Feminist Bioethics

In Canada and the United States, the bioethics movement and second—wave feminism both began in the late 1960s, but the two discourses had little to say to one another for the better part of two decades. It was not until 1989 that the U.S. journal of feminist philosophy, Hypatia, published two special issues devoted to feminism and medical ethics. The few essays by feminists published up to that time in the premier U.S. journal in bioethics, the Hastings Center Report, dealt solely with ethical issues surrounding women's reproductive systems.

All that has changed. The 1990s saw a steady stream of conferences, monographs, anthologies, and essays in learned journals that examine bioethical issues through a feminist lens. Susan Sherwin's No Longer Patient: Feminist Ethics & Health Care appeared in 1992, as did Feminist Perspectives in Medical Ethics, edited by Helen Bequaert Holmes and Laura M. Purdy. The International Network on Feminist Approaches to Bioethics, begun in 1993 by Holmes and Anne Donchin, has some 300 members worldwide and has sponsored several conferences on feminist bioethics, in conjunction with the International Association of Bioethics. In 1995, the prestigious Kennedy Institute of Ethics devoted its Advanced Bioethics Course to feminist perspectives on bioethics, and the plenary lectures of that course were then published in a special issue of the Kennedy Institute of Ethics Journal. In 1996, the Journal of Clinical Ethics published special sections in each of its four issues on feminism and bioethics. That same year saw the publication of an anthology edited by Susan M. Wolf, Feminism and Bioethics: Beyond Reproduction. In 1998, the Journal of Medicine and Philosophy devoted an entire issue to the feminist ethic of care. Anne Donchin and Laura M. Purdy's anthology, Embodying Bioethics: Feminist Advances, appeared in 1999. In 2001, the journal Bioethics published an issue devoted to feminist bioethics. Textbooks and readers in bioethics routinely include essays written by feminists.

Feminist bioethics largely consists of criticism directed at practices surrounding the care of women's bodies, and in particular, the parts of women's bodies that mark them as different from men. There has been an ongoing focus on women's reproductive practices, in the form of arguments in defense of abortion, debates about the wisdom of various methods of assisted reproduction, arguments against sustaining postmortem pregnancies, ethical analyses of various sorts of maternal—fetal conflicts, concern about HIV testing of newborns and pregnant women, pleas for better prenatal care for pregnant women, debates about the use and abuse of the birth control implant Norplant, arguments for and against amniocentesis and other genetic testing of fetuses, and discussions about hormone replacement therapy for postmenopausal women. And when feminist bioethicists have moved "beyond reproduction," as Susan M. Wolf puts it, they have tended to criticize practices of healthcare for women—weighing in, for example, on the debates over the medical management of breast cancer, arguing that tying healthcare insurance to employment disadvantages elderly women, or protesting the injustice of a healthcare delivery system that devotes a disproportionate amount of high—tech care, such as arterial angioplasty and organ transplantation, to men. While this criticism can be seen as a political and moral protest against the sexism that permeates the healthcare system, it has been argued that the preoccupation with women's bodies, and especially women's reproductive health, tends to reinforce the androcentric view that men are normal but women, being abnormal, require special accommodations both within healthcare and within bioethics.

Not all of feminist bioethical criticism focuses on women's (reproductive) health. Mary Mahowald has, for example, used standpoint theory to criticize healthcare providers who systematically discount their patients' knowledge about their illness and treatment. Virginia Warren has pointed out that medicine's preoccupation with crisis issues diverts attention from what may be called housekeeping issues, which are perceived as women's work and are on that account not valued. Susan M. Wolf has argued that gendered differences in medical treatment, suicidal behavior, healthcare insurance, and social expectations about self—sacrifice offer a reason to suppose that legalizing physician—assisted suicide would further oppress women. A number of feminists have criticized the cost—cutting measures resulting in shorter hospital stays that unfairly exploit the gendered division of labor within families, where, compared to men, women do vastly disproportionate amounts of caregiving, even if this means that they are restricted to part—time employment or give up their jobs altogether.

Feminist bioethicists' constructions have consisted mainly of reconceptualizing problems in areas of healthcare practice and policy ranging from postmenopausal motherhood to home healthcare, and then offering solutions based on those reconceptualizations. With the major exception of the work of some feminist bioethicists on the ethic of care, however, constructions in theory have been almost nonexistent. Much more could be done both to expand the ethic of care so that it furnishes conceptual tools for social and political analysis, and to use the practice of medicine itself to enrich ethical theory. That so little of this work has been done is not surprising, not only because feminist bioethics is a very young discourse but also because bioethics in general has failed to produce much distinctive theory, contenting itself with the pragmatic strategy of agreeing on middle—level ethical principles where it can, and scavenging from the standing political and moral theories when it must. Feminist bioethicists, however, do not have the luxury of that sort of pragmatism, because it is the business of feminism to be deeply suspicious of the standing political and moral theories, on the grounds that they are shot through with gender bias and so cannot be regarded as trustworthy. Many feminists argue that their task is to construct new theory rather than to refine theories that leave everything exactly as it was.

Why ought feminists theorize about ethical issues arising from biomedical practice? Why, that is, should there be a feminist bioethics at all? One answer is that medicine ought to be of particular concern to feminists because it is one of the hegemonic discourses of our time, commanding enormous amounts of social prestige and authority. Because it is so powerful that no other discourse except, possibly, that of international capitalism competes with it, it interacts with gender at many levels and in many different ways. Feminists continue to criticize that interaction, but they also wish to learn from it. By studying how power, in the guise of gender, circulates through the healthcare system, they contribute to the body of normative theory that might guide this socially valuable institution in the direction of greater justice.

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