Why a feminist approach to bioethics?

Many have asked how and why feminist theory makes a distinctive contribution to bioethics. In this essay, I outline two ways in which feminist reflection can enrich bioethical studies. First, feminist theory may expose certain themes of androcentric reasoning that can affect, in sometimes crude but often subtle ways, the substantive analysis of topics in bioethics; second, it can unearth the gendered nature of certain basic philosohical concepts that form the working tools of ethical theory.     

Taking Representation Seriously: Rethinking Bioethics Through Clint Eastwood��s Million Dollar Baby

In this article, I propose a new model for understanding the function of representation in bioethics. Bioethicists have traditionally judged representations according to a mimetic paradigm, in which representations of bioethical dilemmas are assessed based on their correspondence to the "reality" of bioethics itself. In this article, I argue that this mimetic paradigm obscures the interaction between representation and reality and diverts bioethicists from analyzing the tensions in the representational object itself. I propose an anti-mimetic model of representation that is attuned to how representations can both maintain and potentially subvert dominant conceptions of bioethics. I illustrate this model through a case study of Clint Eastwood's film Million Dollar Baby. By focusing attention on the film's lack of adherence bioethical procedures and medical science, critics missed how an analysis of its representational logic provides a means of reimagining both bioethics and medical practice. In my conclusion, I build off this case study to assess how an incorporation of representational studies can deepen-and be deepened by-recent calls for interdisciplinarity in bioethics.     

Negotiating international bioethics: a response to Tom Beauchamp and Ruth Macklin

Can the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophy bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.     

Toward a Psychodynamic Approach to Bioethics

Although many first-generation bioethicists were psychiatrists and some received psychoanalytic training, the field of bioethics has developed largely in isolation from psychodynamic theory. While much has been written regarding the ethics of psychoanalysis, only a few scholars have attempted to explain bioethical phenomena in psychodynamic terms. This paper argues for the development of a comprehensive theory of "psychodynamic bioethics" that attempts to explain individual and collective attitudes toward bioethical controversy in psychodynamic terms.     

Feminist bioethics: toward developing a "feminist" answer to the surrogate motherhood question.

Although a wide variety of feminist approaches to bioethics presently share a common feminist methodology (sometimes referred to as "raising the woman question"), they do not all share the same feminist politics, ontology, epistemology, and ethics. As a result of their philosophical differences, feminist bioethicists do not always agree on which biomedical principles, practices, and policies are best suited to serving women's interests. In other words, some feminist bioethicists insist that so-called "assisted reproduction" enhances women's procreative liberty, while others claim that it does nothing of the sort. Although such disagreement among feminist bioethicists reassures the general public that the feminist "program" for bioethics is not ideologically monolithic, it also confuses the public, especially women. In order to overcome this confusion, feminist bioethicists should work toward developing the kind of shared theoretical base that will foster frequent consensus on the biomedical principles, practices, and policies most likely to serve the interests of most women in the U.S. today.     

Feminism, law, and bioethics

Feminist legal theory provides a healthy skepticism toward legal doctrine and insists that we reexamine even formally gender-neutral rules to uncover problematic assumptions behind them. The article first outlines feminist legal theory from the perspectives of liberal, cultural, and radical feminism. Examples of how each theory influences legal practice, case law, and legislation are highlighted. Each perspective is then applied to a contemporary bioethical issue, egg donation. Following a brief discussion of the common themes shared by feminist jurisprudence, the article incorporates a narrative reflecting on the integration of the common feminist themes in the context of the passage of the Maryland Health Care Decisions Act. The article concludes that gender does matter and that an understanding of feminist legal theory and practice will enrich the analysis of contemporary bioethical issues.     

Christian Bioethics in Europe: In Defense against Reductionist Influences from the United States

Christian ideas have continued to inspire European bioethicsuntil now. The central thesis of this essay is that the open-mindednessof Roman Catholic and other Christian denominations in Europeis crucial for understanding why Christian ethics is so wellintegrated in the European culture. The essay describes firstthe institutional frameworks in which these Christian mainlyRoman Catholic ideas are developed. It analyzes further thedifference between the secular Anglo-American and European bioethicsas it has been influenced by these Christian ideas. It finallysummarizes the challenges to which Europe's Christian bioethicalidentity is presently exposed to. The essay states that theChristian inspiration of European bioethics is mainly connectedwith the ideologically moderate, tolerant, and dialogical participationof Christian bioethicists in the bioethical debate in Europe.     

A Synthetic Approach to Bioethical Inquiry

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated.     

Medical ethics in Norway: Modern medicine — Traditional morality

In Norway, by tradition a Lutheran country, the puritan ethics of a “moral minority” has a strong influence on the development and manifestations of medical ethics. Those who exert this influence are found primarily among politicians, the clergy, and, last but certainly not least, among nurses and doctors. The focus of interest is not so much on problems of bioethical moral theory or the teaching of bioethics to students, but very much on attitudes and policies with regard to substantive issues traditionally regarded in Norway as burning bioethical issues, such as: medical research ethics, abortion, prenatal diagnosis, euthanasia, definitions of death, and reproductive technologies.     

A theory of international bioethics: multiculturalism, postmodernism, and the bankruptcy of fundamentalism

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.     

The Uses and Abuses of Moral Theory in Bioethics

Moral theory is an important guide to bioethical decision-making, but it can confuse and mislead those who offer ethical advice to clinicians and researchers, delaying decisions that must be made in a timely fashion. In this paper I examine the ways moral theory can lead bioethicists astray. Absent a sensitivity to the empirical realities of ethical problems, moral theory 1) contributes to the disappearance of the persons caught in an ethical quandary, 2) focuses on the puzzle-solving rather than examining the conditions that generate moral problems, and 3) universalizes ethical dilemmas, overlooking local processes for resolving moral questions. Taken together, empirically informed moral theory and theoretically informed empirical research can help bioethicists transcend the is/ought problem in ethical work.     

The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care (and the unit of value) is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics.     

Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa

Rapid development in the area of assisted reproductive technology (ART), has benefited mankind by addressing reproductive problems. However, the emergence of new technologies and techniques raises various issues and discussions among physicians and the masses, especially on issues related to bioethics. Apart from solutions provided using conventional bioethics framework, solutions can also be derived via a complementary framework of bioethics based on the Higher Objectives of the Divine Law (Maqasid al-Shariah) in tackling these problems. This approach in the Islamic World has been applied and localised in the Malaysian context. Thus, this paper highlights a conceptual theoretical framework for solving current bioethical issues, with a special focus on ART in the Malaysian context, and compares this theory with conventional theories of bioethics.     

Bioethics' gender

I argue that the field of bioethics is gendered feminine, but that the methods it uses to resist this gender identity pose real harm to actual women. Starting with an explanation of what I take 'gender' to be, I enumerate four drawbacks to being gendered feminine. I then argue that bioethics suffers from three of the same four drawbacks. I show how the field escapes the fourth disadvantage by adopting a masculine persona that inflicts damage on women, and conclude by urging bioethicists to reflect on their complicity in abusive power systems such as gender, race and class.     

Idealized and Industrialized Labor: Anatomy of a Feminist Controversy

Prompted by the ever‐increasing cesarean rate, this paper considers the interpretive disjunct between two significant strands of feminist analysis that have arisen in the last four decades as a consequence of the phenomenon of medicalized birth. In contrast to the dominant paradigm of bioethical “Principalism,” both modes of analysis, understood as “the critique of industrialized labor” and “the critique of idealized labor,” are attentive to the way in which social discourses inform bioethical deliberation and practice, but significantly diverge in the nature of their accounts. The “industrialization critique” understands the culture of medical intervention to be impelled by an “obstetric desire” to appropriate women's reproductive potency, whereas the “idealization critique” relates new mothers’ “low childbirth satisfaction” to a pernicious normative ideal propagated by the natural childbirth movement. This paper will explore the anatomy of both critiques and interrogate their fidelity to the phenomenological insight of the body as chiasm between material and ideal. I will argue that while the insights of the idealization critique are well grounded, we must exercise caution about the critique's tendency to reductively understand the embodied experience of labor as entirely discursively produced, a gesture that risks re‐performing the dematerialization of women often effected through obstetric intervention itself.     

Slouching Toward Policy: Lazy Bioethics and the Perils of Science Fiction

Too much contemporary bioethical discourse is weak on science, lazily citing and adopting science fiction scenarios rather than science facts in the framing of analyses and policies. We challenge bioethicists to take more seriously the role of providing informed insight into and oversight over contemporary science and its implications and applications. Bioethicists must work harder to understand the fast-changing truths and limits of basic science, and they must incorporate only appropriate and authentic science into their discourse, just as they did in the past when addressing the quandaries of clinical medicine. The field of bioethics is not so old and entrenched that its future is assured. Bioethicists must make themselves useful to society in order to deserve and retain the public's trust. They can best do this by ensuring that decision making and public policy are grounded in facts, not fictions and fantasies.     

Bioethics' Gender

I argue that the field of bioethics is gendered feminine, but that the methods it uses to resist this gender identity pose real harm to actual women. Starting with an explanation of what I take ‘gender’ to be, I enumerate four drawbacks to being gendered feminine. I then argue that bioethics suffers from three of the same four drawbacks. I show how the field escapes the fourth disadvantage by adopting a masculine persona that inflicts damage on women, and conclude by urging bioethicists to reflect on their complicity in abusive power systems such as gender, race and class.