The role of philosophy and ethics at the edges of medicine

Background

The purpose of this study is to make a philosophical argument against the phenomenological critique of standardization in clinical ethics. We used the context of clinical ethics in Saudi Arabia to demonstrate the importance of credentialing clinical ethicists.

Methods

Philosophical methods of argumentation and conceptual analysis were used.

Results

We found the phenomenological critique of standardization to be flawed because it relies on a series of false dichotomies.

Conclusions

We concluded that the phenomenological framing of the credentialing debate relies upon two extreme views to be navigated between, not chosen among, in the credentialing of clinical ethicists.

     

Reply to: Roberts

In his critique of my views on supererogation, Rodney Roberts (Philosophia, 2014) claims that I treat care ethics as having a more general moral validity than other care ethicists do. He also claims that the kind of sentimentalism I espouse doesn’t sufficiently emphasize sentiment and then goes on to question what I say about supererogation. But in fact other care ethicists also think care ethics can cover the whole of morality, and my sentimentalism emphasizes sentiment just as much and as little as that paradigm sentimentalist Francis Hutcheson does. Further, the critique Roberts makes of my view on supererogation doesn’t allow for the full range of possible cases of supererogation.     

Rights, Wrongs, and Aristotelian Egoism: Illuminating the Rights/Care Dichotomy

Since the recent work of Carol Gilligan, Nel Noddings, and others, it has become commonplace in moral philosophy to employ a dichotomy between an ethics of "Care" and an ethics of "Rights." Gilligan claims that men and women view moral issues in fundamentally divergent ways. Responses to moral problems tend to divide along lines emphasizing respect for rights, in the case of men, and caring for others, in the case of women. Inspired by these findings, several authors have classified moral theories in two basic camps, revolving around the injunction to care or the mandate to respect rights. While many concede that the Care and Rights perspectives are not mutually exclusive, it is increasingly common to view ethicists as forced to choose between these two types of theories.     

MIGRANT DOMESTIC CAREWORKERS: Between the Public and the Private in Catholic Social Teaching

This essay argues that Catholic (magisterial) social teaching's division of ethics into public and private creates a structural lacuna which makes it almost impossible to envision a truly just situation for migrant domestic careworkers (MDCs) within the current horizon of Catholic social thought. Drawing on a variety of sociological studies, I conclude that it is easy for MDCs to “disappear” between two countries, two families, and, finally, two sets of ethical norms. If the magisterium genuinely wishes Catholic ethicists to address the plight of these migrant women, normative Catholic social teaching must pay more attention to household sociological realities and more fully absorb the feminist critique of the sharp line between the public and the private, between care and paid work.     

Putting on Virtue Without Putting Off Feminists

Mary Wollstonecraft's account of virtue discourse and formation, which deploys ancient and medieval ethical resources for modern purposes, challenges a prevalent narrative in Christian ethics today. Several prominent Christian virtue ethicists have left the false impression that serious reflection on the virtues depends on pre‐modern traditions and the eschewal of modern resources. Troubled by skeptical quandaries and the difficulty of adjudicating conflicting claims about virtue, they are concerned with securing a pre‐modern court of appeals. Many feminists worry that these appeals unduly constrain because they naturalize what is contingent and fix what should be open to debate. Wollstonecraft does not share the skeptical concerns and so has no need for metaethical appeals. Adapting Edmund Burke's moral philosophy, her use of virtue discourse deploys his metaphor of “the wardrobe of the moral imagination” to more religious, radical, and democratic ends. This way of proceeding signals the possibility of a rapprochement between feminists of various stripes and those interested in deploying the discourse of the virtues for contemporary Christian ethics.     

Care and Abstract Principles

Since Carol Gilligan's analysis of the “Heinz dilemma,” many philosophers working on care have articulated critiques of abstraction and principles in ethics. Their objections to abstraction and principles have not always been systematically set out. In this paper, I try to clarify the debate. I begin by distinguishing several aspects of the care critique. I then consider the strengths of each from a Kantian perspective. I conclude that, although some of these objections point out potential misuses of abstraction and principle, and in doing so, suggest strategies and cautions for their correct and careful use in ethics, they do not present a successful challenge to abstraction or principles as such.     

“Why Can’t You Control Yourself?” Fat Should Be a Feminist Issue

This article is a comment on Fikkan and Rothblum’s (2011) article “Is Fat a Feminist Issue? Exploring the Gendered Nature of Weight Bias.” They argued that fat women in North America experience significantly more prejudice and discrimination than fat men do, marshaled evidence to support their argument in several domains (e.g., employment, education, romantic relationships, health care, the media), and wondered why feminist scholars have not paid much attention to the oppression of fat women. Here I suggest several reasons why fat women experience more prejudice and discrimination than fat men do: the objectification of women, gender-related aspects of health behavior and knowledge about health and illness, and the importance of self-control to the performance of femininity. I also suggest that there is some overlap in negative stereotypes of both feminists and fat women, which might lead to a desire to distance oneself from both. However, feminists should recognize the intersectionality of fat oppression and the way it colludes with the sexualization and objectification of women in popular culture. Thus, fat should be a feminist issue.     

Feminism and Postmodernism in Susan Frank Parsons

Reviewing The Ethics of Gender, Feminism and Christian Ethics, and The Cambridge Companion to Feminist Theology, the author suggests that Susan Parsons responds to questions postmodernism has posed to both feminism and Christian ethics by using insights gained from various accounts of the moral subject found in feminist philosophy, ethics, and theology. Hesitant to embrace postmodernism's critique of the possibility of ethics, Parsons redefines ethics by establishing a moral point of view within discursive communities. Yet in her brief treatment of Emmanuel Levinas, Parsons does not explore the postmodern option he offers feminists: an understanding of moral responsibility that can be critical of ethics. Parsons also ignores some feminist perspectives in the physical and natural sciences, thereby missing valuable insights of feminists who insist upon the materiality of the body.     

The impact of feminist stereotypes and sexual identity on feminist self-identification and collective action

ABSTRACT

The present study sought to examine the role of sexual identity and exposure to stereotypes of feminism on women’s self-identification as a feminist, endorsement of feminist attitudes, and intention to engage in collective action. Participants (N = 312; all women) disclosed their sexual identity as either heterosexual or non-heterosexual (sexual minority) and were randomly assigned to one of three conditions: exposure to positive stereotypes of feminists, to negative stereotypes of feminists, control condition (no exposure to stereotypes). Results showed stark differences between heterosexual and sexual minority women, with sexual minority women scoring significantly higher on self-identification as feminist, feminist attitudes, and collective action intentions. Exposure to positive stereotypes of feminists increased feminist self-identification regardless of sexual identity. Exposure to negative stereotypes reduced self-identification with feminism, and lower identification mediated the path between negative stereotyping and collective action. Implications of these findings for the advancement of women’s rights movements are discussed.     

Hidden in Plain View: Feminists Doing Engineering Ethics, Engineers Doing Feminist Ethics

How has engineering ethics addressed gender concerns to date? How have the ideas of feminist philosophers and feminist ethicists made their way into engineering ethics? What might an explicitly feminist engineering ethics look like? This paper reviews some major themes in feminist ethics and then considers three areas in which these themes have been taken up in engineering ethics to date. First, Caroline Whitbeck’s work in engineering ethics integrates considerations from her own earlier writings and those of other feminist philosophers, but does not use the feminist label. Second, efforts to incorporate the Ethic of Care and principles of Social Justice into engineering have drawn on feminist scholarship and principles, but these commitments can be lost in translation to the broader engineering community. Third, the film Henry’s Daughters brings gender considerations into the mainstream of engineering ethics, but does not draw on feminist ethics per se; despite the best intentions in broaching a difficult subject, the film unfortunately does more harm than good when it comes to sexual harassment education. I seek not only to make the case that engineers should pay attention to feminist ethics and engineering ethicists make more use of feminist ethics traditions in the field, but also to provide some avenues for how to approach integrating feminist ethics in engineering. The literature review and analysis of the three examples point to future work for further developing what might be called feminist engineering ethics.     

The Confucian Concept of Jen and the Feminist Ethics of Care: A Comparative Study

This article compares Confucian ethics of Jen and feminist ethics of care. It attempts to show that they share philosophically significant common grounds. Its findings affirm the view that care-orientation in ethics is not a characteristic peculiar to one sex. It also shows that care-orientation is not peculiar to subordinated social groups. Arguing that the oppression of women is not an essential element of Confucian ethics, the author indicates the Confucianism and feminism are compatible.     

Bartky,Domination, and the Subject

Bartky's Femininity and Domination analyses the social construction of femininity and the ways that it oppresses women. Utilizing phenomenology, Bartky provides illuminating examples of the experience of oppression and how women are constructed to submit to images and models of femininity. I raise questions concerning the standpoint of normative critique from which Bartky criticizes the oppression of women, the model of agency that she utilizes, and the politics she supports to overthrow oppression and domination.     

The Problem with “Caring” Human Rights

Although Daniel Engster's “caring” human rights are, on the surface, a compelling way to bring the concept of care into the international political realm, I argue they actually serve to perpetuate some of the same problems of mainstream human‐rights discourses. The problem is twofold. First, Engster's particular care theory relies on an uncritical acceptance of our dependence relations. It can, therefore, not only overlook how local and global institutions, norms, and the marketplace shape our relations of (inter)dependence, but also serve to further naturalize our current dependence relations. Second, Engster's caring human rights are only minimally feminist, which means that they do not pay attention to the way in which women's full and equal political participation is a necessary component to challenging and overcoming the oppression, marginalization, and exploitation of women and their caring labor worldwide. Although I am sympathetic to Engster's goals and some of his proposed policy solutions, I argue that we should not abandon the critical, feminist lens of care ethics in favor of “caring” human rights that cannot overcome the care critique of mainstream human‐rights discourses.     

The Responsibility of Men for the Oppression of Women

ABSTRACT Feminist writers arguing that women are oppressed have pointed to men as the oppressors. They have, however, directed little attention to the question of the extent to which men are morally responsible for this oppression, a question which is of special concern for male feminists. Seven categories of men potentially responsible for the oppression of women are identified here; four are argued to be individually responsible for oppressing women and three not. The question of whether men are collectively responsible for the oppression of women is addressed, and three main difficulties are revealed in the endeavour to establish that they are. It is argued that one who is in no way responsible on an individual basis for oppressing women cannot be responsible by sole virtue of being a male. The result has implications for the status of men in the feminist movement.     

Training in clinical ethics: launching the clinical ethics immersion course at the Center for Ethics at the Washington Hospital Center

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. "Immersion" refers to a high-intensity clinical ethics experience in a busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients' charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants' evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics.     

Linking Sexism and Speciesism

Some feminists and animal advocates defend what I call the Linked Oppressions Thesis, according to which the oppression of women and the oppression of animals are linked causally, materially, normatively, and/or conceptually. Alasdair Cochrane offers objections to several versions of the Linked Oppressions Thesis and concludes that the Thesis should be rejected in all its forms. In this paper I defend the Thesis against Cochrane's objections as well as objections leveled by Beth Dixon, and argue that the failure of these objections illuminates the idea of linked oppressions as well as misunderstandings of the Linked Oppressions Thesis, and may provide guidance to philosophers theorizing animal rights from a feminist perspective.     

On Decolonizing Social Ontology and the Feminist Canon for Transnational Feminisms

Serene J. Khader’s Decolonizing Universalism presents a vision for how feminism might be decolonized for transnational work by doing without traditional Western feminist values and focusing instead on opposing sexist oppression. This paper presents a challenge to the idea that feminism consists in opposing sexist oppression, claiming that it instead consists in opposing gender oppression, where that includes combating cissexism and heterosexism. More specifically, it argues that critiquing cissexist criteria within gender categories as well as critiquing harms that follow from having a queer sexual identity are decidedly feminist tasks. Furthermore, cases of these harms where group identities cannot arise in the social ontology due to a lack of hermeneutical resources challenge the idea that feminism is concerned only with oppression. The second half of the paper extends Khader’s critique of the Western liberal moral vocabulary of feminism by proposing a radical decolonization of the feminist canon as it is usually conceived in the global North.     

Feminism,Adaptive Preferences,and Social Contract Theory

Feminists have long been aware of the pathology and the dangers of what are now termed “adaptive preferences.” Adaptive preferences are preferences formed in unconscious response to oppression. Thinkers from each wave of feminism continue to confront the problem of women's internalization of their own oppression, that is, the problem of women forming their preferences within the confining and deforming space that patriarchy provides. All preferences are, in fact, formed in response to a (more or less) limited set of options, but not all preferences are unconscious, pathological responses to oppression. Feminist theory therefore requires a method for distinguishing all preferences from adaptive or deformed preferences. Social contract theory provides such a tool. Social contract theory models autonomous preference‐acquisition and retention at both the external level of causation and the internal level of justification. In doing so, social contract theory exposes preferences that do not meet those standards, acting as both a conceptual test that identifies adaptive preferences and as a practical tool for personal and social clarification. A social contract approach helps persons and societies to identify and to confront preferences rooted in unconscious response to oppression.     

Additional Thoughts on Rethinking Research Ethics

Recently, bioethics has become interested in engaging with narrative, but in this engagement, narrative is usually viewed as a mere helpmate to philosophy. In this precis to his book The Fiction of Bioethics, Tod Chambers argues that narrative theory should not be simply a helpful addition to medical ethics but instead should be thought of as being as vital and important to the discipline as moral theory itself. The reason we need to rethink the relationship of medical ethics to narrative is that ethicists test their ideas by applying them to cases, and cases are a narrative genre. Recognizing the importance that cases have for the way medical ethicists do ethics is essential in order to appreciate the field as a form of applied philosophy. Like other forms of representation, narrative has distinct and defining features, which ethicists, in order to understand the data of their field, must learn to recognize and differentiate. Ethicists need to attend to the way decisions about the discourse of a narrative influences the kind of moral theories judged relevant to it. The author briefly examines six features of narrative discourse that rhetorically condition the way we understand medical ethics cases: filter, reportability, closure, characters, chronotope, and gender.     

Linguistic Alterity and the Multiplicitous Self: Critical Phenomenologies in Latina Feminist Thought

Latina feminists like Gloria Anzaldúa and Mariana Ortega have developed anti‐essentialist accounts of selfhood that are responsive to the problem of alterity and hermeneutic alienation experienced by multiplicitous subjects, understood as those who must navigate between multiple cultural norms and often conflicting interpretive traditions (due to colonial legacies and intersectional oppressions). These accounts can be fortified by examining the sense of inarticulacy that arises from having to name conditions of existence undergirded by social and historical contradictions and ambiguities—especially under the experiential stress of gendered social violence, cultural trauma, and state terror. To address phenomenological accounts of “linguistic terrorism” and the role language plays in multiplicitous accounts of selfhood, I turn to a strategic reading of Nietzsche's existential conception of the self as a living multiplicity, and to his related account of the impoverishment of language. In doing so, I argue more generally that philosophies of agency that critique agential narratives of rupture, instability, and interpretive loss (as part of liberal emancipatory projects) often do so without sufficient attunement to the ways concepts of alterity and liminality operate in North–South contexts or Latina feminist thought. I end by highlighting the critical, decolonial impetus of these concepts as responses to cultural violence.