Implications for Ethics of Healthcare

The implications of Gilligan's analysis for contemporary bioethics are the subject of ongoing discussion. First, an ethic of care may lead to positive changes in bioethical education, including placing greater emphasis on healthcare providers' communication skills and emotional sensitivity, and on the effects that ethical issues have on relationships (Carse). To the extent that bioethicists with formal training in ethics are inclined to emphasize justice over care, it may be desirable to broaden their training to include an ethic of care (Self et al.).

In addition to producing changes in ethics education, a care orientation within bioethics arguably requires placing greater emphasis on beneficence as the healthcare provider's primary responsibility to the patient (Sharpe). Finally, an ethics emphasizing caring for others may produce substantive changes in the way we resolve moral problems. It may encourage resolutions of moral problems that give greater authority to family members in healthcare decision making (Hardwig, 1990, 1991; Jecker, 1990), or it may lead to paying greater attention to how various relationships are affected by moral decisions (Jecker, 1991).

One area within bioethics where an ethic of care has been studied in some detail is abortion. Gilligan found that women who face abortion decisions tend to frame moral issues in terms of a responsibility to care for and avoid hurting others. These women often base decisions about having an abortion on "a growing comprehension of the dynamics of social interaction ... and a central insight, that self and others are interdependent" (p. 74). In other words, rather than conceptualizing abortion in terms of abstract values, such as life, or in terms of competing claims or rights, these women tend to see abortion as a problem of how best to care for and avoid harming the particular people and relationships affected by their choices. Considered in this light, the resolution of abortion requires taking stock of how any decision might affect not only the pregnant woman and fetus, but also the relationship between the pregnant woman and biological father, and relationships and persons within the wider family circle (Jecker, 1999). Arguably, an ethic of care illuminates the moral issues abortion raises better than an ethic of justice, because only an ethic of care portrays individuals as uniquely constituted by their connections to others (Gatens-Robinson).

In addition to these proposed changes, introducing a care orientation within bioethics may shed a negative light on more traditional forms of bioethical analysis (Carse). For example, Virginia Sharpe claims that a justice orientation has dominated bioethics in the past, and this has encouraged ethicists to treat provider—patient relationships as free exchanges between equals. She argues that this picture of the provider—patient relationship is seriously distorted. Rather than being equals in relationships with healthcare providers, patients typically experience diminished power and authority as a result of being physically and emotionally vulnerable and in need of the provider's help (Sharpe). Others charge that a justice orientation has traditionally prevailed within bioethics, resulting in too much focus on competition for power, status, and authority and too little focus on the human relationships at stake (Warren). For example, the autonomy—paternalism debate within bioethics concentrates on who has the authority to make treatment decisions. Similarly, when bioethicists emphasize impersonal ethical principles, such as autonomy, nonmaleficence, beneficence, and justice, the particular persons and relationships involved in ethical dilemmas can become incidental, rather than essential, to the crafting of moral responses.

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