The current global pandemic will continue to challenge bioethics for decades to come. Not only did it bring about new issues of social justice, it deepened stratification of health along existing unfair structures. Further and most grimly, it can be argued the pandemic was an ethics test the global community failed. Especially to those of us invested in ethics professionally, this calls for critical reflection.Obviously, the strains of the pandemic have been very unevenly distributed. As a feminist and queer (...) bioethicist recently into her doctorship, I have had the privilege of observing the pandemic from a Northern European point of view, from Finland to be exact. Our privileges stem from makings of the... (shrink)

Ecological feminism (or ecofeminism) and feminist bioethics seem to have much in common. They share certain methodological and epistemological concerns, offer similar challenges to traditional philosophy, and take up a number of the same practical issues. The two disciplines have thus far had little or no direct interaction; this is one attempt to begin some conversation and perhaps stimulate some cross-pollination of ideas. The email dialogue engaged an active ecofeminist scholar, Karen Warren, and an active feminist bioethicist, Hilde (...) Nelson, in an exchange of ideas. Jessica Pierce, whose research cuts between environmental philosophy and bioethics, served as moderator. (shrink)

The primary contribution of feminism to bioethics is to note how imbalances of power in the sex‐gender system play themselves out in medical practice and in the theory surrounding that practice. I trace the ten‐year history of feminist approaches to bioethics, arguing that while feminists have usefully critiqued medicine's biases in favor of men, they have unmasked sexism primarily in the arena of women's reproductive health, leaving other areas of health care sorely in need of feminist scrutiny. I (...) note as well that feminist bioethicists have contributed very little to bioethical theory. In the second part of the paper I suggest two future directions for feminist bioethics. The first is to expand its critique of gender bias beyond reproductive medicine, devoting attention to the same issues raised by advances in biomedical technology as are taken up by mainstream bioethicists. The second is to develop bioethical theory that is more responsive than are mainstream moral theories to the social practices that subordinate women and minority groups. (shrink)

In this article, I explain what makes a global bioethics “feminist” and why I think this development makes a better bioethics. Before defending this assertion explicitly, I engage in some preliminary work. First, I attempt to define global bioethics, showing why the so-called feminist sameness-difference debate [are men and women fundamentally the same or fundamentally different?] is of relevance to this attempt. I then discuss the difference between rights-based feminist approaches to global bioethics and care-based feminist (...) approaches to global bioethics. Next, I agree with a significant number of feminist bioethicists that care is a more fundamental moral value and practice than justice. Finally, I conclude that feminists’ insights about care, even more than rights, can bring us closer to achieving an inclusive, diverse, and fair feminist global bioethics. (shrink)

Doctors Pratt and de Vries propose a well-structured and courageous approach to analyse and repair an insufficiently recognised discussion about epistemologies and knowledge production in bioethics.1 The authors invite researchers, scholars, public health experts and bioethicists from the global North to reflect about their lack of imagination regarding different sources of narratives produced by the global South. There is a critical analysis of injustices and an urgent call for global bioethicists to reorient their field and focus on the (...) analysis and development of ethical interventions to achieve a comprehensive epistemic justice for global health ethics. Feminist bioethicists from the global South already argued about the importance of the voices and biographies of the people and groups in the communities to reframe the bioethical reasoning regarding the meaning of individual’s needs during public health and humanitarian emergencies.2 Over a decade ago, Diniz and Guilhem described the role and goal of feminist bioethics in Latin America, shaped in an oppressive context promoted and created by …. (shrink)

Feminist bioethics is a relatively new field, the major works in which only started to appear in the late 1980s. At first feminist bioethicists focused mainly on issues of particular concern to women such as reproduction. Recently, papers have begun to appear that show that a feminist analysis can be brought to bear on any subject traditional bioethics discusses. So far, however, feminist bioethics has not been brought to bear on psychiatry. There have been (...) class='Hi'>feminist critiques of psychiatry and feminist discussions of certain diagnostic categories that disproportionately affect women, but these are concerned with womens issues within psychiatry and how psychiatry has been used to oppress women. Certainly these are important, but what has been missing is a discussion of psychiatry in the sense that feminist bioethics suggests a general critique of psychiatry and the rethinking of the practice of psychiatry, regardless of whether the specific instances involved are womens issues. In this paper I look at what such a feminist bioethical intervention into psychiatry would look like. (shrink)

: Although a wide variety of feminist approaches to bioethics presently share a common feminist methodology (sometimes referred to as "raising the woman question"), they do not all share the same feminist politics, ontology, epistemology, and ethics. As a result of their philosophical differences, feminist bioethicists do not always agree on which biomedical principles, practices, and policies are best suited to serving women's interests. In other words, some feminist bioethicists insist that so-called "assisted (...) reproduction" enhances women's procreative liberty, while others claim that it does nothing of the sort. Although such disagreement among feminist bioethicists reassures the general public that the feminist "program" for bioethics is not ideologically monolithic, it also confuses the public, especially women. In order to overcome this confusion, feminist bioethicists should work toward developing the kind of shared theoretical base that will foster frequent consensus on the biomedical principles, practices, and policies most likely to serve the interests of most women in the U.S. today. (shrink)

Feminist criticism of health care and ofbioethics has become increasingly rich andsophisticated in the last years of thetwentieth century. Nonetheless, this body ofwork remains quite marginalized. I believe thatthere are (at least) two reasons for this.First, many people are still confused aboutfeminism. Second, many people are unconvincedthat significant sexism still exists and aretherefore unreceptive to arguments that itshould be remedied if there is no largerbenefit. In this essay I argue for a thin,``core'' conception of feminism that is easy tounderstand (...) and difficult to reject. Corefeminism would render debate within feminismmore fruitful, clear the way for appropriaterecognition of differences among women andtheir circumstances, provide intellectuallycompelling reasons for current non-feminists toadopt a feminist outlook, and facilitatemutually beneficial cooperation betweenfeminism and other progressive socialmovements. This conception of feminism alsomakes it clear that feminism is part of alarger egalitarian moral and political agenda,and adopting it would help bioethics focus onthe most urgent moral priorities. In addition,integrating core feminism into bioethics wouldopen a gateway to the more speculative parts offeminist work where a wealth of creativethinking is occurring. Engaging with thisfeminist work would challenge and strengthenmainstream approaches; it should also motivatemainstream bioethicists to explore othercurrently marginalized parts of bioethics. (shrink)

Medical issues affecting health care have become everyday media events. In response to mounting public concern, growing numbers of bioethicists are being appointed to medical school faculties and public policy panels. However the ideas voiced in these forums are seldom informed by feminist perspectives. In this important book, a distinguished group of feminist scholars and activists discuss crucial bioethics topics in a feminist light. Among the subjects explored are the care/justice debates, transforming bioethics, practice, and reproduction. (...) The book also covers less commonly discussed issues, such as culturally appropriate responses to reproductive health problems in developing countries. (shrink)

When feminist bioethicists express concerns about health‐related gender disparities, they raise considerations about justice and gender that traditional bioethicists have either not raised or raised somewhat weakly. In this article, I first provide a feminist analysis of long‐term healthcare by and for women in the United States and women in Taiwan. Next, I make the case that, on average, elderly US and Taiwanese women fare less well in long‐term care contexts than do elderly US and Taiwanese (...) men. Finally, I explore some suggested practical remedies to reduce gender disparities in long‐term care contexts. (shrink)

Due to globalization, gender, class, and health issues are emerging that require the attention of feminist bioethicists globally. In this paper, I argue that although the basic questions that Western feminist bioethicists address, as well as their work in general, are relevant to health care issues in developing countries like Kenya, they must heighten their focus on unjust global policies that adversely impacted on health care provision in Kenya and led to further oppression of women (women (...) who are already oppressed by the structures of the society), especially in terms of health care. (shrink)

I am a feminist bioethicist whose work focuses on the ethics of eating. Though COVID-19 is not a foodborne illness, it has had significant impacts on eating around the world, including increases in food insecurity, dining restrictions and closures of restaurants, interruptions in supply chains, and rising food prices. Many people have been eating at home more often—some alone, others with members of their households—and emotional or stress eating is on the rise.A feminist perspective is indispensable for understanding (...) and responding appropriately to these changes. The costs of these changes have not been distributed equally, and drawing attention to how disproportionate harm tracks gendered and intersectional... (shrink)

This paper looks at a range of metaphors used within HIV/AIDS discussions and research in support of the claim that bioethicists should pay serious attention to metaphors. Metaphors shape the ways we think about problems and the types of solutions we investigate. HIV/AIDS is an especially rich field for the investigation of metaphor, since the struggles for dominance among different metaphorical options has been very evident. In the field of medical resarch as well as in the area of public (...) policy, different metaphors support different strategies and, therefore, the choice of metaphor has ethical significance. I argue that feminists should engage in these debates since they have an interest in the metaphors selected. They can also learn to be more self-conscious in choosing politically liberating metaphors in other bioethics contexts. (shrink)

The Routledge Handbook of Feminist Bioethics, edited by Wendy A. Rogers et al., presents a thorough, contemporary understanding of feminist bioethics, linking feminist efforts to other critical approaches in the field of bioethics. A more demanding standard for feminist scholarship is set by engaging gender at its intersections with race, class, sexuality, and ability––intersections that require bioethicists to attend to issues like incarceration and transmisogynistic violence that are less frequently tackled in the field. Editors and (...) contributors alike in this volume show that long‐standing feminist conceptual interventions, especially those regarding the significance of relationality and epistemic marginalization, provide key tools for a coalition of critical approaches to bioethics. (shrink)

In this paper I argue that a global bioethicsis possible. Specifically, I present the viewthat there are within feminist approaches tobioethics some conceptual and methodologicaltools necessary to forge a bioethics thatembraces the health-related concerns of bothdeveloping and developed nations equally. Tosupport my argument I discuss some of thechallenges that have historically confrontedfeminists. If feminists accept the idea thatwomen are entirely the same, then feministspresent as fact the fiction of the essential``Woman.'' Not only does ``Woman'' not exist,``she'' obscures important racial, (...) ethnic,cultural, and class differences among women. However, if feminists stress women'sdifferences too much, feminists lose the powerto speak coherently and cogently about genderjustice, women's rights, and sexual equality ingeneral. Analyzing the ways in which the ideaof difference as well as the idea of samenesshave led feminists astray, I ask whether it ispossible to avoid the Scylla of absolutism(imperialism, colonialism, hegemony) on the onehand and the Charybdis of relativism(postmodernism, fragmentation, Balkanization)on the other. Finally, after reflecting uponthe work of Uma Narayan, Susan Muller Okin, andMartha Nussbaum, I conclude that there is a wayout of this ethical bind. By focusing onwomen's, children's, and men's common humanneeds, it is possible to lay thefoundation for a just and caring globalbioethics. (shrink)

Around the world the wealthy can get their lives extended while the poorget little basic medical help. Over the same years that the field ofbioethics has prospered and expanded, this disparity has increased.Reasons for the failure of bioethics to successfully address thishealth/wealth issue include its identification with the cognitiveand social authority of medicine; its gatekeeping behavior;its funding sources; its questionable use of ``principlism'' andits emphasis on crises and dilemmas to the neglect of ``housekeeping''issues. The work of most women in bioethics (...) rarely addresses thehealth/wealth issue; if it does, their work may be ignored, aswere the recommendations of Canadian feminists working under governmentgrants. To achieve equity in health care, the structure of both medicineand bioethics needs to be changed. Yet, since bioethicists generallyhave accepted the status quo, this seems unlikely to happen. (shrink)

Sue Sherwin was among the first feminist bioethicists to insist that bioethics needed to become much more richly contextual and relational than traditional approaches to the discipline were ready to acknowledge. Targeting clinical bioethics and its central notion of patient autonomy, feminist bioethics focused on how broader social inequalities were likely to manifest themselves within clinical encounters among patients, family members, and healthcare professionals. The general idea was that by attending to how more general social inequalities might (...) be affecting clinical encounters, an explicitly feminist bioethics could play a crucial role in developing institutional pathways for empowering patients to make more... (shrink)

In this chapter, I propose that conceptions of justice in bioethics must be feminist, meaning they must be able to capture how the domains of health, healthcare and medicine exacerbate the subordination of those perceived to be women and girls and how injustice impacts their health. After providing context in the first section, I identify three problems with conceptions of justice in the bioethics literature that interfere with their potential to be feminist. They tend to adopt the ahistoricism (...) and distributivism characteristic of theories of justice that have been dominant in political philosophy, and they often rely on gendered conceptions of health that result in troubling comparisons of men and women’s health. My argument is primarily “negative”: it is a critique of generalist conceptions of justice in bioethics. However, in the final section I present characteristics of what a feminist conception of justice needs to look like and indicate how feminist bioethicists are using such a conception in assessing issues of injustice in bioethics. I emphasize the centrality of actual structural injustices, relational egalitarianism, and the assessment of values in conceptions of health and the health sciences. (shrink)

The COVID-19 pandemic is not the first pandemic that many of us have faced in our lives. The HIV/AIDS pandemic continues to affect women, racialized people, and LGBTQ2S+ people around the world today, and there are significantly fewer resources to address, and less political will and news coverage of, this other pandemic.1 Although many see COVID-19 as an unprecedented public health crisis that is challenging our societies and our relationships with each other in unique ways, I argue that we actually (...) have a lot to learn from our responses to HIV/AIDS and that feminist bioethicists can help us understand how the present situation is actually an extension of several underlying medical and social issues and... (shrink)

This paper argues that the various approaches to ethics that bioethicists rely on are not adequate to provide effective moral guidance in how to avoid a series of looming human catastrophes (associated with such threats as environmental degradation, war, extreme poverty, and pandemics). It proposes development of a new approach to ethics, dubbed public ethics, that simultaneously investigates moral responsibilities at multiple levels of human organization from the individual to international bodies. It argues that feminist relational theory can (...) provide guidance to development of this new type of ethics, and it warns against obstacles bioethicists face in its pursuit. (shrink)

Early in the COVID-19 pandemic, researchers reported a surprising trend in disease outcomes: men were more likely to require hospitalization and die from COVID-19 than women. Researchers looked to sex-linked biology to explain these disparities, hypothesizing innate sex differences in immune function, suggesting the use of estrogens or androgen-suppressants as therapy, and even pushing for sex-specific vaccine strategies. Leading bioethicists like Dr. Ezekiel Emanuel at the University of Pennsylvania recently described the sex disparity in COVID-19 outcomes as "the unsolved (...) mystery" of the... (shrink)

Feminist bioethicists have long shed light on the indignities and injustice of reproductive intrusions, be they coerced gestation or forced interventions during pregnancy and birth. Writing about t...

Medicalization occurs when an aspect of embodied humanity is scrutinized by the medical industry, claimed as pathological, and subsumed under medical intervention. Numerous critiques of medicalization appear in academic literature, often put forth by bioethicists who use a variety of “lenses” to make their case. Feminist critiques of medicalization raise the concerns of the politically disenfranchised, thus seeking to protect women—particularly natal sex women—from medical exploitation. This article will focus on three feminist critiques of medicalization, which offer (...) an alternative narrative of sickness and health. I will first briefly describe the philosophical origins of medicalization. Then, I will present three feminist critiques of medicalization. Liberal feminism, trans feminism, and crip feminism tend to regard Western medicine with a hermeneutics of suspicion and draw out potential harms of medicalization of reproductive sexuality, gender, and disability, respectively. While neither these branches of feminism—nor their critiques—are homogenous, they provide much-needed commentaries on phallocentric medicine. I will conclude the paper by arguing for the continual need for feminist critiques of medicalization, using uterus transplantation as a relevant case study. (shrink)

In this paper, I describe a collaborative project involving two feminist trained scientists1 in consultation with a bioethicist, a policy analyst, and a research scientist funded by the National Academies Keck Futures Initiative for the design and implementation of a training program for ethics in synthetic biology. In spring 2011, the project culminated in our coteaching an experimental graduate seminar on ethics and synthetic biology.Synthetic biology most commonly refers to an interdisciplinary field that aims to merge engineering and biology (...) methods to create new technologies. The promise is that these new technologies will solve the world’s most pressing problems: for example, they may provide us with cures.. (shrink)

Feminist bioethicists of a variety of persuasions discuss the 2013 case of Marlise Munoz, a pregnant woman whose medical care was in dispute after she became brain dead.

This article reflects on the work of feminist bioethicists over the past ten years, reviewing how effective feminists have been in using relational theory to reorient bioethics and where we hope it will go from here. Feminist bioethicists have made significant achievements using relational theory to shape the notion of autonomy, bringing to light the relevance of patients' social circumstances and where they are situated within systems of privilege and oppression. But there is much work to (...) be done to reorient bioethics so that it is capable of addressing some current public health challenges. We argue that relational theory holds promise for beginning this work. (shrink)

Building trust between academic medical centers and certain communities they depend on in the research process is hard, particularly when those communities consist of minoritized or historically marginalized populations. Some believe that engagement activities like the creation of advisory boards, town halls, or a research workforce that looks more like community members will establish or reestablish trust between academic medical centers and racialized communities. However, without systematic approaches to dismantle racism, those well‐intended actions become public performativity, and trust building will (...) fail. In this essay, we draw upon foundational ethical principles of trust, distrust, and trust building; apply the concept of bounded justice to performative trust acts; and center the works of Black and Indigenous feminist bioethicists to revisit some of the wisdom and valuable lessons they have contributed. Rebuilding trust is hard to do because people and institutions are often not honest about how hard it is and there is no simple box‐checking task that can disentangle our society's injustices, but there are steps to take in this direction. Individuals and institutions can recognize valuable relevant work that has already been written, partake in critical reflection, and then apply insights gained to take both small and sustainable steps toward transformational change and deeper trust. (shrink)

In this essay, I argue that the daily practice of expert nurses goes far toward enacting the kind of patient autonomy feminist bioethicists envision. Nursing theorists often utilize philosophical theories in their work, but bioethicists have not paid much attention to nursing theory and what it means to be an expert nurse. This is unfortunate because expert nurses do much in their daily practice to make the ideals for autonomy put forth by feminist bioethicists a (...) reality. With this in mind, I bring these two literatures together in what I hope is a fruitful dialogue. (shrink)

There has been considerable work in bioethics addressing injustice and gender oppression in the provision of healthcare services, in the interaction between client and healthcare professional, and in allocation of healthcare services within a particular hospital or health service. There remain several sites of continued injustice that can only be addressed adequately from a broader analytical perspective, one that attends to the social and political contexts framing healthcare policy and practice. Feminist bioethicists have a strong track record in (...) providing this kind of analysis. Using current Australian aged care and welfare policy this paper demonstrates some of the ways in which issues of gender, age, and social inequity shape bioethical debate, policy, and practice in the areas of aged care and welfare provision. The author develops an argument that demonstrates the gender injustice underlying health care and welfare policy. This argument recognises the inevitability of human dependency relations, and questions the adequacy of current political theories to address the requirements for full and equal citizenship. The author shows that an adequate analysis of the ethics of aged healthcare depends on sufficient consideration of the social and political context within which healthcare policy is framed and an adequate understanding of human dependency. (shrink)

The paper contends that, despite critiquing certain aspects of modernist thought feminist bioethics has become stuck in its own inadequate paradigms that pay insufficient attention to either the theoretical insights of postmodernism, or to the capacities of biotechnology in the postmodern era to disrupt prior certainties. In the face of an incalculable expansion of both theoretical and material possibilities, feminist bioethicists working in the field of reproduction have remained largely unwilling to reconfigure notions such as embodiment, subjectivity, (...) agency, and so on. There is little recognition of a need for an openness to the shifting complexities, or to think without prior determination. Starting with a brief critique of the normative values of one governmental body concerned with biotechnology, I move on to suggest how postmodernism mightframe an appropriate bioethical response, both to the explicit material issues, and to a rethinking of ethics itself. (shrink)

As a feminist bioethicist, I have frequently wondered why the exclusion of pregnant women has been the default position for most clinical research and how social values have influenced this decision. Relatedly, I wonder what responsible research involving pregnant women would look like. As a theorist who conducts research on the concept of vulnerability, I have often wanted to know why there has been so little research into the harmful effects of the routine exclusion of pregnant women, including questions (...) such as: What do pregnant women actually think about participating in research? How should we treat pregnant women and their fetuses for the purposes of consent (are they two separable persons or one complex... (shrink)

At this point, I think it is fair to say that most of us know someone—a family member, a coworker, a friend, a student—who is resisting getting a vaccine against COVID-19. Frankly, this amazes me. I was recently discussing this with a friend—"Rebecca"—when to my utter shock, she confessed to me that she "does not trust the vaccine" and is not planning to get one until there is more certainty of its efficacy and safety. While there are many things that (...) stood out to be in this conversation, what stood out to me was a particular comment she made; she said to me: "The thing is, I'm a skeptic, and you're not."I admit, this comment threw me for a loop. How could I, a feminist bioethicist who has dedicated a good chunk of... (shrink)

Conflicts between bioethicists and disability theorists often arise over the permissibility of euthanasia and physician assisted suicide. Where mainstream bioethicists propose universalist guidelines that will direct action across a range of effectively disembodied situations, and take for granted that moral agency requires autonomy, feminist bioethicists demand a contextualisation of the circumstances under which moral decision making is conducted, and stress a more relational view of autonomy that does not require strict standards of independent agency. Nonetheless, neither (...) traditional nor feminist perspectives have fully engaged with the critique of disabled people that they are consistently subjected to discriminatory, even life-threatening, practice and policy in biomedical and health care. The paper revisits some of the issues that drive the often highly polarised debate between bioethicists and disability theorists around the question of end of life decisions involving disabled people. While many bioethicists have doubtless been indifferent to the difference that disability makes, I am also concerned that the very proper demand of disability activists and theorists to scrutinise all end of life decisions for signs of discrimination and even violence has segued into something damagingly restrictive that silences internal dissension and stifles external debate. Given that euthanasia and physician assisted suicide may be issues where conventional argument on either side will founder on deeply felt convictions, I make the radical move to speculate on an entirely different, quasi-Deleuzian, approach to the value of life in order to shake up entrenched positions, and begin to think differently. (shrink)

This section of the journal consists of reflections on the COVID-19 pandemic by feminist bioethicists. We wanted to have a record in IJFAB of the ways in which feminist bioethicists/feminist bioethics were and are affected by the pandemic and also record how our community sees feminist approaches to bioethics as providing resources for understanding and addressing ethical themes raised by the pandemic. The contributions we received cover a wide range of personal, professional, and theoretical (...) issues and approach them in different ways. We are deeply grateful to the authors for sharing their experiences, and hope that our readers find their contributions engaging and... (shrink)

This essay reviews and evaluates the accomplishments of The International Network on Feminist Approaches to Bioethics (FAB) over its initial fifteen years. It focuses on the origins, development, and expanding influence of FAB as a multidisciplinary organization of feminist bioethicists. Also noted are areas of bioethics that as yet have not been adequately addressed from feminist perspectives, including intersections between health and human rights, gender disparities in the treatment of chronic disease, health research priorities that shortchange (...) women, HIV/AIDS proliferation among women in the global South, the health needs of recent migrants, and the encroachment of corporate interests on bioethics. (shrink)

The 2004 Canadian Assisted Human Reproduction Act bans commercial contract pregnancy and egg provision, but Canadians undertake cross-border reproductive travel to access these services. Feminist bioethicists have argued that the ethical justification for enforcing the ban domestically, namely exploitation, grounds its extraterritorial enforcement. I raise an additional problem when Global Southern or low-income countries are destinations for travel: neocolonialism. Further, I argue that a ban on commercialized reproduction is problematic. Although well-suited to address neocolonial forces of exploitation and (...) commodification, a ban reinforces neocolonialism by paying insufficient attention to the agency of gestational laborers and egg providers. (shrink)

As COVID-19 swept across the globe, ethicists everywhere took up a call to arms to advise and guide the medical profession through an unprecedented event. "Fairness" quickly became the word de jour in this pandemic. But when it comes to health "fair" is a four-letter word. It is of no surprise to feminist bioethicists, but fairness, equality, and equity are not equivalent. As we have seen revealed again and again over the last two years, the social and structural (...) determinants that contribute to good health are not fairly distributed amongst the population. Instead, where we live and work, how much money we have, our education, gender, and ethnicity all contribute to how accessible healthcare services are, our... (shrink)

Florencia Luna begins her essay, “Challenges for Assisted Reproduction and Secondary Infertility in Latin America,” by saying: “I want to explore a new way to think about Assisted Reproductive Technologies (ARTs) in the Latin American context.” I think she clearly achieves that objective. I want to suggest that she does more than this, however. In addition to revealing how traditional depictions of infertility in the United States and Europe are anachronistic for Latin America, her analysis offers feminist bioethicists (...) in the United States the opportunity to revisit our own assumptions about infertility and improve our work as a result.Luna states early in her essay that her analysis will center on secondary .. (shrink)

This paper focuses on epistemic practices within biomedical ethics that are related to disability. These practices are one of the reasons that there is tension between biomedical ethicists and disability advocates. I argue that appeals to conceptual neutrality regarding disability, which Anita Silvers recommends, are counterproductive. Objectivity as neutrality serves to obscure the social values and interests that inform epistemic practices. Drawing on feminist standpoint theory and epistemologies of ignorance, I examine ways that appeals to objectivity as neutrality serve (...) to maintain the status quo and ignorance regarding disability. I adapt Charles Mills’s notion of “white ignorance” in order to consider the systematic social ignorance regarding disability that is treated as knowledge. Bioethicists commonly dismiss the reports of disabled people regarding their quality of life as biased, while claiming that their own judgments are objective. Sandra Harding’s notion of strong objectivity is useful for thinking about ways that examination of values and interests informing epistemic practices related to disability in biomedical ethics could create better knowledge practices by taking the standpoint of disabled people seriously. (shrink)

In this paper, I look at several examples that demonstrate what I see as a troubling tendency in much of mainstream bioethics to discount the views of disabled people. Following feminist political theorists who argue in favour of a stance of humility and sensitive inclusion for people who have been marginalized, I recommend that bioethicists adopt a presumption in favour of believing rather than discounting the claims of disabled people. By taking their claims at face value and engaging (...) with disabled people in open dialogue over impairment and disadvantage, bioethicists may take to heart an important lesson about human fragility and resilience. (shrink)

Promoting respect for the four principles remains of great practical importance in ordinary medicineThe following are four “scenarios” with brief outlines of how Raanan Gillon has analysed them using the “four principles” approach. These are the four cases that the commentators were asked to analyse.Professor Gillon has for many years advocated the use of the Beauchamp and Childress four principles approach as a widely and interculturally acceptable method for medical ethics analysis . At present there seems to be a backlash (...) by some bioethicists against this approach, with among others, adherents of feminist ethics, narrative ethics, virtue ethics, and various varieties of regional ethics claiming to offer better approaches to medical ethics.At Raanan Gillon’s request this special issue of the Journal of Medical Ethics is intended to focus on this aspect of his work, with a view not only to discussing the issue of how different approaches to medical ethics are and/or are not compatible with the four principles approach but also to make clear to JME readers what alternative ethics analysis method is preferred and used by the various commentators.THE “STANDARD” JEHOVAH’S WITNESS CASEIn the first scenario, that of the “standard” Jehovah’s Witness case, a competent adult patient loses a massive amount of blood from a blood vessel bleeding in an acute duodenal ulcer. The best chance of …. (shrink)

Fetal and Maternal Bodies brings together the voices of abortion providers, abortion counselors, clinic owners, neonatologists, bioethicists, and historians to discuss how and why providing abortion care is moral work. The collection offers voices not usually heard as clinicians talk about their work and their thoughts about life and death. In four subsections--Providers, Clinics, Conscience, and The Fetus--the contributions in this anthology explore the historical context and present-day challenges to the delivery of abortion care. Contributing authors address the motivations (...) that lead abortion providers to offer abortion care, discuss the ways in which anti-abortion regulations have made it increasingly difficult to offer feminist-inspired services, and ponder the status of the fetus and the ethical frameworks supporting abortion care and fetal research. Together these essays provide a feminist moral foundation to reassert that abortion care is moral work. (shrink)

This commentary responds to “Home Care in America: The Urgent Challenge of Putting Ethical Care into Practice,” by Coleman Solis and colleagues, in the May‐June 2023 issue of the Hastings Center Report. More specifically, we respond to the authors’ call for “inquiry into the nature, value, and practice” of home care. We argue that the most urgently needed normative reset for thinking about care work is the replacement of dominant individualistic thinking with systemic thinking. Deepening a focus on the social, (...) economic, and historical forces that shape the state of contemporary care work will help bioethicists to argue more effectively for improvements to working conditions. In turn, better working conditions will ease the oppositional stance between caregivers and receivers that has been set up by the current system, enabling all parties involved to better pursue the feminist ethical ideal of care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Just Share: Justice and Fairness in Resource Allocation*Pat Milmoe Mccarrick (bio) and Martina Darragh (bio)Each of us has some basic sense of what the words “fair” or “just” or “fairness” or “justice” mean. Each of us probably also has an idea of what is “fair” in health care. The attempt by the state of Oregon in the mid-1980s to quantify this notion made a previously private exercise a (...) public one. This transition has been chronicled in the bioethics literature that focuses on resource allocation. These works examine both theories of justice and concepts of “health”; the fair distribution of health resources has been of continuing interest since the beginning of bioethics in the 1960s. Early writing on justice includes authors Tom L. Beauchamp, Robert H. Blank, James F. Childress, H. Tristram Engelhardt, Paul T. Menzel, Paul Ramsey, and Robert M. Veatch (VII).During the 1980s, bioethicists such as Daniel Callahan and Norman Daniels proposed thinking of health care decisions not as moments of personal crisis but as choices that span a lifetime, possibly involving tradeoffs in other areas of one’s life, e.g., education. The Oregon experience added another dimension to the discussion. The initial rank-ordering of health services by cost produced a skewed list—for example, surgery for life-threatening conditions ranked below minor, elective procedures. For the project to make sense, the ranking algorithm could not be based on cost alone, but rather on a combination of costs and benefits both to individuals and to the community—“concatenations of individual and group goods” (I, Jecker and Jonsen 1995). Various metaphors have been used in the literature to facilitate discussion of this shift from individual to individual/community trade-offs: medical services as a “commons” (I, Asch 1995, Jecker and Jonsen 1995, Michels 1994); resource allocation as a “lifeboat” (I, Campbell 1995; III, Kaveny 1994); medical care as “shares” in a community health (III, Nelson 1992, Ford and Kissick 1995; II, Anderson 1993); and rationing as traveling through the desert with one jug of water for two people (a story from the Halachah literature) (I, Zoloth-Dorfman 1995). [End Page 81]Such metaphors do not promote any one “theory of justice” but rather draw from the work of a number of bioethicists as well as from theological, sociological, economic, and business literature. The five major conceptions of justice that are referenced most frequently are: “(1) a libertarian conception, which takes liberty to be the ultimate political ideal; (2) a socialist conception, which takes equality to be the ultimate political ideal; (3) a welfare liberal conception, which takes contractual fairness or maximal utility to be the ultimate political ideal; (4) a communitarian conception, which takes the common good to be the ultimate political ideal; and (5) a feminist conception, which takes a gender-free society to be the ultimate political ideal” (I, Sterba 1995).The use of new metaphors also draws on expanded concepts of “health.” “As health care is currently practiced, the most powerful symbols for public and professional alike are those that promise the defeat of time” (I, Campbell 1995). When medical care is perceived as an unrelated series of individual cures, the fact that health care resources are finite cannot be addressed.Reflections concerning the difficulties in limiting the use of health care resources have an ancient lineage and reveal a tight bond with the obsession to postpone death at all costs. Plato in Book 3 of the Republic recognizes the quandary of infinite expectations and finite resources that characterizes the challenge of health care choices. (I, Engelhardt 1996)The proliferation of expensive medical technologies and the loss of autonomy by health care professionals further complicates perceptions of the crucial issues at hand. Some have said that Americans place too much emphasis on individualism to address these issues. Daniels et al. believe that this is too pessimistic a view and that the American commitment to protecting equal opportunity for all provides a firm basis for developing a public consensus on what is fair in health care (III, Daniels, Light, and Caplan 1996). Finally, several authors suggest that the nature of all four principles of medical ethics, not justice alone, must be... (shrink)

The well-being account of sacrifice says that sacrifices are gross losses of well-being. This account is attractive because it explains the relationship between sacrifice and moral obligation. However, sacrifices made on behalf of loved ones may cause trouble for the account. Loving sacrifices occur in a context where the agent’s well-being and the beneficiary’s well-being are intertwined. They present a challenge to individualism about well-being. Drawing inspiration from feminist philosophers and bioethicists, I argue that a notion of ‘relational (...) well-being’, analogous to ‘relational autonomy’, can help account for loving sacrifices without either undermining the well-being theory of sacrifice or minimizing the very real sacrifices made in caregiving situations. (shrink)

We contribute to the complex and problematic relationship between interculturality, gender and bioethics from the perspective of Latin American Social Ethics. We first review moments of the constitution and development of Latin American Social Ethics and identify categories that open possibilities to articulate with the critique of intercultural philosophy and decolonial feminist epistemologies. We also consider the criticisms of the notion of recognition from proposals of Latin American intercultural philosophy and we move towards the proposals of gender diversity and (...) the criticisms of Latin American feminisms, to incorporate other voices in the bioethicist argumentation, which speak of care, solidarity, responsibility, commitment. (shrink)

In the helpful article “Why Bioethics Needs a Disability Moral Psychology,” Joseph Stramondo adds to the critique of actually existing bioethics and explains why disability activists and scholars so often find fault with the arguments of bioethicists. He is careful not to stereotype either community—rightly, given that bioethicists endorse positions as disparate as utilitarianism, deontology, virtue ethics, and feminist ethics, among others. Although Stramondo never explicitly mentions utilitarians or liberals, it seems probable that these are the main (...) targets of his discontent. The disability community, as he concedes, is also a broad church. Yet for this reason, I do not believe that you can read off positions on bioethics questions from either disability embodiment or disability organization affiliation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Live Like Nobody Is Watching: Relational Autonomy in the Age of Artificial Intelligence Health Monitoring by Anita HoTina Nguyen (bio)Live Like Nobody Is Watching: Relational Autonomy in the Age of Artificial Intelligence Health Monitoring by Anita Ho New York: Oxford University Press, 2023As the reach of artificial intelligence (AI)- and machine learning (ML)-enabled technologies continues to expand in the healthcare field, bioethicists have examined the ethical issues (...) that come as a result of using these technologies. In this ethical assessment, most bioethicists, myself included, have discussed how AI/ML violates the ethical principle of autonomy. The commonly cited definition of autonomy comes from Beauchamp and Childress's Principles of Biomedical Ethics (2019), where autonomy is the right of the individual to make decisions for themselves. However, autonomy regarding AI/ML in healthcare has not been or is rarely discussed from the feminist perspective. In Live Like Nobody Is Watching: Relational Autonomy in the Age of Artificial Intelligence Health Monitoring (further referred to as Live Like Nobody Is Watching), Anita Ho, in addition to other points, argues that AI for health monitoring needs to be examined through a relational autonomy lens. Not only is this perspective innovative but it also shows how a predominantly male field has shaped the narrative surrounding AI/ML. In this review, I provide a brief overview of the chapters, explore Ho's arguments for relational autonomy, and discuss future applications of this work.Live Like Nobody Is Watching begins with a preface where the readers are introduced to a real-life scenario. Ho describes a friend's experience of [End Page 101] debating with themself whether to use surveillance for their mother with early-stage dementia who claims someone has been moving her things. This sets up the rest of the book in which questions of should these technologies be used and in what context are they appropriate are debated using relational autonomy. The introduction serves as a brief primer to AI (ML and deep learning) and its role in healthcare followed by a layout of the subsequent chapters. Chapter 1 connects health monitoring AI with relational autonomy, where Ho suggests that the liberal view of autonomy is not appropriate for health monitoring technologies. This is due to the fact that the patient populations using these technologies are reliant, to various degrees, on social relationships. In chapters 2, 3, and 4, Ho addresses how health-monitoring AI requires relational autonomy through use cases concerning home-health monitoring, direct-to-consumer monitoring, and AI monitoring for medication adherence. Throughout these chapters, Ho discusses the claimed benefits of these AI/ML interventions and cautions about the ethical challenges, such as health inequities and testimonial injustice, that can arise with these technologies. Finally, chapter 5 serves as the conclusion, where Ho ultimately argues that health-monitoring AI should be viewed through relational autonomy instead of the traditional view, and she advocates for dialogic engagement (including bringing patients/patients' families into the conversation). The narrative goes full circle with the events in the preface being addressed in the epilogue, where the friend decided to incorporate a smart frame device that would allow them to have video calls with their mother. However, the friend is still grappling with the idea of surveillance given an incident in which another dementia resident accidentally wandered into their mother's room. To this, Ho ends the book by proposing better lighting in the hallways rather than immediately turning to the next high-tech innovation.Ho presents several arguments throughout the book but emphasizes the main argument that relational autonomy should be practiced over the traditional, liberal view of autonomy. Ho discusses the three elements of socio-relational autonomy (using Catriona Mackenzie's work): self-governance, self-determination, and self-authorization. Components of the traditional bioethical view of autonomy are seen in these three elements, with the process of informed consent being closely tied to the concept of autonomy. Under the traditional view, an autonomous individual should have decision-making capacity and be able to make a decision based on the information provided to them without coercion. In the informed consent process, patients should be provided adequate information along with... (shrink)

This paper argues that competing ethical positions in the Terri Schiavo debate—calls to “err on the side of life” or to “err on the side of liberty”—aim to regulate life and not to defend its sanctity or freedom. Advancing analyses of the “biopolitics” of the case, I show how Terri Schiavo’s status as a speaking-being is an important question for both positions. Informed by feminist concerns about the marginalization and ventriloquization of voices, I argue that bioethicists should “lend (...) an ear” to the voices of Terri Schiavo. (shrink)