Abstract

Despite the vast number of cultures and peoples that reside in the West, ethical action in bioethics is determined through the perspective of la Totalidad, which does not include the Other or individuals from the periphery. In my dissertation, I argue that the universalization of U.S. clinical bioethics (la bioética estadounidense) and the coloniality of knowledge that extends from it are, at its core, imperialistic in nature and result in the exclusion of patients with intersectional identities. While clinical bioethics was first conceived as a critical tool for medicine, the acceptance of principlism as the central theory in the field and its moral foundation in the “common morality” has severely reduced the critical aspect of clinical bioethics. Using a case analysis, I demonstrate principlism's weaknesses in addressing the complexities that arise from marginalized identities. Instead, I propose a more comprehensive and suitable framework for clinical bioethics, a feminist and Dusselian Agapean framework, which can address patients at both the center and the periphery of bioethics. Synthesizing the critical work of feminist bioethicists and Latin American philosophers through the ethics of liberation and Intervention Bioethics, I develop a practical approach that is more inclusive and successful than principlism. The Agapean framework holds Dusselian agape as its material principle and maintains the protection of the worst off in society and the prevention of possible harm through the centralization of relational autonomy, playful narrativity, a need for advocacy, and social justice through equal participation. Using this approach, I address the coloniality of power and gender found in our way of producing knowledge in clinical bioethics. This dissertation fills a gap in the field by addressing the colonial aspects of mainstream bioethics and proposing a needed alternative. Moreover, by providing English translations to critical passages from Spanish and Portuguese bioethics texts, it shines a light on voices from the periphery, which have been traditionally invisibilized.