This project draws on scholarship of feminist and womanist scholars, and on results of interviews with scientists currently involved in molecular genetics. With reference to Margaret Urban Walker's “practices of moral responsibility,” the social practices of molecular geneticists are exphred, and strategies identified through which scientists negotiate their moral responsibilities. The implications of this work for scientists and for feminists are discussed.

Problems with clinical research that create conflicts between doctors' therapeutic and research obligations may be fueled by a rigid view of science as determiner of truth, a heavy reliance on statistics, and certain features of randomized clinical trials. I suggest some creative, feminist approaches to such research and explore ways to provide choice for patients and to use values in directing both therapy and science - to enhance the effectiveness of each.

The paper identifies the phenomenal rise of increasingly invasive forms of elective cosmetic surgery targeted primarily at women and explores its significance in the context of contemporary biotechnology. A Foucauldian analysis of the significance of the normalization of technologized women's bodies is argued for. Three "Paradoxes of Choice" affecting women who "elect" cosmetic surgery are examined. Finally, two utopian feminist political responses are discussed: a Response of Refusal and a Response of Appropriation.

Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow. A literature review focused on medical ethics education among North (...) American medical schools reveals that instruction in ethics is considered to be vitally important for medical students. Agreement by medical educators on a possible core curriculum in ethics should be explored. To develop such a curriculum, deliberative curriculum inquiry by means of a targeted Delphi technique may be a useful methodology. However, the literature reveals that medical curricular change is notoriously slow. General implications for medical ethics education as a discipline are discussed. (shrink)

Some authors have advanced a contractual model to protect patient autonomy within the therapeutic relationship. Such a conception of the physician–patient relationship is intended to serve both parties by respecting patients' choices and preserving physician integrity. I critique this contractual view and offer an alternative, feminist contextualized approach to autonomy within the therapeutic relationship. This approach places the physician-patient relationship within a larger social context, and indicates the many social inequalities that render insupportable the notion of physicians and patients as (...) contracting equals. (shrink)

Anthropologists and sociologists offer numerous critiques of bioethics. Social scientists criticize bioethicists for their arm-chair philosophizing and socially ungrounded pontificating, offering philosophical abstractions in response to particular instances of suffering, making all-encompassing universalistic claims that fail to acknowledge cultural differences, fostering individualism and neglecting the importance of families and communities, and insinuating themselves within the “belly” of biomedicine. Although numerous aspects of bioethics warrant critique and reform, all too frequently social scientists offer ungrounded, exaggerated criticisms of bioethics. Anthropological and sociological (...) critiques of bioethics are hampered by the tendency to equate bioethics with clinical ethics and moral theory in bioethics with principlist bioethics. Also, social scientists neglect the role of bioethicists in addressing organizational ethics and other “macro-social” concerns. If anthropologists and sociologists want to provide informed critiques of bioethics they need to draw upon research methods from their own fields and develop richer, more informed analyses of what bioethicists say and do in particular social settings. (shrink)

The term community in ethics and bioethics traditionally has been used to designate either a specific kind of moral relationship available to rational agents or, in contrast, the context in which any sense of rational agency can even be understood. I argue that bioethics is better served when both selves and community are expressed through a more processive language that highlights the functional character of such concepts. In particular, I see the turn to processive community in bioethics as a turn (...) towards method, contextualization, and narrative. In clinical practice, such a processive account demands that bioethics concentrate on methods of developing healthy dialogue and deeper understanding from within the problematic situation rather than trying to fix problems using ethical tools developed from outside the present situation. Community, I argue, is in and of the interactive processes of inquiry itself. Such inquiry, such communitying, requires that we engage individual patients in context; it demands more than simply gaining their permission or mere consent; it demands developing a supportive environment for participation. (shrink)

Through the vehicle of Nicolas Sarkozy’s so-called “Dakar Address” we will analyse the West’s persisting lack of insight into the need for a Western decolonization. We will try to identify the dangers that come from this refusal, such as the abidance in colonial patterns, the enduring self-understanding as superior com-pared to Africa, and the persisting unwillingness to accept the colonial guilt. Decolonization has to be understood as a two-fold business. Decolonization is over-coming endured and perpetrated violence. It is not only (...) important that the colonial oppressed regain strength, it is equally important that the perpetrator of colonial violence understand their excess of violence and work on effecting its return impossible. We explain how Western thinking remains dangerous and untrustwor-thy if it refuses its own decolonization. Finally, we will draw attention to a fundamental pattern of Western thought that clashes with the fundamental values of the West: contempt. In a final step we suggest how this contempt can be overcome through desuperiorisation and the establishment of elative ethics. (shrink)

Although a pregnant woman can now refuse any medical treatment needed by the fetus, the Court of Appeal has acknowledged that ethical dilemmas remain, adverting to the inappropriateness of legal compulsion of presumed moral duties in this context. This leaves the impression of an uncomfortable split between the ethics and the law. The notion of a pregnant woman refusing medical treatment needed by the fetus is troubling and it helps little simply to assert that she has a legal right to (...) do so. At the same time, the idea that a pregnant woman fails in her moral duty unless she accepts any recommended treatment or surgery—however great the burdens—is also not without difficulty. This article seeks to find a way between these two somewhat polarized positions by arguing that, instead of being a question primarily about whether legally to enforce moral obligations, the «maternal—fetal conflict» begins with previously unrecognized difficulties in determining when a woman's prima facie moral rights invoked in the treatment context should «give way» to the interests of the fetus. This difficulty is mirrored within the law. Thus, how can we tell when a pregnant woman has the moral or legal duty to submit to a caesarean section? Seen in this way, the conflict is a problem which lies at the interface between moral and legal rights and duties, showing that there are important conceptual links between the ethics and the law. Against this background, this article explores the limits of a pregnant woman's right to bodily integrity by focusing upon the idea of her moral duty to aid the fetus through her body. Here we find difficulties in determining the existence and extent of this somewhat extraordinary duty. Such a duty is contrasted with both negative and positive duties toward others in the course of «general conduct». Attention to the social context of pregnancy and the refusal of treatment within this is also instructive. Overall, the purpose is to foster understanding and acceptance of the current legal position. (shrink)

This paper addresses Peter Singer's claim that cognitive ability can function as a universal criterion for measuring moral worth. I argue that Singer fails to adequately represent cognitive capacity as the object of moral knowledge at stake in his theory. He thus fails to put forth credible knowledge claims, which undermines both the trustworthiness of his moral theories and the morality of the actions called for by these theories. I situate Singer's methods within feminist critiques of moral reasoning and moral (...) epistemology, and argue that Singer's methods are problematic for moral reasoning because they abstract from their object valuable contextual features. I further develop this claim by showing the importance of embodiment for the construal of objects of moral knowledge. Finally, I develop the moral and scholarly implications of this critique. By showing that the abstract, universal methods of reasoning Singer employs cannot credibly construe the objects of ethical inquiry, I call into question the validity of these methods as a means to moral knowledge in general. Furthermore, since moral reasoning takes place within an embodied moral landscape, it is itself a moral enterprise. Singer's moral reasoning, and ours, must be held accountable for its knowledge claims as well as its concrete effects in the world. (shrink)

Zusammenfassung Im internationalen Diskurs sind feministische Perspektiven auf die Medizinethik bereits etabliert. Demgegenüber scheinen diese bislang nur vereinzelt in den deutschsprachigen medizinethischen Diskurs eingebracht zu werden. In diesem Artikel untersuchen wir, welche feministischen Perspektiven im deutschsprachigen medizinethischen Diskurs vertreten sind, und schlagen weitere Ansätze für eine feministische Medizinethik vor. Zu diesem Zweck zeichnen wir mittels einer systematisierten Literaturrecherche feministische Perspektiven im deutschsprachigen medizinethischen Diskurs seit der Etablierung der Medizinethik als eigenständiger institutionalisierter Disziplin nach. Wir analysieren, welche Themen bereits innerhalb der (...) Medizinethik aus einer feministischen Perspektive untersucht worden sind, und identifizieren Leerstellen. Basierend auf der Literaturrecherche, unseren eigenen Vorarbeiten sowie der Zusammenarbeit in der Arbeitsgruppe in der Akademie für Ethik in der Medizin „Feministische Perspektiven in der Bio- und Medizinethik“ stellen wir drei Thesen vor, die aus unserer Sicht einer Weiterentwicklung des deutschsprachigen medizinethischen Diskurses dienen können. Die erste These bezieht sich auf die Ziele feministischer Medizinethiken und besagt, dass diese (epistemische) Gerechtigkeit anstreben. Die zweite These stellt zentrale Eigenschaften von feministischen Medizinethiken als kritisch und kontext-sensibel heraus. In der dritten These diskutieren wir Intersektionalität und Postkolonialismus als theoretische Ansätze, die zu einer epistemisch gerechten, kritischen und kontext-sensiblen Medizinethik beitragen können. Wir argumentieren, dass feministische Perspektiven grundständig verankert werden sollten. Der Artikel schließt mit einem Ausblick auf die Arbeit der im letzten Jahr gegründeten Arbeitsgruppe in der Akademie für Ethik in der Medizin „Feministische Perspektiven in der Bio- und Medizinethik“. (shrink)

‘Feminist masculinity’ might seem like a contradiction in terms. One might have assumed that we can embrace feminism or embrace masculinity, but not both. If traditional masculinity is contrary to feminist values, a pressing query for feminist men is whether repudiation of traditional masculinity should move one to reject normative masculinity entirely, or to reframe and reclaim it instead. bell hooks and Michael Kimmel each counsel against discarding manhood and masculinity. hooks envisions feminist masculinity as an alternative to patriarchal dominance, (...) with masculinity to be reconstituted in terms of love, integrity, and mutuality; Kimmel advocates moving from immature and traditional masculinities toward justice and democratic manhood, with a new model of masculinity that identifies real men with adulthood and doing the right thing. Neither proposal provides a viable stance for feminist men without collapsing into androgyny or risking erasure of some men’s and women’s identities and experiences. Building on Alcoff’s work on anti-racist whiteness, I suggest that feminist allyship practices ground a normative model of masculinity compatible with, and informed by, feminist values. We may understand allyship masculinities as open-ended feminist approaches to manhood: masculinities predicated on recognizing and responding to, rather than ignoring or accepting, the privileges and expectations distinctive of men under patriarchy. (shrink)

Two key themes structure the work of French philosopher of science Gilbert Simondon: the processes of individuation and the nature of technical objects. Moreover, these two themes are also at the heart of contemporary debates within Ethics and Bioethics. Indeed, the question of the individual is a key concern in both Virtue Ethics and Feminist Ethics of Care, while the hyper-technical reality of the present stage of medical technology is a key reason for both the urgency for and the success (...) of the field of Bioethics. And yet, despite its potential for thinking about these issues, Simondon’s philosophy remains largely unknown. Rather than exploring Simondon’s complex ontology for itself, the aim of this paper is to establish what contribution his work can make in Ethics and Bioethics on two essential questions: the relational structure of the self and the nature of the human-technology relation. I argue that Simondon’s re-conceptualization of the individual harmonizes with perspectives in Feminist Bioethics (particularly the Ethics of Care) and points toward what I call an “open” Virtue Ethics that takes relations to be essential. In order to establish this connection, I explore at length the relational approach to Feminist Bioethics offered by Susan Sherwin’s work. I argue that a Simondonian account of technology and of the individual furthers the relational understanding of the self, offers a characterization of Virtue Ethics that is in harmony with the Ethics of Care, and clarifies a notion of responsibility that is implicated in the complex reality of the modern technological milieu. (shrink)

: This project draws on scholarship of feminist and womanist scholars, and on results of interviews with scientists currently involved in molecular genetics. With reference to Margaret Urban Walker's "practices of moral responsibility," the social practices of molecular geneticists are explored, and strategies identified through which scientists negotiate their moral responsibilities. The implications of this work for scientists and for feminists are discussed.

A man with Alzheimer's who wanders around, a caregiver who disconnects the alarm, a daughter acting on het own, and a doctor who is not consulted set the stage for a feminist reflection on capacity/competence assessment. Feminist theory attempts to account for gender inequality in the political and in the epistemological realm. One of its tasks is to unravel the settings in which actual practices, i.c. capacity/competence assessment take place and offer an alternative. In this article the focus will be (...) on a feminist ethics of care in which relationality, care, vulnerability, and responsibility are privileged concepts and attitudes. The emphasis on these notions leads to a specific view of autonomy that has consequences for both carereceivers (patients, clients) and caregivers (professional and not professional). These concepts constitute a default setting that shapes the context for capacity/competence assessment. Whereas this notion is meant to distinguish between those who need to be taken care of and those who do not, reflection on what it means to say ‘those who need to be taken care of’ is also required. The feminist analysis presented here emphasizes the necessity of the contextualization of assessment of competence. It sketches the multifold and complex grid that comprehends capacity assessment. (shrink)

Definition of the problemFeminist approaches to medical ethics are well established in international discourses. By contrast, in the German-speaking medical ethical discourse, they still seem to be rather marginal. In this article, we analyze which feminist perspectives are prominent in German medical ethics and suggest new approaches.ArgumentsWe present our results from a systematized review of the literature, in which we identify existing feminist approaches within the German-speaking medical ethics discourse as well as research gaps. Based on the review, our preliminary (...) research and discussions in the working group “Feminist perspectives in bio and medical ethics”, we defend three hypotheses aimed at advancing the German feminist medical ethical discourse. We posit that (1) feminist medical ethics aim at (epistemic) justice, (2) feminist medical ethics are critical and context-sensitive, and (3) intersectional and postcolonial approaches within feminist medical ethics may contribute to epistemically just, critical, and context-sensitive medical ethics.ConclusionWe argue that feminist perspectives should be implemented as a fundamental perspective in medical ethics because they can bring together key dimensions such as epistemically just, critical, context-sensitive, intersectional, and postcolonial thinking. (shrink)

The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

Throughout the development of an "ethic of care" different from an "ethic of justice," the relationship between the two has been problematic. Are they theories between which one must choose? Are they complementary? Are they domain-specific? In support of my view that neither is adequate by itself, I here examine the private domain of care of the dying by intimates, and find there important issues both of care and of justice.

No Longer Patient: Feminist ethics and health care by Susan Sherwin. Philadelphia: Temple University Press, 1992.

I was an undergraduate studying bioethics in Toronto during the SARS pandemic in what seem like, in retrospect, much simpler times. Now, living in Texas, I'm finishing my PhD degree in the medical humanities. This current pandemic has provided me with an education in trust, scientific expertise, provider burnout, and social justice. It has invigorated my research examining how moral tensions in the therapeutic relationship are heightened when physicians write about patient care. Still, the inevitable comparisons, not just with being (...) in school back then but also with student life before the pandemic, bring... (shrink)

No Longer Patient: Feminist ethics and health care by Susan Sherwin. Philadelphia: Temple University Press, 1992.