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Wendy A. Rogers
Introduction
Bioethics emerged as an academic discipline in the 1960s and 1970s, largely in response to social and technological changes that challenged established attitudes and practices. Questions arose concerning the rights of patients and research participants, while the use of emerging medical technologies raised moral questions about the nature of life, decision-making and the legitimate boundaries of medicine. Bioethics as a discipline sought to foster ethical debate about challenging cases; provide ethical guidance to physicians and researchers about practice; and advise governmental authorities regarding relevant policy. However, the nascent discipline seemed oblivious to many of the gendered aspects of healthcare and the ways that healthcare practices reinforced oppressive gender norms. Entrenched gender biases in the foundational disciplines of bioethics such as philosophy, law, medicine, and theology were transplanted largely intact into the new discipline. By the late 1980s, feminist bioethicists, drawing upon feminist ethics and epistemology, started to challenge the gendered norms and assumptions of bioethics. While early feminist attention focused on reproductive practices, a sustained critique of the assumptions and theoretical approaches of traditional bioethics emerged during the 1990s. Since then, contributions of feminist bioethics have shaped the way that central bioethical notions, such as autonomy, are conceptualized; provoked methodological diversity; and extended the agenda of bioethics to include global and social issues far beyond the initially narrow concerns of medical care and biomedical research.
Alison Jaggar acknowledges the challenge of characterizing feminist approaches to ethics, but nonetheless, identifies three “minimum conditions of adequacy for any approach to ethics that purports to be feminist” (1989: 910). These are: to offer action guides aimed at subverting the subordination of women; to span both the public and the private realms; and, to take seriously, but not uncritically, the experiences of all women. Following Jaggar, the term “feminist bioethics” is used here to describe an approach to bioethics that takes gender to be a central analytic category, and that is concerned with identifying and seeking to change relations of oppression and domination (Sherwin 1992). Within this broad definition, there are many differences among feminist bioethicists in terms of methodology, theoretical foundations, focus, and so forth.
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In what follows, I describe some of the broad concerns motivating feminist bioethics before describing substantive and methodological contributions made by feminist bioethics to the field. The chapter ends with a survey of future directions and emerging topics attracting feminist analysis.
Bioethics and Gender
Feminist bioethics is premised upon the notion that both the focus of traditional bioethics, and its very concepts, are imbued with unacknowledged androcentric bias, thereby marginalising gender as a significant category when considering the ethical issues that arise in the biological and life sciences. Yet gender permeates the subject matter of bioethics in multiple ways. Hierarchies and power relations are ubiquitous within the institutions and practices of healthcare, often to the disadvantage of women. Gender bias exists in research, and in the definition of various conditions that track gender. There are gendered aspects to many medical interventions; while gendered patterns associated with social inequities and the distribution of resources perpetuate women’s poverty and oppression. While women are marginalized as a group in male dominated societies, nonetheless there are also hierarchies and inequities among women themselves due to race, ethnicity, class, sexuality and so forth, which intersect in various ways with explicitly gendered hierarchies.
Gender-based hierarchies are widespread within healthcare. Men continue to dominate high-prestige and high-income medical specialties, while the nursing workforce remains largely feminized, creating an inter-professional knowledge and power hierarchy. Those providing personal care are further disenfranchised. In healthcare consultations, women are more likely to be patients than men for reasons including higher rates of morbidity, gendered patterns of help-seeking behavior, and the medicalization of normal female reproductive functions. These factors replicate wider societal patterns in which men are seen as experts, well suited to rational decision-making based upon privileged knowledge, while women are associated with the irrationalities of the flesh and a lack of knowledge and expertise, especially where this is based upon personal experience.
Implicit hierarchies of knowledge and power contribute to both gender essentialism and insensibility to gender in healthcare. The former manifests in viewing women largely in terms of their reproductive capacities, leading to a focus on the medical management of various aspects of reproductive functions ranging from menstruation to menopause; and the associated skewing of research on women towards disorders affecting the female reproductive tract (Rogers and Ballantyne 2008). Gender essentialism also underlies the historic (and in some areas) continuing exclusion of women from research due to concerns that they may be, or become, pregnant thus risking harm to the fetus, or that the menstrual cycle will unduly interfere with research results.
Gender insensibility exerts the opposite effect by denying any significant difference between men and women such that the results of research performed with exclusively male cohorts are deemed to be equally applicable to women. This approach takes no account of relevant physiological or anatomical differences between men and women that can affect both manifestations of disease and responses to treatment (Adshead 2011; Bluhm 2011; Mosca et al. 2011). In addition, it fails to apprehend the wide-reaching impact of entrenched gender norms on all aspects of health and healthcare. Taken together, gender insensibility and gender essentialism result in a skewing of medical attention towards the female reproductive tract and its functions, and away from other health problems that affect women just as much as men.
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Gender bias, evident in the ways that diseases are defined, diagnosed and treated, illustrates another way in which gender and bioethics intersect. There is a long history of associating femaleness with madness, reflected in gendering within psychiatric diagnostic categories (Chesler 2005; Bluhm 2011; Gould 2011). In diseases that affect both men and women, there are gendered patterns in medical responses to presentations of the same disorders. Cardiovascular disease, for example, has been under recognized and under treated in women, with men more likely than women to receive appropriate interventions; and women are under treated for pain compared with men (Hoffman and Tarzian 2001). There may be many reasons for these gender-based disparities. They may, for example, reflect stereotypical views about women’s behavior or propensity to complain, but at the very least, findings such as these indicate that gender equity in healthcare is an ongoing challenge.
Next, some of the signature technological advances that ignited interest in bioethics relate to reproduction, and are mediated in and through the bodies of women. Assisted reproductive technologies, from artificial insemination and in vitro fertilization through to surrogacy and uterus transplantations, take place exclusively in female bodies. Likewise the creation of embryos for donation or research is a gendered activity, with different consequences for those donating ova rather than sperm (Dickenson 2006). Abortion is a perennially contentious topic in bioethics, where mainstream discussions tended to focus on the status of the fetus while failing to take account of the unavoidable impact of continuing or terminating a pregnancy on the woman involved (Tooley 1972; Marquis 1989).
Finally, in what is by no means an exhaustive list of the ways that gender is central to its subject matter, bioethics is concerned with issues of justice, ranging from local resource allocation decisions through to global inequities. Around the globe, women are over-represented among the socio-economically disadvantaged, have access to fewer material resources than men, and form the vast majority of those providing personal care to others. These are clearly matters of social injustice in their own right, but these social inequities are amplified through the effects of social disadvantage on health, leading to inequitable burdens of morbidity on women.
All of the factors discussed briefly above support the view that the central concerns of bioethics are deeply gendered, and that gender is a morally relevant category when discussing and analyzing the ethical issues associated with healthcare and the life sciences. Yet, as Susan Wolf notes (1996), bioethics was relatively oblivious to gender and slow to adopt relevant developments in feminist ethics and epistemology. Wolf attributes this tardiness to a number of causes. First, from its earliest inception, bioethics was concerned with the rights of patients and research participants. This led to a focus on decision-making in the clinical/research encounter, understood in terms of individual autonomy. Drawing upon the resources of liberal individualism, the autonomous individual was conceptualized in terms of isolated and self-serving decision-making; a being bereft of morally significant relationships and with no identifiable group characteristics, such as race or gender.
Second, bioethics was dominated by principles, understood as universal moral rules for generic and substitutable individual persons. In the interests of impartiality, gender and other potentially relevant contextual features were stripped from the generic individuals subject to these abstract principles. Third, bioethics emerged in response to the concerns of physicians and policy makers, thus the viewpoint and interests of those male-dominated groups dictated the subject matter under investigation. Once again, women, especially women as patients and carers, were not among those setting the agenda for the new discipline. Finally, Wolf argues that bioethics developed in relative isolation from areas of scholarship where feminist concerns were firmly on the agenda, such as critical theory and postmodernism.
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These reasons help to explain both the androcentric bias of bioethics, and why there was little engagement with feminism despite the highly gendered nature of much of the substance of bioethics. Starting in the 1980s, a series of feminist critiques sought to remedy this situation.
Feminist Critiques of Bioethics
In a comprehensive history of feminist bioethics, Anne Donchin and Jackie Leach Scully (2015) identify a number of key publications from the early 1980s onwards. These include work by Helen B. Holmes (with Betty Hoskins and Michael Gross 1980; 1981; with Laura Purdy 1982), Gena Corea (1985), Susan Sherwin (1992), and Wolf (1996). Much of this initial work focused on critiques of healthcare practices affecting women, largely to do with reproduction. These concerns broadened to include the experiences of women as patients (Sherwin 1992); the politics of women’s health (Sherwin et al. 1998); disability standpoint (Wendell 1996); and broader cultural critiques of attitudes towards women’s bodies (Bordo 1993; Mahowald 1993). Wolf (1996) explicitly expanded the horizons of feminist bioethics beyond reproduction to an overt critique of both the subject matter and the methodological approaches of bioethics, drawing attention to androcentric biases affecting the structure and nature of the field. Further critiques drew on key thinking in feminist ethics by scholars such as Carol Gilligan (1982), Nel Noddings (1984), Eva Kittay and Diana Meyers (1987), Jaggar (1989), Sarah Ruddick (1989), Rosemary Tong (1993), Margrit Shildrick (1997), Kittay (1999), and Catriona Mackenzie and Natalie Stoljar (2000).
Despite considerable diversity in approaches among the authors mentioned above, they are all identified as feminist by their commitment to identifying and correcting male bias in theory and in practice. And while these critiques of male-dominated bioethics are by no means univocal, I discuss them here in terms of two overarching concerns: to do with conceptions of agency, and to do with equality.
The identity of the individual agent in early bioethics discourse can be traced back to two sources: that of the neo-Cartesian ideal moral self; and the independent rational decision maker of liberal individualism (Jaggar 1989; Wolf 1996). Jaggar describes the neo-Cartesian ideal moral self as “a disembodied, separate, autonomous, unified, rational being, essentially similar to all other moral selves” (1989: 99), while Wolf (1996) characterizes the liberal individual as serving only his own atomistic interests. Feminists found much to criticise in this conception of the agent.
First, this account of agency strips away the body in order to valorize the independent and rational decision-making capacities of the agent. But of course, the decision maker does not exist independent of her body. An individual’s body is central to, or constitutive of her identity, and inexorably shapes the choices and options open to that individual (Young 1980). Being a human agent is a lived experience, such that an individual’s subjectivity and desires stem from her experiences with this rather than that kind of body, while her options for choice and action are likewise shaped by physical characteristics such as age, shape, gender, race, ability or disability. To many feminists, it makes no sense to consider the agent as disembodied; agents are always this particular person with these specific bodily characteristics. Further, it seems that the agent of bioethical theory does in fact have a bodily identity, but the body in question is male rather than female, thereby building in a bias towards male experience and male values at the centre of the notionally universal agent of bioethical theory. The disembodied agent of bioethical theory just happens to have characteristics (such as rationality and objectivity) that are traditionally associated with being male, and that are frequently described in opposition to characteristics attributed to women (such as irrationality, partiality).
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This covert male gendering of the bioethical subject disenfranchises the experiences of women and disregards the effects of embodiment on subjectivity. Such an approach discounts the central role of the (gendered) body in constituting identity, ignores the lasting effects of interventions in the body, and overlooks the role of the body in mediating perception, consciousness and action. In addition, adopting an implicitly male universal agent thereby excludes consideration of the bodily experiences of women, such as pregnancy and childbirth, physical vulnerability, or providing personal care to others. These experiences are thereby stripped of their moral import and deemed irrelevant to bioethics. Where the body does intrude, it is largely construed as property, as something owned by the agent and therefore something that may be disposed of as the agent sees fit. This view is reflected in arguments for free markets in organs or in surrogacy, on the grounds that the individual owns her body and can therefore sell its parts or services as one would sell other property (Radcliffe-Richards 2007).
Questions about control over one’s body lead directly to the conception of autonomy associated with the universal moral agent of early bioethics. Feminists were concerned about the largely individualistic view of autonomy attributed to such agents, especially in its more libertarian manifestations (e.g., Englehardt 1986). This view was characterized by a focus on state neutrality regarding values; freedom from interference; and satisfaction of preferences through the exercise of choice. On this account, the prevention of harm to others is the only justification for interfering in an autonomous individual’s uncoerced choices. However, there are concerns regarding libertarian accounts of autonomy (Mackenzie 2015). First, freedom from interference or negative liberty is insufficient for guaranteeing autonomy, because autonomy requires both freedom and access to genuine opportunities. Second, the notion of freely exercised choice fails to take account of the social context of, and constraints on, individual choice. Many individuals have a limited palette of opportunities from which to choose (circumscribed not only by their gender, but also by their class, ethnicity, sexuality, etc.), significantly constraining their autonomy. These kinds of limits cannot be remedied by non-interference alone. Third, by discounting the need for opportunities as well as freedom, and the inequalities that exist in access to opportunities, libertarian approaches to autonomy ignore questions of social justice, overlook exploitation, and may exacerbate existing inequalities (Sherwin 1992). For example, on libertarian accounts, a person may be deemed to be exercising her autonomy if she enters into a surrogacy arrangement, so long as her choice is not coerced (narrowly understood). But this approach fails to take account of the person’s context; her lack of other opportunities; the nature of her relationships and the responsibilities these entail; her sense of herself as an agent in the world; the corrosive and patterned effects of poverty; hierarchies in the commissioning process, and so forth, all of which undermine claims about the freedom of her choice. Feminist methodologies draw attention to these concerns through a focus on embodiment, personal identity, relationships and opportunities, and through interrogation of the context within which individuals have more or less power to imagine or realize their chosen ends.
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Feminists are particularly concerned about the asocial and self-interested nature attributed to the universal agent. This approach takes social relationships to be contingent rather than necessary in any way to the development or exercise of individual autonomy. To the extent that an individual does have social relationships, these are understood to be voluntary, as for example, a friendship between colleagues at work. Any responsibilities engendered by relationships are understood as voluntarily assumed constraints on autonomy. Wolf argues that this notion that autonomous agents are self-sufficient and independent is impoverished, harmful, and inaccurate. In particular, it takes no account of the dependency and interdependency that characterizes human relationships, and by focusing on the individual, it excludes consideration of the moral dimensions of relationships. Claiming that relationships are voluntary and largely between equals takes no account of the dependency of children and frail adults. Furthermore, this gender-insensible approach ignores the fact that the responsibilities of caring for dependent others fall largely to women, whether or not those relationships are undertaken voluntarily. Many relationships, biological or otherwise, are non-voluntary, creating networks of unavoidable rather than assumed responsibilities that constrain and shape the autonomy of those involved.
A second group of feminist concerns about traditional bioethics focuses on equality. These concerns overlap to some extent with issues emerging from the critiques of agency and autonomy noted above, such as lack of opportunities, exploitation, and disadvantage. Jaggar (1989) tracks the history of feminist debate about sexual equality, initially premised on the belief that equality before the law for men and women would lead to an end to gender-based inequalities. By the late 1970s, it became clear that legal equality did not always lead to substantive equality. For example, “no-fault” divorce settlements in which men and women received equal shares of household assets left women in substantially weaker economic positions than men, exacerbating existing inequalities (Weitzman 1985). Feminist philosophers wrestled with how to resolve this problem, acutely aware both of the shortcomings of gender-insensible approaches and of the danger that initiatives intended to recognize sexual difference and redress inequalities might equally be used to disadvantage women, reinforce notions of gender essentialism and entrench gender-based hierarchies. Gilligan’s key work (1982) supporting the view that there are gendered differences in moral reasoning lead to vigorous debates about the value of this line of reasoning (see for example Kittay and Meyers 1987).
Despite differences between theorists, feminist ethics and bioethics generally assumes that gender is a morally salient feature of individuals. Rather than accepting that individuals are identical and substitutable, feminist approaches argue that, unless proven otherwise, men and women are not equally situated and that equality requires taking account of gendered (and other) differences. These views challenge liberal notions of justice that focus on equality as procedural fairness or freedom to pursue opportunities, accounts that fail to consider either the patterning of inequalities or the actual outcomes of “fair” procedures.
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Feminist critiques of equality are linked to concerns about impartiality. Central to liberal notions of justice is the requirement that individuals be treated impartially by weighing the interests of each person equally. Jaggar identifies two feminist critiques of this view. First, Noddings’ 1984 account of the ethics of care is premised upon the claim that care is the natural basis of morality, in which case impartiality would require us to care equally for all humankind. But, Noddings argues, given that we cannot care equally for all, but only for those with whom we are in specific relationships, it is impossible and hypocritical to make claims about impartiality understood as a universal moral duty. Many feminist bioethicists treat Noddings’ ethics of care warily as it is premised on ostensibly essentialist claims about women being better at caring than men. Nonetheless, she has been highly influential in establishing the moral relevance and gendered nature of caring and care work, and the significance of the context within which care is offered. In addition, her work has contributed to debates about the respective roles of justice and care as foundations of morality.
Sherwin (1989) and Code (1988) provide an alternative critique of impartiality, claiming that impartiality paradoxically undermines respect for individuals and fairness, as without knowledge of context it is not possible to distinguish appropriately between individuals and thus treat them accordingly. On these accounts individuals are not substitutable; rather it is imperative to understand and take account of context, as individual circumstances are morally relevant in assessing claims and weighing interests. In feminist bioethics, this has led to a focus on thick descriptions and detailed narratives in ethical analysis. Sherwin (1992) makes the related point that an impartial individualistic approach to morality ignores socially patterned inequalities that track membership of groups, and is thus unable to tackle inequalities that are distributed differentially among identifiable social groups.
This brief summary focused on feminist critiques of the abstract and individualistic notions of agency, autonomy, and equality seen to be implicit or explicit within early and dominant bioethical theory. Feminists built on these critiques by developing competing accounts of key concepts and new methodological approaches, and countering male bias by extending the scope of bioethical concern to wider social and global issues.
Shaping the Field: Feminist Contributions to Bioethics
Feminist bioethics is now a recognized academic sub-discipline, with its own specialist journal (International Journal of Feminist Approaches to Bioethics [IJFAB]), and national and international organizations and conferences. Given the disciplinary and methodological diversity within the field, it is challenging to single out a few key contributions. Here I focus on relational autonomy and feminist accounts of care, dependency and vulnerability; and identify features of feminist methodological approaches.
Relational autonomy is the term used to describe feminist approaches to understanding and analyzing autonomy. As discussed above, feminists were critical of the notion of autonomy implicit within bioethics, understood as the free and rational exercise of will by atomistic and self sufficient agents (Stoljar 2013). The qualifier “relational” refers to the claim that any plausible theory of autonomy must concede that exercising autonomy is compatible with agents being part of and valuing social relationships (Mackenzie and Stoljar 2000). In addition, “relational” emphasizes the nature of agents as socially and historically embedded and shaped by their circumstances.
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There are four key features of relational theory (Mackenzie 2015). The first concerns the socially scaffolded nature of the skills that are required to exercise autonomy, known as autonomy competencies. Autonomous decisions require the individual to understand information, imagine the effects of different options, reflect on her values, make a decision taking a range of relevant information into account, and so forth. These skills do not arise fully formed; rather they are developed in and through interactions with others in socially significant relationships. No one is born with autonomy competency; rather we are born vulnerable, dependent, and requiring care. Relational autonomy recognizes that achieving autonomy competencies relies upon the relationships through which care and support are provided to the initially vulnerable.
The second feature of relational theory concerns the identity of the autonomous agent. Rather than taking identity to be given, isolated and self-sufficient, relational theorists argue that identity is constituted in and through social relationships that take place in specific historical contexts and that are subject to prevailing social norms regarding race, gender, ability, and so forth. This view of socially constituted identity has implications for how we think about authenticity, and about the sources and meaning of our preferences. The view of the self as socially constituted recognizes that values and preferences may change as identity evolves over time.
The third and fourth features of relational accounts concern internal and external constraints on autonomy. Exercising autonomy requires the individual to hold a set of self-evaluative attitudes that allow her to see herself, and be seen as autonomous— attitudes such as self-trust, self-respect and self-esteem. And just as supportive relationships can scaffold and build autonomy competency, hostile, abusive or oppressive relationships can undermine or destroy the self-regarding attitudes that enable individuals to exercise autonomy. This feature of relational theory helps to explain why a person may hold autonomy competencies, but be unable to act autonomously if she lacks the requisite self-attitudes. Finally, relational theorists identify external barriers to exercising autonomy in the form of access to meaningful opportunities. This feature of relational theory clearly links autonomy and justice by identifying that freedom to make choices is not sufficient to guarantee autonomy as individuals require resources to put their preferences into action.
Relational theory has been hugely influential in feminist bioethics. Feminist scholars have drawn upon insights from relational theory to develop accounts of self-trust (McLeod 2002), informed consent (Stoljar 2011), conscientious autonomy (Kukla 2005), public health ethics (Baylis et al. 2008) and healthcare ethics more broadly (Sherwin et al. 1998); as well as to investigate related concepts.
The moral salience of relationships figures prominently in feminist contributions to our understanding of care, dependency, and vulnerability. Regarding care, Gilligan (1982) argues for a form of moral reasoning specific to women that prioritizes care and relationships of care, in contrast to the justice orientation attributed to male moral reasoning. On her account, the highest level of female moral reasoning is characterized by an individual considering what is best for herself and others, taken as a relational unit. Noddings (1984), who identifies her work as feminine rather than feminist, takes care to be the fundamental moral virtue of women, expressed in and through the relationship of the “one-caring” and the “cared-for.” For Noddings, care is specific, occurring between identifiable individuals, and providing the cared-for with a model for future relationships (Tong 2009). The ethics of care has been highly influential in nursing ethics as this approach provides a theoretical framework for the practical work of providing patient care (Kuhse 1997; Groenhout 2004).
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While many disagree with the specifics of Gilligan and Noddings, the recognition that relationships are not between equals, and often if not always involve some degree of dependency, has been highly influential on thinkers such as Sara Ruddick (1989) and Eva Kittay (1999). Kittay uses the language of dependency and dependency work, thereby avoiding concerns about stereotyping women as natural carers. On Kittay’s account, it is relationships rather than rights that ground the care of dependents, where relationships morally demand meeting the needs of dependents. Dependency relations are socially constructed, but often not voluntarily chosen as they arise in the context of existing relationships and responsibilities. Kittay bases her account of equality in the notion that we are totally dependent as infants and children, and that our very survival is premised upon the labors of some mother (or dependency worker), making dependency a universally shared experience grounding our common humanity. In turn, this universal experience gives rise to a responsibility on the part of society to recognize and support dependency workers.
Like care and dependency, vulnerability is a third concept taken up by feminist theorists interested in relational theory. The concept of vulnerability is foundational in bioethics, grounding protections for patients and research participants. Yet for some time the concept was little theorized, leading at times to a labeling approach associated with stereotyping and discrimination (Rogers 2014). Florencia Luna (2009) proposes an account of vulnerability understood as separate layers rather than a general attribute, requiring careful examination of context-sensitive features to inform responses. In their account, Mackenzie et al. (2014) propose a typology of vulnerability that draws particular attention to vulnerability arising as the result of oppressive social relations. They argue that responses to the vulnerable must be directed by the obligation to foster autonomy, in order to counter objectionable paternalism and mitigate the threats to agency that often accompany vulnerability.
Questions of social justice permeate feminist discussions of autonomy, dependency and vulnerability (Mackenzie 2014). Social justice is crucial to the development and exercise of autonomy, understood relationally. Achieving this requires recognition of inequalities, including those that are gendered, in ways that explicitly address their causes. On feminist accounts, social justice requires attention to the distribution of power as much as of material resources (Young 1990). Sherwin (2008) develops this line of reasoning in her work, arguing for a focus on the social and institutional constitution of agency and the need to understand how patterns of power and privilege, which shape the opportunities and choices available to citizens, are reinforced or challenged by public practices, policies and institutions. Feminist accounts of public health ethics are likewise premised on the demand for social justice (Rogers 2006; Baylis et al. 2008), partly in recognition of the connections between disadvantage, discrimination and ill health. Baylis et al. argue that a relational account of public health illuminates the ways in which health policy decisions shape opportunities, and exert different effects on different social groups.
In addition to substantive contributions to theory, feminist approaches have had a lasting impact upon methodology in bioethics. There is no single feminist methodological approach to bioethics. Nonetheless, it is reasonable to claim that feminist bioethics is characterized by an interest in rich empiricism, attention to lived experiences and explicit recognition of one’s own perspective or standpoint (Wolf 1996). Feminists favor an expanded understanding of the dimensions of moral reasoning, in contrast to the abstract principlism of at least some mainstream bioethics (Rawlinson 2008). One response to abstraction lies in the use of narrative, placing great emphasis upon hearing and understanding the specific details of a bioethical issue from the perspective of the main protagonists (Lindemann 1997). Mary Rawlinson (2001) draws on resources from European philosophy to argue for greater attention to lived experience and proposes the pregnant body as a metaphor for relations of moral decision-making in bioethics. Postmodern approaches provide another avenue for critiquing claims about universalism to build a more particularist feminist framework (Shildrick 1997; Shildrick and Mykitiuk, 2005; see also the work of Margaret Little 2001). Philosophy of the body has proved to be a useful tool in investigating the moral dimensions of lived experience, the integrity of the body, and the boundaries between life and death (Young 1980; Shildrick 2008), while insights from disability theorists have illustrated the complex interplay of power, discrimination and limited choice affecting people living with disability (Leach Scully 2010).
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This section has briefly surveyed some of the main contributions of feminist bioethics to the field, of which relational theory is the most influential. Relational autonomy is now a widespread, although not always accurately employed concept in bioethics, while thick descriptions of cases and attention to context have become commonplace. In the final section, I consider future directions for feminist bioethics.
Future Directions for Feminist Bioethics
Feminist bioethics has moved far beyond an early focus on reproduction, although aspects of reproduction such as surrogacy, uterus transplantation, gender selection and genetic technologies continue to attract attention. A scan of issues of IJFAB (for example, 6.2, 7.2 and 8.2) reveals growing interest in globalism, and attention to the way that national domestic issues reverberate on a global scale. Investigations into the long-term care needs of ageing populations in wealthy countries, treatment of migrant health workers, the effects of health tourism, transnational reproduction, and inter-country disparities reflect the concerns and methods identified above while extending the scope of bioethics beyond the clinical encounter. Transnational interest encompasses a critique of Western-centric perspectives in bioethics, with attempts to engage feminist bioethics scholars from around the globe (Narayan and Hardy 2000; Tong et al. 2001; Ryan 2004). There is developing interest in environmental bioethics, drawing upon resources from environmental ethics and ecofeminism (Mies and Shiva 1993; Mellor 1997). Environmental concerns link to those about sustainability and food ethics (Rawlinson 2016), both of which lend themselves to feminist analysis, as does the topic of animal ethics. Technological innovations continue to drive debate, with a new investigation of sexism sparked by developments in neural imaging (Fine 2010), while old inequities recur in new clinical contexts such as surgery (Biller-Andorno 2002).
Anne Donchin describes feminist bioethics as a response to the “tepid agenda and exclusionary practices of the burgeoning field of bioethics” (2008, 146). The scholars who first identified themselves as feminist bioethicists, as well as those joining the field subsequently, have challenged theoretical foundations, demanded justice, opposed oppression and discrimination and developed new avenues of enquiry. Nonetheless, there remains much to do.
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Related Topics
Feminist methods in the history of philosophy (Chapter 1); the sex/gender distinction and the social construction of reality (Chapter 13); embodiment and feminist philosophy (Chapter 15); personal identity and relational selves (Chapter 18); rationality and objectivity in feminist philosophy (Chapter 20); feminist and queer intersections with disability studies (Chapter 30); feminist conceptions of autonomy (Chapter 41); feminist ethics of care (Chapter 43); neoliberalism, global justice, and transnational feminisms (Chapter 48).
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