Relational Selves

The recent challenges to ethical theory from psychological studies of moral experience have profound implications for beneficence. In 1982 Carol Gilligan published her research on the moral development of women, titled In a Different Voice. She claimed that females tend to see moral problems in terms of relationships. They are prone to think of their choices in problem solving as issues of care and responsibility for those relationships. By contrast, males tend to see moral problems in terms of rules and principles, and are prone to think of their choices as logical adjudications. Women's moral orientations tend toward valuing and preserving ties among persons, while men's tend toward abstract thinking by an agent largely removed from and impartial to the parties involved. Gilligan's claim is not that there are precise gender types for moral experience but that the model of the moral self as an abstract, isolated, principled, and hierarchical thinker is insufficient.

Consider the case of Jake and Amy, two eleven-year-olds, who discuss the question "When responsibility to oneself and responsibility to others conflict, how should one choose?" (Gilligan, pp. 35ff.). While Jake adjudicates these responsibilities as if it were a problem of rule application, Amy's response is pragmatic and assumes a relational self. Jake seeks fairness in the manner of a judge; Amy is concerned to see that others' needs are met and relationships are nurtured. The point is not so much that Jake and Amy offer different answers but that they see different issues, and see themselves in different ways.

The implications for a principle of beneficence in bioethics, and in the ethical codes of health professionals, are substantial. Gilligan's research directly challenges the adequacy of thinking of beneficence simply as a principle to be applied to cases, and recommends a notion of beneficence grounded in complex, relational understandings of the self. Hence, the issues of beneficence can no longer be formulated as if the agent were essentially solitary and could contemplate the scope of his or her duties from afar. The self is already, and essentially, immersed in a web of convivial responsibilities. The ethical formulations of most health professions exhibit precisely the hierarchical distancing and the assumption of optional relationships depicted in the "male" model. Attending to the second voice in moral experience would mean moving bioethics beyond an exhaustive reliance on applying beneficence, as a principle, to problem cases. It would also mean taking the ethical codes of health professionals beyond the contract model and into a recognition of a deeper and more integral bond between healers and the sick, and between health professionals and society.


SEE ALSO: Autonomy; Bioethics; Compassionate Love; Confidentiality; Ethics: Normative Ethical Theories; Justice; Paternalism; Professional-Patient Relationship

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