policy that states, "empathy includes appropriate emotional distance from the client to ensure objectivity and an appropriate professional response." While these rules, present in each lecture and clinical placement, violated her every moral fiber, Arsenault tells how she survived nursing education by promising herself that she would allow her beliefs to be incorporated into patient-client care.

Arsenault then speaks of Mary who is dying. Arsenault is invited to Mary's home for lunch one July afternoon. They each sip their soup. Mary is in a very weakened state yet reminisces from the time she was young—learning to fly as a young adult, marriage and then business ventures with her husband—as she turns the pages of the photo album on her lap. Arsenault listens. Mary falls asleep. Arsenault kisses Mary on the forehead then leaves quietly, closing the door, knowing this visit would probably be the last. Mary dies two days later. Arsenault became friends with a patient-client in her care and accepted the invitation for lunch, knowing "I gave Mary the best medicine she needed: time and compassion." Arsenault says that she also received a gift—"the opportunity to be the kind of nursing practitioner she loves to be," in-person compassion, listening, and caring that includes physical contact.

Through her choice of imagery, Arsenault blurs boundaries of self and other in important ways that demonstrate her own sense of care. She enlivens her description of Mary and their time together with images that evoke their entanglements with material, non-material, human, and nonhuman realities that blur life and death: the empty couch where she lay "on an oversized down-filled pillow" and "multi-coloured hand-made blankets" on an empty bed. The images are static, with the exception of blurry, ghostly dots of light that emerge and move in front of the material items of Mary's home—as if to say Mary is still present in Arsenault's rendering of the material world. The image shifts to an old album of black and white family photos. The photos are a reminder of the ways memories of the past continue to have material presence. We then see a black and white image of hands clasping, an expression of Arsenault's tactile memories that again enliven Mary, making the borders of life and death permeable (Shildrick, 2019, p. 14). Arsenault expresses her care encounter with Mary in processual terms that were central to guiding her as a nurse practitioner in ways, affording possibilities for care attuned to Mary. These reflections reaffirm, as Maria Puig de la Bellacasa (2012) describes, that "to care about something, or for somebody, is inevitably to create relation" (p. 198).

In Go Home (go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling; enter password "cripethics"), Isabelle Cheng relates a dental care encounter where her grandmother is the patient-client and she is the family member. The dentist takes a tissue sample from Cheng's grandmother, called Badi-mommy, telling her that what he sees is routine. "Go home. Rest. Eat well. Sleep well," he says to her. It would first appear that the dentist is carrying out an unremarkable diagnostic procedure on a consenting patient-client who has no reason to be concerned, yet Cheng knows there is much more at stake for both patient-client and family. As a healthcare professional, Cheng realizes that the dentist is disclosing a probable diagnosis to Cheng in coded language in order to protect her grandmother from such knowledge and prepare the family for likely bad news about their grandmother's health. As a family member intimately involved in her Badi-mommy's care, she interprets the dentist's action as compassionate and felt "hopeful, grateful, empowered," to be given time to rally family for the days ahead without the added difficulty of her grandmother knowing her condition. Cheng uses multiple images of natural landscapes and spaces, accompanied by the low, focused, guttural chanting of Tibetan monks to express how this approach to care was a gift of time, compassion, choice, control, and chance to process. Badi-mommy's autonomy, through the dentist's decision not to disclose illness, gives way to another understanding of the patient-client, one that extends Badi-mommy's autonomy to intimate relationships with her granddaughter and family involved in her care.

Cheng's story shows us how the accumulated histories of bodies shape their ever-changing nature, as do current or future interactions with healthcare providers and the diagnostic tools, spaces, technologies, and knowledges of systems, which likewise fold into (and shape) the becoming of bodies. With the sound of a heavy door slamming shut, the scene changes to the surgeon's office, where the surgeon matter-of-factly informs Badi-mommy that surgery is not an option: "You'll go home. You'll wither away and you'll die." We see flames burning as Cheng expresses that she is "enraged, disgusted, hopeless, so sad." While the surgeon upholds standards of care involving disclosing a terminal diagnosis to someone capable of receiving it, for Cheng, she communicates this brutally. In contrast, Cheng views the approach of the dentist as supporting the family, and in so doing, supporting her Badi-mommy through the family's mobilizing for her care, understanding that Badi-mommy and her family are inseparable. Cheng reflects on how the surgeon's stark delivery of such diagnoses may become routinized and wonders aloud, "have I done this in my work?" Reflecting on the ethics of these encounters, she submits that though the dentist violated ethical standards, he showed far more compassion for Badi-mommy and the family than the surgeon, whose clinical delivery of accurate information in-keeping with deontological ethics violated Badi-mommy and the family in other ways. As aging scholars Pia Kontos and Alisa Grigorovich (2018) have shown in their work on Ontario's long-term care facilities and the need for "relational citizenship," such an ethics confirms an unevenly experienced yet interconnected and co-constituted, or intercorporeal vitality emerging from relational embodiments. For us, crip-ethics are inextricably entangled with health knowledges, technologies, spaces and care relationships because all play a part in expanding or contracting the pathways for who and what a bodymind can become.

The final image of the story shows Badi-mommy holding a child. By making visible the multiple positions she holds—in relation to her grandmother, her grandmother's doctors, the healthcare system, and her interlocutor role with her family—Cheng brings to the surface how healthcare ethics enlarge beyond patient-client and professional. The surgeon clearly acknowledges the autonomy of Cheng's grandmother. Healthcare professionals might debate the surgeon's choice of words and manner. Would there have been a more compassionate and supportive way of delivering the message of death? Very likely. Even so, Cheng implies that this would not have been enough. Cheng, as a family member, retroactively recognizes the family needed the dentist's subtle transgression, which enlarged and cripped Badi-mommy's autonomy, and gave the family a period of reprieve and time to plan. Cheng ends by asking a series of open-ended questions as a provocation to other providers to reflect on their own practice, as well as an exhortation to the system to listen more intently to disabled persons and "the families who love them." The dentist violated a norm for another norm—the collective care and wellbeing of Badi-mommy within her family.

Compassionate transgressions expressed in the stories of healthcare providers Cheng and Arsenault speak to experiences of resolving ethical dilemmas through an embodied awareness of larger intra-acting forces in ways that were perceived to give care specific to each patient-client and their relationalities. For Arsenault, the nursing protocols involving rigid boundaries of care during end of life needed to be transgressed to provide compassion. For Cheng, ethical relations of care center the family's relations with Badi-mommy, not the individualized relationship between Badi-Mommy and Cheng or between Badi-mommy and the healthcare providers. Individual care becomes intertwined with the family's care of Badi-Mommy and family wellbeing in an "intercorporeal generosity" (as cited by Diprose in Shildrick, 2015, p.100). Cheng and Arsenault narrate the pressing call for interactions attuned to disability that urge toward a crip-ethics against procedural ethical norms through compassionate transgressions to provide care.

Fluid and Volatile Embodied Entanglements

Stories by retired nurse and nursing professor Nadine Cross and personal support worker Julia Phillips present fluid and volatile embodied entanglements. Embodied entanglements refer to the somatic multiplicity of bodies that decenter the individual autonomous subject through dynamic movements and relations that flow, torque, twist, fragment, spin, expand, mess, interact, and enmesh with material and nonmaterial, human and nonhuman bodies and their discourses. Cross and Phillips explore the ways matter and culture co-constitute somatic multiplicities within the context of neoliberalism and biomedicine. At the same time, their stories reveal the entanglements of body and mind that are produced and felt in relationship and context in ways that disrupt linear temporality.

Shildrick (2019) has considered how such somatic multiplicity shifts political and ethical conditions by deconstructing the normative structures of autonomy through introducing the body as a heterogenous, porous, and becoming (micro)chimera. Chimeras disrupt boundaries of containment since they are, according to Shildrick, "a combination of forms, either intraspecies or transspecies, that nevertheless retain genetic and usually morphological distinctions within a single body" (2019, p. 11). Human DNA, for example, is a mix of bacterial, fungal, parasitical and viral components that outnumber the human cell (p. 12). Since microbes, amongst other nonhuman life matter, make up a large portion of the human body, human beings are not autonomous in an anatomical sense: "we are materialised as genetically multiple…each individual has a unique microbial makeup that interacts both with the external environment and within the body between different microbial communities" (p. 13). For Shildrick, somatic multiplicity complicates the conventional bookends of human life as microbes are constantly living and dying and death becomes part of an "enduring vitalism" (p. 11). The stories developed by Cross and Phillips exemplify such expanded inter and intra-acting fluid and volatile temporality because they refuse and move beyond the bookends imposed by a subject normatively conceived as autonomous to become cripped autonomy which we discuss, next.

Cross uses humorous black and white cartoon line drawings, prose, and poetry to share her experience of living with depression in her untitled video (go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling; enter password "cripethics"). She recounts being asked by a healthcare provider when her experience of depression started. "Why?" Cross asks, but the film does not provide an answer. She recalls the sadness, but there is no exact start date: "deux ou trois?," she asks in a rising voice. Nor is there an end or cure date. This echoes Alison Kafer's (2013) exploration of curative-time wherein "one's life is always on hold, in limbo, waiting for the cure to arrive" (p. 44). Cross shares her experience living with depression: what it looks, feels, and sounds like. It feels "like I'm hiding and hiding something—like someone is standing on my chest. It is hard to breathe, and my heart aches. Mostly, I am teetering at the abyss: "Life. No life." To add to the tactility of her depression, she includes a drawing of herself under a patchy blanket, an elephant standing on her chest, and her standing at the edge of a cliff. She hears the voice of her sadness as if wearing muffled headphones: a dragon appears to scold her with a speech bubble saying, "Can't you snap out of it? Try exercise." In contrast, what helps is her family and friends "who stay no matter," as well as "drugs, therapy, eventually laughter." Cross accompanies her laughter with a new representation of her body—with three eyes, fangs, and smile. Cross's depression exceeds the mind's control over it, and her body expands in new directions beyond the control of normative representations of individual autonomy. Lastly, the final image shows Cross smiling with a colourful gift and hearts emanating from her body. With this image, Cross names "the compassionate gift of self-understanding" that depression is a pattern of her life, for life, and accepts this with pride. Even more, this self-acceptance and knowledge bring her into sustaining and loving relationships with family and friends, as well as technologies of drugs and therapy. Her burst of free-sounding laughter signals vitality. There is an expression of depression that Cross is asking people to accept, not as something to be cured. Instead, Cross's story compels us to ask new questions about how we engage with this embodied knowledge. The flow of living with sadness and the embodied sounds, feelings, and appearance of it comes alive through the illustrations and her poetic prose while it folds into her aids of family, friends, drugs, therapy, and self-compassion. Cross refuses an origin story within a biomedical frame and creates a social and cultural frame. This orientation to depression further evokes a crip-ethics in relation to self that refuses familiar disability narratives of cure and overcoming (and their related self-disciplinary practices) and reorients with a disability politic of radical acceptance—as an embodiment / enmindment that is part of "my life, for life."

Julia Phillips's video (go to https://revisioncentre.ca/cripethics-embodied-and-embedded-digital-storytelling; enter password "cripethics") uses drawings to show the viewer how she remembers the institutional approach to caring for disabled individuals who are complexly embodied, with multiple interdependences beyond those coded as normative. Her own institutional attitude changes when she and patient-client, "Joanie", develop a relationship that deepens into lasting friendship spontaneously animated by shared interests, inclement weather and the proximity of her mother's home while they were out together one afternoon.

Phillips tells us how her institution's care routines dehumanized residents by not recognizing them as persons: "I would do my work just like everyone else, not caring if they had any feelings or thoughts," she says as a black and white drawing of beds lined up in an assembly line emerges. "To me, it was a job to care for them, which would include feeding them in bed, showers as if an assembly line, and no sense of individual personality. We put each person in the same type of gown and diaper and left them in bed. And then we'd go and have our coffee. I didn't question, and I assumed that was normal." Phillips' experience of dehumanizing residents in an institutional structure meant to provide for their care is part of a Canadian legacy of eugenic worldmaking tied to capitalist notions of efficiency and rational modernity that has attempted to remove disability from human community through egregious practices of segregation and sterilization (Garland-Thompson, 2017). As Malacrida puts it, disabled persons, whose embodied difference is deemed "matter out of place" and in need of order and control, are considered a threat to normative notions of the productive human (2012). Such devaluing of disabled bodies accounts for their systematic neglect and abuse within institutions. Relating to disabled persons as bodies to be provided care in an impersonal way, as unruly bodies without personhood, whether disabled persons are considered human emerges as a question. For Phillips, relating to Joanie in ways that went beyond the impersonal encounters of commodified hygiene and feeding routines changed her perspective.

"Then I met Joanie," Phillips says as she excitedly recounts the commonalities of age and interests. Accompanied by colour photo images of Joanie in her wheelchair, Phillips recounts the development of personal interactions, one in which a fuller acknowledgement of Joanie emerges for Phillips beyond the assembly-like line of care Phillips once practiced on Joanie affording her a less than human embodiment. Phillips' own position as a provider expands as she shares experiences and builds relationships beyond the transactional activities of feeding, cleaning and putting to bed. Phillips recounts the single largest disruptor of the routine dehumanizing institutional interactions and awakening to Joanie's personhood. Carrying Joanie up a set of stairs to her mother's apartment for shelter from a storm, Phillips more fully saw Joanie when seated in her mother's living room chair. Phillips, Joanie, the outdoor path they took, the weather, the stairs, their physical proximity to Philip's mother's apartment were all interacting in ways that emerged in physical, perceptual changes for Phillips. This interaction was not in a singular or exclusively mind-constituted decision through reason, but one where bodyminds were intimately connected and moving amid a dynamic landscape. The process of interaction reshaped Phillips' embodied perceptions and crip autonomy emerged in a new way: "I saw her in my world…as the individual she was." "At that moment she became my friend. Not a patient. And I began to listen." That day, Phillips experienced and recognized the emergence of a deeper connection with Joanie. Counter to the neoliberal, efficient, assembly line approach to care that minimizes the time-space of social relations and obligations, they continued to have a relationship for thirty years.

Aligning with Shildrick's aforementioned analysis (2019), these stories challenge singular and static notions of embodiment: binary notions of the self and other; rigid corporeal boundaries; natural/cultural. They make a case for unique, heterogenous, and entangled embodiments open to the environment that establish conditions for political and ethical decisions and beneficial health on new community-oriented terms open to cohabitation with difference. Cross and Phillips' stories reveal embodied entanglements that are both fluid and volatile, meaning dynamic with generative disruptions emerging spontaneously. Their stories give us, quoting Donna Haraway, a "view from a body" whereby their verbal and non-verbal expressions can be understood as manifestations of bodyminds that are intra-acting with other people, non-humans, discourses, and technologies (1991, p. 196). Their expressions and our interpretations become generative spaces where displacements of binaries occur as in Cross's story from depressed/not depressed to living with depression for life with friends, family, technologies and in Phillips' story from human/ not human to fluid and dynamic relationship with multifaceted entanglements, giving way to new care practices that become enlivened and equity-oriented.

Conclusion

In this paper, we "crip" autonomy; by cripping we disrupt the normative assumptions of autonomy which cleave to able-bodiedness, masculinity, heteronormativity and whiteness, and instead, foster the disruption that disability brings. We arrive at cripping autonomy through a feminist, relational, embodied and processual ethics.

The digital/multimedia stories presented here show competencies and capacities that emerge within intra-actions of healthcare providers and disabled persons living at the intersections of age-related, racial, sexual, gender and class differences. Through reflections on these stories, we have outlined three dimensions of embodied and processual crip-ethics: in/vulnerability, compassionate transgressions, and fluid and volatile embodied entanglements. Emergent in encounters between and within providers, patient-clients and others, human and nonhuman (e.g., gardens, family, living spaces and personal items), is a crip-ethics that materializes in intra-actions in and between bodies and worlds, not in the form of rule-bound, consequence or utility based deliberations, but in the unfolding and refolding of processes between bodies and things in time.

The videos analyzed provide clues for greater attunement to ethical conundrums that hold possibilities for improved care for both disability-identified persons and healthcare providers. The provider-storytellers' ways of working through ethical conundrums gesture toward a processual crip-ethics that attends to difference in inter- and intra-actions and to providers' and patient-clients' becomings in spacetime or processual becomings. The stories bring viewers into the problematics of normative ethics in that each provider demonstrates different reasons for the inadequacy of individual autonomy as a tenet guiding ethical interactions. In Graham's story, Telling, a wound or vulnerability, in this case from Graham's own family past, underlies her once driven desire to advise young teens about birth control. Sharing her vulnerability opens space to consider different approaches where for example, more time might allow for more meaningful interaction to address the needs and interests of young women. In Graham's and Zitzelsberger's stories, the inadequacies of conditions of training and practice that encourage providers to embody the mythical, invulnerable expert (Rice, Cook & Bailey, 2021; Viscardis et al., 2019) surface as each uncovers/attunes to vulnerabilities that emerge in healthcare encounters. Arsenault shows the processes of care that exceed rules and show the porousness of boundaries between life and death. In Go Home, Cheng relates a compassionate transgression which she receives as a gift that empowers her and her family to prepare themselves and Badi-mommy to receive the news of cancer. Cross refuses an origin story for her depression, whether biomedical or social. Depression surfaces as something that her bodymind cannot or will not disclose. Still, she insists on the materiality of her depression and her need for others to recognize this as part of her agency of achieving wellness with depression, relationships and technologies (e.g. therapy, medicine) in the world. For Phillips, processual encounters between healthcare providers and disabled persons in their care can open possibility to crip autonomous notions of the human with trust and intimacy where people can know and be known in safe ways and comfortable tempos for self, other, and relationship.

From these providers, the healthcare encounter in the familiar healthcare office or space gives way to visuals and sounds of places and spaces consistently outside healthcare institutions, including homes, expansive gardens, and outdoor paths, where we suggest wider intra-acting entanglements enable vulnerability, compassion, embodied fluidity and responsiveness to generative volatility to take place more freely, disruptive of institutionalized and standardized routines. The attributes of these spaces hold keys for further undoing normative ethics and inviting us to attune ourselves to disruptive, re-imaginative, and re-constitutive intercorporeality while, at the same time, acknowledging the need for humanism and a cripping of its categories, including of autonomy, to address oppression and subjection. Yet, premised in an affirmative approach to difference, processual crip-ethics, we insist, are non-universalizable, allowing for affirmative possibilities for disabled people in healthcare in specific instances.

All provider-recipient stories reframed embodied openness as a vulnerability that requires rethinking how cripped autonomy is embodied as well as embedded within and emerging from entangled relationalities between those who are unevenly brought together under Canadian structures of care. In our analysis of healthcare provider stories, the process-attuned, intercorporeal, and indeterminate elements of care encounters create a break in/through ableist and otherwise power-saturated systems, creating space to reflect upon the affects and effects of interactions in ways that focus on the flourishing of disabled persons within relational ensembles.

Processual crip-ethics is especially relevant during the post-pandemic crisis when care risks are continually being foreshortened. There is a pressing need for these considerations to be brought to bear on emergency protocols such as the Ontario Government's "Adult Critical Care Clinical Emergency Standard of Care for Major Surge (2021)." The protocol's focus on physician assessment of individual biomedical life beyond 12 months, we argue, reinforces the construction of invulnerability within healthcare by placing life and death decisions in the hands of medical providers and weaponizing the precarity of disabled (and fat and aging) persons, leaving healthcare providers in the lurch unable to provide care in ways that the stories presented here require, and disabled persons without recourse to life. We argue, strongly, for healthcare that attends to and supports the flourishing of life marked as disabled, especially under crisis conditions that default to eugenic modes of thought and action, and for a continued centering of the relational ensembles that crip autonomy and move toward justice.