Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in (...) the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patients self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality. (shrink)

Recent discussions in the various circles of feminism, postmodernism, and environmentalism have begun to make clear that ontology and epistemology without ethics is deadly - oppressive to women, oppressive to men, oppressive to the earth. In response to this crisis of reason in modernity, this collection of essays suggests the importance of knowing other-wise, non-rational ways of knowing which are wise to the "other" - a spiritual knowing of the heart with the passionate eye of love. Knowing Otherwise calls into (...) question the Western philosophical tradition of giving pride of place to reason in the acquisition of knowledge. Reasoning is only one of many ways in which we engage, i.e. know, the world. We know more than we think. We know by touch, by feel, by taste, by sight, by sounds, by smell, by symbols, by sex, by trust - by means of every modality of human experience. Philosophy becomes, in the fashion of Levinas, "the wisdom of love at the service of love. Tracing connections between epistemology, ethics, and spirituality - between "knowing" and the "other," between an other and the Other - all the essays serve as points of convergence between postmodern discussions and the Calvinian spirituality which is the home for writers in this collection. In particular, this collection explores the contributions of feminist thought and thinkers such as Emmanuel Levinas, Richard Rorty, Jacqes Derrida, and John D. Caputo to a spiritually and ethically sensitive knowing. (shrink)

Knowledge needed for ethical care must be constructed in the relationship between professional and patient who strive together to understand what meaning the disease factors have within the experience of the individual patient. Three kinds of knowledge are described. The first two, descriptive knowledge and abstract knowledge, are part of the more comprehensive and complex inherent knowledge. The reality of human experience and meaning is profoundly more complex than the scientific approach of fragmentation for purposes of dissection and diagnosis. In (...) order to develop descriptive, abstract and inherent knowledge as outlined here, three moves need to be made: the move from dominance to collaboration, the move from abstraction to context, and the move from beneficence to nurturance. (shrink)